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

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.