Antibiotic Resistance Pattern in Pediatric Deep Neck Space Infection

Kharel, Bijaya; Shahi, Kapil; Gurung, Urmila

doi:10.1055/s-0042-1744042

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International Archives of Otorhinolaryngology

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Sumário

Original Research • iao 26 (4) • Oct-Dec 2022 • https://doi.org/10.1055/s-0042-1744042 copy

Antibiotic Resistance Pattern in Pediatric Deep Neck Space Infection

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Neck space infection in the pediatric age group is common but can be life-threatening if not diagnosed properly. Since it is a polymicrobial disease, antibiotic usage should be guided by culture sensitivity pattern.

Objectives

To assess the microbiology, antibiotic resistance pattern and the outcome of the medical and surgical management of deep neck space infection in children.

Methods

This was a prospective study of children admitted for management of neck space infection from August 2017 to August 2018. The age, gender, organisms isolated, sensitivity and resistance to antibiotics, length of hospital stay, complications, and recurrence were noted. The descriptive data were analyzed.

Results

Out of 108 cases, there were 51 males (47.2%) and 57 females (52.8%) ranging from 1 month to 15 years, with a mean age of 5.32 +/– 4.35 years. The mean period of hospitalization was 6.98 days. Staphylococcus aureus was the most common organism isolated with less coagulase-negative staphylococci and streptococci. Clindamycin was the most sensitive drug (82.35%) followed by vancomycin and cloxcillin, while amoxicillin/ampicillin, a commonly used drug, was the least sensitive (20.58%). The abscess recurrence rate was 9.28%. The outcomes of either medical treatment or a combined medical or surgical treatment in properly selected cases were comparable.

Conclusion

Clindamycin or cloxacillin can be used as a first-line option for neck infection in children. Ampicillin/amoxicillin alone has a small role in neck abscess because of high resistance to this type of antibiotic.

Keywords
abscess; antibacterial drug resistance; child; neck

Age	Frequency	Percentage
Up to 1 year	24	22.22
1–5 years	41	37.94
5–10 years	26	24.07
10–15 years	17	15.74

Spaces localized above the hyoid level	Number	Percentage
1. Submandibular & submental abscess	55	50.9%
2. Parapharyngeal abscess	23	21.29%
3. Peritonsillar abscess	11	10.18%
4. Parotid abscess	5	4.67%
5. Masticator/Temporal abscess	3	2.78%
6. Ludwig’s angina	3	2.78%
Spaces localized below the hyoid level
7. Anterior visceral	1	0.92%
Spaces localized in the entire circumference of the neck
8. Retropharyngeal abscess	3	2.78%
Miscellaneous
9. Necrotizing fasciitis of neck	4	3.7%

Sensitivity pattern of Staphylococcus aureus (n = 34)
Drug	Sensitivity pattern
Drug	Sensitivity		Resistance
Clindamycin	28	(82.35%)	6	(17.64%)
Vancomycin	25	(73.53%)	9	(26.47%)
Cloxacillin	24	(70.59%)	10	(29.41%)
Gentamycin	23	(67.64%)	11	(32.36%)
Amikacin	23	(67.64%)	11	(32.36%)
Chloramphenicol	15	(44.11%)	19	(55.89%)
Erythromycin	10	(29.41%)	24	(70.58%)
Ciprofloxacin	9	(26.47%)	25	(73.53%)
Doxycycline	9	(26.47%)	25	(73.53%)
Levofloxacin	7	(20.58%)	27	(79.42%)
Ampicillin/Amoxicillin	7	(20.58%)	27	(79.42%)

Sensitivity pattern of Coagulase-negative staphylococci (n = 4)
Drug	Sensitivity pattern
Drug	Sensitivity		Resistance
Clindamycin	4	(100%)	0
Vancomycin	4	(100%)	0
Cloxacillin	3	(75%)	1	(25%)
Amikacin	2	(50%)	2	(50%)
Gentamycin	2	(50%)	2	(50%)
Chloramphenicol	2	(50%)	2	(50%)
Ciprofloxacin	2	(50%)	2	(50%)
Doxycycline	2	(50%)	2	(50%)
Levofloxacin	2	(50%)	2	(50%)
Erythromycin	1	(50%)	3	(75%)
Ampicillin/Amoxicillin	0		4	(100%)

	Frequency	Percentage
None	98	90.74
Single recurrence	8	7.41
Multiple recurrence	2	1.85
Total	108	100.0

Recurrence	Age in years	Episode	Previous management	Space involved	Collection size noted in previous episode (in ml)	Possible reason for recurrence	Days of previous stay
Recurrence 1	5	Multiple	Surgical	Parotid / Parapharyngeal	15	Inadequate drainage	10
Recurrence 2	5	Single	Surgical	Submandibular	5	Inadequate drainage short duration of treatment	5
Recurrence 3	3	Single	Surgical	Parapharyngeal	20	–	8
Recurrence 4	5	Single	Surgical	Parotid	5	–	15
Recurrence 5	15	Single	Surgical	Parapharyngeal	18	–	12
Recurrence 6	6	Single	Surgical	Parotid	30	Inadequate drainage	8
Recurrence 7	10	Single	Surgical	Submandibular	15	–	9
Recurrence 8	7	Single	Surgical	Submandibular	5	–	8
Recurrence 9	2	Multiple	Surgical	Necrotizing fasciitis of neck	8	Immunocompromised	108
Recurrence 10	1	Single	Surgical	Submandibular	8	–	10

		Overall	Medical and surgical management	Medical management only	p-value
Gender	Male (51)		38	13	0.133
Gender	Female(57)		49	8	0.133
Age		5.39	5.058	6.774	0.105
Total count prior to admission		15389	16040	12693	0.009
Days of stay		6.98	6.11	10.62	0.07
Recurrence rate			(8/78) 10.2%	(2/20) 10%	1

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[1] Address for correspondence Bijaya Kharel, MS, ENT-HNS, Department of ENT- Head and Neck Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu 44600, Nepal (e-mail: bijayaasim@gmail.com).