Long-Term Trends in Microbiology and Outcomes of Pediatric Deep Neck Infections: An 18-Year Study.

Abstract

Importance: Pediatric deep neck infection (DNI) is a potentially life-threatening condition. However, contemporary large-scale data describing microbial etiology and outcomes remain limited. Understanding long-term pathogen trends is essential for guiding empiric antibiotic therapy and improving outcomes.

Objective: To investigate temporal changes in bacterial pathogens, treatment strategies, and outcomes of pediatric DNI across an 18-year period.Design, Setting, and Participants: Retrospective multicenter cohort study using the Chang Gung Research Database (CGRD), a de-identified nationwide database from Taiwan's largest medical system. Hospitalized patients younger than 18 years with DNI from 2006 to 2023 were identified and divided into two 9-year periods (2006-2014 and 2015-2023).

Main outcomes and measures: Demographics, comorbidities, treatment modalities, disease severity, and microbiological profiles were analyzed. Bacterial isolates were evaluated at genus and species levels, with methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) assessed separately.

Results: Among 1,743 pediatric DNI cases (1,017 in 2006-2014; 726 in 2015-2023), antibiotic-only therapy increased (91.5% to 94.4%), surgical intervention decreased (8.5% to 5.7%), and no tracheostomies were performed. ICU admission declined (8.9% to 6.8%), mediastinal complications decreased (0.6% to 0%), and mortality remained 0.1%. Staphylococcus increased while Streptococcus decreased; Veillonella replaced Peptostreptococcus among anaerobes. MRSA became the predominant facultative anaerobic/aerobic pathogen, and Veillonella parvula emerged as the leading anaerobic species.

Conclusions and relevance: Over 18 years, pediatric DNI in Taiwan demonstrated a marked shift toward conservative, antibiotic-based management with sustained excellent outcomes. Concurrently, MRSA and anaerobes such as Veillonella emerged as dominant pathogens in culture-positive patients, highlighting the need to consider empiric regimens that adequately cover these evolving bacterial profiles specifically in severe, refractory, or surgically managed cases.