Analysis of the Bacteriology and Antimicrobial Sensitivities of Peritonsillar Abscesses

背景：扁桃腺周圍膿瘍為頭頸深部最常見之感染，其中許多病人先患有扁桃腺炎或咽喉炎並曾接受過治療；但是當膿瘍形成後通常需要予以引流及合併抗生素治療。本研究欲探討扁桃腺周圍膿瘍之細菌學、抗生素抗藥性與曾接受抗生素治療之影響。方法：以病歷回溯方式收集自2005年5月至2011年3月於本院住院扁桃腺周圍膿瘍病患資料予以分析。結果：共計有72名病患採集膿瘍送檢而納入本研究，其中64件培養呈現陽性，共計檢出137菌種。微生物培養陽性率為88.9%，平均每套檢體檢出2.1隻病原菌。檢體培養結果呈現純嗜氧菌佔總樣本數23.4%、純厭氧菌佔32.8%，混合嗜氧與厭氧菌種樣本佔43.8%。共有40名病患（60%）曾經已接受口服抗生素治療，但與其他未曾接受過治療病患相較，白血球數目、住院後給予抗生素之分布、陽性培養率與抗藥性比率兩組並無顯著差異（p = 0.49）。整體來說嗜氧菌佔51.8%，其中以Streptococcus （27.7%）、Klebsiella pneumoniae （8.8%）與Haemophilus influenzae （6.6%）最常見。厭氧菌佔48.2%，其中以Prevotella （23.4%）、Fusobacterium nucleatum （13.1%）與Bacteroides fragilis （7.3%）最常見。抗生素感受性檢測顯示檢出細菌抗藥性分別為penicillin 37.2%、cefazolin 24.1%、clindamycin27.8%、與amoxicillin-clavulanate 8%。結論：扁桃腺周圍膿瘍致病菌以混合嗜氧與厭氧菌種感染為主。是否曾接受過抗生素治療於住院應無需要考慮開立不同之抗生素，因為治療後之恢復期並無差異。致病菌種對penicillin有較高的抗藥性，故臨床上選用時必需多加謹慎考量。本研究顯示於膿瘍引流後，選擇開立cefazolin或clindamycin等經驗性抗生素之療效與直接使用廣效性抗生素相仿。

關鍵字

扁桃腺周圍膿瘍；細菌學；抗生素敏感性；經驗性抗生素

並列摘要

BACKGROUND: Peritonsillar abscess is the most common type of deep head and neck tissue abscess and may be associated with a history of antecedent tonsillitis or pharyngitis. It is typically treated by draining the abscess and administering parenteral antibiotics. Reports on the causative microorganisms of peritonsillar abscesses were variable and changed over time. Therefore, this study aimed to investigate the bacteriology, antimicrobial sensitivities, and influence of prior antibiotic treatment on cases of peritonsillar abscess.METHODS: We conducted a retrospective chart review of patients diagnosed with peritonsillar abscesses who admitted to a regional hospital in northern Taiwan between May 2005 and March 2011.RESULTS: Of the 119 patients identified, only 72 abscess cultures were performed which included 41 male (57%) and 31 female (43%). There were 64 culture-positive specimens with 88.9% positive culture rate in our cohort, including pure aerobic isolates in 23.4% of the specimens, pure anaerobic isolates in 32.8%, and mixed aerobic and anaerobic isolates in 43.8%. Forty patients (60%) had received prior oral antibiotic treatment before admission but the mean white blood cell counts and the use of antibiotics did not differ from those without. A non-significantly larger proportion of mixed aerobic and anaerobic isolates was noted in patients who received prior antibiotic treatment (p = 0.49). However, the rates of positive culture, resistant isolates, and duration of hospitalization did not differ significantly between groups. Of the whole 137 isolates, 51.8% were aerobic organisms, and the predominant bacteria included Streptococcus sp. (27.7%), Klebsiella pneumoniae (8.8%), and Haemophilus influenzae (6.6%). Anaerobic isolates constituted 48.2% of the total isolates, and Prevotella sp. (23.4%), Fusobacterium nucleatum (13.1%), and Bacteroides fragilis (7.3%) constituted the predominant isolates. Antimicrobial sensitivity analysis revealed a resistance rate of 37.2% for penicillin, 24.1% for cefazolin, 27.8% for clindamycin, and 8% for amoxicillin-clavulanate.CONCLUSIONS: Peritonsillar abscesses are infections predominantly composed of mixed aerobic and anaerobic bacteria. Immense variations in the bacteriology have been reported in the literature, and these variations warrant further investigation of endemic data as guide to proper use of empirical antibiotics. Prior oral antibiotic treatment may alter the distribution of isolated bacteria, yet our results suggest of no need to alter the selection of empirical antibiotics from that of the standard recommendations, as the recovery was not significantly different. After drainage of the abscess, our results show that the empirical use of first-line antibiotics, such as cefazolin or clindamycin, is as efficacious as that of broad-spectrum antibiotics.

並列關鍵字

peritonsillar abscess ； bacteriology ； antimicrobial sensitivities ； empirical antibiotics

國際替代計量

Analysis of the Bacteriology and Antimicrobial Sensitivities of Peritonsillar Abscesses

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