The epidemiology, antibiotic resistance and post-discharge course of peritonsillar abscesses in London, Ontario

Abstract

BackgroundPeritonsillar abscesses (PTA) are a common complication of tonsillitis. Recent global epidemiological data regarding PTAs have demonstrated increasing antimicrobial resistance patterns. No similar studies have been conducted in Canada and no Canadian study has examined the post-discharge course of treated patients.MethodsA prospective observational study of the epidemiology, antibiotic resistance and post-discharge course of patients presenting with a peritonsillar abscess to the Emergency Department in London, Ontario over one year. A follow-up telephone survey was conducted 2–3 weeks after abscess drainage.Results60 patients were diagnosed with an abscess, giving an incidence of 12/100,000. 46 patients were enrolled in the study; the average duration of symptoms prior to presentation was 6 days, with 51% treated with antibiotics prior to presentation. Streptococcus pyogenes and Streptococcus anginosus were present in 56% of isolates and of those, 7/23 (32%) of specimens demonstrated resistance to clindamycin. Eight patients were treated with clindamycin and had a culture that was resistant, yet only one had recurrence. Telephone follow-up was possible for 38 patients: 51% of patients reported a return to solid food within 2 days, and 75% reported no pain by 5 days. Resolution of trismus took a week or longer for 51%.InterpretationClindamycin resistance was identified in a third of Streptococcus isolates, which should be taken into account when prescribing antibiotics. Routine culture appears unnecessary as patients recover quickly from outpatient drainage and empiric therapy, with less pain than expected, but trismus takes time to resolve.

Prognostic factors and effects of early surgical drainage in patients with peritonsillar abscess

“…In the current patient population, the mean duration between symptom onset and resolution of symptoms of 3.2 days and the mean duration between symptom onset and complete recovery from the disease of 5.5 days were comparable with findings from other studies [9,10]. The male:female ratio of patients with PTA in the present study was 2.9:1, again consistent with previous reports [2,11].…”

Microbiological Features of Upper Respiratory Tract Infections in Bulgarian Children for the Period 1998-2014

“…Selective pressure from the common and not always well grounded use of macrolides in childhood leads to fast expansion of streptococcal strains with limited or absent susceptibility towards these antibiotics, which could lead to serious complications and sequels after infections caused by them (16)(17)(18)(19)(20). Confirmed data for appearance of new more virulent strains of М. сatarrhalis with obligatory production of ß-lactamase during the last years have been published even in Bulgaria (8,12).…”

“…This happens especially in cases with bacterial biofilm formation, where bacterial metabolism is amplified and thus the host immune defense system is more hampered by these more virulent bacterial species (2,10). In such cases the infection process, from upper respiratory tract mucus, propagates outside the initial localization and leads to complications such as middle ear infections or pneumonia, in some cases even it can lead to bacteremia or infections of central nervous system (2,18,(20)(21)(22).…”

“…33, No. 6,2016 due to the change of the action target in the last ten years has become a serious problem for therapy, particularly in combination with a change in penicillin-binding proteins because they are major classes of antimicrobial agents for the treatment of respiratory infections in children, and nowadays there has been reports for failures in the treatment of serious infections caused by multidrug-resistant strains (6,9,15,19,20).…”

Specified data for tonsil surgery in Germany

“…In some trials it becomes obvious that mainly male adolescents and adults are affected [56], [57], [58], with a ratio of 3:1 [53], [59]. There are other investigations that do not reveal a gender-related preponderance [49], [52], [53], [55], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68]. The present study confirmed the finding, that patients younger than 19 years of age were predominantly female [53], [55], [58].…”