title: Retropharyngeal abscess in children: the rising incidence of methicillin-resistant Staphylococcus aureus.
abstract: BACKGROUND
  Because of a recent upsurge in retropharyngeal abscess (RPA) cases due to community-associated methicillin-resistant Staphylococcus aureus (MRSA), we reevaluated the microbiology, clinical manifestations and treatment outcome of RPA over the past 6 years (2004 to 2010). Findings were compared with those of a previous 11-year study (1993 to 2003) period.
  
  
  METHODS
  A retrospective review of medical records of children with RPA.
  
  
  RESULTS
  One hundred fourteen children (61 males) with RPA were identified representing a 2.8-fold increase in incidence (per 10,000 admissions) over the previous 11-year period. Abscess drainage was performed in 74 (65%). A total of 116 isolates (93 aerobes, 23 anaerobes) were recovered from 66 specimens. S. aureus was recovered from 25 (38%) of the 66 specimens compared with 2 (4.9%) of 41 in the previous 11 years; 16 (64%) of 25 were MRSA compared with none in the previous 11 years. Children whose abscess grew MRSA were younger (mean 11 months) than the others (mean 62 months) (P<0.001) and required longer duration of hospitalization (mean 8.8 days) than the rest (mean 4.5 days) (P=0.002). Five children had mediastinitis; all caused by MRSA. All MRSA isolates were susceptible to clindamycin. Ceftriaxone plus clindamycin was the most common treatment regimen. All patients had resolution of their abscesses.
  
  
  CONCLUSIONS
  RPA has increased in frequency in our pediatric population with an associated increase of Staphylococcus aureus, mainly community-associated MRSA. This is likely due to the overall increase in community-associated MRSA infections in our pediatric patients. Treatment with ceftriaxone and clindamycin in addition to surgical drainage was effective.
authors.affiliation: Division of Infectious Diseases, Children's Hospital of Michigan, and Carman and Ann Adams Department of Pediatrics, Wayne State University, Detroit, MI, USA. nabdel@dmc.org
authors.forename: Nahed
authors.initials: N
authors.lastname: Abdel-Haq
authors.forename: Marianela
authors.initials: M
authors.lastname: Quezada
authors.forename: Basim I
authors.initials: BI
authors.lastname: Asmar
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D004322:Drainage; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D017703:Retropharyngeal Abscess / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000601:surgery; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D002443:Ceftriaxone