Clinical aspects of peritonsillar abscesses and deep neck infections

Introduction Complications of peritonsillar abscesses (PTA) are rare but feared. Prompt diagnosis and therapy are essential, as untreated infection can lead to deep throat infection (DNI). The bacterial etiology of PTAs has not been elucidated, and antimicrobial therapy is not uniform. The aim of this review was to examine the incidence of PTAs as well as complications, therapy, and microbiology.

Method Patients who were hospitalized with PTA between 2012 and 2021 in the Department of Otolaryngology of the Klinikum rechts der Isar of the Technical University of Munich were included. The diagnosis code J36.0 according to ICD 10 was evaluated.

Results Between 2012 and 2021, 1179 patients were treated with PTA. Of these, 3.9% (n=46) had a complication. These were: Neck tissue spread (n=10), retro-, and parapharyngeal abscess (n=32), mediastinitis (n=1), necrotizing fasciitis (n=1), soft palate abscess (n=2). Most common antibiotics were ampicillin/sulbactam (46.6%), cefuroximeaxetil (10.9%), clindamycin (6.1%). Microbiological examination was performed in 557/1179 of PTAs and 29/46 of DNI. The results were: Group A Streptococcus (GAS) (19.7% PTA; 17.4% DNI), Staphylococcus (3.1% PTA; 10.9% DNI), Fusobactaria (4.6% PTA; 6.5% DNI), Klebsiella Pneumoniae (0,3% PTA;8,7% DNI), mixed infection (1.2% PTA; 15.2% DNI).

Discussion Staphylococcus, Klebsiella, and mixed infections were detected significantly more frequently in DNI. Internationally, the trend is toward less invasive surgical approaches in PTAs, making adequate antibiotic treatment even more essential. Our results illustrate that ampicillin/sulbactam is the antibiotic of choice as empirical therapy in PTA and DNI, but that microbiological diagnostics are necessary, as mixed infections are often present.

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Artikel online veröffentlicht:
19. April 2024