Suppurative Cervical Lymphadenitis in Infancy: Microbiology and Sociology

Objective. To investigate the associations between patient age, sociological factors, and the microbiology of pediatric neck infections. Methods. Retrospective chart review of children up to 5 years old who underwent surgical management of suppurative cervical lymphadenitis. Results. A total of 76 individuals met inclusion criteria; 93% of culture-positive infections were caused by Staphylococcus aureus in infants, compared with 59% in children between 13 months and 5 years of age (P =.002). Of the S aureus isolates, 51% were methicillin-resistant S aureus (MRSA) and 49% were methicillin-sensitive S aureus. Methicillin resistance was associated with African American race (P =.004); 67% of participants received empirical antibiotics prior to admission. Of these, 73% received antibiotics in the β-lactam class, and 25% received treatment with clindamycin. Conclusions. Incidence of MRSA is high in infants with cervical lymphadenitis who fail empirical antibiotic therapy and require surgical management. Empirical coverage for cervical lymphadenitis with β-lactam antibiotics may provide inadequate coverage for early infection in this population.