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Changing microbiology of pediatric neck abscesses in iowa 2000–2010
Author(s) -
Walker Paul C.,
Karnell Lucy Hynds,
Ziebold Christine,
Kacmarynski Deborah S.F.
Publication year - 2013
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.23500
Subject(s) - medicine , clindamycin , staphylococcus aureus , methicillin resistant staphylococcus aureus , abscess , antibiotics , microbiology and biotechnology , vancomycin , incidence (geometry) , staphylococcal skin infections , incision and drainage , staphylococcal infections , surgery , bacteria , biology , genetics , physics , optics
Objectives/Hypothesis: To examine the changing microbiology of pediatric neck abscesses over a 10‐year period with particular interest in methicillin‐resistant Staphylococcus aureus (MRSA) infections and their associated antibacterial‐resistance patterns, including resistance to clindamycin, a frequently used antibiotic for Staphylococcus aureus . Study Design: Retrospective chart review at a tertiary academic medical center. Methods: One hundred and twenty‐two consecutive pediatric patients managed between January 2000 and June 2010 with incision and drainage of a proven neck abscess. Results: Seventy‐four patients with 76 abscesses were identified. A microorganism was found in 65 (85%) of the 76 abscesses. Forty‐three percent grew Staphylococcus aureus (SA), 12% were methicillin‐resistant Staphylococcus Aureus (MRSA), and 31% were methicillin‐susceptible Staphylococcus aureus (MSSA). There was a significant increase in the incidence of MRSA infections during the study period, with only one case of MRSA diagnosed in the first half of the study (from 2000–2004) compared with seven in the second half (from 2005–2010) ( P = 0.023). The second most common bacterial etiology or isolate was Streptococcus pyogenes in 27%, while the remaining 30% grew mixed oral flora and other microorganisms. Conclusions: These findings demonstrate a statistically significant rise in the proportion of MRSA neck infections in pediatric patients in Iowa. Resistance to clindamycin was highest among MSSA isolates. Clindamycin‐resistant S. aureus and Streptococcus pyogenes are established pathogens in neck infections. In communities with similar microbiology patterns, empiric treatment with combination therapy of a beta lactam and vancomycin or trimethoprim/sulfamethoxazole should be initiated until culture results are available. Laryngoscope, 2013