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Pediatric mediastinitis as a complication of methicillin-resistant Staphylococcus aureus retropharyngeal abscess Wright CT; Stocks RM; Armstrong DL; Arnold SR; Gould HJArch Otolaryngol Head Neck Surg 2008[Apr]; 134 (4): 408-13OBJECTIVE: 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.|*Methicillin Resistance[MESH]|*Staphylococcus aureus[MESH]|Child[MESH]|Child, Preschool[MESH]|Cohort Studies[MESH]|Humans[MESH]|Incidence[MESH]|Infant[MESH]|Mediastinitis/*epidemiology/*microbiology/therapy[MESH]|Retropharyngeal Abscess/*complications/microbiology/therapy[MESH]|Retrospective Studies[MESH]|Staphylococcal Infections/*complications/diagnosis/therapy[MESH] |
