扁桃周囲膿瘍治療における細菌検査の役割

Role of routine bacteriologic studies in the treatment of peritonsillar abscess

はじめに

　扁桃周囲膿瘍は，扁桃炎，扁桃周囲炎に引き続いて扁桃周囲に膿瘍を形成する病態であり，耳鼻咽喉科領域でよくみられる救急疾患である。深頸部膿瘍や縦隔膿瘍といった重篤な状況に進行することがあり早期に適切な治療が必要となる^1）。扁桃周囲膿瘍の起炎菌としては溶連菌や口腔内細菌が挙げられる^2）。通常，感染症治療においては使用抗菌薬を選択するために細菌検査は必須と考えられているが，一方で扁桃周囲膿瘍に関しては細菌検査は有用でないとする海外の報告もみられる^3〜5）。しかし，わが国では扁桃周囲膿瘍に対して細菌検査を施行するのが一般的である。そこで今回われわれは扁桃周囲膿瘍の治療において細菌検査結果が治療に与える影響について検討した。

　Peritonsillar abscess, which usually resulted from acute tonsillitis and subsequent peritonsillar cellulitis, is a localized accumulation of pus within the peritonsillar tissues. Previous studies have demonstrated that the bacteriologic studies do not change the treatment of peritonsillar abscess and that they are not necessary on the initial presentation. Here, we reevaluated the bacteriologic studies of the peritonsillar abscess. Bacteriologic studies were performed only in 55％ of the case. Only one of these results were recorded in the charts. The days required for the culture report were 2 to 10 days（median 5.5 days）. In none of the cases, the treatment was changed based on the culture reports. All of the cases were treated with antibiotics selected empirically throughout their treatment period. These results imply that the bacteriologic study is not useful for the treatment of the present patients. However, the antibiogram made from the bacteriologic study is necessary for the future therapy.