Throat Swab Culture Positivity and Antibiotic Resistance Profiles in Children 2-5 Years of Age Suspected of Bacterial Tonsillitis at Hargeisa Group of Hospitals, Somaliland: A Cross-Sectional Study

Introduction

Tonsillitis is the third most frequently diagnosed infection in the pediatric age and is associated with significant morbidity and loss of school attendance. Throat swab cultures are useful for the confirmation of children with a clinically suspected tonsillitis. However, Somaliland is one of the underdeveloped countries with a low standard of sanitation and poor health seeking culture. Treatment of tonsillitis with antibiotics is irrational and not empirical. This study determined the bacterial throat swab culture positivity and antibiotic resistance profiles of the bacterial isolates among children 2-5 years of age with suspicion of tonsillitis at Hargeisa Group of Hospital, Somaliland.

Materials and Methods

A cross-sectional study was conducted from March to July 2020. A total of 374 children from 2 to 5 years of age suspicion of tonsillitis was included using a convenient sampling method. Throat swabs were collected, and bacterial isolation and identification were done using standard bacteriological procedures. Antimicrobial susceptibility testing was done using the disk diffusion method. Data on demographic variables and clinical profiles were collected using structured questionnaires. Logistic regression analysis was computed to identify factors associated with bacterial tonsillitis.

Results

Overall, 120 (32.1%) (95% CI 27.4-36.8%) of children were positive for bacterial throat cultures. Of these, 23 (19.2%) were mixed bacterial isolates. The most frequent bacterial isolates were beta-hemolytic streptococci 78 (55%), Staphylococcus aureus 42 (29%), and Streptococcus pneumoniae 10 (7%). Isolates revealed 83.3-100% rate of resistance to ampicillin. Beta-hemolytic streptococci isolates were 94.9% resistant to ampicillin. S. aureus was resistant to clarithromycin (38%) while S. pneumoniae isolates were 100% resistant to ampicillin. History of tonsillitis (AOR = 0.12; 95% CI = 0.06-0.21), difficulty in swallowing (AOR = 6.99; 95% CI = 3.56-13.73), and attending schools (AOR = 2.98; 95% CI = 1.64-5.42) were found to be associated with positive throat culture.

Conclusions

Resistance to ampicillin and MDR among beta-hemolytic streptococci and other isolates of throat colonizers in children with clinically suspected of bacterial tonsillitis are major concerns in Hargeisa, Somaliland. Therefore, treatments of cases are recommended to be guided by regular culture and antimicrobial susceptibility testing to prevent complications of tonsillitis and associated antibiotic resistance.

Risk of Postoperative Bleeding in Tonsillectomy for Peritonsillar Abscess, as Opposed to in Recurrent and Chronic Tonsillitis-A Retrospective Study

Tonsillectomy is a routine surgery in otorhinolaryngology and the occurrence of postoperative bleeding is not a rare complication. The aim of this retrospective, observational, analytic, cohort study is to compare the incidence of this complication for the most common indications. A group of patients indicated for tonsillectomies for peritonsillar abscess (group I) was compared to a group of patients indicated for chronic and recurrent tonsillitis (group II). There are a lot of pathophysiological differences in patients indicated for acute tonsillectomy for peritonsillar abscess and in patients indicated for elective tonsillectomy for chronic or recurrent tonsillitis. No technique to minimize the risk of bleeding after tonsillectomy has been found and a large part of postoperative bleeding occurs in postoperative home-care, which makes this issue topical. In total, 2842 unilateral tonsillectomies from the years 2014–2019 were included in the study. Bleeding occurred in 10.03% and, surprisingly, despite completely different conditions in the field of surgery (oedema, acute inflammation in peritonsillar abscess), there was no statistically significant difference between incidence of postoperative bleeding in the studied groups (p = 0.9920). The highest incidence of bleeding was found in the patients of group I on the eighth postoperative day, with those aged 20–24 years (p = 0.0235) being the most at risk, and in group II, on the sixth postoperative day, with those aged 25–29 years (p = 0.0128) and 45–49 years (p = 0.0249) being the most at risk.

Antibiotics in treatment of peritonsillar infection: clindamycin versus penicillin

OBJECTIVE

This study aimed to compare antibiotic treatment with clindamycin versus penicillin V or G in terms of time to recovery and recurrence in patients with peritonsillar infection, including both peritonsillar cellulitis and peritonsillar abscess.

METHOD

This retrospective cohort study examined the records of 296 patients diagnosed with peritonsillar infection. Based on the ENT doctor's choice of antibiotics, patients were divided into clindamycin and penicillin groups.

RESULTS

Mean number of days in follow up was 3.5 days in the clindamycin group and 3.4 days in the penicillin group. The recurrence rate within 2 months was 7 per cent in the clindamycin group and 4 per cent in the penicillin group.

CONCLUSION

This study found no significant differences in either recovery or recurrence between the groups. This supports the use of penicillin as a first-line treatment, considering the greater frequency of adverse effects of clindamycin shown in previous studies, as well as its profound collateral damage on the intestinal microbiota, resulting in antibiotic resistance.

Staphylococcus aureus in tonsils of patients with recurrent tonsillitis: prevalence, susceptibility profile, and genotypic characterization

Introduction

Bacterial tonsillitis is an upper respiratory tract infection that occurs primarily in children and adolescents. Staphylococcus aureus is one of the most frequent pathogens in the etiology of tonsillitis and its relevance is due to its antimicrobial resistance and persistence in the internal tissues of the tonsils. Tonsillectomy is indicated in cases of recurrent tonsillitis after several failures of antibiotic therapy.

Material and methods

In this study we evaluated 123 surgically removed tonsils from patients who had history of recurrent tonsillitis. The tonsils were submitted to microbiological analysis for detection of S. aureus. The isolates were identified by PCR for femA gene. Antimicrobial susceptibility of the isolates was determined by disk diffusion tests. All isolates were submitted to PCR to detect mecA and Panton-Valentine leucocidin (PVL) genes. The genetic similarity among all isolates was determined by pulsed field gel electrophoresis.

Results

Sixty-one S. aureus isolates were obtained from 50 patients (40.7%) with mean age of 11.7 years. The isolates showed high level resistance to penicillin (83.6%), 9.8% had inducible MLSb phenotype, and 18.0% were considered multidrug resistant (MDR). mecA gene was detected in two isolates and the gene coding for PVL was identified in one isolate. The genetic similarity analysis showed high diversity among the isolates. More than one genetically different isolate was identified from the same patient, and identical isolates were obtained from different patients.

Conclusions

MDR isolates colonizing tonsils even without infection, demonstrate persistence of the bacterium and possibility of antimicrobial resistance dissemination and recurrence of infection. A specific clone in patients colonized by S. aureus was not demonstrated.