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Abstract：
BACKGROUND: A parotid abscess (PA) is a complication of an acute bacterial parotitis with a potentially life-threatening course. To date, data on the diagnosis and therapy of PA is sparse and mostly consists of case reports or case series. Therefore, this study aimed at comprehensively analyzing the microbiological spectrum and the therapeutic management in a bi-institutional setting.
METHODS: A retrospective clinical chart review was performed to identify all patients surgically treated for PA at two tertiary care centers in Germany. Data on demographics, clinical management and microbiological data including species identification, pathogenicity, type of antibiotic therapy, adjustment of antibiotics, antibiotic sensitivity testing, and smear test results were extracted. Intervention-related variables and etiology were analyzed for their statistical association with outcome variables.
RESULTS: Overall, 85 patients were included. Most patients (92.9%) underwent surgical incision. Around half of the patients (45.9%) were treated under local anesthesia. No facial nerve palsy was observed. The most frequently detected pathogens were Streptococci (n = 23), followed by Staphylococcus aureus (n = 6) including one case of methicillin-resistant Staphylococcus aureus. Most patients (68.2%) received an aminopenicillin ± beta-lactamase inhibitor as empiric antibiotic therapy. In 6 cases the antibiotic therapy was modified after receiving the antibiogram. Four patients (5.2%) presented with recurrent PA. Etiology was idiopathic (42.4%), followed by tumorous (12.9%), obstructive, and immunosuppressive (each 11.8%). Patients with a dental focus (p = 0.007) had a longer duration of hospitalization.
CONCLUSIONS: The results show that the surgical therapy of PA under local anesthesia is safe. A dental examination should routinely be performed to rule out a dental focus. Obtaining a microbiological specimen in order to modify antibiotic therapy if necessary and a histopathological specimen to rule out a tumorous etiology is obligate.
METHODS: A retrospective clinical chart review was performed to identify all patients surgically treated for PA at two tertiary care centers in Germany. Data on demographics, clinical management and microbiological data including species identification, pathogenicity, type of antibiotic therapy, adjustment of antibiotics, antibiotic sensitivity testing, and smear test results were extracted. Intervention-related variables and etiology were analyzed for their statistical association with outcome variables.
RESULTS: Overall, 85 patients were included. Most patients (92.9%) underwent surgical incision. Around half of the patients (45.9%) were treated under local anesthesia. No facial nerve palsy was observed. The most frequently detected pathogens were Streptococci (n = 23), followed by Staphylococcus aureus (n = 6) including one case of methicillin-resistant Staphylococcus aureus. Most patients (68.2%) received an aminopenicillin ± beta-lactamase inhibitor as empiric antibiotic therapy. In 6 cases the antibiotic therapy was modified after receiving the antibiogram. Four patients (5.2%) presented with recurrent PA. Etiology was idiopathic (42.4%), followed by tumorous (12.9%), obstructive, and immunosuppressive (each 11.8%). Patients with a dental focus (p = 0.007) had a longer duration of hospitalization.
CONCLUSIONS: The results show that the surgical therapy of PA under local anesthesia is safe. A dental examination should routinely be performed to rule out a dental focus. Obtaining a microbiological specimen in order to modify antibiotic therapy if necessary and a histopathological specimen to rule out a tumorous etiology is obligate.
摘要：
背景：腮腺脓肿（PA）是急性细菌性腮腺炎的并发症，可能危及生命。迄今为止,PA的诊断和治疗数据很少,主要由病例报告或病例系列组成.因此,这项研究旨在全面分析双机构环境中的微生物谱和治疗管理。
方法：在德国的两个三级护理中心进行回顾性临床检查，以确定所有接受PA手术治疗的患者。人口统计数据，临床管理和微生物数据，包括物种鉴定，致病性，抗生素治疗的类型，调整抗生素，抗生素敏感性测试，并提取涂片检查结果。分析干预相关变量和病因与结果变量的统计关联。
结果：总体而言，包括85名患者。大多数患者（92.9％）接受了手术切口。大约一半的患者（45.9％）在局部麻醉下治疗。未观察到面神经麻痹。最常见的病原体是链球菌（n=23），其次是金黄色葡萄球菌（n=6），包括1例耐甲氧西林金黄色葡萄球菌。大多数患者（68.2％）接受了氨基青霉素±β-内酰胺酶抑制剂作为经验性抗生素治疗。在6例患者中，接受抗生素检查后对抗生素治疗进行了修改。4例患者（5.2%）出现PA复发。病因为特发性（42.4%），其次是肿瘤(12.9%)，阻塞性,和免疫抑制（各11.8%）。有牙齿病灶（p=0.007）的患者住院时间较长。
结论：结果表明，局部麻醉下PA的手术治疗是安全的。应常规进行牙科检查以排除牙科焦点。必须获得微生物样本以在必要时修改抗生素治疗，并获得组织病理学样本以排除肿瘤病因。
方法：在德国的两个三级护理中心进行回顾性临床检查，以确定所有接受PA手术治疗的患者。人口统计数据，临床管理和微生物数据，包括物种鉴定，致病性，抗生素治疗的类型，调整抗生素，抗生素敏感性测试，并提取涂片检查结果。分析干预相关变量和病因与结果变量的统计关联。
结果：总体而言，包括85名患者。大多数患者（92.9％）接受了手术切口。大约一半的患者（45.9％）在局部麻醉下治疗。未观察到面神经麻痹。最常见的病原体是链球菌（n=23），其次是金黄色葡萄球菌（n=6），包括1例耐甲氧西林金黄色葡萄球菌。大多数患者（68.2％）接受了氨基青霉素±β-内酰胺酶抑制剂作为经验性抗生素治疗。在6例患者中，接受抗生素检查后对抗生素治疗进行了修改。4例患者（5.2%）出现PA复发。病因为特发性（42.4%），其次是肿瘤(12.9%)，阻塞性,和免疫抑制（各11.8%）。有牙齿病灶（p=0.007）的患者住院时间较长。
结论：结果表明，局部麻醉下PA的手术治疗是安全的。应常规进行牙科检查以排除牙科焦点。必须获得微生物样本以在必要时修改抗生素治疗，并获得组织病理学样本以排除肿瘤病因。
