Acute bacterial suppurative parotitis: microbiology and management.

The parotid gland is the salivary gland most commonly affected by inflammation. The most common pathogens associated with acute bacterial parotitis are Staphylococcus aureus and anaerobic bacteria. The predominant anaerobes include gram-negative bacilli (including pigmented Prevotella and Porphyromonas spp.), Fusobacterium spp., and Peptostreptococcus spp. Streptococcus spp. (including S. pneumoniae) and gram-negative bacilli (including Escherichia coli) have also been reported. Gram-negative organisms are often seen in hospitalized patients. Organisms less frequently found are Arachnia, Haemophilus influenzae, Klebsiella pneumoniae, Salmonella spp., Pseudomonas aeruginosa, Treponema pallidum, cat-scratch bacillus, and Eikenella corrodens. Mycobacterium tuberculosis and atypical mycobacteria are rare causes of parotitis. Therapy includes maintenance of hydration and administration of parenteral antimicrobial therapy. Once an abscess has formed surgical drainage is required. The choice of antimicrobial depends on the etiologic agent. Maintenance of good oral hygiene, adequate hydration, and early and proper therapy of bacterial infection of the oropharynx may reduce the occurrence of suppurative parotitis.