Korean J Pediatr 2010;53(8):801-804 • DOI: 10.3345/kjp.2010.53.8.801 803 Table 3. Culture of Aspirated Fluid Microorganism MSSA 21 ( 55.3) Sterile 12 ( 31.5) Group A Streptococcus 2 ( 5.3) Loss of specimen 3 ( 7.9) Total 38 (100.0) Abbreviation: MSSA, methicillin sensitive Staphylococcus aureus n (%) not related with the size of the lymph nodes and prior antibiotic treatment. 3. Culture of aspirated fluid Bacterial cultures were sent to the laboratory on all patients, but the specimens of three patients were lost (Table 3). Cultures from twenty-one (60.0%) out of 35 patients confirmed that culture of aspirated fluid grew out ofS. aureus. Of theS. aureus isolates that grew in culture, 100% were methicillin-sensitiveS. aureus (MSSA). Of MSSA isolates, 100, 75, 60 % were sensitive to clindamycin, trimethoprim/sulfamethoxazole, ciprof loxacin, respectively. Cultures from two (5.7%) patients grew out Streptococcus pyogenes . Cultures from 12 patients (34.3%) grew out of no organisms. Discussion Suppurative cervical lymphadenitis is a common problem in children. Most children with this condition are treated successfully without complication. Forty to eighty percent of cases of acute unilateral cervical lymphadenitis of 1- to 4-year old children are due toS. aureus orS. pyogenes 1). Antibiotics should be targeted against S. aureus and group Astreptococcus , and should include a 10-day course of oral cephalexin, amoxicillin/clavulanate, or clindamycin9). In most cases, symptomatic improvement should be noted after 2 to 3 days of therapy, although complete resolution of nodal enlargement may require several weeks2). The initial treatment approach of patients with suppurative cervical lymphadenitis that had failed to respond to antibiotic treatment is open surgical drainage. Some investigators reported considering an open approach when there is no improvement after 48-72 hours of appropriate antibiotic treatment4, 10). But in the pediatric age group, open surgical drainage has some limitations. It needs to be performed under general anesthesia, and may be associated with disfiguring scars. Other limitations are longer hospitalization and peri- and post-operative morbidity. In our study, needle aspiration is mentioned as a therapeutic rather than diagnostic procedure. Needle aspiration is limited evidence to suggest a single definitive approach to the work-up and treatment of a child with suppurative cervical lymphadenitis. But it has been used successfully in patients with atypical mycobacterial cervical adenitis11). In a previous study, Gorenstein et al8) reported that therapeutic needle aspiration was an attractive alternative to an open incision and drainage procedure. They suggested that seven (70%) out of 10 patients had 1 puncture and all patients had no scars and relapses of lymph nodes. All patients responded favorably to the procedure with defervescence and gradual regression of the cervical mass. Serour et al7) reported needle aspiration as the treatment of suppurative cervical lymphadenitis that required drainage procedures in thirty-five children seems to be an effective and safe treatment of suppurative cervical lymphadenitis that may avoid open surgical drainage. Twenty-seven (77.1%) out of 35 children underwent 1 puncture. There were no major complications and no relapses or scar formation. In our study, thirty-eight children underwent needle aspiration treatment with suppurative cervical lymphadenitis that required open surgical drainage. All patients underwent only 1 puncture. Two patients (5.2%) out of 38 patients experienced reformation of an abscess and all recovered completely after antibiotic retreatment. Two patients that experienced reformation of an abscess received initially antibiotic treatment against S. aureus and group A streptococcus because the most common pathogens are S. aureus and group Astreptococcus 3). After isolation in culture, antibiotic re-treatment is based on determination of the etiological agent and its relevant antibiotic sensitivity. A minor complication was detected in 2 patients. One was remnant necrotic tissue and the other was a small scar formation, which was resolved spontaneously in both patients. Similar to other studies, there were no major complications in our study. But two (5.2%) out of 38 patients had a minor complication that was not troublesome and was resolved spontaneously. In conclusion, the advantage of needle aspiration over open surgical drainage is that it is a simple, safe and effective procedure which does not require general anesthesia. Our study had several limitations. First, this was a retrospective study. Second, this single- center study included only a small number of patients. Therefore, further investigation is clearly needed to determine an initial approach of patients with suppurative cervical lymphadenitis that required open surgical drainage through prospective and large-scale studies.