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Resource utilization of intraoperative cultures for pediatric deep neck space abscesses
Sophie G Shay1, Sarah Khayat2, Rebecca Xu3
1Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA; Pediatric Otolaryngology, Children's Hospital of Wisconsin, Milwaukee, WI, USA.
Introduction:
Peritonsillar (PT), parapharyngeal (PP), and retropharyngeal (RP) abscesses are common pediatric deep neck space infections (DNSI). Despite established literature on DNSI microbiology, obtaining intraoperative cultures remains commonplace. The objective was to evaluate the resource utilization of intraoperative cultures when draining PT, PP, and RP abscesses.
Methods:
Pediatric patients (age <18.0 years) who underwent surgical drainage of a PT, PP, or RP abscess between January 2013 and June 2018 were retrospectively reviewed. Changes in antimicrobials based on intraoperative culture results were assessed by use of Fisher's exact tests or Wilcoxon rank-sum tests, as appropriate. Multivariable linear regression was used to model the association between factors of interest and number of cultures obtained.
Results:
Eighty-eight patients underwent surgical drainage, of which 80 patients (median age 6.96 years) had intraoperative bacterial cultures (32 PT, 21 PP, and 27 RP). There were no positive fungal or acid-fast bacilli cultures. Seven patients had culture-directed changes in treatment; none of these patients had a PT abscess. Age was inversely associated with culture-directed changes (p = 0.006) while the use of blood cultures (p = 0.012) was positively associated with culture-directed treatment changes. Hospital length of stay (p < 0.001) and history of prior DNSI (p = 0.001) were associated with number of cultures obtained.
Conclusions:
Younger children with PP and RP abscesses are most likely to benefit from intraoperative bacterial cultures. Cultures of PT abscesses are unlikely to change clinical management. Fungal and acid-fast bacilli cultures are unlikely to yield clinically useful information. Prudent use of intraoperative cultures may decrease the use of hospital resources and admission-related costs.
Insights
Intraoperative cultures for pediatric deep neck space infections (DNSI) are most beneficial for younger children with parapharyngeal (PP) and retropharyngeal (RP) abscesses. Cultures from peritonsillar (PT) abscesses rarely alter treatment, suggesting a need for more judicious use of these tests.
Area of Science:
- Pediatric Otolaryngology
- Infectious Diseases
- Surgical Microbiology
Background:
- Deep neck space infections (DNSI) like peritonsillar (PT), parapharyngeal (PP), and retropharyngeal (RP) abscesses are common in children.
- Intraoperative cultures are frequently obtained despite existing knowledge of DNSI microbiology.
- The resource utilization of intraoperative cultures in pediatric DNSI requires evaluation.
Purpose of the Study:
- To assess the clinical utility and resource implications of intraoperative cultures in pediatric patients undergoing surgical drainage of PT, PP, and RP abscesses.
- To identify factors associated with culture-directed treatment changes and the number of cultures obtained.
Main Methods:
- Retrospective review of pediatric patients (<18 years) who had surgical drainage of PT, PP, or RP abscesses (January 2013 - June 2018).
- Analysis of changes in antimicrobial therapy based on intraoperative culture results using Fisher's exact tests or Wilcoxon rank-sum tests.
- Multivariable linear regression to model associations between patient factors and culture outcomes.
Main Results:
- Eighty-eight patients underwent drainage; 80 had intraoperative cultures (32 PT, 21 PP, 27 RP).
- Only seven patients (none with PT abscess) had culture-directed treatment changes; younger age and blood cultures were associated with changes.
- No fungal or acid-fast bacilli cultures were positive; hospital length of stay and prior DNSI history correlated with the number of cultures obtained.
Conclusions:
- Intraoperative cultures are most valuable for younger children with PP and RP abscesses, with limited impact on PT abscess management.
- Fungal and acid-fast bacilli cultures provide minimal clinical benefit in these pediatric cases.
- Optimizing the use of intraoperative cultures can potentially reduce healthcare resource utilization and associated costs.
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