The role of microbiological examination in treating peritonsillar abscess based on the retrospective analysis of data from six years

Abstract

Introduction and objective: Peritonsillar abscess is the most common deep neck infection. Without adequate treatment, this otolaryngological disease pattern can cause life-threatening complications. The empirical choice of antibiotics is crucial which requires knowledge of the most common pathogens and the potential resistance. Methods: A retrospective analysis of cases treated for peritonsillar abscess was performed between 2012 and 2017. We summarized the aerobic and anaerobic culture results of the surgical samples and the empirically selected antibiotics. The most common pathogens were determined via routine microbiological culture tests. We compared our data with the results of international studies. Results: During the 6-year study at our Clinic, 217 patients with peritonsillar abscess were treated. The microbiological tests were available for analysis in only 146 cases. In 47 cases, Fusobacterium species (including 25 cases with Fusobacterium necrophorum), in 31 cases Actinomyces species and in 29 cases Streptococcus pyogenes were isolated. In 2/3 of the patients, polymicrobial infection was detected. Conclusion: In the treatment of peritonsillar abscesses, surgical intervention can result in clinical improvement because of the elimination of the anaerobic milieu. A well-chosen antibiotic can accelerate the healing process and reduce the complication rate. Proper microbiological sampling is of great importance, and in cases of non-recovery or poor recovery, this may create the opportunity to switch for targeted antibiotic therapy. The results of this study show that polymicrobial flora is very important for the development of the peritonsillar abscess, thus the recommended antibiotic therapy is amoxicillin–clavulanic acid or 2nd/3rd generation cefalosporin combined with metronidazol or clindamycin.