Microbiology in complicated head and neck infections

To identify the pathogens associated with complicated ear, throat and sinus infections and to link the relevant susceptibility patterns to the empirical therapy currently advised in the Dutch guidelines.

Retrospective, descriptive study of consecutive cases.

Tertiary referral centre.

All consecutive patients with a complicated ear, nose and throat infection who underwent surgery at a tertiary referral centre during a six-year period. The term 'complicated' was used to define infections that had spread outside the primary region of infection (middle ear cavity, pharyngeal mucosa, or paranasal sinus) and which therefore, under our policy, required surgical intervention.

Microbiological culture and susceptibility pattern

A total of 96 patients were included in this study. The predominant causative organisms for the infections were Streptococcus pneumonia, beta hemolytic streptococci and Streptococcus milleri for ear, throat, and sinus infections, respectively. These were all susceptible to the recommended empirical therapy. Cultures from 6 patients yielded coagulase-negative staphylococci resistant to frequently used antibiotics. The mortality rate in our series was 13% for ear infections. This was caused by complicated infections in young children and patients with cholesteatoma. Ten per cent of the ear infections in adults yielded Pseudomonas aeruginosa and 25% yielded anaerobes.

Ear infections in young children and in patients with cholesteatoma should be treated aggressively. Our results suggest that patients with intracranial complications stemming from ear infections should preferably be treated with a combination therapy including antibiotics targeting gram negatives and anaerobes. The role of coagulase-negative staphylococci, especially in neck abscesses, may be more important than has been thought until now.