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Nie W, Du L, Chen G, Zheng Y, Yang X, Li B, Zhang W, Zheng J. Ultrasound-guided puncture drainage versus surgical incision drainage for deep neck space abscesses: a protocol for a systematic review with meta-analysis and trial sequential analysis. BMJ Open 2024; 14:e077631. [PMID: 38176871 PMCID: PMC10773404 DOI: 10.1136/bmjopen-2023-077631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION Deep neck space abscesses (DNAs) are serious surgical emergencies, associated with life-threatening complications. Surgical incision and drainage combined with antibiotics is the main treatment for DNAs, but drawbacks still exist. Ultrasound-guided puncture drainage is an alternative treatment for some DNAs with limited clinical evidence. Hence, the optimal drainage technique for the treatment of DNAs remains unclear. Therefore, we will perform a protocol for a systematic review and meta-analysis to identify the efficacy of ultrasound-guided puncture drainage for DNAs. METHODS AND ANALYSIS PubMed, Ovid Medline, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang database, VIP database and trial registry databases will be searched from inception to September 2023 to identify randomised controlled trials of patients diagnosed with DNAs accepting ultrasound-guided puncture drainage. The primary outcome will be the length of hospital stay. The secondary outcomes will be the cure rate, incidence of retreatment, complications and overall cost to the healthcare system. Fixed-effects or random-effects model will be used according to the statistical heterogeneity. Mean differences or standardised mean differences with 95% CIs for continuous data and risk ratio (RR) with 95% CIs for dichotomous data. The Cochrane risk-of-bias tool 2, Grading of Recommendations Assessment, Development and Evaluation (GRADE) and trial sequential analysis will be conducted to evaluate the evidence quality and control the random errors. Funnel plots and Egger's regression test will be performed to evaluate publication bias. ETHICS AND DISSEMINATION Ethical approval was not required for this systematic review protocol. The results will be disseminated through peer-reviewed publications. PROSPERO REGISTRATION NUMBER CRD42023441031.
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Affiliation(s)
- Wei Nie
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Du
- Department of Anesthesiology, Sichuan Cancer Hospital and Research Institute, Chengdu, Sichuan, China
| | - Guo Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yongbo Zheng
- Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xibiao Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bo Li
- Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weiyi Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jianqiao Zheng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Oz Alcalay L, Fanous E, Goldberg L, Livni G, Pasternak Y. Risk Factors for Invasive Interventions in Hospitalized Children With Suppurative Cervical Lymphadenitis. Clin Pediatr (Phila) 2024:99228231222702. [PMID: 38174715 DOI: 10.1177/00099228231222702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Suppurative cervical lymphadenitis sometimes resolves with oral antibiotic treatment; however, many children are hospitalized for intravenous treatment due to lack of improvement. When there is no substantial improvement, the possibility of a liquefaction process is considered, and as a result, source control such as needle aspiration or open surgical drainage is recommended. We examined, among pediatric patients hospitalized with suppurative cervical lymphadenitis, clinical and laboratory predictors for invasive intervention that may lead to early imaging and intervention, hasten recovery, and shorten length of hospitalization. We compared laboratory and clinical characteristics of pediatric patients hospitalized with suppurative cervical lymphadenitis during 2010-2017, according to 3 treatments: needle aspiration (N = 54), open surgical drainage (N = 37), and conservative adequate antibiotic treatment only (N = 292). Physical indicators such as local erythema and fluctuation were found as predictors for invasive interventions in hospitalized pediatric patients diagnosed with suppurative cervical lymphadenitis. No significant associations were found between invasive interventions and laboratory parameters assessed in this study. Children who underwent interventions displayed a prolonged average length of hospitalization and received extended antibiotic treatment prior to hospital admission. In hospitalized pediatric patients diagnosed with suppurative cervical lymphadenitis, physical examination findings are the main predictive factors for invasive interventions. Consequently, when such straightforward clinical findings are observed in the context of insufficient improvement during antibiotic treatment, they should prompt consideration of invasive intervention.
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Affiliation(s)
- Lital Oz Alcalay
- Department of Pediatrics A, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eliana Fanous
- Department of Pediatrics A, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Lotem Goldberg
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Gilat Livni
- Department of Pediatrics A, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Infectious Disease Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Yehonatan Pasternak
- Department of Pediatrics A, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mc Loughlin L, Rasheed F, Brinkman D, Hoare S, Colreavy M. A comparison of ultrasound-guided aspiration with open surgical drainage in the management of pediatric acute suppurative cervical lymphadenitis. Int J Pediatr Otorhinolaryngol 2024; 176:111806. [PMID: 38035531 DOI: 10.1016/j.ijporl.2023.111806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/24/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES Image-guided aspiration has been proposed as an alternative to the traditional open drainage in acute suppurative cervical lymphadenitis, although little evidence comparing these approaches exists. The aim of this study was to compare ultrasound-guided aspiration and open surgical drainage in the management of pediatric acute suppurative cervical lymphadenitis. METHODS Patients treated for acute suppurative cervical lymphadenitis at a tertiary referral pediatric hospital over a three-year period were retrospectively analyzed. RESULTS Of eighteen patients included, 9 (50 %) underwent aspiration and 9 (50 %) underwent open surgical drainage. None required repeat intervention or readmission over a median follow up of 10.5 weeks. Those undergoing aspiration had a shorter post-operative length of stay (1.67 vs 4.33 days, p = 0.001) compared with open surgical drainage. CONCLUSION Ultrasound-guided aspiration of pediatric acute suppurative cervical lymphadenitis is a safe and effective alternative to open drainage.
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Affiliation(s)
- Laura Mc Loughlin
- Department of Otolaryngology, Temple Street Children's University Hospital, Dublin, Ireland.
| | - Fizza Rasheed
- Department of Otolaryngology, Temple Street Children's University Hospital, Dublin, Ireland
| | - David Brinkman
- Department of Otolaryngology, Temple Street Children's University Hospital, Dublin, Ireland
| | - Siobhan Hoare
- Department of Radiology, Temple Street Children's University Hospital, Dublin, Ireland
| | - Michael Colreavy
- Department of Otolaryngology, Temple Street Children's University Hospital, Dublin, Ireland
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Howard-Jones AR, Al Abdali K, Britton PN. Acute bacterial lymphadenitis in children: a retrospective, cross-sectional study. Eur J Pediatr 2023; 182:2325-2333. [PMID: 36881144 PMCID: PMC10175353 DOI: 10.1007/s00431-023-04861-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 03/08/2023]
Abstract
Acute bacterial lymphadenitis is a common childhood condition, yet there remains considerable variability in antibiotic treatment choice, particularly in settings with low prevalence of methicillin-resistant Staphylococcus aureus such as Europe and Australasia. This retrospective cross-sectional study reviewed children presenting with acute bacterial lymphadenitis to a tertiary paediatric hospital in Australia between 1 October 2018 and 30 September 2020. Treatment approaches were analysed with respect to children with complicated versus uncomplicated disease. A total of 148 children were included in the study, encompassing 25 patients with complicated disease and 123 with uncomplicated lymphadenitis, as defined by the presence or absence of an associated abscess or collection. In culture-positive cases, methicillin-susceptible S. aureus (49%) and Group A Streptococcus (43%) predominated, while methicillin-resistant S. aureus was seen in a minority of cases (6%). Children with complicated disease generally presented later and had a prolonged length of stay, longer durations of antibiotics, and higher frequency of surgical intervention. Beta-lactam therapy (predominantly flucloxacillin or first-generation cephalosporins) formed the mainstay of therapy for uncomplicated disease, while treatment of complicated disease was more variable with higher rates of clindamycin use. Conclusion: Uncomplicated lymphadenitis can be managed with narrow-spectrum beta-lactam therapy (such as flucloxacillin) with low rates of relapse or complications. In complicated disease, early imaging, prompt surgical intervention, and infectious diseases consultation are recommended to guide antibiotic therapy. Prospective randomised trials are needed to guide optimal antibiotic choice and duration in children presenting with acute bacterial lymphadenitis, particularly in association with abscess formation, and to promote uniformity in treatment approaches. What is Known: • Acute bacterial lymphadenitis is a common childhood infection. • Antibiotic prescribing practices are highly variable in bacterial lymphadenitis. What is New: • Uncomplicated bacterial lymphadenitis in children can be managed with single agent narrow-spectrum beta-lactam therapy in low-MRSA prevalence settings. • Further trials are needed to ascertain optimal treatment duration and the role of clindamycin in complicated disease.
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Affiliation(s)
- Annaleise R Howard-Jones
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology - Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, New South Wales, Australia
- Discipline of Child & Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Khalfan Al Abdali
- Department of Pediatrics, Pediatric Infectious Diseases Unit, Nizwa Hospital, Ministry of Health, Nizwa, Sultanate of Oman
| | - Philip N Britton
- Discipline of Child & Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.
- Department of Infectious Diseases & Microbiology, The Children's Hospital at Westmead, Westmead, NSW, Australia.
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Dunya G, Keefe KR, Orb Q, Smith ME, Park AH. Surgical vs interventional radiology drainage of neck abscesses in pediatric patients. Int J Pediatr Otorhinolaryngol 2023; 164:111382. [PMID: 36413933 DOI: 10.1016/j.ijporl.2022.111382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/25/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare outcomes using an open surgical incision and drainage (S-ID) versus an aspiration under interventional radiology drainage (A-ID) of pediatric neck abscesses. The primary outcome measure was successful drainage requiring one intervention, and the secondary outcome measures were readmission rates and overall cost to the healthcare system. METHODS Retrospective data collection of all pediatric patients treated at the Primary Children's Hospital for neck abscess from 2008 to 2020. Patients who did not require drainage were not included. Comparison between S-ID and A-ID was performed according to the primary and secondary outcomes. RESULTS Two hundred fifty nine patients were included in the study. Twenty-six patients had A-IR and 234 patients had S-ID. Patient demographics were not significantly different between both groups. Overall length of stay was greater in the A-ID group (5 vs 3.3 days) (p < 0.05). A second procedure was more frequent in the A-ID group with 11/26 (42%) versus 12/234(5%) in the S-ID group (P = 0.001) even after controlling for multiple possible confounding factors. The rate of readmission was also higher in the A-ID group with 3/26 (11%) versus 7/234 (3%) in the S-ID group (P = 0.006). Both groups showed similar overall cost (P = 0.621). CONCLUSIONS A-ID and S-ID are both methods to treat head and neck abscess requiring drainage. However, overall results indicate a higher rate of failure requiring a second intervention and a higher rate of readmission in the A-ID group. In our study cost was noted to be similar between both methods.
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Affiliation(s)
- Gabriel Dunya
- Division of Otolaryngology-Head and Neck Surgery, Lebanese American University Rizk Hospital, Lebanon
| | | | - Quin Orb
- Department of Otolaryngology- Head and Neck Surgery, University of Utah, USA
| | - Marshall E Smith
- Department of Otolaryngology- Head and Neck Surgery, University of Utah, USA
| | - Albert H Park
- Department of Otolaryngology- Head and Neck Surgery, University of Utah, USA.
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Nielsen NØ, Nørlinger C, Greve T, Klug TE. Cervical suppurative lymphadenitis in children: microbiology, primary sites of infection, and evaluation of antibiotic treatment. Eur Arch Otorhinolaryngol 2021; 279:3053-3062. [PMID: 34623496 DOI: 10.1007/s00405-021-07115-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
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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Affiliation(s)
- Nicolai Østergaard Nielsen
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark.
| | - Christian Nørlinger
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
| | - Thomas Greve
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
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7
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Needle aspiration of lateral neck abscess in children: A simple and effective treatment. Int J Pediatr Otorhinolaryngol 2021; 149:110850. [PMID: 34340004 DOI: 10.1016/j.ijporl.2021.110850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 05/12/2021] [Accepted: 07/18/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cervical abscesses frequently occurred in pediatric patients. Surgical drainage is currently recommended in the cases not responding to medical therapy. Needle aspiration may represent a simple, effective and minimally invasive treatment for acute neck suppuration in selected cases. OBJECTIVE To evaluate the effectiveness of needle aspiration in the treatment of cervical abscesses in pediatric age as an alternative to surgical drainage. METHODS From November 2013 to November 2019, at the ENT Department of the "Bambino Gesù" Pediatric Hospital, Rome, we treated 47 children with cervical abscess by performing aspiration with a 19 G needle in wakefulness after applying local anesthetic. Parenteral antibiotic treatment was associated with all patients both before and after treatment. RESULTS Complete regression of the abscess occurred in 46 children with no evidence of recurrence in the follow-up period. Surgical drainage was required in only one patient due to the lack of resolution of the abscess episode. No complications such as hematomas or hypertrophic scars were found in any patient. CONCLUSIONS Our results confirm the effectiveness of needle aspiration in the treatment of cervical abscesses in children as an alternative to surgical drainage.
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Srivanitchapoom C, Yata K. Suppurative cervical lymphadenitis in adult: An analysis of predictors for surgical drainage. Auris Nasus Larynx 2020; 47:887-894. [PMID: 32370913 DOI: 10.1016/j.anl.2020.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/18/2020] [Accepted: 04/16/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Lymphadenitis can be treated successfully by empirical antibiotic therapy. However, inflamed lymph nodes can progress into an abscess with local and/or systemic reaction, which requires more complex treatment strategies. The study aim to analyze possible predictors for abscess formation within inflamed nodes that require surgical drainage. MATERIALS AND METHODS We retrospectively enrolled 241 patients with acute or sub-acute cervical lymphadenitis. Demographic including, lymph node characteristics, management, and final diagnosis were recorded. Predictors for abscess formation within the lymph node that required surgical drainage were evaluated using univariate and multivariate analysis. Patient and lymph node characteristics that differentiated suppurative cervical lymphadenitis (SCL) from other lymphadenitis were also analyzed. RESULTS There were 41 cases of SCL, 173 cases of uncomplicated cervical lymphadenitis, and 27 cases of tuberculous cervical lymphadenitis (TBLN). Abscess was surgically drained in 39 patients, while 2 patients received a needle aspiration. In 9 patients, SCL complications included cellulitis of the neck soft tissue, supraglottic swelling, internal jugular vein thrombosis, and sepsis. Two patients were diagnosed with melioidosis and actinomycosis after drainage. Multivariate analysis showed that an immunocompromised host, male sex, and receiving prior inadequate treatment were predictors for surgical drainage. TBLN patients had similar manifestations as SCL patients. However, affected nodes in SCL patients were singular, painful, and showed fluctuation. CONCLUSIONS Following SCL diagnosis, abscess drainage and appropriate antibiotic treatment should be considered. Aspiration or surgical drainage can be effective in certain patients. Pathogen isolation and tissue biopsy should be performed to ensure accurate diagnosis and antibiotic selection. In addition, TBLN and melioidosis should be considered, especially in endemic areas.
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Affiliation(s)
- Chonticha Srivanitchapoom
- Otolaryngology Unit, Phayao Hospital, 269 moo 11, Tumbon Bantom, Muang Phayao, Phayao 56000, Thailand.
| | - Kedsaraporn Yata
- Otolaryngology Unit, Phayao Hospital, 269 moo 11, Tumbon Bantom, Muang Phayao, Phayao 56000, Thailand
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Hamiter M, Manzi B, Gungor A. Needle aspiration as primary surgical treatment of pediatric deep neck space abscesses. Am J Otolaryngol 2019; 40:102296. [PMID: 31521402 DOI: 10.1016/j.amjoto.2019.102296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/09/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Examination of the outcomes of needle aspiration (NA) under sedation as the primary surgical treatment for pediatric deep neck space abscesses (DNSA) to determine its adequacy, safety, and cost. STUDY DESIGN Retrospective chart review. METHODS 10 consecutive pediatric patients (age 4-48 months) that were diagnosed with DNSA starting from August 2008 through October 2015 were included in our review. All patients were on antibiotics and were treated with NA as the primary surgical treatment modality. Procedures were all performed in our pediatric sedation suite. We have examined our outcomes including need to convert to open incision and drainage (I&D), number of aspirations required, hospital stay, if purulence obtained, culture results, and imaging modality used. We also compared our results with previous studies using incision and drainage as the primary treatment modality focusing on the duration of their hospital stay. RESULTS None of our 10 patients required an open I&D. Two of 10 (20%) did require repeat aspiration once with no patient requiring more than two aspirations. Median hospital stay was 4 days (range 3-8). CONCLUSION In our small study group NA performed under sedation was an effective treatment modality with duration of hospital stay comparable to other studies that included treatment with I&D under general anesthesia.
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Affiliation(s)
- Mickie Hamiter
- LSU Health Shreveport, Department of Otolaryngology, Shreveport, LA, USA.
| | - Brian Manzi
- LSU Health Shreveport, Department of Otolaryngology, Shreveport, LA, USA
| | - Anil Gungor
- LSU Health Shreveport, Department of Otolaryngology, Shreveport, LA, USA
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Kimia AA, Rudloe TF, Aprahamian N, McNamara J, Roberson D, Landschaft A, Vaughn J, Harper MB. Predictors of a drainable suppurative adenitis among children presenting with cervical adenopathy. Am J Emerg Med 2018; 37:109-113. [PMID: 29754963 DOI: 10.1016/j.ajem.2018.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/25/2018] [Accepted: 05/05/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES We sought to identify predictors for a drainable suppurative adenitis [DSA] among patients presenting with acute cervical lymphadenitis. METHODS A retrospective cross sectional study of all patients admitted to an urban pediatric tertiary care emergency department over a 15 year period. Otherwise healthy patients who underwent imaging for an evaluation of cervical lymphadenitis were included. Cases were identified using a text-search module followed by manual review. We excluded immunocompromised patients and those with lymphadenopathy felt to be not directly infected (i.e. reactive) or that was not acute (symptom duration >28 days). Data collected included: age, gender, duration of symptoms, highest recorded temperature, physical exam findings, laboratory and imaging results, and surgical findings. A DSA was defined as >1.5 cm in diameter on imaging. We performed binary logistic regression to determine independent clinical predictors of a DSA. RESULTS Three hundred sixty-one patients met inclusion criteria. Three hundred six patients (85%) had a CT scan, 55 (15%) had an ultrasound and 33 (9%) had both. DSA was identified in 71 (20%) patients. Clinical features independently associated with a DSA included absence of clinical pharyngitis, WBC >15,000/mm3, age ≤3 years, anterior cervical chain location, largest palpable diameter on exam >3 cm and prior antibiotic treatment of >24 h. The presence of fever, skin erythema, or fluctuance on examination, was not found to be predictive of DSA. CONCLUSIONS We identified independent predictors of DSA among children presenting with cervical adenitis. Risk can be stratified into risk groups based on these clinical features.
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Grazioli P, Bazzana T, Berlucchi M, Nassif N, Tonni D, Redaelli de Zinis LO. Minimally invasive approach to suppurated cervical lymphadenitis in children: Our experience on 60 patients. Clin Otolaryngol 2018; 43:1177-1179. [PMID: 29687954 DOI: 10.1111/coa.13117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2018] [Indexed: 11/30/2022]
Affiliation(s)
- P Grazioli
- Pediatric Otolaryngology Head Neck Surgery, Children Hospital "ASST Spedali Civili", Brescia, Italy
| | - T Bazzana
- Pediatric Otolaryngology Head Neck Surgery, Children Hospital "ASST Spedali Civili", Brescia, Italy
| | - M Berlucchi
- Pediatric Otolaryngology Head Neck Surgery, Children Hospital "ASST Spedali Civili", Brescia, Italy
| | - N Nassif
- Pediatric Otolaryngology Head Neck Surgery, Children Hospital "ASST Spedali Civili", Brescia, Italy
| | - D Tonni
- Pediatric Otolaryngology Head Neck Surgery, Children Hospital "ASST Spedali Civili", Brescia, Italy
| | - L O Redaelli de Zinis
- Pediatric Otolaryngology Head Neck Surgery, Children Hospital "ASST Spedali Civili", Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Head and Neck Surgery, University of Brescia, Brescia, Italy
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12
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McMullan BJ, Andresen D, Blyth CC, Avent ML, Bowen AC, Britton PN, Clark JE, Cooper CM, Curtis N, Goeman E, Hazelton B, Haeusler GM, Khatami A, Newcombe JP, Osowicki J, Palasanthiran P, Starr M, Lai T, Nourse C, Francis JR, Isaacs D, Bryant PA. Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: systematic review and guidelines. THE LANCET. INFECTIOUS DISEASES 2016; 16:e139-52. [PMID: 27321363 DOI: 10.1016/s1473-3099(16)30024-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 03/04/2016] [Accepted: 03/29/2016] [Indexed: 12/22/2022]
Abstract
Few studies are available to inform duration of intravenous antibiotics for children and when it is safe and appropriate to switch to oral antibiotics. We have systematically reviewed antibiotic duration and timing of intravenous to oral switch for 36 paediatric infectious diseases and developed evidence-graded recommendations on the basis of the review, guidelines, and expert consensus. We searched databases and obtained information from references identified and relevant guidelines. All eligible studies were assessed for quality. 4090 articles were identified and 170 studies were included. Evidence relating antibiotic duration to outcomes in children for some infections was supported by meta-analyses or randomised controlled trials; in other infections data were from retrospective series only. Criteria for intravenous to oral switch commonly included defervescence and clinical improvement with or without improvement in laboratory markers. Evidence suggests that intravenous to oral switch can occur earlier than previously recommended for some infections. We have synthesised recommendations for antibiotic duration and intravenous to oral switch to support clinical decision making and prospective research.
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Affiliation(s)
- Brendan J McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, NSW, Australia
| | - David Andresen
- Department of Infectious Diseases, Immunology, and HIV Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia
| | - Christopher C Blyth
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, WA, Australia; PathWest Laboratory Medicine, WA, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, WA, Australia
| | - Minyon L Avent
- The University of Queensland, UQ Centre for Clinical Research and School of Public Health, Herston, QLD, Australia
| | - Asha C Bowen
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, WA, Australia; Menzies School of Health Research, Darwin, NT, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, WA, Australia
| | - Philip N Britton
- Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Julia E Clark
- Infection Management and Prevention Service, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Celia M Cooper
- Department of Microbiology and Infectious Diseases, SA Pathology, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Nigel Curtis
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Emma Goeman
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Briony Hazelton
- Sydney Medical School, University of Sydney, NSW, Australia; Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia
| | - Gabrielle M Haeusler
- Department of Infectious Diseases and Infection Control, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Infection and Immunity, Monash Children's Hospital, Clayton, VIC, Australia
| | - Ameneh Khatami
- Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - James P Newcombe
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Joshua Osowicki
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Pamela Palasanthiran
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, NSW, Australia
| | - Mike Starr
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Tony Lai
- Department of Pharmacy, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Clare Nourse
- Infection Management and Prevention Service, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Joshua R Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, NT, Australia
| | - David Isaacs
- Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Penelope A Bryant
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
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