Bacterial infections of the oropharynx and deep neck spaces: an investigation of changes in presentation patterns during the COVID-19 pandemic

Abstract

Background: The aim of this study was to investigate whether changes in practice during the COVID-19 pandemic altered clinical presentation characteristics among adults with bacterial throat infections. Methods: A retrospective cohort study was conducted that included adult patients presenting with bacterial oropharyngeal infections to a tertiary level hospital in Melbourne, Australia. All patients presenting during the first phase of COVID-19 lockdown in Melbourne (1st April– 1st July in 2020), and those from the same period 12-months prior, were included. Results: There were fewer presentations of bacterial throat infections during the pandemic period compared to the same time 1 year prior. There was a significantly reduced proportion of patients on oral antibiotics prior to their presentation in 2020, as compared to the same period 12-months earlier (30% vs. 50%, respectively; P < 0.01), as well as a significant increase in the length of time patients were symptomatic before presenting to hospital (5 days vs. 4 days, respectively; P < 0.01). Despite this, there was no significant increase in the number of representations post discharge from hospital, or the length of hospital admission. Conclusion: The overall number of patients presenting with tonsillitis, pharyngitis, peritonsillar abscess and deep neck space infection were reduced during the pandemic period. Patients experienced symptoms for a longer period of time and fewer were on antimicrobial therapy prior to presentation. This study highlights a shift towards delayed patient presentation and reduced oral antibiotic commencement in cases of oropharyngeal infections as a result of the COVID-19 pandemic.