Bacteriology of peritonsillar abscess in patients over 40 years--a neglected age group

The clinical presentation of peritonsillar abscess (PTA) in patients over 40 years is scarcely reported. Since older patients present differently than younger patients, our aim was to investigate possible correlation between illness severity in the older age group and their bacteriologic studies. A retrospective study on all cases of PTA admitted between June 1996 and June 2003 was carried out. Details regarding sex and age were obtained. Bacteriologic studies were analyzed for gram stain, aerobic and anaerobic culture results. Two hundred and eighty-two patients (143 male and 139 female) had 311 hospitalizations due to PTA with known results of the microbiologic studies. Mean age was 29.6 (range 4-80 years). Sixty-five adults over 40 of age were found comprising 23 % of our cohort. Aerobic growth in the older group was found to be significantly lower (P < 0.05). Anaerobic growth was identified in 44.7 % of the positive pathogen growth. The older age group also showed a tendency to higher rates of anaerobic bacterial growth (57.1 % compared to 41 % in the young age group; P = 0.09, OR = 1.91). Older population with PTA presents with significant lower rates of aerobic bacteria and a tendency towards higher rates of anaerobic growth. The dangerous combination of the latter with the higher reported rates of comorbidities and less prominent symptoms and signs compared to the younger patients might clarify the need for prompt and aggressive surgical and antibiotic treatment.