Pediatric mediastinitis as a complication of methicillin-resistant Staphylococcus aureus retropharyngeal abscess

Charles T. Wright, Rose Mary S. Stocks, David L. Armstrong, Sandra Arnold, Herbert J. Gould

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Objective: To examine changes in the incidence, bacteriology, and complications of retropharyngeal infection (RPI) over an 8-year period. Design: Retrospective medical record review. Setting: Tertiary children's hospital. Patients: The study population comprised 108 patients younger than 18 years old. Intervention: Medical record review of patients with a discharge diagnosis of RPI (International Classification of Diseases, Ninth Revision code 478.24). Main Outcome Measures: Cases from June 1997 to May 2001 were compared with those from June 2001 to May 2005 to examine changes in the incidence, bacteriology, and complications of RPI. Results: The number of RPI cases doubled from 36 to 72 in the final 4 years. In the first 4 years, no isolates of methicillin- resistant Staphylococcus aureus (MRSA) were found, and 1 patient developed mediastinitis. In the last 4 years, 8 of 25 patients (32%) with positive cultures had MRSA isolated, and 7 cases of mediastinitis occurred. Of the 8 children with cultures positive for MRSA, 6 developed mediastinitis. The median age for all children with RPI was 32.5 months (n=108). The median age for children with MRSA and mediastinitis was 6.5 months (n=8) and 5.5 months (n=8), respectively. Conclusions: An alarming increase in the number of RPI cases occurred over the final 4 years. Methicillin-resistant S aureus is now a significant pathogen in patients with RPI at our institution. Documented local increases in community-associated MRSA infections and universal sensitivity to clindamycin suggest that community-associated MRSA is responsible for the change in bacteriology. A high correlation exists between MRSA infection and mediastinitis. Patients with MRSA infections are younger and may be vulnerable to developing mediastinitis because of immature immune systems. A higher index of suspicion is needed for MRSA, especially in patients younger than 1 year.

Original languageEnglish (US)
Pages (from-to)408-413
Number of pages6
JournalArchives of Otolaryngology - Head and Neck Surgery
Volume134
Issue number4
DOIs
StatePublished - Apr 1 2008

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Retropharyngeal Abscess
Mediastinitis
Methicillin-Resistant Staphylococcus aureus
Pediatrics
Infection
Bacteriology
Medical Records
Methicillin Resistance
Clindamycin
Incidence
International Classification of Diseases
Tertiary Care Centers
Immune System

All Science Journal Classification (ASJC) codes

  • Surgery
  • Otorhinolaryngology

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Pediatric mediastinitis as a complication of methicillin-resistant Staphylococcus aureus retropharyngeal abscess. / Wright, Charles T.; Stocks, Rose Mary S.; Armstrong, David L.; Arnold, Sandra; Gould, Herbert J.

In: Archives of Otolaryngology - Head and Neck Surgery, Vol. 134, No. 4, 01.04.2008, p. 408-413.

Research output: Contribution to journalArticle

Wright, Charles T. ; Stocks, Rose Mary S. ; Armstrong, David L. ; Arnold, Sandra ; Gould, Herbert J. / Pediatric mediastinitis as a complication of methicillin-resistant Staphylococcus aureus retropharyngeal abscess. In: Archives of Otolaryngology - Head and Neck Surgery. 2008 ; Vol. 134, No. 4. pp. 408-413.
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abstract = "Objective: To examine changes in the incidence, bacteriology, and complications of retropharyngeal infection (RPI) over an 8-year period. Design: Retrospective medical record review. Setting: Tertiary children's hospital. Patients: The study population comprised 108 patients younger than 18 years old. Intervention: Medical record review of patients with a discharge diagnosis of RPI (International Classification of Diseases, Ninth Revision code 478.24). Main Outcome Measures: Cases from June 1997 to May 2001 were compared with those from June 2001 to May 2005 to examine changes in the incidence, bacteriology, and complications of RPI. Results: The number of RPI cases doubled from 36 to 72 in the final 4 years. In the first 4 years, no isolates of methicillin- resistant Staphylococcus aureus (MRSA) were found, and 1 patient developed mediastinitis. In the last 4 years, 8 of 25 patients (32{\%}) with positive cultures had MRSA isolated, and 7 cases of mediastinitis occurred. Of the 8 children with cultures positive for MRSA, 6 developed mediastinitis. The median age for all children with RPI was 32.5 months (n=108). The median age for children with MRSA and mediastinitis was 6.5 months (n=8) and 5.5 months (n=8), respectively. Conclusions: An alarming increase in the number of RPI cases occurred over the final 4 years. Methicillin-resistant S aureus is now a significant pathogen in patients with RPI at our institution. Documented local increases in community-associated MRSA infections and universal sensitivity to clindamycin suggest that community-associated MRSA is responsible for the change in bacteriology. A high correlation exists between MRSA infection and mediastinitis. Patients with MRSA infections are younger and may be vulnerable to developing mediastinitis because of immature immune systems. A higher index of suspicion is needed for MRSA, especially in patients younger than 1 year.",
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