A study of postoperative fever following paediatric tonsillectomy

Abstract

The aetiology of post-tonsillectomy fever is obscure. Bacteraemia during surgery, anaesthetic agents and the inflammatory response of tissue to injury have been implicated. A prospective study was undertaken in 100 consecutive children to evaluate the occurrence and severity of fever in the 24 h after tonsillectomy and its relationship to bacteraemia during surgery and qualitative and quantitative cultures (colony counts) of organisms in tonsil core tissue. Fifty-four patients had a fever (> 37.5 degrees C) postoperatively, of whom, 30 had a fever greater than 38 degrees C. Blood cultures during tonsillectomy were positive in 22 patients. There was no statistically significant difference between the occurrence of fever and the techniques of tonsillectomy and haemostasis. There was also no association between positive blood, core or surface cultures and the incidence or severity of fever nor any association between colony count in core cultures and fever. Our results suggest that postoperative fever in the 24 h following tonsillectomy is not caused by infection.

Bacteremia following pediatric adenoidectomy

“…In the literature, there are many reports of blood cultures after tonsillectomy [7,[13][14][15], but, to our knowledge, there is little information about postadenoidectomy bacteremia. Thus, Van Eyck [8] in the 70s encountered a 40% of bacteremia after adenoidectomy (two of five adenoidectomies), but he also said that ''this bacteremia is asymptomatic and remains no longer than 1 h'' [8].…”

Utility of prophylactic antibiotics in pediatric adenoidectomy

“…sepsis and endocarditis in patients with valvular heart disease) [12,13]. In medical literature, there are many reports of blood cultures after tonsillectomy [14][15][16][17][18][19][20][21], but few articles about post-adenoidectomy bacteremia. Van Eyck [4] in the 70s found 40% of bacteremia after adenoidectomy (two of five adenoidectomies) but he also said that ''this bacteremia is asymptomatic and remains no longer than 1 h'' [4].…”

Comparative Study of Surface and Core Microflora of Chronic Tonsillitis

“…Recurrent attacks of tonsillitis make the wisdom of using frequent course of broad spectrum antibiotics questionable. Surgical excision of tonsil is the best modality of treatment for recurrent infection, as pathogens from core of the tonsil remain unidentified and are resistant to the antibiotic therapy based on the tonsillar surface microflora 2,3,12 .…”

“…Antimicrobial treatment is often not successful to completely cure the pathogens and prevent recurrences of the infections commonly found in the tonsils 3,4 . In most of the cases, failure to control or completely remove the microbial load in the core of tonsils either due to inappropriate antimicrobial therapy or inadequate antibiotic penetration in the core paves way to either persistence of core infections or reinoculation of the initially sterilized surface.…”

“…A high tissue concentration of these bacteria correlates with clinical parameters of infection and hyperplasia of the tonsils. The role of Streptococcus pyogenes, while undisputed in acute and epidemic tonsillitis, should perhaps be re-evaluated in recurrent and/or hyperplastic tonsillitis 3 . Adenotonsillar disease can be divided into two categories, infection and hypertrophy.…”