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Association between clinical outcome and microbiological findings in peritonsillar abscess - an observational study
Elin Lindberg1, Ann Hermansson2, David Nygren3,4
1Department of Otorhinolaryngology, Head and Neck Surgery, Lund University, Lund, Sweden. elin.l.lindberg@skane.se.
Background:
Previous studies on causative pathogens in peritonsillar abscesses have yielded varying results. However, Group A streptococci (GAS) and Fusobacterium necrophorum have been identified frequently. The aim of this study was to investigate pathogens in peritonsillar abscesses in patients tested for both ß-hemolytic streptococci and F. necrophorum, and to investigate associations between pathogens and clinical outcome.
Method:
This retrospective observational study included all patients in the Skåne Region, Sweden (population 1.4 million) with a diagnosis of peritonsillar abscess between 2016 and 20, and in whom tests were performed for both ß-hemolytic streptococci (culture) and F. necrophorum (PCR). Exclusion criteria included previous (30 days) purulent complication to pharyngotonsillitis or antibiotic therapy. Chart review from 30 days prior to 6 months after the index visit was performed. Logistic regression was performed to evaluate the association between pathogens and complications, with negative microbiological findings set as reference category. Complications were defined as a composite outcome (0/1) of recurrent pharyngotonsillitis/peritonsillar abscess, other pharyngeal abscess or septic complications within 30 days (early), and 1-6 months (late).
Results:
In a total of 637 patients, F. necrophorum was identified in 210 (33%), GAS in 159 (28%) and GCS/GGS in 40 (6%) patients. F. necrophorum was most common in adolescents and young adults. Only F. necrophorum was associated with the development of either of early (OR 3.8 (2.0-7.1 95%CI)) and late complications (OR 2.5 (95%CI 1.3-4.9).
Conclusion:
F. necrophorum was the most commonly identified pathogen in peritonsillar abscesses. It was also the only pathogen associated with the development of complications.
Insights
Fusobacterium necrophorum is the most common cause of peritonsillar abscesses and the only pathogen linked to complications. Early identification and management of F. necrophorum are crucial for better patient outcomes.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Microbiology
Background:
- Peritonsillar abscess (PTA) etiology varies, with Group A streptococci (GAS) and Fusobacterium necrophorum frequently implicated.
- Limited data exists on pathogen prevalence and clinical associations in PTA.
Purpose of the Study:
- To investigate pathogens in peritonsillar abscesses (PTA).
- To determine associations between specific pathogens and clinical outcomes, including complications.
Main Methods:
- Retrospective observational study of 637 patients diagnosed with PTA in Sweden (2016-2020).
- Pathogen testing included ß-hemolytic streptococci (culture) and F. necrophorum (PCR).
- Logistic regression analyzed pathogen-complication associations, defining complications as recurrent infections or septic events.
Main Results:
- Fusobacterium necrophorum was the most prevalent pathogen (33%), followed by GAS (28%).
- F. necrophorum was most common in adolescents and young adults.
- F. necrophorum was significantly associated with both early (OR 3.8) and late (OR 2.5) complications.
Conclusions:
- F. necrophorum is the predominant pathogen in peritonsillar abscesses.
- F. necrophorum is the sole pathogen identified as a risk factor for PTA complications.
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