Berfin ÖZGÖKÇE ÖZMEN, Mehtap AKÇA, Edanur YEŞİL, Merve TÜRKEGÜN ŞENGÜL, Necdet KUYUCU

Çocukluklarda Derin Boyun Enfeksiyonlarının Değerlendirilmesi: 5 Yıllık Retrospektif Çalışma

Amaç: Bu çalışmada, Çocuk Enfeksiyon Hastalıkları servisimizde derin boyun enfeksiyonu (DBE) tanısıyla yatarak takip edilen olguların demografik özellikleri, klinik, mikrobiyolojik ve radyolojik bulguları ile beraber enfeksiyon yeri ve yaş gruplarına ayrılarak değerlendirildi. Gereç ve Yöntem: Ocak 2017-Aralık 2022 tarihleri arasında olguların demografik özellikleri, klinik, mikrobiyolojik ve radyolojik ile beraber bulaşma yeri ve yaş gruplarına ayrılarak değerlendirildi. Bulgular: Toplam 39 DBE tanısı olan olgu izlendi. Olguların 22’si (%56,4) 10 yaş altında, 17’si (%43,6) 10-18 yaş arasındaydı. En sık semptom/belirtiler; yüksek ateş (%97,4) ve boyunda şişlik (%94,9) idi. On iki olguda (%30,8) peritonsiller, dokuz olguda (%23,1) retrofaringeal, on dört olguda (%35,9) parafaringeal, diğer dört olguda (%10,3) dil kökü enfeksiyonu saptandı. Başvuru sırasında tüm hastalara intravenöz (iv) antibiyotik verildi ve %66,7'sine apse drenajı yapıldı. Olgulara sıklıkla (%41) ampisilin-sulbaktam ya da (%25,6) ampisilin-sulbaktam + klindamisin verildi. On üç olgu (%33,3) sadece antibiyotik tedavisi ile düzeldi. Diğer yirmi altı olguya (%66,7) cerrahi drenaj uygulandı ve apse kültürü alındı. Hastaların on dördünde (%35,8) drenaj materyalinde mikroorganizma üredi ve en sık izole edilen patojen Metisilin duyarlı Staphylococcus aureus (MSSA) idi. Cinsiyet ile yaş grupları arasında istatistiksel olarak anlamlı bir ilişki görülmedi (p=0.358). Enfeksiyon alanı ile yaş grupları arasında istatistiksel olarak anlamlı bir ilişki izlenmedi (p=0.06). Hastanede yatış süresi medyanları ile enfeksiyon alanları arasında istatistiksel olarak anlamlı bir farklılık saptanmadı (p=0.087). Sonuç: Yüksek ateş ve boyunda şişlik şikayeti ile başvuran çocuklarda ayırıcı tanıda DBE düşünülmelidir. Çalışmamızda yaş grupları ile enfeksiyon alanları arasında, olguların çoğu antibiyotik ile düzelmektedir, ancak tedaviye yanıt alınmayan olgularda gecikmeden cerrahi drenaj uygulanmalıdır.

Anahtar Kelimeler:

Çocuk, derin boyun enfeksiyonları, parafaringeal apse, peritonsiller apse, retrofaringeal apse

Evalution of Deep Neck Infections in Childhood: A-5 Year Retrospective Study

Aim: In this study, the demographic characteristics of the patients who were hospitalized with the diagnosis of deep neck infections (DNI) in our Pediatric Infectious Diseases ward were evaluated by dividing the clinical, microbiological, and radiological findings into the site of infection and age groups. Materials and Methods: Between January 2017 and December 2022 the records of inpatients with DNI were reviewed retrospectively. Demographic characteristics of the cases, clinical, microbiological, and radiological findings, as well as the place of infection and age groups were evaluated. Results: A total of 39 patients with DNI were followed up. Twenty-two (56,4%) of the cases were under the age of 10 and 17 (43,6%) were between the ages of 10-18. The most common sign/symptoms were fever (97,4%) and neck swelling (94,9%). Peritonsillar infection was detected in 12 cases (30,8%), retropharyngeal infection in nine cases (23,1%), para pharyngeal infection in 14 cases (35,9%), and tongue root infection in four cases (10,3%). All patients were given intravenous (iv) antibiotics at the time of admission, and abscess drainage was performed in 66,7% of them. Ampicillin-sulbactam (41%) or ampicillin-sulbactam + clindamycin (25,6%) was given frequently (41%). Thirteen cases (33,3%) improved with antibiotic treatment alone. Surgical drainage was applied to the other twenty- six cases (66,7%) and an abscess culture was obtained. Microorganisms obtained in the drainage material in fourteen (35,8%) of the patients, and the most common pathogen was Methicillin. susceptible Staphylococcus aureus (MSSA). There was no statistically significant relationship between gender and age groups (p=0.358). There was no statistically significant relationship between the area of infection and age groups (p=0.06). The median length of stay in hospital and infection areas did not show a statistically significant difference (p=0.087 ). Conclusion: Deep neck infections should be considered in the differential diagnosis of children presenting with fever and neck swelling. In the study conducted between age groups and areas of infection, most of the cases improve with antibiotics, but surgical drainage should be applied without delay in cases that do not respond to treatment.

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