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[The clinical importance of bacteremia during tonsillectomy]
Introduction:
Post-tonsillectomy bacteraemia is a well recognized aetiological factor in streptococcal endocarditis. Prophylactic penicillin has been recommended to reduce its incidence in susceptible patients undergoing tonsillectomy. Recent studies have shown a change in the microflora and an increase in the number of penicillin-resistant organisms in the tonsils of patients undergoing tonsillectomy.
Objective:
The aim of this study was to assess the incidence of post-tonsillectomy bacteraemia, identify the associated organisms, and review the suitability of penicillin in prophylactic regimens.
Material And Methods:
102 children were included. Blood culture samples were taken after removal of the first tonsil, which was randomly electrodissected or blunt dissected. Statistical analysis was performed using ANOVA.
Results:
Of the 102 patients included in the study, 41 (40.1%) had positive post-tonsillectomy blood cultures. Haemophilus influenzae was isolated from 23 (56%) of the positive cultures and Streptococcus viridans from 15 (36.5%). Twenty-five percent of H. influenzae and 50% of the viridans group produced beta-lactamase.
Conclusions:
A beta-lactamase stable antibiotic would be more appropriate than penicillin for prophylaxis during tonsillectomy.
Insights
Post-tonsillectomy blood cultures frequently show bacteria, including penicillin-resistant strains. A beta-lactamase stable antibiotic is recommended over penicillin for prophylaxis to prevent infections like endocarditis.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Microbiology
Context:
- Post-tonsillectomy bacteraemia is a known cause of streptococcal endocarditis.
- Penicillin prophylaxis is standard for susceptible patients undergoing tonsillectomy.
- Emerging penicillin-resistant organisms in tonsils necessitate reassessment of prophylactic strategies.
Purpose:
- To determine the incidence of post-tonsillectomy bacteraemia.
- To identify bacteria causing post-tonsillectomy bacteraemia.
- To evaluate the efficacy of penicillin for prophylaxis.
Summary:
- 40.1% of 102 children had positive blood cultures post-tonsillectomy.
- Haemophilus influenzae (56%) and Streptococcus viridans (36.5%) were common isolates.
- Significant proportions of these isolates produced beta-lactamase, an enzyme inactivating penicillin.
Impact:
- Findings suggest penicillin is inadequate for prophylaxis due to resistance.
- Beta-lactamase stable antibiotics are recommended for improved post-tonsillectomy infection prevention.
- This study informs updated clinical guidelines for tonsillectomy procedures.