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Microbiological features and pathogenesis of peritonsillar abscesses
I J Mitchelmore1, A J Prior, P Q Montgomery
1Department of Medical Microbiology, St. Bartholomew's Hospital, West Smithfield, London, UK.
Summary
Peritonsillar abscesses are often caused by mixed anaerobic bacteria, not just streptococci. Antibiotics should target anaerobic bacteria, especially with beta-lactamase-producing strains present.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Microbiology
Background:
- Peritonsillar abscess (PTA) is a common complication of tonsillitis.
- Understanding the microbial etiology of PTA is crucial for effective treatment.
Purpose of the Study:
- To identify the aerobic and anaerobic bacteria responsible for peritonsillar abscesses.
- To correlate microbiological findings with clinical data and antibiotic susceptibility.
Main Methods:
- Aspiration of pus from 53 peritonsillar abscesses for bacterial culture.
- Correlation of microbiological results with clinical data from 44 patients.
- Use of Gram stain and gas-liquid chromatography for bacterial identification.
Main Results:
- 85% of cultures were positive, with 7 yielding aerobic and 38 yielding anaerobic infections.
- Anaerobic infections were typically mixed, with Peptostreptococcus micros and Streptococcus milleri being predominant.
- Lancefield group A beta-haemolytic streptococci were found in a minority of cases.
- 18.9% of samples contained beta-lactamase-producing bacteria.
Conclusions:
- Peritonsillar abscess is predominantly caused by mixed anaerobic infections.
- First-line antibiotic therapy should include agents effective against anaerobic bacteria, considering beta-lactamase production.