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Post-tonsillectomy bacteraemia
R J Gaffney1, M A Walsh, D P McShane
1Department of Otolaryngology, St James's Hospital, Dublin, Ireland.
Abstract:
Post-tonsillectomy bacteraemia is a well recognized aetiological factor in streptococcal endocarditis. Prophylactic penicillin has been recommended to reduce its incidence in susceptible patients undergoing tonsillectomy. Recent studies have shown a change in the microflora and an increase in the number of penicillin resistant organisms in the tonsils of patients undergoing tonsillectomy. The aim of this study has been to assess the incidence of post-tonsillectomy bacteraemia, identify the organisms associated with it and review the suitability of penicillin in prophylactic regimens. Of the 32 patients included in the study, 11 (34.4%) had positive post-tonsillectomy blood cultures. We were surprised at this low incidence of bacteraemia and have postulated a possible reason. Haemophilus influenzae was isolated from 4 (36.4%) of the positive cultures and Streptococcus viridans in only 1 (9%). Rather than using penicillin for prophylaxis a beta-lactamase stable antibiotic would be more appropriate.
Insights
Post-tonsillectomy bloodstream infections (bacteraemia) were less common than expected. Penicillin may not be the best antibiotic for preventing these infections due to resistant bacteria like Haemophilus influenzae.
Area of Science:
- Infectious Diseases
- Microbiology
- Otolaryngology
Background:
- Post-tonsillectomy bacteraemia is linked to streptococcal endocarditis.
- Penicillin prophylaxis is standard for susceptible patients undergoing tonsillectomy.
- Rising penicillin resistance in tonsillar microflora necessitates reassessment.
Purpose of the Study:
- To determine the incidence of post-tonsillectomy bacteraemia.
- To identify causative organisms.
- To evaluate the suitability of penicillin for prophylaxis.
Main Methods:
- Blood cultures were taken post-tonsillectomy.
- Organisms were identified.
- Incidence and resistance patterns were analyzed.
Main Results:
- 11 of 32 patients (34.4%) showed bacteraemia.
- Haemophilus influenzae (36.4%) was more common than Streptococcus viridans (9%).
- Low incidence of bacteraemia observed.
Conclusions:
- Current penicillin prophylaxis may be suboptimal.
- Beta-lactamase stable antibiotics are recommended.
- Further research into optimal prophylactic strategies is warranted.