Impact of anti-inflammatory drug consumption in peritonsillar abscesses: a retrospective cohort study

Thomas Feasson (1, 2) , Mathilde Debeaupte (3) , Clément Bidet (4) , Florence Ader (2, 5) , François Disant (3) , Tristan Ferry (6, 2) , Christian Chidiac (2, 6) , Florent Valour (2, 6)

1 UCBL - Université Claude Bernard Lyon 1
2 Service de Maladies Infectieuses et Tropicales [Hôpital de la Croix-Rousse - HCL]
3 Hôpital Edouard Herriot [CHU - HCL]
4 Centre hospitalier de Valence
5 LegioPath - Pathogenèse des légionelles- Legionella pathogenesis
6 StaPath - Pathogénie des Staphylocoques – Staphylococcal Pathogenesis

BACKGROUND: The experience of clinicians in charge of the in-hospital management of peritonsillar abscesses supports the association between severe forms and anti-inflammatory drug (AID) consumption. However, this observation is based on a limited number of clinical studies. Our objective was to assess the prevalence and impact of AID consumption in patients with peritonsillar abscesses. METHODS: All patients referred to the ear, nose and throat surgery department for a peritonsillar abscess were included in a retrospective cohort study (2012-2014). RESULTS: Among the 216 included patients (male, 55~%; median age, 32~years [IQR, 26-40]), 127 had received AID (59~%), including corticosteroids (n = 67, 31~%) and/or non-steroidal AIDs (NSAIDs, n = 76, 35~%). 199 patients (92~%) benefit from a puncture and 5 (2~%) from a surgery under general anesthesia, associated with ceftriaxone/metronidazole (51~%) or amoxicillin/clavulanic acid (46~%). An iterative surgical procedure was required in 93 cases (43~%), including 19~% under general anesthesia. Bacteriological analysis (79~%) mainly disclosed streptococci (66~%) of A (18~%) and/or milleri (33~%) groups. The prevalence of anaerobes was higher in patients using AIDs (46~% versus 29~%, p = 0.034), regardless of prior antibiotic therapy. 65 patients benefited from a CT-scan; AID consumption was associated with larger abscesses (6.8 [IQR, 3.7-12.7] versus 2.9 [IQR, 0.9-7.8] cm(3); p = 0.005). AID consumption was not a risk factor of iterative surgical procedure. CONCLUSIONS: In comparison to the prescribing habits in uncomplicated upper respiratory tract infection, the high prevalence of AID consumption in patients with peritonsillar suppuration suggests a role of AIDs in promoting these complications.

Mots clés: Adrenal Cortex Hormones; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Inflammatory Agents; Anti-inflammatory drugs; Ceftriaxone; Corticosteroids; Female; Humans; Male; Metronidazole; Nonsteroidal anti-inflammatory drugs; Peritonsillar Abscess; Pharyngeal infection; Retrospective Studies; Streptococcus; Tonsillar abscess

Domaines: Immunologie; Bactériologie; Virologie

Thomas Feasson, Mathilde Debeaupte, Clément Bidet, Florence Ader, François Disant, et al.. Impact of anti-inflammatory drug consumption in peritonsillar abscesses: a retrospective cohort study. BMC Infectious Diseases, 2016, 16 (1), pp.432. ⟨10.1186/s12879-016-1761-2⟩. ⟨hal-01911428⟩