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Wong CH, Chew SC. Neck Space Infection: A Retrospective Study of 40 Cases at a Tertiary Care Center in Sibu, Malaysia. Indian J Otolaryngol Head Neck Surg 2024; 76:2391-2403. [PMID: 38883552 PMCID: PMC11169142 DOI: 10.1007/s12070-024-04475-4] [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: 11/18/2023] [Accepted: 01/01/2024] [Indexed: 06/18/2024] Open
Abstract
This study is intended to explore the relationship of etiologies of neck space infection (NSI) and its prevalent microorganisms of NSI and to compare the treatments and its clinical outcomes with other studies. A retrospective study of 1 year duration from April 2022-April 2023 at ENT department Hospital Sibu includes total 40 NSI patients. 30 male and 10 female patients, with a male-to-female ratio of 3 were studied, with a mean age of 35.07 (± 18.25) years. Diabetes mellitus still constituted a high risk factor (27.3%), while patients with biohazard status (Hepatitis B and C) contributes 15.1%. There were 18 cases (45%) which etiology remained unknown, followed by odontogenic infection (27.5%), then upper respiratory tract infection (7.5%). 9 out of 40 patients required intensive care unit (ICU) care, with a median of 2.5 days ICU admission. Among the complications developed, airway obstruction (9 patients; 42.9%) was the most common. The most common infected neck space in our study was the submandibular space 18.1%; then the parapharyngeal space 13.3% and peritonsillar space 10.8%. The most common microorganism isolated was Streptococci Viridans (6 cases, 15%), followed by streptococcus pyogenes Group A (5 cases, 12.5%), then Klebsiella pneumoniae (4 cases, 10%). Interestingly, 62.5% of the neck infection cases were caused by single bacteria, while only 7.5% cases were infected by polymicrobial cause. Augmentin (amoxicillin and clavulanic acid) constitutes the highest proportion (40.4%) of first line antibiotics, while unasyn (ampicillin-sulbactam) was be a second substitute (13.5%). The duration of hospitalization ranged from 1 to 8 weeks, with a mean stay of 1.54 ± 1.49 weeks days. We achieved a high recovery rate of 97.5% with 1 patient died due to extensive small bowel ischemia.
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Affiliation(s)
- Chyau Hong Wong
- Hospital Sibu, 5 1/2KM, Jalan Oya, 96000 Sibu, Sarawak Malaysia
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Gozgec E, Sakat MS, Kilic K. A Case Report On the Potential for Spatial Spread of Parapharyngeal Abscess in A Diabetic Patient. EAR, NOSE & THROAT JOURNAL 2024:1455613231226035. [PMID: 38362856 DOI: 10.1177/01455613231226035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Affiliation(s)
- Elif Gozgec
- Department of Radiology, Ataturk University School of Medicine, Erzurum, Turkey
| | - Muhammed Sedat Sakat
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Korhan Kilic
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey
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van der Merwe P, Rule R, Olorunju S, Jacobs F. The empirical use of aminoglycosides in Ludwig's angina based on bacterial analysis of 63 cases. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101409. [PMID: 36738888 DOI: 10.1016/j.jormas.2023.101409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
PURPOSES To determine if the empirical use of aminoglycosides is justified in Ludwig's angina based on microscopy, culture and sensitivity results. METHODS A retrospective analysis was done on patients that presented with Ludwig's angina to the Maxillofacial and Oral surgery department at the University of Pretoria. Demographical data was extracted from patient files. Pus specimens that were submitted as part of the initial surgical intervention were analysed. RESULTS Sixty-three patients were included in the study with the majority, 76.19% (n=48/63), comprising males. The mean patient age was 38.6 years (range 6 months to 78 years). The majority of infections (87.3%) had an odontogenic aetiology (n=55/63). Forty-four percent of the patients had immunosuppressive co-morbidities (n=28/63). Streptococci contributed 71.26% (n=62/87) of the cultured bacteria. Similar bacteria were cultured in the immunocompromised and the immunocompetent patients (p=0.672). Ninety-two percent (n=57/62) of the streptococci cultured were sensitive to penicillin. The addition of aminoglycosides to the study sample would not have made a statistically significant difference (p=0.1556). CONCLUSION Based on the findings of this study, the empirical use of aminoglycosides is not warranted in either immunocompromised or immunocompetent patients with Ludwig's angina.
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Affiliation(s)
- Petrie van der Merwe
- Department of Maxillofacial and Oral Surgery, Faculty of Health Sciences, School of Dentistry, Oral and Dental Hospital, University of Pretoria, C/o Steve Biko and Dr Savage Roads, Gezina, Pretoria 0002, South Africa.
| | - Roxanne Rule
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; Department of Medical Microbiology, National Health Laboratory Services, Tshwane Academic Division, Pretoria, South Africa
| | - Steve Olorunju
- Biostatistics Unit (Pretoria office), South African Medical Research Council (SAMRC), South Africa
| | - Fred Jacobs
- Department of Maxillofacial and Oral Surgery, Faculty of Health Sciences, School of Dentistry, Oral and Dental Hospital, University of Pretoria, C/o Steve Biko and Dr Savage Roads, Gezina, Pretoria 0002, South Africa
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Desa C, Tiwari M, Pednekar S, Basuroy S, Rajadhyaksha A, Savoiverekar S. Etiology and Complications of Deep Neck Space Infections: A Hospital Based Retrospective Study. Indian J Otolaryngol Head Neck Surg 2023; 75:697-706. [PMID: 37275082 PMCID: PMC10235246 DOI: 10.1007/s12070-022-03428-z] [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: 02/08/2022] [Accepted: 12/19/2022] [Indexed: 01/01/2023] Open
Abstract
Infections of the deep spaces of the neck often present a true clinical challenge to a Head and Neck surgeon which may rapidly spread due to the various connections between the spaces resulting in morbidity and mortality. This study aims to obtain knowledge about various DNSI's and their predisposing factors.. It was a hospital based retrospective cross-sectional study done in Goa Medical College, India. A total of 300 patients who presented with DNSI's over the past 7 years were studied. Simple proportions and percentages were calculated and Chi-square test was used to study associations. A total of 300 patients were evaluated and male preponderance was seen. Most of the patients were seen belonging to the pediatric age group (26%). Infections of dental origin (45.67%) were the most common etiological factor associated with poor oral hygiene and tobacco chewing (12.67%). Major comorbidities were anemia (34%) and diabetes (19.3%) which were directly related to the complications. The most common complication was airway compromise (14.66%) which was treated by tracheostomy. DNSI should be treated like a medical as well as a surgical emergency which can be life-threatening especially in diabetics and elderly who are immunocompromised and need special attention. Odontogenic infections associated with poor oral hygiene and tobacco chewing could be prevented by educating the population about oral hygiene.
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Affiliation(s)
- Carnegie Desa
- Department of ENT, Goa Medical College, Bambolim, Goa India
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Ho CY, Chan KC, Wang YC, Chin SC, Chen SL. Assessment of Factors Associated With Long-Term Hospitalization in Patients With a Deep Neck Infection. EAR, NOSE & THROAT JOURNAL 2023:1455613231168478. [PMID: 37010020 DOI: 10.1177/01455613231168478] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Deep neck infection (DNI) is a severe infectious disorder of deep neck spaces that can cause serious complications. Long-term hospitalization is when a patient spends more time in the hospital than originally expected for a disease. There are few studies assessing the risk factors associated with long-term hospitalization for a DNI. This study investigated the factors causing DNI patients to experience long-term hospitalization. METHODS Long-term hospitalization is defined as a length of hospital stay exceeding 28 days (> 4 weeks) in this research. A total of 362 subjects with a DNI between October 2017 and November 2022 were recruited. Among these patients, 20 required long-term hospitalization. The relevant clinical variables were assessed. RESULTS In a univariate analysis, C-reactive protein (odds ratio [OR] = 1.003, 95% CI: 1.000-1.007, P = .044), involvement of ≥3 deep neck spaces (OR = 2.836, 95% CI: 1.140-7.050, P = .024), and mediastinitis (OR = 8.102, 95% CI: 3.041-21.58, P < .001) were significant risk factors for long-term hospitalization in DNI patients. In a multivariate analysis, mediastinitis (OR = 6.018, 95% CI: 2.058-17.59, P = .001) was a significant independent risk factor for long-term hospitalization for a DNI. There were no significant differences in pathogens between the patients with and without long-term hospitalization (all P > .05). However, the rates of no growth of specific pathogens were significantly different between patients with and without long-term hospitalization, and those with long-term hospitalization had greater rates of growth of specific pathogens (P = .032). The rate of tracheostomy in patients with long-term hospitalization was higher than for those without (P < .001). Nevertheless, the rates of surgical incision and drainage between patients with and without long-term hospitalization did not achieve statistical significance (P = .069). CONCLUSIONS Deep neck infection (DNI) is a critical, life-threatening disease that could lead to long-term hospitalization. The higher CRP and involvement of ≥3 deep neck spaces were significant risk factors in univariate analysis, while concurrent mediastinitis was an independent risk factor associated with long-term hospitalization. We suggest intensive care and prompt airway protection for DNI patients with concurrent mediastinitis.
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Affiliation(s)
- Chia-Ying Ho
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kai-Chieh Chan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Chien Wang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Otorhinolaryngology & Head and Neck Surgery, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
| | - Shy-Chyi Chin
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shih-Lung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
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Singhal G, Jain S, Sen K. Clinical Presentation and Microbiological Profile of Deep Neck Space Infections in Different Age Groups. Indian J Otolaryngol Head Neck Surg 2022; 74:1870-1876. [PMID: 36452853 PMCID: PMC9702455 DOI: 10.1007/s12070-020-01869-y] [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: 02/10/2020] [Accepted: 04/29/2020] [Indexed: 11/29/2022] Open
Abstract
Deep neck space infection (DNI), is defined as infections in the deep fascia enclosing potential spaces of the neck. In the past the diagnosis and treatment of DNI have challenged. The health care personnel at all levels. The complex anatomy and the deep location of this region remains a big problem with significant risks of morbidity and mortality. The aim of this study is to analyse the difference in clinical presentation and microbiology of DNI in different age groups. Eighty two patients with DNI which were managed at the Department of Otorhinolaryngology, ABVIMS and Dr. Ram Manohar Lohia Hospital New Delhi, between November 2017 and March 2019 formed the basis of our prospective cross sectional observational study. We observed that DNI is a frequent and potentially life threatening condition in children and adults despite the use of antibiotics. For appropriate surgical management knowledge of complex spaces of the neck and their communication with the other spaces is necessary.
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Affiliation(s)
- Gaurang Singhal
- Department of ENT, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, Baba Kharag Singh MARG, New Delhi, 110001 India
| | - Shalini Jain
- Department of ENT, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, Baba Kharag Singh MARG, New Delhi, 110001 India
| | - Kanwer Sen
- Department of ENT, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, Baba Kharag Singh MARG, New Delhi, 110001 India
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Swain S, Lenka S, Jena P. Deep neck abscess: Our experiences at a tertiary care teaching Hospital of Eastern India. MATRIX SCIENCE MEDICA 2022. [DOI: 10.4103/mtsm.mtsm_15_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lan P, Zhao D, Gu J, Shi Q, Yan R, Jiang Y, Zhou J, Yu Y. Genome-Based Analysis of a Sequence Type 1049 Hypervirulent Klebsiella pneumoniae Causing Bacteremic Neck Abscess. Front Microbiol 2021; 11:617651. [PMID: 33537016 PMCID: PMC7848818 DOI: 10.3389/fmicb.2020.617651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/24/2020] [Indexed: 01/05/2023] Open
Abstract
Hypervirulent Klebsiella pneumoniae (hvKP) has raised grave concerns in recent years and can cause severe infections with diverse anatomic locations including liver abscess, meningitis, and endophthalmitis. However, there is limited data about neck abscess caused by hvKP. A K. pneumoniae strain Kp_whw was isolated from neck abscess. We characterized the genetic background, virulence determinates of the strain by genomic analysis and dertermined the virulence level by serum resistance assay. Kp_whw belonged to sequence type (ST) 1049 K locus (KL) 5. Kp_whw showed hypermucoviscosity phenotype and was resistant to ampicillin but susceptible to the majority of the other antimicrobial agents. A pLVPK-like virulence plasmid and a chromosomal ICEKp5-like mobile genetic element were carried by Kp_whw, resulting in the risk of dissemination of hypervirulence. The strain exhibited relative higher level of core genome allelic diversity than accessory genome profile, in comparison to hvKP of K1/K2 serotype. Kp_whw was finally demonstrated as virulent as the ST23 K1 serotype hvKP strain NTUH-K2044 in vitro. In conclusion, this work elaborates the genetic background of a clinical hvKP strain with an uncommon ST, reinforcing our understanding of virulence mechanisms of hvKP.
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Affiliation(s)
- Peng Lan
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China.,Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dongdong Zhao
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiong Gu
- Department of Infectious Diseases, The First Hospital of Jiaxing, Zhejiang, China
| | - Qiucheng Shi
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
| | - Rushuang Yan
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China.,Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Jiang
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
| | - Jiancang Zhou
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunsong Yu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China
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Ahmad R, Haque M. Oral Health Messiers: Diabetes Mellitus Relevance. Diabetes Metab Syndr Obes 2021; 14:3001-3015. [PMID: 34234496 PMCID: PMC8257029 DOI: 10.2147/dmso.s318972] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/19/2021] [Indexed: 12/13/2022] Open
Abstract
This article aims to narrate the various oral complications in individuals suffering from diabetes mellitus. Google search for "diabetes mellitus and oral complications" was done. The search was also carried out for "diabetes mellitus" and its oral complications individually. Diabetes mellitus is a chronic metabolic disorder that is a global epidemic and a common cause of morbidity and mortality in the world today. Currently, there are about 422 million cases of diabetes mellitus worldwide. Diabetic patients can develop different complications in the body such as retinopathy, neuropathy, nephropathy, cardiovascular disease. Complications in the oral cavity have been observed in individuals suffering from diabetes mellitus. A study noted that more than 90% of diabetic patients suffered from oral complications. Another research has shown a greater prevalence of oral mucosal disorders in patients with diabetes mellitus than non-diabetic population: 45-88% in patients with type 2 diabetes compared to 38.3-45% in non-diabetic subjects and 44.7% in type 1 diabetic individuals compared to 25% in the non-diabetic population. Oral complications in people with diabetes are periodontal disease, dental caries, oral infections, salivary dysfunction, taste dysfunction, delayed wound healing, tongue abnormalities, halitosis, and lichen planus. The high glucose level in saliva, poor neutrophil function, neuropathy, and small vessel damage contribute to oral complications in individuals with uncontrolled diabetes. Good oral health is imperative for healthy living. Oral complications cause deterioration to the quality of life in diabetic patients. Complications like periodontal disease having a bidirectional relationship with diabetes mellitus even contribute to increased blood glucose levels in people with diabetes. This article intends to promote awareness regarding the oral health of diabetics and to stress the importance of maintaining proper oral hygiene, taking preventive measures, early detection, and appropriate management of oral complications of these patients through a multidisciplinary approach.
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Affiliation(s)
- Rahnuma Ahmad
- Department of Physiology, Medical College for Women and Hospital, Dhaka, Bangladesh
| | - Mainul Haque
- The Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, 57000, Malaysia
- Correspondence: Mainul Haque The Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur, 57000, Malaysia Email
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Suehara AB, Rodrigues AAN, Kavabata NK, Menezes MB, Ramos EDEA, Kawamukai JN, GonÇalves AJ. Predictive factors of lethality and complications of deep fascial space infections of the neck. Rev Col Bras Cir 2020; 47:e20202524. [PMID: 32901705 DOI: 10.1590/0100-6991e-20202524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/09/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify predictive factors for lethality and complications of deep fascial space infections of the neck (DFSIN), establishing an early and aggressive treatment in the neck before the progression to descending mediastinitis. METHODS we retrospectively analyzed 133 cases of DFSIN treated at Discipline of Head and Neck Surgery of the Medicine School of Santa Casa de Misericórdia de São Paulo. We accessed demographic characteristics, associated diseases, clinical presentation, laboratorial tests, length of hospital stay, number of involved anatomic neck spaces, intra-operative and microbiology findings. We analyzed these data using logistic regression to predict DFSIN lethality and life threatening complications (mediastinitis, septic shock, pneumonia, pleural empyema, skin necrosis). RESULTS lethality and complication ratios were 9% and 50.3%, respectively. The logistic regression model showed that patients with septic shock were more likely to have progression to death (p < 0.001) and, the presence of more than two involved neck spaces (p < 0.001) and older individuals (p = 0.017) were more likely to have complicated deep neck infections. Descending necrotizing mediatinitis increased the lethality ratio by 50%, and was associated to necrotizing fasciitis (p=0.012) and pleural empyema (p<0.001). CONCLUSION septic shock is a lethal predictive factor and age as well as more than two involved neck spaces are the predictive factors for complications. Necrotizing fasciitis is an important factor for complications and death. Therefore, its surgical treatment must be more aggressive. Descending mediastinitis has a high lethal rate and the successful treatment is based on early diagnosis and aggressive surgical approach.
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Affiliation(s)
- Alexandre BabÁ Suehara
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia, Disciplina de Cirurgia de Cabeça e Pescoço - São Paulo - SP - Brasil
| | | | - Norberto Kodi Kavabata
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia, Disciplina de Cirurgia de Cabeça e Pescoço - São Paulo - SP - Brasil
| | - Marcelo Benedito Menezes
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia, Disciplina de Cirurgia de Cabeça e Pescoço - São Paulo - SP - Brasil
| | - Evelyn DE Almeida Ramos
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, acadêmica - São Paulo - SP - Brasil
| | | | - Antonio JosÉ GonÇalves
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia, Disciplina de Cirurgia de Cabeça e Pescoço - São Paulo - SP - Brasil
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Complicated Posterior Cervical Skin and Soft Tissue Infections at a Single Referral Center. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5230763. [PMID: 32802854 PMCID: PMC7424528 DOI: 10.1155/2020/5230763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 07/21/2020] [Indexed: 11/17/2022]
Abstract
Background Although the incidence and mortality of complicated skin and soft tissue infections have decreased, this infection is still relatively frequent and can be associated with lethal complications. In this study, the authors present our clinical experience of patients with complicated posterior cervical skin and soft tissue infections (CPCSSTIs) diagnosed and treated in a reconstructive unit in northeastern China. Methods A retrospective chart review of patients diagnosed with CPCSSTIs from January 2009 to December 2018 was performed. To make the results objective and convincing, a data analysis was performed relating to demographic characteristics, clinical presentation, predisposing factor, bacterial culture, laboratory and radiographic evaluations, diagnostic clues, management, and complications as well as the clinical course and outcome. Results During the ten-year period, there were 174 consecutive patients admitted to our reconstructive center with final diagnosis of CPCSSTIs included. All the patients were adults, and the majority were male (67.2%). The patient's mean age was 51.3 years (range, 15-88 years). There were 114 patients (65.5%) that had associated systemic diseases, with diabetes mellitus (40.2%) as the most common predisposing factor. Common presented clinical symptoms were pain (90.8%), swelling (85.1%), and erythema (77%) of the neck. Surgical treatment was performed in all the patients, and most of them (83.9%) received the first surgery within 24 h. The most commonly isolated pathogen was Staphylococcus aureus (30%). Vancomycin (21.3%) was the most commonly used antibiotics, followed by cefepime (18.4%). All the patients survived and were discharged with a mean duration of hospitalization of 28.7 days. Those patients with predisposing factors (31.4 ± 12.35 days) or complications (41.0 ± 12.5 days) tended to have a longer hospital stay. The mean total costs of admission per patient were 47 644 RMB. Conclusion This study highlights the high cost burden of CPCSSTI patients. Those patients with predisposing factors or complications tended to have a longer hospital stay.
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O'Brien KJ, Snapp KR, Dugan AJ, Westgate PM, Gupta N. Risk Factors Affecting Length of Stay in Patients with Deep Neck Space Infection. Laryngoscope 2019; 130:2133-2137. [PMID: 31763702 DOI: 10.1002/lary.28367] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/13/2019] [Accepted: 09/30/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Analyze risk factors affecting length of stay (LOS) for patients presenting with deep neck space infections including care by medical versus surgical team. METHODS This is a retrospective chart review from January 2005 through May 2018 at the University of Kentucky analyzing factors related to deep neck space abscesses. Patients included adults >18 years old admitted for deep neck space infections undergoing surgical intervention. This study compared effects of treatment on a medical versus surgical service on LOS while accounting for patient confounders. Independent variables included age, gender, tobacco use, medical comorbidities, Charlson comorbidity index, American Society of Anesthesiology (ASA) classification, presence of drain, readmissions, and repeat surgical interventions. Univariate and multivariate analysis were performed. RESULTS One hundred sixty-three patients were included in the analysis. LOS was significantly longer for those on medicine services (P < .001). Patients on medicine services had a higher incidence of diabetes (P = .011), higher Charlson comorbidity score (P = .001), and higher incidence of repeat interventions (P = .005). Postoperative LOS remained lower for patients on a surgical service (P = .009) after adjusting for Charlson comorbidity scores. Presence of a drain or tobacco use was not significant between service management (P = .89; P = .63) or LOS (P = .366; P = .225). CONCLUSION Increased postoperative LOS was associated with age, diabetes, ASA class, Charlson comorbidity index, and repeat procedures. Patients on a medicine service had longer LOS and higher comorbidity indices. Patients had shorter hospital stays on surgical services after adjusting for comorbidity indices. Use of a drain or presence of tobacco use did not affect LOS. LEVEL OF EVIDENCE 3 Laryngoscope, 130:2133-2137, 2020.
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Affiliation(s)
- Kaitlin July O'Brien
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Kaitlin R Snapp
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Adam J Dugan
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Philip M Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Nikita Gupta
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
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13
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Jayagandhi S, Cheruvu SC, Manimaran V, Mohanty S. Deep Neck Space Infection: Study of 52 Cases. Indian J Otolaryngol Head Neck Surg 2019; 71:923-926. [PMID: 31742095 DOI: 10.1007/s12070-019-01592-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022] Open
Abstract
Deep neck spaces are still common in developing countries like India, even though its less prevalent in developed nations. It can lead to serious complications like jugular vein thrombosis and dissemination of infection if not diagnosed early and intervened. This is a retrospective chart review of 52 patients from 2014 to 2017 in a tertiary care hospital. Only patients with infection deeper to the superficial fascia of neck were included. Submandibular space infection was the most common and precipitating factor being dental infection. Most common comorbid condition was diabetes mellitus. Klebsiella pneumoniae was the most common isolated organism and few patients had mixed culture with anaerobes. Injectable cephalosporin with metronidazole was the most effective antibiotic combination against such infections. Low threshold for early surgical intervention reduce hospital stay and enable quick recovery of patients. Usage of over the counter antibiotics masks the conditions and complicate diagnosis and treatment of this condition.
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Affiliation(s)
- Sathishkumar Jayagandhi
- Department of ENT Head and Neck Surgery, Sri Ramachandra Medical College and Hospital, Porur, Chennai, 600116 India
| | - Saranya Chithra Cheruvu
- Department of ENT Head and Neck Surgery, Sri Ramachandra Medical College and Hospital, Porur, Chennai, 600116 India
| | - Vinoth Manimaran
- Department of ENT Head and Neck Surgery, Sri Ramachandra Medical College and Hospital, Porur, Chennai, 600116 India
| | - Sanjeev Mohanty
- Department of ENT Head and Neck Surgery, Sri Ramachandra Medical College and Hospital, Porur, Chennai, 600116 India
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