Microbiological profile of acute retropharyngeal abscesses in children: analysis of 26 Egyptian patients

Objectives: this work aims to describe our experience in a tertiary centre for the diagnosis of acute retropharyngeal abscesses in children as regards the diagnosis, microbiological analysis and their management

Methodology: A prospective study that included 26 patients suffering from acute retropharyngeal abscess in children was done for a period of about 3 years from September 2011 to July 2014 on pediatric patients. CT was used for diagnosis of the abscess. Twenty patients were underwent surgical drainage of the abscess. Pus was aspirated from all patients and used for microbiological analysis. Data for clinical presentation, X-ray, CT scan findings, bacteriological profile and management of the cases were collected

Results: 26 patients were investigated in this study. Males were more commonly affected than females. Their ages ranged from 8month to 12 years [mean +/- 5.45 years]. The most common symptoms at time of investigation were fever followed by dysphagia/odynophagia and neck swelling. The most common clinical sign was cervical lymphadenopathy. Positive microbial cultures were detected in 84.6%. Polymicrobial growth was recorded in 34.6%. The most common isolated organism was MRSA [38.5%] followed by Staphylococcus aureus [26.9%] and Pseudomonas aeruginosa [19.2%]

Conclusion: The used antibiotics in the retropharyngeal abscesses to be used should cover mainly Gram positive bacteria especially MRSA. This may substitute surgical intervention in many cases. MRSA found to be a rising causative agent of acute retropharyngeal abscess in children in our locality. Obtaining samples may be difficult for microbiological culture. Antibiotics should be prescribed immediately according to the antibiotic guide in each locality to reduce the morbidity rate of the acute retropharyngeal abscess

Candidemia among chronic HCV patients in intensive care unit: risk factors and antifungal susceptibility testing

Candida is one of the common causes of blood stream infection [BSI] especially in intensive care unit [ICU] and associated with high mortality rates. Due to low immunity, the patients with chronic hepatitis C virus [HCV] are prone to Candida infection. This study presents data on species distribution, clinical risk factors and antifungal susceptibility profiles of candidemia obtained from chronic HCV patients in hepatic ICU in specialized medical hospital of Mansoura University. All the bloodstream isolates were isolated by manual lysis centrifugation method and identified to species level by CHROMagar Candida and API 20C AUX. Also, multiplex PCR was done to detect candida spp. in blood samples. Antifungal susceptibility was done by M 27A2 [broth microdilution] and M 44 [disk diffusion] methods of the Clinical and Laboratory Standards Institute [CLSI] to fluconazole, voriconazole and amphotricin B. From 342 patients, 33 candida isolates were recovered by manual lysis centrifugation method, and 26 were detected by PCR. Candida albicans [C. albicans] was the predominant species [13/33], followed by Candida parapsilosis [C. parapsilosis] [6/33]. Resistance to fluconazole was observed in 15.38% [2/13] of C. albicans isolates, 50% [2/4] Candida glabrata [C. glabrata] isolates, and 100% [4/4] C. krusei isolates. Resistance to voriconazole and AMB were observed in 5 isolates [15.2%] and in 4 [12.1%] isolates, respectively. Neutropenia carries the highest risk factor with candidemia [Odds ratio 14.08 with confidence intervals 95% 6.05-32.8]. So, C. albicans is the most common cause of Candidemia among chronic HCV patients in ICU, followed by C. parapsilosis, and the rates of resistance to azoles antifungal and AMB are still low