Because of a recent increase in retropharyngeal abscess cases due to community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), a retrospective evaluation of the microbiology, clinical manifestations and treatment outcome of retropharyngeal abscess over the past 6-years (2004-2010) was performed at Children's Hospital of Michigan, Detroit, Michigan. The Findings were compared to those of a previous 11 year study (1993-2003) period.
One hundred eleven children with retropharyngeal abscess were treated representing a 2.8 fold increase in incidence (per 10,000 admissions) over the previous 11-year period. A total of 116 isolates (93 aerobes, 23 anaerobes) were isolated from 66 drained specimens (2/3 of the total). The study showed increased frequency of isolation of MRSA with an associated increase of S. aureus mainly CA-MRSA. S. aureus was recovered from 25 (38%) of 66 specimens compared to 2 (4.9%) of 41 in the previous 11 years; 16 (64%) of 25 were MRSA compared to none in the previous 11 years. Children whose abscess grew MRSA were younger (mean 11 months) than the others (mean 62 month) (p< 0.001). Five children had mediastinitis; all caused by MRSA. All MRSA isolates were susceptible to clindamycin.This is likely due to the overall increase in CA-MRSA infections in pediatric patients. Treatment with ceftriaxone and clindamycin in addition to surgical drainage was effective in most patients.
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