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Comprehensive bacterial cultures were performed on specimens obtained from adult patients (<jats:italic>n<\/jats:italic> = 60) with surgically verified PPA, who were prospectively enrolled at five Danish ear-nose-throat departments. The prevalent isolates (in PPA pus) were unspecified anaerobes (73%), non-hemolytic streptococci (67%), <jats:italic>Streptococcus anginosus<\/jats:italic> group (SAG) (40%), <jats:italic>Corynebacterium<\/jats:italic> spp. (25%), <jats:italic>Neisseria<\/jats:italic> spp. (23%), <jats:italic>Fusobacterium<\/jats:italic> spp. (22%), <jats:italic>Fusobacterium necrophorum<\/jats:italic> (17%), <jats:italic>Prevotella<\/jats:italic> spp. (12%), and <jats:italic>Streptococcus pyogenes<\/jats:italic> (10%). The bacteria most frequently isolated in heavy (maximum) growth were unspecified anaerobes (60%), SAG (40%), <jats:italic>F. necrophorum<\/jats:italic> (23%), and <jats:italic>Prevotella<\/jats:italic> spp. (17%). The predominant microorganisms (those found in highest relative abundance) were unspecified anaerobes (53%), SAG (28%), non-hemolytic streptococci (25%), <jats:italic>F. necrophorum<\/jats:italic> (15%), <jats:italic>S. pyogenes<\/jats:italic> (10%), and <jats:italic>Prevotella<\/jats:italic> spp. (10%). Four potential pathogens were found in both heavy growth and highest relative abundance in at least 50% of cases: <jats:italic>F. necrophorum<\/jats:italic>, <jats:italic>Prevotella<\/jats:italic> spp., SAG, and <jats:italic>S. pyogenes<\/jats:italic>. SAG, <jats:italic>Prevotella<\/jats:italic> spp., <jats:italic>F. necrophorum<\/jats:italic>, <jats:italic>S. pyogenes<\/jats:italic>, and <jats:italic>Bacteroides<\/jats:italic> spp. were recovered with the same or higher frequency from PPA pus compared with tonsillar tissue and surface. Our findings suggest that SAG, <jats:italic>F. necrophorum<\/jats:italic>, Prevotella, and <jats:italic>S. pyogenes<\/jats:italic> are significant pathogens in PPA development.<\/jats:p>","DOI":"10.1007\/s10096-021-04180-y","type":"journal-article","created":{"date-parts":[[2021,2,10]],"date-time":"2021-02-10T09:08:58Z","timestamp":1612948138000},"page":"1461-1470","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Microbiology of parapharyngeal abscesses in adults: in search of the significant pathogens"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5053-8034","authenticated-orcid":false,"given":"Tejs Ehlers","family":"Klug","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Greve","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camilla","family":"Andersen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pernille","family":"Hahn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Danstrup","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niels Krintel","family":"Petersen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirjana","family":"Ninn-Pedersen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophie","family":"Mikkelsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S\u00f8ren","family":"Pauli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Fuglsang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helle","family":"D\u00f8ssing","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne-Louise","family":"Christensen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Rusan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anette","family":"Kjeldsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,2,10]]},"reference":[{"key":"4180_CR1","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1177\/000348940611500207","volume":"115","author":"JY Sichel","year":"2006","unstructured":"Sichel JY, Attal P, Hocwald E, Eliashar R (2006) Redefining parapharyngeal space infections. 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