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Kathryn Ossowski, MD; Robert H. Chun, MS, MD; Dana Suskind, MD; Fuad M. Baroody, MD

Arch Otolaryngol Head Neck Surg. 2006;132:1176-1181.

Objective  To compare the proportion of community-associated, methicillin-resistant Staphylococcus aureus (MRSA) infections in pediatric head and neck abscesses between 2 study periods.

Design  Retrospective case review.

Setting  Tertiary care pediatric otolaryngology practice.

Patients  Pediatric patients with head and neck abscesses presenting over 2 separate 2.5-year intervals: July 1999 through December 2001 and January 2002 through June 2004.

Interventions  Incision and drainage of abscess.

Main Outcome Measures  Type and antimicrobial susceptibility of cultured organisms.

Results  We identified 21 abscesses in 19 patients from July 1999 through December 2001 and 32 abscesses in 32 patients from January 2002 through June 2004. Of the 21 abscesses in the first study period, 15 demonstrated pathogen growth compared with 29 of 32 abscesses in the second study period. In the first period, 6 (40%) of 15 abscesses yielded S aureus compared with 17 (58.6%) of 29 abscesses in the second period. The proportion of abscesses yielding MRSA increased from 0% (0/6) in the first study period to 64.7% (11/17) in the second study period (P<.01). All MRSA infections were considered to be community acquired.

Conclusions  Our study demonstrates a statistically significant rise in the proportion of community-associated MRSA infections of the head and neck in the pediatric population at our institution. For communities where similar microbial recovery patterns exist, we suggest that a culture be obtained as soon as possible in a child presenting with a head and neck abscess to identify the organism. Until that time, the best empirical treatment is clindamycin, with other agents available if warranted by culture and sensitivity results. A treatment algorithm is presented.

Author Affiliations: Section of Otolaryngology–Head and Neck Surgery, Pritzker School of Medicine, University of Chicago, Chicago, Ill.

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