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Retropharyngeal Abscess in Children: The Rising Incidence of Methicillin-Resistant Staphylococcus aureus

Abdel-Haq, Nahed MD*†; Quezada, Marianela MD; Asmar, Basim I. MD*†

Pediatric Infectious Disease Journal: July 2012 - Volume 31 - Issue 7 - p 696–699
doi: 10.1097/INF.0b013e318256fff0
Original Studies

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.

From the *Division of Infectious Diseases, Children’s Hospital of Michigan; Carman and Ann Adams Department of Pediatrics, Wayne State University; and Henry Ford Hospital Health System, Detroit, MI.

Accepted for publication March 19, 2012.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Nahed Abdel-Haq, MD, Division of Infectious Diseases, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI. E-mail: nabdel@dmc.org.

© 2012 Lippincott Williams & Wilkins, Inc.