Retropharyngeal abscess in children: the emerging role of group A beta hemolytic streptococcus.
BACKGROUND
Because of a recent increase in the number of cases of retropharyngeal abscess (RPA) admitted to our hospital, we reviewed the incidence, microbiology, and treatment outcome of RPA during an 11-year period (1993-2003).


METHODS
A retrospective review of medical records of children with RPA.


RESULTS
Sixty-seven children (46 males) with RPA were identified, representing a 4.5-fold increase in incidence over a previous 12-year period. The majority (66%) of patients presented during the last 4 years. Computed tomography revealed inflammatory or ring enhancing lesion in all patients. Abscess drainage was performed in 51 (76%) patients. A total of 101 isolates (84 aerobes, 17 anaerobes) were recovered from 41 specimens (a mean of 2.5 isolates per specimen). Group A beta hemolytic streptococcus (GABHS) was recovered from 22 (54%) of 41 specimens compared with 6 (35%) of 17 over the previous 12 years. Treatment included i.v. antibiotics: ampicillin/sulbactam or clindamycin plus either cefuroxime or ceftriaxone, followed by oral amoxicillin/clavulanate or clindamycin. All patients recovered.


CONCLUSIONS
RPA, an aerobic/anaerobic polymicrobial infection, is increasing in frequency and is associated with increased recovery of GABHS in our patients. Whether this rise in incidence is due to increased invasiveness of GABHS strains is to be determined.
Abdel-Haq
Nahed M
NM
Division of Infectious Diseases, Children's Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI 48201, USA. nabdel@dmc.org
Harahsheh
Ashraf
A
Asmar
Basim L
BL
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D017703:Retropharyngeal Abscess / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D034363:Viridans Streptococci / Q000302:isolation & purification
D000900:Anti-Bacterial Agents