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Peritonsillar abscess (PTA): clinical characteristics, microbiology, drug exposures and outcomes of a large multicenter cohort survey of 412 patients hospitalized in 13 French university hospitals

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Abstract

The aim of this study was to describe the epidemiology of hospitalized patients with peritonsillar abscess (PTA). We conducted a multicenter survey in 13 French university hospitals in 2009–2012 describing 412 patients. Median age was 29 year (range, 2–84) and current smoking habit was reported by 177 (43 %) patients. Most of the patients (92 %) had consulted a physician for sore throat within 10 days before admission for PTA diagnosis. Additional symptoms such as visible tonsil abnormalities (83 %), tender cervical adenopathy (57 %) and fever ≥ 38.5 °C (53 %) were also reported. A total of 65 % patients (269/412) reported recent systemic anti-inflammatory agents (AIAs) exposure by medical prescription (70 %), self-medication (22 %), or both (8 %); 61 % and 27 % reported recent exposure to antibiotic and topical treatments for sore throat, respectively. Non-steroidal AIAs were used most often (45 %), particularly arylpropionic derivatives. A rapid diagnosis antigen test (RDT) for Streptococcus pyogenes was performed in 70 (17 %) patients and was positive in 17 (24 %), of whom 9 (53 %) were exposed to AIAs and 14 (82 %) to antibiotics. To treat PTA, antibiotic therapy was given to 392 (95 %) patients. Of 333 antibiotic prescriptions, amoxicillin-clavulanic acid and metronidazole were the most prescribed antibiotics (42 and 17 %, respectively). Surgical drainage of the abscess was performed in 119 (29 %) cases and tonsillectomy in 75 (18 %) cases. The clinical outcome was favorable during the hospital stay in 404 (98 %) patients. In conclusion, patients with sore throat are often exposed to AIAs before PTA diagnosis, and antibiotic prescription was not often based on the RDT positivity.

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Acknowledgments

We thank Line Happi-Djeukou and Olivier Boutin for their contribution to data collection and for contacting the primary-care physicians who enrolled the controls. We thank Tanguy Roman for his contribution for building the electronic database.

Author’s contribution

Conceived and designed the study: DL, NA, FB, JC, CF, GP

Performed the monitoring of the study: DL, VP, NA, CF, CR, GP

Analyzed the data: DL, CB

Wrote and validate the final version of the paper: DL, VP, PL, CB, NA, JC, CF, EB, GP

French PTA study group

Betty Mazet-Guillaume, Laurent Lacourreye and Marie-Laure Joly-Guillou (Angers University Hospital, Angers, France); Enrique Casalino, Béatrix Barry and Antoine Andremont (Bichat-Claude Bernard University Hospital, Paris, France); Eric Roupie, Sylvain Moreau and Roland Leclerq (Caen University Hospital, Caen, France) Etienne Zuber, Jean-François Vellin and Richard Bonnet (Clermont-Ferrand University Hospital, Clermont-Ferrand, France); Carole Paquier, Christian Righini and Jacques Croize (Grenoble University Hospital, Grenoble, France); Delphine Garrigue, Xavier Pasquesoone and Daniel Izard (Lille University Hospital, Lille, France); Gilles Potel, Philippe Bordure and Pascale Bemer (Nantes University Hospital, Nantes, France); Christine Ginsburg, Pascal Corlieu and Claire Poyart (Cochin University Hospital, Paris, France); Patrick Plaisance, Philippe Herman and Laurent Raskine (Lariboisière University Hospital, Paris, France); Michel Scepi, Xavier Dufour and Christophe Burucoa (Poitiers University Hospital, Poitiers, France); Jacques Bouget, Franck Jegoux and Michel Cormier (Pontchaillou University Hospital, Rennes, France); Dominique Lauque, Elie Serrano and Gérard Chabanon (Rangueil University Hospital, Toulouse, France); Regis Lanotte, Emmanuel Lescanne and Holstein (Bretonneau University Hospital, Tours, France).

Author information

Authors and Affiliations

  1. Bacteriology and Infection Control Department, Nantes University Hospital, 44093, Nantes, France

    D. Lepelletier, C. Bourigault & J. Caillon

  2. Emergency Department, Nantes University Hospital, 44093, Nantes, France

    V. Pinaud, P. Le Conte, E. Batard & G. Potel

  3. Infectious Diseases Department, Nantes University Hospital, 44093, Nantes, France

    N. Asseray

  4. Medqual, Nantes University Hospital, 44093, Nantes, France

    F. Ballereau

  5. Otorhinolaryngology Department, Nantes University Hospital, 44093, Nantes, France

    C. Ferron

  6. Otorhinolaryngology Department, Michallon University Hospital, 38000, Grenoble, France

    C. Righini

  7. Medical School, EA 3826, University of Nantes, 44035, Nantes, France

    D. Lepelletier, N. Asseray, F. Ballereau, J. Caillon, E. Batard & G. Potel

Authors
  1. D. Lepelletier
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  2. V. Pinaud
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  3. P. Le Conte
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  4. C. Bourigault
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  5. N. Asseray
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  6. F. Ballereau
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  7. J. Caillon
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  8. C. Ferron
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  9. C. Righini
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  10. E. Batard
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  11. G. Potel
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Consortia

for the French PTA Study Group

Corresponding author

Correspondence to D. Lepelletier.

Ethics declarations

We declared that compliance with ethical standard was followed during the study period.

Funding

No specific funding has been received.

Conflict of interest

The authors declare that no potential conflicts of interest exist.

Ethical approval

Approval was obtained from the Ethic Committee of the Nantes Clinical Research Directory.

Informed consent

Written informed consent was obtained from each hospitalized patient with peritonsillar abscess.

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Lepelletier, D., Pinaud, V., Le Conte, P. et al. Peritonsillar abscess (PTA): clinical characteristics, microbiology, drug exposures and outcomes of a large multicenter cohort survey of 412 patients hospitalized in 13 French university hospitals. Eur J Clin Microbiol Infect Dis 35, 867–873 (2016). https://doi.org/10.1007/s10096-016-2609-9

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  • DOI: https://doi.org/10.1007/s10096-016-2609-9

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