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Presentation and Management of Neck Abscess: Have Things Changed over a 20-Year Period?

Objectives: Our recent clinical experience with deep neck space infection indicated difference in the presentation, etiology, and bacteriology compared to previously published report from our institution. Hence we decided to evaluate 1) change in the presentation, physical examination, bacteriology, and empiric antibiotic therapy for patients with deep neck space abscess compared to previously published report and, 2) incidence of methicillin-resistant Staphylococcus aureus (MRSA) related infection in our patient population. Methods: Institutional Review Board approved retrospective analysis of patients who underwent incision and drainage of neck abscess in the operating room between 2008-2012 at LAC+USC Medical Center. Comparison was made with previously published historical data. Data analysis was done using SAS 9.1. Results: 44 patients were included in the present study compared to 50 in previously published study. Compared to previously published report from our institution, there has been a statistically significant difference in 1) most common presenting symptom: dysphagia (64%) vs pain (76%); 2) location of neck abscess: parapharyngeal (54%) vs anterior triangle (28%); 3) etiology: upper respiratory tract infection (URI) (41%) vs intravenous drug abuse (IVDA) (28%); 4) higher prevalence of anaerobic bacteria (86%) vs 50%; 5) MRSA was present in only 1 (2%) patient; 6) Clindamycin was empiric antibiotic in 34 (77%) of the patients, with the need for change after culture report in 5 (11%) patients. Chi-square p-value was <0.05 for all comparisons. Conclusions: URI and odontogenic infections are now the major cause of neck abscesses compared to IVDA in previous report. Clindamycin is an appropriate empiric antibiotic. MRSA incidence is low.