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Dou K, Shi Y, Yang B, Zhao Z. Risk factors for life-threatening complications of head and neck space infections: A systematic review and meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101954. [PMID: 38908479 DOI: 10.1016/j.jormas.2024.101954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/17/2024] [Accepted: 06/20/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE The present systematic review was performed to identify risk factors associated with life-threatening complications of head and neck space infections (LCHNSI) within the included studies and assess the magnitude of their impact on patients. METHODS We systematically searched PubMed, Web of Science, EmBase, Scopus and CNKI for articles that reported risk factors associated with life-threatening complications of head and neck space infections from inception to 14 December 2023. Only factors reported in at least three papers were considered in the meta-analysis. Pooled odds ratio (OR) and 95 % confidence interval (CI) were calculated using fixed effects model and random effects model. The between-study heterogeneity of effect size was quantified using the Q statistic and I2. In addition, subgroup analysis stratified by study characteristics and sensitivity analysis were performed to explore the potential sources of heterogeneity and the stability of the results. RESULTS The review included a total of 29 studies. The results revealed that the risk factors which associated with LCHNSI were included diabetes mellitus (OR = 3.31, 95 % CI: 2.49-4.40), total leukocyte count(≥15 × 109/L) (OR = 1.21, 95 %CI: 1.04-1.42), multiple space involvement (OR = 4.32, 95 %CI: 3.47-5.38), combined systemic diseases (OR = 9.94, 95 %CI: 6.30-15.67), advanced age(≥60) (OR = 3.90, 95 %CI: 2.80-5.44), dyspnoea (OR = 23.39, 95 %CI: 12.41-44.10), high temperature(≥39°C) (OR = 3.23, 95 %CI: 2.02-5.17), retropharyngeal space involvement (OR = 3.62, 95 %CI: 2.06-6.35), parapharyngeal space involvement (OR = 4.62, 95 %CI: 2.27-9.42). CONCLUSIONS According to the current analysis, diabetes mellitus, total leukocyte count(≥15 × 109/L), combined systemic diseases, multiple space involvement, advanced age(≥60), dyspnoea, high temperature (≥39 °C), retropharyngeal space involvement, parapharyngeal space involvement were the risk factors for LCHNSI. To mitigate the incidence of LCHNSI, clinical staff should carefully manage these risk factors, ensure prompt diagnosis, and implement timely preventive measures.
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Affiliation(s)
- Ke Dou
- Department of Stomatology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang 110004, China
| | - Yue Shi
- School of Nursing and Rehabilitation, Nantong University, Nantong 226001, Jiangsu Province, China
| | - Baoyi Yang
- Department of Stomatology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang 110004, China
| | - Zhiguo Zhao
- Department of Stomatology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang 110004, China.
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Nhat LX, Vinh VH, Thi CP, Van Khoi N. Surgical management of descending necrotizing mediastinitis: strategy for thoracic interference. J Cardiothorac Surg 2023; 18:229. [PMID: 37438726 DOI: 10.1186/s13019-023-02321-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/28/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND The present descriptive study shares the overall experience of treating all these patients where different surgical process was adopted depending on the treatment required after carefully evaluating the risk factors and comorbidities. METHODS The present study was conducted at the Department of Thoracic Surgery, Choray Hospital, Vietnam between the period of 2010 to 2020. We have treated 95 patients altogether in this duration. RESULTS We were able to save most of the patients by applying thoracotomy and thoracic irrigation for most of the patients based on the observed indications that were identified immediately after the compulsory standard cervicotomy. The indication for thoracic interference was considered when the infection was deeply spread into the mediastinum and cannot get out through cervicotomy, although the most effective method of drainage was applied. CONCLUSION Our statistical investigation of the patient data suggested the possible association and influence of comorbidity such as diabetes. Therefore, we recommend that in specific cases thoracotomy along with thoracic irrigation and repetitive surgical draining could be a better option to reduce the infection and the mortality rate. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Lam Xuan Nhat
- Department of Thoracic Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Vu Huu Vinh
- Department of Thoracic Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam.
| | - Chau Phu Thi
- Department of Thoracic Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Van Khoi
- Department of Thoracic Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
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Descending necrotizing mediastinitis: etiopathogenesis, diagnosis, treatment and long-term consequences-a retrospective follow-up study. Eur Arch Otorhinolaryngol 2023; 280:1983-1990. [PMID: 36478116 PMCID: PMC9988808 DOI: 10.1007/s00405-022-07769-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The primary aim of this retrospective study was to analyze the progression of descending necrotizing mediastinitis (DNM), evaluate the impact of comorbidities on complications and mortality and to observe long-term consequences of DNM on dysphagia and measurements quality of life. DNM is a serious infectious disease that requires multimodal treatment. Current literature varies in conclusions of risk factors, management and outcome of DNM. In addition, little is known about persisting effects on quality of life. METHODS Retrospective data analysis of 88 patients with DNM representing the largest single-center study. Recording data of patients and diseases as well as clinical progression from 1997 to 2018. Two questionnaires were sent to the participants to measure quality of life and to detect dysphagia. RESULTS 88 patients were included. The most frequently found pathogen were Streptococcus spp. (52%). 75% of the patients underwent multiple surgeries, mean count of surgical procedures was 4.3 times. 84% received intensive care treatment. Median length of stay on the intensive care unit was 7 days. 51% had pre-existing comorbidities associated with reduced tissue oxygenation (e.g., diabetes). The most common complication was pleural effusion (45%). During the observation period, the mortality rate was 9%. 12 questionnaires could be evaluated. 67% of the participants were affected by dysphagia at the time of the survey. CONCLUSIONS Descending necrotizing mediastinitis (DNM) is a severe disease requiring an immediate initiation of multimodal treatment. Although quality of life usually isn´t impaired permanently, dysphagia may often persist in patients after DNM.
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Fan D, Hou J, Yang J, Zhao Z, Fang Q, Wu X. Predictive value of serum interleukin-6 to determine surgical drainage of deep neck space infection in adults. Eur Arch Otorhinolaryngol 2023; 280:1403-1410. [PMID: 36208332 DOI: 10.1007/s00405-022-07683-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/28/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to determine whether interleukin-6 (IL-6) could be used as a predictor for surgical drainage in deep neck space infection (DNSI). METHODS A retrospective study was conducted to analyze 69 adult patients newly diagnosed as DNSI from January 2017 to December 2021 at a single center. The patients were treated with either surgical drainage or not. The following clinical data including age, gender, maximum diameter of abscess (MDA), laboratory data, therapeutic modalities, comorbidities, duration of hospitalization and complications were collected and evaluated. RESULTS Patients in drained group had significantly elevated MDA, IL-6, procalcitonin, C-reactive protein and neutrophil to lymphocyte ratio compared to patients in non-drained group (all P < 0.01). Significant predictors for surgical drainage were IL-6 and MDA as independent factors, with the optimum cutoff values of 52.5 pg/mL and 14.4 mm, respectively. Moreover, the IL-6 had a wider area under the curve than MDA for prediction of surgical drainage in DNSI. CONCLUSIONS IL-6 as a promising predictor of the need for surgical drainage can be effectively used for routine assessment in the early stage of DNSI to determine the optimal treatments.
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Affiliation(s)
- Dachuan Fan
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui, China.
| | - Jinxiao Hou
- Department of Hematology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Jianming Yang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui, China
| | - Zhentao Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui, China
| | - Qi Fang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui, China
| | - Xiaoman Wu
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui, China
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Yun JS, Lee CH, Na KJ, Song SY, Oh SG, Jeong IS. Surgical Experience with Descending Necrotizing Mediastinitis: A Retrospective Analysis at a Single Center. J Chest Surg 2023; 56:35-41. [PMID: 36575811 PMCID: PMC9845862 DOI: 10.5090/jcs.22.110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 12/29/2022] Open
Abstract
Background We analyzed our experience with descending necrotizing mediastinitis (DNM) treatment and investigated the efficacy of video-assisted thoracoscopic surgery (VATS) for mediastinal drainage. Methods This retrospective analysis included patients who underwent surgical drainage for DNM at our hospital from 2005 to 2020. We analyzed patients' baseline characteristics, surgical data, and perioperative outcomes and compared them according to the mediastinal drainage approach among patients with type II DNM. Results Twenty-five patients (male-to-female ratio, 18:7) with a mean age of 54.0±12.9 years were enrolled in this study. The most common infection sources were pharyngeal infections (60%). Most patients had significantly increased white blood cell counts, elevated C-reactive protein levels, and decreased albumin levels on admission. The most common DNM type was type IIB (n=16, 64%), while 5 and 4 patients had types I and IIA, respectively. For mediastinal drainage, the transcervical approach was used in 15 patients and the transthoracic approach (VATS) in 10 patients. The mean length of hospital stay was 26.5±23.8 days, and the postoperative morbidity and in-hospital mortality rates were 24% and 12%, respectively. No statistically significant differences were found among patients with type II DNM between the transcervical and VATS groups. However, the VATS group showed shorter mean antibiotic therapy duration, drainage duration, and hospital stay length than the transcervical group. Conclusion DNM manifested as severe infection requiring long-term inpatient treatment, with a mortality rate of 12%. Thus, active treatment with a multidisciplinary approach is crucial, and mediastinal drainage using VATS is considered relatively safe and effective.
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Affiliation(s)
- Ju Sik Yun
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Cho Hee Lee
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kook Joo Na
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea,Corresponding author Kook Joo Na Tel 82-61-379-7662 Fax 82-61-379-7665 E-mailORCIDhttps://orcid.org/0000-0003-0923-1414
| | - Sang Yun Song
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Sang Gi Oh
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - In Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Yoshimura M, Daifu T, Suehiro M, Shoji T, Higuchi Y. Descending Necrotizing Mediastinitis Caused by Streptococcus pyogenes in a Child with Primary Epstein-Barr Virus Infection. Pediatr Rep 2022; 15:16-19. [PMID: 36649003 PMCID: PMC9844267 DOI: 10.3390/pediatric15010003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
Descending necrotizing mediastinitis (DNM) is a severe, life-threatening disease with a high mortality rate resulting from sepsis or other complications. DNM can also be a rare and severe complication of Epstein-Barr virus (EBV) infection in adolescents and young adults but has never been reported in a pre-school child. A 4-year-old girl was admitted to our hospital with a 2-day history of fever and chest pain. Computed tomography (CT) revealed a right sided pleural effusion, fluid collection in the retropharyngeal and mediastinal areas, cervical lymphadenopathy, and marked hepatosplenomegaly. She was diagnosed with empyema, retropharyngeal abscess, and mediastinitis. To improve her dyspnea, a chest tube was inserted, and antibiotic treatment was initiated. Her condition improved temporarily, but on day 5 in our hospital, she developed a fever again. A repeat CT scan showed exacerbation of fluid retention in the retropharyngeal area and the mediastinum, for which she underwent drainage and debridement of necrotic tissue in the retropharynx and mediastinum. The presence of cervical lymphadenopathy and marked hepatosplenomegaly suggested the involvement of EBV. Serological tests for EBV revealed primary EBV infection at the time of the DNM onset. Finally, she was diagnosed with DNM following primary EBV infection. At follow-up 1 year later, she was doing well. The risk of DNM should be recognized in patients, even pre-school aged children, with primary EBV infection.
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Affiliation(s)
- Miki Yoshimura
- Department of Pediatrics, Otsu Red Cross Hospital, Otsu 520-8511, Japan
| | - Tomoo Daifu
- Department of Pediatrics, Otsu Red Cross Hospital, Otsu 520-8511, Japan
- Correspondence: ; Tel.: +81-77-522-4131
| | - Minoru Suehiro
- Department of Pediatrics, Otsu Red Cross Hospital, Otsu 520-8511, Japan
| | - Tsuyoshi Shoji
- Department of Thoracic Surgery, Otsu Red Cross Hospital, Otsu 520-8511, Japan
| | - Yoshihisa Higuchi
- Department of Pediatrics, Otsu Red Cross Hospital, Otsu 520-8511, Japan
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Risk Factors of Descending Necrotizing Mediastinitis in Deep Neck Abscesses. Medicina (B Aires) 2022; 58:medicina58121758. [PMID: 36556959 PMCID: PMC9788205 DOI: 10.3390/medicina58121758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background and Objectives: Cervical space infection could also extend to the mediastinum due to the anatomical vicinity. The mortality rate of descending necrotizing mediastinitis is 85% if untreated. The aim of this study was to identify risk factors for the progression of deep neck abscesses to descending necrotizing mediastinitis. Materials and Methods: We retrospectively reviewed the medical records of patients undergoing surgical treatment of deep neck abscesses from August 2017 to July 2022. Computed tomography (CT) was performed in all patients. Before surgery, lab data including hemoglobulin (Hb), white blood cell count, neutrophil percentage, C-reactive protein (CRP) level, and blood glucose were recorded. Patients' characteristics including gender, age, etiology, and presenting symptoms were collected. Hospitalization duration and bacterial cultures from the wound were also analyzed. Results: The C-reactive protein (CRP) level was higher in patients with a mediastinal abscess than in patients without a mediastinal abscess (340.9 ± 33.0 mg/L vs. 190.1 ± 72.7 mg/L) (p = 0.000). The submandibular space was more commonly affected in patients without a mediastinal abscess (p = 0.048). The retropharyngeal (p = 0.003) and anterior visceral (p = 0.006) spaces were more commonly affected in patients with a mediastinal abscess. Conclusions: Descending necrtotizing mediastinitis results in mortality and longer hospitalization times. Early detection of a mediastinal abscess on CT is crucial for treatment. Excluding abscesses of the anterior superior mediastinum for which transcervical drainage is sufficient, other mediastinal abscesses require multimodal treatment including ENT and thoracic surgery to achieve a good outcome.
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Arslan H, Bayır Ö, Aksoy Ş, Keseroğlu K, Saka C, Tatar EÇ, Saylam G, Korkmaz MH. Management of deep neck infections in adults and importance of clinical and laboratory findings. J Investig Med 2022; 70:1488-1493. [PMID: 35760449 DOI: 10.1136/jim-2021-002271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 11/04/2022]
Abstract
This study aimed to analyze laboratory and radiological imaging results in the prediction of treatment strategy in patients with deep neck infections. Eighty-three patients (55 (66.3%) men, mean age: 38.2±14.5 years) were included in the study. Patients were divided into three groups according to the treatment strategy: group 1 received only antibiotic treatment, group 2 underwent abscess drainage with needle puncture in addition to antibiotic treatment, and group 3 underwent surgical drainage with antibiotic treatment. Laboratory outcomes, imaging methods, duration of hospital stay, treatment strategy, and clinical outcomes were analyzed.According to the laboratory results, complete blood count values did not vary among the three groups, but C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values were higher in group 3 (p<0.01). Based on receiver operating characteristic (ROC) analysis, the cut-off levels for CRP and ESR associated with the need for surgical drainage were 133 mg/L and 42.5, respectively. According to radiological imaging results, the number of involved neck spaces was significantly different among the three groups (p=0.03), and group 3 had more spaces involved when compared with groups 1 and 2 (p=0.04). Gas formation in the neck tissues was noted in 10 patients in group 3 and 5 patients in groups 1 and 2 (p=0.02). ESR and CRP levels were higher in patients who underwent surgical drainage. In patients with deep neck space infections, the involvement of two or more neck spaces and gas formation on radiological images might indicate surgical drainage as a treatment strategy.
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Affiliation(s)
- Hande Arslan
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Ömer Bayır
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Şevket Aksoy
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Kemal Keseroğlu
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Cem Saka
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Emel Çadallı Tatar
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Güleser Saylam
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
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Multidisciplinary Approach in the Treatment of Descending Necrotizing Mediastinitis: Twenty-Year Single-Center Experience. Antibiotics (Basel) 2022; 11:antibiotics11050664. [PMID: 35625308 PMCID: PMC9137525 DOI: 10.3390/antibiotics11050664] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 12/03/2022] Open
Abstract
Descending necrotizing mediastinitis (DNM) is an acute, rare, severe condition with high mortality, but the optimal management protocol is still controversial. We retrospectively analyzed the results of multidisciplinary management in patients treated for DNM at our center over the last twenty years. Fifteen male patients, mean age 49.07 ± 14.92 years, were treated: 9 with cervico-pharyngeal etiopathogenesis, 3 peri-tonsillar/tonsillar, 2 odontogenic, 1 post-surgical; 6 with DNM type I, 6 with type IIA, and 3 with type IIB (Endo’s classification). Mean time between diagnosis and treatment was 2.24 ± 1.61 days. In all cases, mediastinum drainage via thoracotomy was performed after neck drainage via cervicotomy, associated with tooth treatment in two; one required re-operation; tracheostomy was necessary in 9, temporary intensive care unit stay in 4; 6 developed complications, without post-operative mortality. Main isolated germs were Staphylococci and Candida; 7 had polymicrobial infection. The most used antibiotics were meropenem, metronidazole, teicoplanin, third-generation cephalosporins and clyndamicin; anti-fungal drugs were fluconazole, caspofungin and anidulafungin. On multivariate analysis, presence of cardiovascular disease was statistically significantly associated with longer chest tube duration and hospital stay. DNM requires early diagnosis and treatment to reduce mortality and morbidity. The most effective treatment should provide a multidisciplinary approach, combining cervicotomy and thoracotomy to drain all infectious collections with administration and monitoring of the proper antimicrobial therapy.
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Gao W, Lin Y, Yue H, Chen W, Liu T, Ye J, Cai Q, Ye F, He L, Xie X, Xiong G, Wu J, Wang B, Wen W, Lei W. Bacteriological analysis based on disease severity and clinical characteristics in patients with deep neck space abscess. BMC Infect Dis 2022; 22:280. [PMID: 35321647 PMCID: PMC8944129 DOI: 10.1186/s12879-022-07259-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/09/2022] [Indexed: 12/16/2022] Open
Abstract
Background Deep neck space abscess (DNSA) is a serious infection in the head and neck. Antibiotic therapy is an important treatment in patients with DNSA. However, the results of bacterial culture need at least 48 h, and the positive rate is only 30–50%, indicating that the use of empiric antibiotic treatment for most patients with DNSA should at least 48 h or even throughout the whole course of treatment. Thus, how to use empiric antibiotics has always been a problem for clinicians. This study analyzed the distribution of bacteria based on disease severity and clinical characteristics of DNSA patients, and provides bacteriological guidance for the empiric use of antibiotics. Methods We analyzed 433 patients with DNSA who were diagnosed and treated at nine medical centers in Guangdong Province between January 1, 2015, and December 31, 2020. A nomogram for disease severity (mild/severe) was constructed using least absolute shrinkage and selection operator–logistic regression analysis. Clinical characteristics for the Gram reaction of the strain were identified using multivariate analyses. Results 92 (21.2%) patients developed life-threatening complications. The nomogram for disease severity comprised of seven predictors. The area under the receiver operating characteristic curves of the nomogram in the training and validation cohorts were 0.951 and 0.931, respectively. In the mild cases, 43.2% (101/234) had positive culture results (49% for Gram-positive and 51% for Gram-negative strains). The positive rate of cultures in the patients with severe disease was 63% (58/92, 37.9% for Gram-positive, and 62.1% for Gram-negative strains). Diabetes mellitus was an independent predictor of Gram-negative strains in the mild disease group, whereas gas formation and trismus were independent predictors of Gram-positive strains in the severe disease group. The positivity rate of multidrug-resistant strains was higher in the severe disease group (12.1%) than in the mild disease group (1.0%) (P < 0.001). Metagenomic sequencing was helpful for the bacteriological diagnosis of DNSA by identifying anaerobic strains (83.3%). Conclusion We established a DNSA clinical severity prediction model and found some predictors for the type of Gram-staining strains in different disease severity cases. These results can help clinicians in effectively choosing an empiric antibiotic treatment.
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Affiliation(s)
- Wenxiang Gao
- Otorhinolaryngology Hospital, First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, Guangdong, People's Republic of China
| | - Yu Lin
- Otorhinolaryngology Hospital, First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, Guangdong, People's Republic of China
| | - Huijun Yue
- Otorhinolaryngology Hospital, First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, Guangdong, People's Republic of China
| | - Weixiong Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, First People's Hospital of Foshan, Foshan, Guangdong, People's Republic of China
| | - Tianrun Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jin Ye
- Department of Otorhinolaryngology-Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - Qian Cai
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - Fei Ye
- Department of Otorhinolaryngology-Head and Neck Surgery, Zhongshan People's Hospital, Zhongshan, Guangdong, People's Republic of China
| | - Long He
- Department of Otorhinolaryngology-Head and Neck Surgery, First People's Hospital of Guangzhou, Guangzhou, Guangdong, People's Republic of China
| | - Xingqiang Xie
- Department of Otorhinolaryngology-Head and Neck Surgery, First People's Hospital of Zhaoqing, Zhaoqing, Guangdong, People's Republic of China
| | - Guoping Xiong
- Department of Otorhinolaryngology-Head and Neck Surgery, Jiangmen Central Hospital Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong, People's Republic of China
| | - Jianhui Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, Zhongshan People's Hospital, Zhongshan, Guangdong, People's Republic of China
| | - Bin Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, First People's Hospital of Guangzhou, Guangzhou, Guangdong, People's Republic of China
| | - Weiping Wen
- Otorhinolaryngology Hospital, First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, Guangdong, People's Republic of China
| | - Wenbin Lei
- Otorhinolaryngology Hospital, First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, Guangdong, People's Republic of China.
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Mantzouranis K, Georgakopoulou VE, Mermigkis D, Damaskos C, Garmpis N, Papalexis P, Gkoufa A, Drossos P, Chlapoutakis S, Garmpi A, Sklapani P, Trakas N, Tsiafaki X. Staphylococcus aureus mediastinitis following a skin infection in a non-immunocompromised patient: A case report. Biomed Rep 2021; 15:104. [PMID: 34760277 PMCID: PMC8567464 DOI: 10.3892/br.2021.1480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/12/2021] [Indexed: 11/06/2022] Open
Abstract
Mediastinitis is a severe inflammation of the structures located in the mid-chest cavity. Three main causes of infective mediastinitis are traditionally recognized: Deep infection of a sternal wound following cardiothoracic surgery, perforation of the esophagus, and the descending necrotizing mediastinitis as a result of odontogenic, pharyngeal or cervical infections. Mediastinitis, as a complication of skin infection with hematogenous spread is infrequent. Methicillin-resistant Staphylococcus aureus (MRSA) is a gram-positive bacteria, and is responsible for numerous severe infections. MRSA mediastinitis is a rare infection and is typically associated with complications of sternotomy and retropharyngeal abscesses. Here, the second known case of mediastinitis of a hematogenous origin in a non-immunocompromised 41-year-old patient following primary skin infection, accompanied by sternal osteomyelitis, lung consolidation and pleural effusion is described; MRSA was the responsible pathogen. The clinical course was favorable after 6 weeks of antibiotics administration without drainage or surgical intervention.
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Affiliation(s)
| | | | | | - Christos Damaskos
- Renal Transplantation Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.,N.S. Christeas Laboratory of Experimental Surgery and Surgical Research; Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Garmpis
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research; Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.,Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Petros Papalexis
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.,Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
| | - Aikaterini Gkoufa
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Panagiotis Drossos
- Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
| | | | - Anna Garmpi
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Pagona Sklapani
- Department of Cytology, Mitera Hospital, 15123 Athens, Greece
| | - Nikolaos Trakas
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | - Xanthi Tsiafaki
- 1st Pulmonology Department Sismanogleio Hospital, 15126 Athens, Greece
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Brajkovic D, Zjalić S, Kiralj A. Prognostic factors for descending necrotizing mediastinitis development in deep space neck infections-a retrospective study. Eur Arch Otorhinolaryngol 2021; 279:2641-2649. [PMID: 34542654 DOI: 10.1007/s00405-021-07081-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Descending necrotizing mediastinitis (DNM) is the most serious complication of deep neck infections (DNI). The objective of this retrospective study was to evaluate prognostic factors for DNM development in deep space neck infections. METHODS The study enrolled patients admitted to the Emergency Center of Vojvodina with the diagnosis of multispace DNI with or without DNM either as the primary diagnosis or with discharged diagnosis after surgical treatment during 7-year period. The data were obtained from patient medical records. RESULTS After final analysis total of 141 charts were randomized for statystical analysis, 124 charts in DNI and 17 in DNI + DNM groups. The most common cause of infection in both groups was odontogenic. On multivariate regression analysis of collected data infection of retropharyngeal, pretracheal and carotid space, C-reactive protein and procalcitonine values were statistically significant predictors for DNM development. CONCLUSIONS Treatment and diagnosis of DNM requires multidisciplinary approach, with prompt clinical and radiological examinations, empirical broad spectrum antibiotic therapy and radical surgical debridement. Multispace neck infection and especially infection of retropharyngeal, carotid and pretracheal spaces are the most sensitive predictors for DNM development in deep space neck infections. CLINICAL RELEVANCE If the infection from deep neck spaces reach retropharyngeal, carotid or pretracheal space, the DNM is probable to occur. TRIAL REGISTRATION ClinicalTrials.gov ID NCT04865003. Date of registration 27.4.2021.
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Affiliation(s)
- Denis Brajkovic
- Clinical Center of Vojvodina, Clinic for Maxillofacial and Oral Surgery, Hajduk Veljkova 1-9, 21000, Novi Sad, Serbia.
- Faculty of Medicine, Department for Dentistry and Maxillofacial Surgery, University of Novi Sad, Novi Sad, Serbia.
| | - Severina Zjalić
- Clinical Center of Vojvodina, Clinic for Anesthesiology, Intensive Care and Pain Management, Novi Sad, Serbia
| | - Aleksandar Kiralj
- Clinical Center of Vojvodina, Clinic for Maxillofacial and Oral Surgery, Hajduk Veljkova 1-9, 21000, Novi Sad, Serbia
- Faculty of Medicine, Department for Dentistry and Maxillofacial Surgery, University of Novi Sad, Novi Sad, Serbia
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13
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Kim Y, Han S, Cho DG, Jung WS, Cho JH. Optimal Airway Management in the Treatment of Descending Necrotizing Mediastinitis Secondary to Deep Neck Infection. J Oral Maxillofac Surg 2021; 80:223-230. [PMID: 34582808 DOI: 10.1016/j.joms.2021.08.159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To review our experiences of descending necrotizing mediastinitis (DNM) secondary to deep neck infection (DNI) and determine appropriate airway management for decreasing mortality and morbidity of patients with DNM. METHODS Medical records of 20 patients (8 women and 12 men) who had been managed for DNM secondary to DNI between March 2006 and December 2019 were analyzed. Diagnosis and extent of infection were confirmed by computed tomography of the neck and chest. The upper airway was closely monitored with a fiberoptic laryngoscope. Complications were evaluated according to various types of airway management in our serial cases. RESULTS Five (25%) out of 20 patients died as a result of septic shock and multiorgan failure. None of these patients died of accidental airway obstruction or airway management mishaps. Keeping short-term orotracheal intubation was safe and adequate after the initial surgery. Early tracheotomy was performed for 4 patients and it was significantly associated with mortality (P = .032). Three patients who underwent late tracheotomy had no mortality. Patients with tracheotomy had longer duration of overall hospital stay than those without tracheotomy. CONCLUSIONS Well-controlled airway management might decrease mortality, hospitalization, and airway complications in patients with DNM secondary to DNI. Keeping orotracheal intubation rather than upfront tracheotomy should be first considered when managing airway along with examination of the upper airway with a fiberoptic laryngoscope.
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Affiliation(s)
- Yoonho Kim
- Resident, Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungjun Han
- Clinical Assistant Professor, Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic University of Korea, Seoul, Republic of Korea
| | - Deog Gon Cho
- Professor, Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won-Sang Jung
- Clinical Associate Professor, Department of Radiology, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung-Hae Cho
- Assistant Professor, Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic University of Korea, Seoul, Republic of Korea.
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14
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Gehrke T, Scherzad A, Hagen R, Hackenberg S. Deep neck infections with and without mediastinal involvement: treatment and outcome in 218 patients. Eur Arch Otorhinolaryngol 2021; 279:1585-1592. [PMID: 34160666 PMCID: PMC8897324 DOI: 10.1007/s00405-021-06945-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Abstract
Purpose Infections of the deep neck, although becoming scarcer due to the widespread use of antibiotics, still represent a dangerous and possibly deadly disease, especially when descending into the mediastinum. Due to the different specialities involved in the treatment and the heterogenous presentation of the disease, therapeutic standard is still controversial. This study analyzes treatment and outcome in these patients based on a large retrospective review and proposes a therapeutic algorithm. Methods The cases of 218 adult patients treated with deep neck abscesses over a 10-year period at a tertiary university hospital were analyzed retrospectively. Clinical, radiological, microbiological and laboratory findings were compared between patients with and without mediastinal involvement. Results Forty-five patients (20.64%) presented with abscess formation descending into the mediastinum. Those patients had significantly (all items p < 0.0001) higher rates of surgical interventions (4.27 vs. 1.11) and tracheotomies (82% vs. 3.4%), higher markers of inflammation (CRP 26.09 vs. 10.41 mg/dl), required more CT-scans (3.58 vs. 0.85), longer hospitalization (39.78 vs 9.79 days) and more frequently needed a change in antibiotic therapy (44.44% vs. 6.40%). Multi-resistant pathogens were found in 6.67% vs. 1.16%. Overall mortality rate was low with 1.83%. Conclusion Despite of the high percentage of mediastinal involvement in the present patient collective, the proposed therapeutic algorithm resulted in a low mortality rate. Frequent CT-scans, regular planned surgical revisions with local drainage and lavage, as well as an early tracheotomy seem to be most beneficial regarding the outcome.
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Affiliation(s)
- Thomas Gehrke
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
| | - Agmal Scherzad
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Stephan Hackenberg
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
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Lin Y, Gao W, Yue H, Chen W, Liu T, Ye J, Cai Q, Ye F, He L, Xie X, Xiong G, Wang B, Pang F, Li P, Wu J, Wang B, Huang J, Wen W, Lei W. A novel risk score for the prediction of airway management in patients with deep neck space abscess: a multicenter retrospective cohort study. J Intensive Care 2021; 9:41. [PMID: 34016187 PMCID: PMC8139013 DOI: 10.1186/s40560-021-00554-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Airway management, including noninvasive endotracheal intubation or invasive tracheostomy, is an essential treatment strategy for patients with deep neck space abscess (DNSA) to reverse acute hypoxia, which aids in avoiding acute cerebral hypoxia and cardiac arrest. This study aimed to develop and validate a novel risk score to predict the need for airway management in patients with DNSA. METHODS Patients with DNSA admitted to 9 hospitals in Guangdong Province between January 1, 2015, and December 31, 2020, were included. The cohort was divided into the training and validation cohorts. The risk score was developed using the least absolute shrinkage and selection operator (LASSO) and logistic regression models in the training cohort. The external validity and diagnostic ability were assessed in the validation cohort. RESULTS A total of 440 DNSA patients were included, of which 363 (60 required airway management) entered into the training cohort and 77 (13 required airway management) entered into the validation cohort. The risk score included 7 independent predictors (p < 0.05): multispace involvement (odd ratio [OR] 6.42, 95% confidence interval [CI] 1.79-23.07, p < 0.001), gas formation (OR 4.95, 95% CI 2.04-12.00, p < 0.001), dyspnea (OR 10.35, 95% CI 3.47-30.89, p < 0.001), primary region of infection, neutrophil percentage (OR 1.10, 95% CI 1.02-1.18, p = 0.015), platelet count to lymphocyte count ratio (OR 1.01, 95% CI 1.00-1.01, p = 0.010), and albumin level (OR 0.86, 95% CI 0.80-0.92, p < 0.001). Internal validation showed good discrimination, with an area under the curve (AUC) of 0.951 (95% CI 0.924-0.971), and good calibration (Hosmer-Lemeshow [HL] test, p = 0.821). Application of the clinical risk score in the validation cohort also revealed good discrimination (AUC 0.947, 95% CI 0.871-0.985) and calibration (HL test, p = 0.618). Decision curve analyses in both cohorts demonstrated that patients could benefit from this risk score. The score has been transformed into an online calculator that is freely available to the public. CONCLUSIONS The risk score may help predict a patient's risk of requiring airway management, thus advancing patient safety and supporting appropriate treatment.
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Affiliation(s)
- Yu Lin
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, People's Republic of China
| | - Wenxiang Gao
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, People's Republic of China
| | - Huijun Yue
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, People's Republic of China
| | - Weixiong Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, First People's Hospital of Foshan, Foshan, Guangdong, People's Republic of China
| | - Tianrun Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jin Ye
- Department of Otorhinolaryngology-Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - Qian Cai
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - Fei Ye
- Department of Otorhinolaryngology-Head and Neck Surgery, Zhongshan People's Hospital, Zhongshan, Guangdong, People's Republic of China
| | - Long He
- Department of Otorhinolaryngology-Head and Neck Surgery, First People's Hospital of Guangzhou, Guangzhou, Guangdong, People's Republic of China
| | - Xingqiang Xie
- Department of Otorhinolaryngology-Head and Neck Surgery, First People's Hospital of Zhaoqing, Zhaoqing, Guangdong, People's Republic of China
| | - Guoping Xiong
- Department of Otorhinolaryngology-Head and Neck Surgery, Jiangmen Central Hospital Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong, People's Republic of China
| | - Bin Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, First People's Hospital of Foshan, Foshan, Guangdong, People's Republic of China
| | - Feng Pang
- Department of Otorhinolaryngology-Head and Neck Surgery, Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - Pei Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jianhui Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, Zhongshan People's Hospital, Zhongshan, Guangdong, People's Republic of China
| | - Bin Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, First People's Hospital of Guangzhou, Guangzhou, Guangdong, People's Republic of China
| | - Junru Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Jiangmen Central Hospital Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong, People's Republic of China
| | - Weiping Wen
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, People's Republic of China
| | - Wenbin Lei
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan 2nd Road, Guangzhou, Guangdong, People's Republic of China.
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