1169. Retropharyngeal Abscess in Children: The Rising incidence of Methicillin-Resistant Staphylococcus aureus
Session: Poster Abstract Session: Staphylococcus aureus Infections in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Background: We noted a recent increase in the number of children admitted to our hospital with retropharyngeal abscess (RPA) due to community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA).  We wanted to evaluate the changes in the microbiology, clinical characteristics and treatment outcome of RPA in our patient population over the past 6 years. 

Methods: 

A retrospective review of medical records of children with RPA during a 6-year period (2004-2010).  Clinical presentation, microbiology, treatment and outcome were compared to those of a previous 11 year study (1993-2003) findings. 

Results: 

114 children (61 males) with RPA were identified representing a 3.6 fold increase in incidence (per 10,000 admissions) over the previous 11 years.  Computed tomography revealed inflammatory or ring enhancing lesion in all patients.  Abscess drainage was performed in 74 (65%).  A total of 116 isolates (93 aerobes, 23 anaerobes) were recovered from 66 specimens (1.8 isolates per specimen).  S. aureus, viridans streptococci and Streptococcus pyogenes were the most common aerobes and Prevotella species were the most common anaerobes.  S. aureus was recovered from 25 (38%) of 66 specimens compared to 2 (4.9%) of 41 in the previous 11 years; 16 (64%) of 25 were CA-MRSA compared to none in the previous 11 yrs.  Most (75%) cases of MRSA were in the last 3 years.  Children whose abscess culture grew MRSA were younger (mean 11 mo) than the others (mean 62 mo) (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 recovered, however, one developed anoxic brain injury due to intraoperative rupture of the innominate artery during drainage of mediastinal fluid.

Conclusion:   

RPA has recently increased in frequency in our pediatric population with associated increase in recovery of S. aureus mainly CA- MRSA in the younger patients. This is likely the result of increased rates of CA-MRSA infections in general in our pediatric population.  Treatment with ceftriaxone and clindamycin, in addition to surgical drainage, was very effective.  


Subject Category: P. Pediatric and perinatal infections

Nahed Abdel-Haq, MD, Children's Hospital of Michigan, Wayne State University, Detroit, MI, Marianela Quezada, MD, Henry Ford Health System , Detroit , MI and Basim Asmar, MD, Pediatrics/ Pediatric Infectious Diseases, Children's Hospital of Michigan, Wayne State University, Detroit, MI

Disclosures:

N. Abdel-Haq, None

M. Quezada, None

B. Asmar, None

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