Faculty Collaboration Database

Resource utilization of intraoperative cultures for pediatric deep neck space abscesses. Int J Pediatr Otorhinolaryngol 2020 Aug;135:110115

Date

05/25/2020

Pubmed ID

32447171

DOI

10.1016/j.ijporl.2020.110115

Scopus ID

2-s2.0-85084847768 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

INTRODUCTION: Peritonsillar (PT), parapharyngeal (PP), and retropharyngeal (RP) abscesses are common pediatric deep neck space infections (DNSI). Despite established literature on DNSI microbiology, obtaining intraoperative cultures remains commonplace. The objective was to evaluate the resource utilization of intraoperative cultures when draining PT, PP, and RP abscesses.

METHODS: Pediatric patients (age <18.0 years) who underwent surgical drainage of a PT, PP, or RP abscess between January 2013 and June 2018 were retrospectively reviewed. Changes in antimicrobials based on intraoperative culture results were assessed by use of Fisher's exact tests or Wilcoxon rank-sum tests, as appropriate. Multivariable linear regression was used to model the association between factors of interest and number of cultures obtained.

RESULTS: Eighty-eight patients underwent surgical drainage, of which 80 patients (median age 6.96 years) had intraoperative bacterial cultures (32 PT, 21 PP, and 27 RP). There were no positive fungal or acid-fast bacilli cultures. Seven patients had culture-directed changes in treatment; none of these patients had a PT abscess. Age was inversely associated with culture-directed changes (p = 0.006) while the use of blood cultures (p = 0.012) was positively associated with culture-directed treatment changes. Hospital length of stay (p < 0.001) and history of prior DNSI (p = 0.001) were associated with number of cultures obtained.

CONCLUSIONS: Younger children with PP and RP abscesses are most likely to benefit from intraoperative bacterial cultures. Cultures of PT abscesses are unlikely to change clinical management. Fungal and acid-fast bacilli cultures are unlikely to yield clinically useful information. Prudent use of intraoperative cultures may decrease the use of hospital resources and admission-related costs.

Author List

Shay SG, Khayat S, Xu R, Srdanovic N, Patel SJ, Valika T, Lavin JM

Author

Sophie G. Shay MD Assistant Professor in the Otolaryngology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Age Factors
Anti-Bacterial Agents
Blood Culture
Child
Child, Preschool
Colony Count, Microbial
Drainage
Drug Substitution
Female
Health Resources
Humans
Intraoperative Period
Length of Stay
Male
Neck
Peritonsillar Abscess
Retropharyngeal Abscess
Retrospective Studies