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Cervical suppurative lymphadenitis in children: microbiology, primary sites of infection, and evaluation of antibiotic treatment

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Abstract

Purpose

The significant pathogens associated with paediatric cervical suppurative lymphadenitis (CSL) are unclarified, and there is a lack of clinical evaluations of antibiotic regimens in paediatric CSL. We aimed to (1) explore the bacterial findings and the associated primary sites of infection in paediatric cases of CSL and (2) evaluate the clinical outcomes in patients treated with different antibiotic regimens.

Methods

All children (< 18 years) treated for non-mycobacterium CSL at the Department of Otorhinolaryngology, Aarhus University Hospital, from 2001 to 2018 were retrospectively evaluated.

Results

Eighty-five patients were included in the study. The prevalent isolates were S. aureus (57%), S. pyogenes (17%), non-haemolytic streptococci (11%), and F. necrophorum (3%). The primary sites of infection were identified in 30 (35%) patients. The most common sites were the oropharynx (n = 15), the middle ear (n = 10), and the skin (n = 5). All patients were treated with surgical incision and antibiotics. No statistically significant differences were found between patients treated with antibiotics covering streptococci (n = 60) versus antibiotics covering streptococci and S. aureus (n = 25) in terms of duration of hospitalisation (median 4 vs 4 days, p = 0.26), altered antibiotic treatment because of insufficient clinical or biochemical progress (7% vs 12%, p = 0.41), and abscess recurrence (8% vs 12%, p = 0.69).

Conclusion

S. aureus was the predominant pathogen in paediatric CSL at all cervical levels, and even in cases with evidence of primary site infection not normally associated with S. aureus. We were unable to underscore the importance of antibiotic treatment covering S. aureus based on evaluation of the clinical outcomes.

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Funding

The authors received no financial support to declare that are relevant to the content of this article.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark

    Nicolai Østergaard Nielsen, Christian Nørlinger & Tejs Ehlers Klug

  2. Department of Clinical Microbiology, Aarhus University Hospital, Aarhus N, Denmark

    Thomas Greve

Authors
  1. Nicolai Østergaard Nielsen
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  2. Christian Nørlinger
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  3. Thomas Greve
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  4. Tejs Ehlers Klug
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Contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by NØN, CN and TEK. Microbiological review was performed by TG. The first draft of the manuscript was written by NØN and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Nicolai Østergaard Nielsen.

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Conflict of interest

The authors received no conflicts of interest to declare that are relevant to the content of this article.

Ethics approval

The study was approved by the Danish Data Protection Agency (1-16-02-587-18) and the Danish Patient Safety Authority (3-3013-2919/1). In accordance with Danish law, the study was not reported to the Ethics Committee of Aarhus County.

Consent to participate/publication

According to Danish law, it is illegal to contact patients to obtain informed consent in retrospective studies, but permission to conduct the study was given by the Danish Patient Safety Authority.

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Nielsen, N.Ø., Nørlinger, C., Greve, T. et al. Cervical suppurative lymphadenitis in children: microbiology, primary sites of infection, and evaluation of antibiotic treatment. Eur Arch Otorhinolaryngol 279, 3053–3062 (2022). https://doi.org/10.1007/s00405-021-07115-7

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  • DOI: https://doi.org/10.1007/s00405-021-07115-7

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