Post-Pandemic shifts in peritonsillar abscess: incidence and microbiological trends following the cessation of COVID-19-related nonpharmaceutical interventions.

BACKGROUND

The impact of COVID-19-related nonpharmaceutical interventions (NPI) on the bacterial composition of upper airway infections remains largely unexplored.

OBJECTIVES

We aimed to investigate the incidence and microbiology of peritonsillar abscess (PTA) following the cessation of NPI and to compare these findings with the periods before and during NPI implementation.

METHODS

We performed a cross-sectional analysis of all PTA cases and their microbiological findings from 12 March, 2018 to 11 March, 2024, among patients admitted to the Ear-Nose-Throat Department, Aarhus University Hospital. Patients were categorised into three two-year periods in relation to NPI. Age-stratified population data for the catchment area were sourced from Statistics Denmark.

RESULTS

A total of 1,030 patients were included. The annual incidence rate of PTA was significantly higher post-NPI (26.9 cases/100,000) compared to both the NPI period (14.9 cases/100,000, p < 0.001) and the pre-NPI period (21.8 cases/100,000, p = 0.003). Increased post-NPI rates were observed across all age groups. The number of cases positive for Streptococcuspyogenes and Fusobacterium necrophorum increased post-NPI (n = 102 and n = 89, respectively) compared to during the NPI period (n = 28 and n = 64, p < 0.001 and p = 0.052, respectively) and pre-NPI (n = 67 and n = 60, p = 0.009 and p = 0.021, respectively). Statistically non-significant increasing trends were found for less prevalent bacteria.

CONCLUSION

Following NPI cessation, PTA incidence rates surpassed both the NPI and pre-NPI levels. The rising PTA incidence rates post-NPI were primarily driven by an increasing number of cases positive for S. pyogenes and F. necrophorum, suggesting an immunity debt to these prevalent pathogens.