Abstract
This study is the first to provide an extensive overview of the microbiology of acute ear, nose and throat infections requiring hospitalisation. All 2,028 cases of acute infections admitted between 1 January 2001 and 31 December 2006 were reviewed to assess the use of pre-admission antibiotics, microbiological results, antibiotic and surgical management and length of hospitalisation. Infections of the oropharynx accounted for the vast majority of admissions, followed by ear infections, and cutaneous neck abscesses. Peritonsillar abscess was the most frequent diagnosis, accounting for over one third of admissions (39.8%, 808 out of 2,028). Complete microbiological data were available for 1,430 cultures, and were analysed for trends with respect to diagnosis, age, gender and use of pre-admission antibiotics. Forty-six percent (657 out of 1,430) of cultures yielded no growth or normal flora. This value increased to 77.0% (298 out of 387) in patients with pre-admission antibiotics. The distribution of microbiological isolates varied significantly between patients with and without pre-admission antibiotics, as well as with respect to age and gender. The most frequently isolated bacteria were Group A Streptococcus (13.7%, 196 out of 1,430), Fusobacterium necrophorum (13.6%, 195 out of 1,428) and Staphylococcus aureus (8.0%, 114 out of 1,430). Fusobacterium necrophorum was primarily isolated from cases of peritonsillar abscess (90.8%, 177 out of 195). This study suggests that F. necrophorum is a far more widespread pathogen in otorhinolaryngology than previously reported, and questions the value of routine culturing, as results rarely altered initial treatment. Further research on the microbiological variations with age and gender is recommended to better target culturing and treatment, and enhance our understanding of the pathogenesis of ear, nose and throat infections.
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References
Brook I (2007) Microbiology and principles of antimicrobial therapy for head and neck infections. Infect Dis Clin North Am 21(2):355–391
Bhattacharyya N, Shapiro J (2002) Contemporary trends in microbiology and antibiotic resistance in otolaryngology. Auris Nasus Larynx 29(1):59–63
Heslop A, Ovesen T (2006) Severe acute middle ear infections: microbiology and treatment. Int J Pediatr Otorhinolaryngol 70(10):1811–1816
Kieff DA, Bhattacharyya N, Siegel NS, Salman SD (1999) Selection of antibiotics after incision and drainage of peritonsillar abscesses. Otolaryngol Head Neck Surg 120(1):57–61
Mandal BK (1976) The dilemma of partially treated bacterial meningitis. Scand J Infect Dis 8(3):185–188
Pickens J, Sangster G, Gray J, McMurdoch J (1978) The effect of pre-admission antibiotics on the bacteriological diagnosis of pyogenic meningitis. Scand J Infect Dis 10(3):183–185
Bohr V, Rasmussen N, Hansen B, Kjersem H, Jessen O, Johnsen N et al (1983) 875 cases of bacterial meningitis: diagnostic procedures and the impact of preadmission antibiotic therapy. J Infect 7(3):193–202
Kaplan SL, Smith EO, Wills C, Feigin RD (1986) Association between preadmission oral antibiotic therapy and cerebrospinal fluid findings and sequelae caused by Haemophilus influenzae type b meningitis. Pediatr Infect Dis 5(6):626–632
Ferguson R (1986) The effect of antibiotic therapy before admission to hospital on recognition of the causative organism in acute bacterial meningitis. J Infect 13(3):241–244
Batty A, Wren MWD (2005) Prevalence of Fusobacterium necrophorum and other upper respiratory tract pathogens isolated from throat swabs. Br J Biomed Sci 62(2):66–70
Schweinfurth JM (2006) Demographics of pediatric head and neck infections in a tertiary care hospital. Laryngoscope 116(6):887–889
Jokipii AM, Jokipii L, Sipila P, Jokinen K (1988) Semiquantitative culture results and pathogenic significance of obligate anaerobes in peritonsillar abscesses. J Clin Microbiol 26(5):957–961
Brook I, Frazier EH, Thompson DH (1991) Aerobic and anaerobic microbiology of peritonsillar abscess. Laryngoscope 101(3):289–292
Jousimies-Somer H, Savolainen S, Makitie A, Ylikoski J (1993) Bacteriologic findings in peritonsillar abscesses in young adults. Clin Infect Dis 16 (Suppl 4]:S292–S298
Stjernquist-Desatnik A, Prellner K, Schalen C (1990) Colonization by Haemophilus influenzae and group A streptococci in recurrent acute tonsillitis and in tonsillar hypertrophy. Acta Otolaryngol 109(3–4):314–319
Stenfors LE, Raisanen S, Rantala I (1991) In vivo attachment of group A streptococci to tonsillar epithelium during acute tonsillitis. Scand J Infect Dis 23(3):309–313
Arguedas A, Dagan R, Soley C, Loaiza C, Knudsen K, Porat N et al (2003) Microbiology of otitis media in Costa Rican children, 1999 through 2001. Pediatr Infect Dis J 22(12):1063–1068
Nielsen HU, Konradsen HB, Lous J, Frimodt-Moller N (2004) Nasopharyngeal pathogens in children with acute otitis media in a low-antibiotic use country. Int J Pediatr Otorhinolaryngol 68(9):1149–1155
Butbul-Aviel Y, Miron D, Halevy R, Koren A, Sakran W (2003) Acute mastoiditis in children: Pseudomonas aeruginosa as a leading pathogen. Int J Pediatr Otorhinolaryngol 67(3):277–281
Bartolome Benito M, Perez Gorricho B (2006) Acute mastoiditis: increase of incidence and controversies in antibiotic treatment. Rev Esp Quimioter 19(4):337–341
Stenfors LE, Raisanen S (1993) The membranous tonsillitis during infectious mononucleosis is nevertheless of bacterial origin. Int J Pediatr Otorhinolaryngol 26(2):149–155
Stenfors LE, Bye HM, Raisanen S, Myklebust R (2000) Bacterial penetration into tonsillar surface epithelium during infectious mononucleosis. J Laryngol Otol 114(11):848–852
Rustom IK, Sandoe JA, Makura ZG (2008) Paediatric neck abscesses: microbiology and management. J Laryngol Otol 122:480–484
Guss J, Kazahaya K (2007) Antibiotic-resistant Staphylococcus aureus in community-acquired pediatric neck abscesses. Int J Pediatr Otorhinolaryngol 71(6):943–948
Brook I (2002) Aerobic and anaerobic microbiology of suppurative sialadenitis. J Med Microbiol 51(6):526–529
Gehanno P, Panajotopoulos A, Barry B, Nguyen L, Levy D, Bingen E et al (2001) Microbiology of otitis media in the Paris, France, area from 1987 to 1997. Pediatr Infect Dis J 20(6):570–573
Sih TM (2001) Acute otitis media in Brazilian children: analysis of microbiology and antimicrobial susceptibility. Ann Otol Rhinol Laryngol 110(7 Pt 1):662–666
Leskinen K, Jero J (2003) Acute mastoiditis caused by Moraxella catarrhalis. Int J Pediatr Otorhinolaryngol 67(1):31–33
Brook I (1987) Microbiology of retropharyngeal abscesses in children. Am J Dis Child 141(2):202–204
Han JK, Kerschner JE (2001) Streptococcus milleri: an organism for head and neck infections and abscess. Arch Otolaryngol Head Neck Surg 127(6):650–654
Hirai T, Kimura S, Mori N (2005) Head and neck infections caused by Streptococcus milleri group: an analysis of 17 cases. Auris Nasus Larynx 32(1):55–58
Clark WB, Brook I, Bianki D, Thompson DH (1997) Microbiology of otitis externa. Otolaryngol Head Neck Surg 116(1):23–25
Roland PS, Stroman DW (2002) Microbiology of acute otitis externa. Laryngoscope 112(7 Pt 1):1166–1177
Cohen-Kerem R, Uri N, Rennert H, Efrat M (1999) Acute mastoiditis in children: is surgical treatment necessary. J Laryngol Otol 113(12):1081–1085
Huang TT, Tseng FY, Yeh TH, Hsu CJ, Chen YS (2006) Factors affecting the bacteriology of deep neck infection: a retrospective study of 128 patients. Acta Otolaryngol 126(4):396–401
Brook I, Frazier EH (1990) Aerobic and anaerobic bacteriology of wounds and cutaneous abscesses. Arch Surg 125(11):1445–1451
Brook I, Yocum P, Foote PA Jr (1995) Changes in the core tonsillar bacteriology of recurrent tonsillitis: 1977–1993. Clin Infect Dis 21(1):171–176
Riordan T (2007) Human infection with Fusobacterium necrophorum (Necrobacillosis), with a focus on Lemierre’s syndrome. Clin Microbiol Rev 20(4):622–659
Lemierre A (1936) On certain septicaemias due to anaerobic organisms. Lancet 40:701–703
Brazier JS (2006) Human infections with Fusobacterium necrophorum. Anaerobe 12(4):165–172
Jones JW, Riordan T, Morgan MS (2001) Investigation of postanginal sepsis and Lemierre’s syndrome in the South West Peninsula. Commun Dis Public Health 4(4):278–281
Brazier JS, Hall V, Yusuf E, Duerden BI (2002) Fusobacterium necrophorum infections in England and Wales 1990–2000. J Med Microbiol 51(3):269–272
Aliyu SH, Marriott RK, Curran MD, Parmar S, Bentley N, Brown NM et al (2004) Real-time PCR investigation into the importance of Fusobacterium necrophorum as a cause of acute pharyngitis in general practice. J Med Microbiol 53(Pt 10):1029–1035
Jensen A, Hagelskjaer Kristensen L, Prag J (2007) Detection of Fusobacterium necrophorum subsp. funduliforme in tonsillitis in young adults by real-time PCR. Clin Microbiol Infect 13(7):695–701
Batty A, Wren MW, Gal M (2005) Fusobacterium necrophorum as the cause of recurrent sore throat: comparison of isolates from persistent sore throat syndrome and Lemierre’s disease. J Infect 51(4):299–306
Leugers CM, Clover R (1995) Lemierre syndrome: postanginal sepsis. J Am Board Fam Pract 8(5):384–391
Hagelskjaer LH, Prag J, Malczynski J, Kristensen JH (1998) Incidence and clinical epidemiology of necrobacillosis, including Lemierre’s syndrome, in Denmark 1990–1995. Eur J Clin Microbiol Infect Dis 17(8):561–565
Cherukuri S, Benninger MS (2002) Use of bacteriologic studies in the outpatient management of peritonsillar abscess. Laryngoscope 112(1):18–20
Hanna BC, McMullan R, Gallagher G, Hedderwick S (2006) The epidemiology of peritonsillar abscess disease in Northern Ireland. J Infect 52(4):247–253
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Rusan, M., Klug, T.E. & Ovesen, T. An overview of the microbiology of acute ear, nose and throat infections requiring hospitalisation. Eur J Clin Microbiol Infect Dis 28, 243–251 (2009). https://doi.org/10.1007/s10096-008-0619-y
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DOI: https://doi.org/10.1007/s10096-008-0619-y