title: Changing microbiology of pediatric neck abscesses in Iowa 2000-2010.
abstract: OBJECTIVE
  To examine the changing microbiology of pediatric neck abscesses over a 10-year period with particular interest in methicillin-resistant Staphylococcus aureus (MRSA) infections and their associated antibacterial-resistance patterns, including resistance to clindamycin, a frequently used antibiotic for Staphylococcus aureus.
  
  
  METHODS
  Retrospective chart review at a tertiary academic medical center.
  
  
  METHODS
  One hundred and twenty-two consecutive pediatric patients managed between January 2000 and June 2010 with incision and drainage of a proven neck abscess.
  
  
  RESULTS
  Seventy-four patients with 76 abscesses were identified. A microorganism was found in 65 (85%) of the 76 abscesses. Forty-three percent grew Staphylococcus aureus (SA), 12% were methicillin-resistant Staphylococcus Aureus (MRSA), and 31% were methicillin-susceptible Staphylococcus aureus (MSSA). There was a significant increase in the incidence of MRSA infections during the study period, with only one case of MRSA diagnosed in the first half of the study (from 2000-2004) compared with seven in the second half (from 2005-2010) (P = 0.023). The second most common bacterial etiology or isolate was Streptococcus pyogenes in 27%, while the remaining 30% grew mixed oral flora and other microorganisms.
  
  
  CONCLUSIONS
  These findings demonstrate a statistically significant rise in the proportion of MRSA neck infections in pediatric patients in Iowa. Resistance to clindamycin was highest among MSSA isolates. Clindamycin-resistant S. aureus and Streptococcus pyogenes are established pathogens in neck infections. In communities with similar microbiology patterns, empiric treatment with combination therapy of a beta lactam and vancomycin or trimethoprim/sulfamethoxazole should be initiated until culture results are available.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Hospitals and Clinics, Iowa City, Iowa 52242-1078, USA.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Walker
authors.forename: Lucy Hynds
authors.initials: LH
authors.lastname: Karnell
authors.forename: Christine
authors.initials: C
authors.lastname: Ziebold
authors.forename: Deborah S F
authors.initials: DS
authors.lastname: Kacmarynski
mesh_terms: D000038:Abscess / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin; D004322:Drainage; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007484:Iowa / Q000453:epidemiology; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D009333:Neck / Q000382:microbiology / Q000473:pathology*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin