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Neal TW, Carr BR, Schlieve T. Are higher odontogenic infection severity scores associated with difficult intubations? Oral Maxillofac Surg 2024; 28:435-440. [PMID: 37326786 DOI: 10.1007/s10006-023-01168-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE This study aimed to determine if there is a relation between odontogenic infection severity score (OISS) and difficult intubation at the time of surgical treatment for severe odontogenic infections (SOI). A secondary goal of this study was to determine the utility of OISS as a predictor of difficult intubations. METHODS This retrospective cohort study was composed of consecutive patients admitted and surgically treated in the operating room (OR) for SOIs. Patients with an OISS ≥ 5 were designated as Group 1 and < 5 Group 2. RESULTS There was a statistically significant difference in difficult intubations between the two groups (p = 0.018). Patients with an OISS ≥ 5 were nearly four times more likely to be difficult intubations compared to patients with an OISS < 5 (OR 3.70, 95% CI 1.19-11.45). When OISS ≥ 5 was used to predict difficult intubation, the sensitivity was 69%, the specificity was 63%, the positive predictive value was 23%, and the negative predictive value was 93%. CONCLUSION OISS ≥ 5 was associated with a higher prevalence of difficult intubations compared to an OISS < 5. OISS may provide clinically relevant data that can be used with established risk factors, laboratory values, and clinical judgment.
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Affiliation(s)
- Timothy W Neal
- Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, USA.
| | - Brian R Carr
- Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, USA
| | - Thomas Schlieve
- Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, USA
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Neal TW, Schlieve T. Complications of Severe Odontogenic Infections: A Review. BIOLOGY 2022; 11:biology11121784. [PMID: 36552293 PMCID: PMC9775288 DOI: 10.3390/biology11121784] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
Severe odontogenic infections are routinely treated with little associated morbidity and mortality. Improvements in surgical techniques, antibiotic treatments, and imaging modalities have made associated complications exceedingly rare. A number of complications have been described in the literature including airway obstruction, descending necrotizing mediastinitis, orbital abscess, septic cavernous sinus thrombosis, cerebral abscess, sepsis, necrotizing fasciitis, and Lemierre's syndrome. The purpose of this article is to discuss the pathophysiology of severe odontogenic infections and the risk factors associated with the development of complications. Given the morbidity and mortality of these conditions, it is important to review the clinical features of each and the diagnostic tools that aid in early recognition.
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Akram ZM, Khalid KB, Oraibi QK, Nassar MF. Antimicrobial resistance of bacterial pathogens isolated from the infections of post maxillofacial surgery. J Med Life 2022; 15:944-950. [PMID: 36188658 PMCID: PMC9514827 DOI: 10.25122/jml-2021-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 02/25/2022] [Indexed: 11/17/2022] Open
Abstract
Inappropriate antibiotic prescriptions contributed to a global issue of antimicrobial resistance. This study aimed to assess the prevalence of bacterial pathogens and antimicrobial resistance isolated from maxillofacial infections (MIs). Two hundred and twenty-two patients with different MIs were included in this study. Swab samples were taken from the site of infections. Samples were cultured, and isolated bacteria were identified using various biochemical tests. Antimicrobial resistance patterns of isolates were assessed by the disk diffusion method. The mean age of the patients was 50.8 years. The male-to-female ratio was 127/95 (P<0.05). Smoking and alcohol consumption were found in 60.36% and 37.38% of patients, respectively. Most patients had a ≤1-week infection duration (P<0.05). Abscess lesion was the most predominant infection type (P<0.05). The prevalence of aerobic bacteria among abscess, pus localization, and deep facial infections was 59.33%, 64.28%, and 46.66%, respectively. The prevalence of anaerobic bacteria among abscess, pus localization, and deep facial infections was 40.66%, 23.80%, and 53.33%, respectively. Staphylococcus aureus (10.36%) and Prevotella buccalis (8.55%) had the uppermost distribution amongst all examined samples. Isolated bacteria exhibited the uppermost resistance rate toward penicillin (65.76%), tetracycline (61.26%), gentamicin (58.10%), and ampicillin (57.65%) antimicrobials. The lowest resistance rate was obtained for linezolid (25.67%), ceftriaxone (31.08%), and azithromycin (31.08%) antimicrobials. Linezolid, ceftriaxone, and azithromycin had effective antimicrobial activities toward bacteria isolated from MIs. Therefore, cautious antibiotic prescription might decrease the prevalence of antimicrobial resistance in dental and maxillofacial infections.
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Affiliation(s)
- Zaid Mustafa Akram
- Department of Dentistry, Al-Rafidain University College, Baghdad, Iraq,Corresponding Author: Zaid Mustafa Akram, Department of Dentistry, Al-Rafidain University College, Baghdad, lraq. E-mail:
| | | | | | - Maadh Fawzi Nassar
- Department of Chemistry, Faculty of Science, University Putra Malaysia, Selangor, Malaysia
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Maeda K, Hirai Y, Nashi M, Yamamoto S, Taniike N, Takenobu T. Clinical features and antimicrobial susceptibility of oral bacteria isolated from the blood cultures of patients with infective endocarditis. J Dent Sci 2022; 17:870-875. [PMID: 35756779 PMCID: PMC9201522 DOI: 10.1016/j.jds.2021.09.023] [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: 08/30/2021] [Revised: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background/purpose The epidemiology of infective endocarditis (IE) is under constant change due to the aging society and increases in antimicrobial-resistant pathogens. However, IE remains severe. This study aimed to review the current clinical characteristics of IE and the antimicrobial susceptibility of oral bacteria (OB) isolated from blood cultures to implement appropriate antimicrobial prophylaxis. Materials and methods We retrospectively investigated the clinical features of 180 patients with IE in whom OB and pathogens except OB (eOB) were identified as causative microorganisms via blood cultures. The susceptibility of the OB group to eight antibiotics was examined by broth microdilution. Results Among causative microorganisms, the isolation rate of staphylococci was slightly higher than that of OB; however, the difference was not significant (36.7% vs. 33.8%, p = 0.3203). The number of patients with underlying cardiac disease was significantly higher in the OB group than in the eOB group (53.7% vs. 34.1%, p = 0.0113). Only one ampicillin-resistant OB was detected (2.0%). OBs were significantly less susceptible to clarithromycin and azithromycin than to ampicillin (98.0% vs. 66.7% and 98.0% vs. 60.0%, p = 0.0003 and p = 0.0003, respectively). Moreover, OBs were significantly less susceptible to clarithromycin and azithromycin than to clindamycin (66.7% vs. 88.2% and 60.0% vs. 88.2%, p = 0.0301 and p = 0.0217, respectively). Conclusion OBs were susceptible to ampicillin. However, the susceptibility of OBs to clarithromycin and azithromycin was significantly lower than that to ampicillin and clindamycin. These results are important and should help decisions regarding guide antimicrobial prophylaxis.
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Affiliation(s)
- Keigo Maeda
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
- Department of Fixed Prosthodontics and Occlusion, Osaka Dental University, Osaka, Japan
| | - Yuzo Hirai
- Department of Oral and Maxillofacial Surgery, Nishi-Kobe Medical Center, Kobe, Japan
| | - Masanori Nashi
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shinsuke Yamamoto
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Naoki Taniike
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Toshihiko Takenobu
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
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Limardo A, Blanco L, Menéndez J, Ortega A. Ultrasound-guided Drainage vs Surgical Drainage of Deep Neck Space Abscesses: A Randomized Controlled Trial. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:4-10. [DOI: 10.1016/j.otoeng.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022]
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Neal TW, Hammad Y, Carr BR, Schlieve T. The Cost of Surgically Treated Severe Odontogenic Infections: A Retrospective Study Using Severity Scores. J Oral Maxillofac Surg 2022; 80:897-901. [DOI: 10.1016/j.joms.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/02/2022] [Accepted: 01/02/2022] [Indexed: 11/16/2022]
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Limardo A, Blanco L, Menéndez J, Ortega A. Ultrasound-guided drainage vs surgical drainage of deep neck space abscesses: A randomized controlled trial. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 73:S0001-6519(20)30167-9. [PMID: 34301374 DOI: 10.1016/j.otorri.2020.08.004] [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: 05/27/2020] [Revised: 08/01/2020] [Accepted: 08/03/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The most common cause of deep neck infections is dental infection. They are diagnosed with physical examination, imaging studies, ultrasound, or computed tomography. Surgical drainage of collections should always be performed early in a classical or percutaneous way, depending on the case. The aim of the study was to compare ultrasound-guided percutaneous drainage techniques vs. surgical drainage in deep cervical abscesses of odontogenic origin in a controlled and randomized trial. METHODS A randomized controlled clinical trial was performed from January 2015 to December 2019. Hospital stay was evaluated as an efficiency variable. Epidemiological and secondary variable data (tumour, trismus, fever, pain), leukocytosis, cosmetic result comparing both techniques were analysed. Statistical analysis was carried out with STATA v 14.0. RESULTS 128 patients were analysed, 51 women and 77 men. Average age 27.3 (SD = 10.13). The percutaneous group had a mean hospital stay of 3.03 (SD = 2.86) days and the surgical group 5.46 (SD = 2.96). The p-value was <.001. Cosmetic results showed differences favouring the percutaneous drainage group. None of the other variables showed statistically significant results. DISCUSSION Surgical treatment (cervicotomy and debridement) should be undertaken early with evidence of extensive collection in deep spaces. Minimally invasive image-guided procedures are an alternative. These can be performed in well-located, unilocular collections, without compromising of the patient's airway. Percutaneous drainage and suction techniques if necessary, serially, or drainage placement may be performed. CONCLUSIONS Ultrasound-guided and serially guided percutaneous drainage is the best therapeutic option in patients with mild and/or moderate dental infections.
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Affiliation(s)
- Andrés Limardo
- Sección de Cirugía de Cabeza y Cuello, Hospital Prof. A. Posadas, El Palomar, Argentina; Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Luis Blanco
- Sección de Cirugía de Cabeza y Cuello, Hospital Prof. A. Posadas, El Palomar, Argentina; Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - José Menéndez
- Sección de Cirugía de Cabeza y Cuello, Hospital Prof. A. Posadas, El Palomar, Argentina
| | - Adrían Ortega
- Sección de Cirugía de Cabeza y Cuello, Hospital Prof. A. Posadas, El Palomar, Argentina
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Ho MH, Claudia JC, Tai WC, Huang KY, Lai CH, Chang CH, Chang YC, Wu YC, Kuo MYP, Chang PC. The treatment response of barrier membrane with amoxicillin-loaded nanofibers in experimental periodontitis. J Periodontol 2020; 92:886-895. [PMID: 32996124 DOI: 10.1002/jper.20-0256] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/11/2020] [Accepted: 09/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Infection control is a major determinant of guided tissue regeneration (GTR). This study aims to develop an antibiotic-loaded membrane to assist periodontal repair. METHODS Poly(D,L-lactic acid) (PDLLA) nanofibers encapsulating amoxicillin (PDLLA-AMX) were fabricated using the electrospinning technique, and their structures, drug encapsulation efficiency, and release characteristics were assessed. The viability and behaviors of periodontal ligament (PDL) cells on nanofibers, and antibacterial capabilities of nanofibers were evaluated in vitro. Early therapeutic efficiency of the antibiotic-loaded membranes was investigated in rats with ligature-induced experimental periodontitis, and the outcomes were evaluated by gene expression, microcomputed tomography imaging, and histology within 7 days of membrane placement. RESULTS AMX was successfully encapsulated in the PDLLA nanofibers and released in a sustained manner. After initial attachment was achieved, cells stretched out along with the directions of nanofibers. The viability and expression of migration-associated gene of PDL cells were significantly improved, and the growth of Streptococcus sanguinis and Porphyromonas gingivalis was significantly reduced in the PDLLA-AMX group compared with the controls. On PDLLA-AMX-treated sites, wound dehiscence and sulcular inflammation were reduced. Collagen fiber matrix deposition was accelerated with upregulated type I collagen and interleukin-1β, and downregulated matrix metalloproteinase-8, whereas periodontal bone level and the expressions of vascular endothelial growth factor and core-binding factor subunit alpha-1 were equivalent to conventional membrane treatment. CONCLUSIONS PDLLA-AMX nanofibers inhibited bacterial growth and promoted the viability and mobility of PDL cells after initial cell attachment. Membranes with PDLLA-AMX nanofibers reduced inflammation and accelerated periodontal repair at an early stage, providing good prospects for the further development of GTR membranes.
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Affiliation(s)
- Ming-Hua Ho
- Department of Chemical Engineering, College of Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Jeannete Cindy Claudia
- Department of Chemical Engineering, College of Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Wei-Chiu Tai
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Kuan-Yu Huang
- Department of Chemical Engineering, College of Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Chern-Hsiung Lai
- College of Life Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-He Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Ying-Chieh Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Yu-Chang Wu
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Mark Yen-Ping Kuo
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan.,Division of Periodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Chun Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan.,Division of Periodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Nadig K, Taylor NG. Management of odontogenic infection at a district general hospital. Br Dent J 2019; 224:962-966. [PMID: 29999002 DOI: 10.1038/sj.bdj.2018.445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 11/09/2022]
Affiliation(s)
- K Nadig
- Royal Surrey County Hospital, Department of Oral & Maxillofacial Surgery, Egerton Road, Guildford, GU2 7XX
| | - N G Taylor
- Royal Surrey County Hospital, Department of Oral & Maxillofacial Surgery, Egerton Road, Guildford, GU2 7XX
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10
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Katoumas K, Anterriotis D, Fyrgiola M, Lianou V, Triantafylou D, Dimopoulos I. Epidemiological analysis of management of severe odontogenic infections before referral to the emergency department. J Craniomaxillofac Surg 2019; 47:1292-1299. [PMID: 31331847 DOI: 10.1016/j.jcms.2019.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/29/2019] [Accepted: 05/04/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aims of the present study are to present the epidemiology and management of patients hospitalized with odontogenic infections in a major Greek hospital from 2015 to 2016 and to find out whether the basic principles of management of odontogenic infections were followed before referral to the emergency department of the Oral and Maxillofacial Surgery Clinic (OMFSED). METHODS A retrospective study of the patients hospitalized with odontogenic infections was performed, including management both prior and after referral to the OMFSED. RESULTS During the two-year period from 2015 to 2016, 102 patients, 54 men (52.9%) and 48 women (47.1%) were hospitalized with severe odontogenic infections. The most common space involved in severe odontogenic infections was the submandibular (52.9%), and in 31.4% of the patients multiple spaces were involved. The lower third molars were the most common cause (36.5%). In 83 patients (81.4%) the tooth causing the infection had not received any treatment whatsoever and in all cases (100%) no decision for early incision and drainage prior to the referral to the OMFSED was made. CONCLUSION The data presented reveal that the basic principles of management of odontogenic infections are not followed before referral of the patients to the OMFSED.
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Affiliation(s)
- Konstantinos Katoumas
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "G. Gennimatas", Leoforos Mesogion 154, 11527, Athens, Greece.
| | - Dimitrios Anterriotis
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "G. Gennimatas", Leoforos Mesogion 154, 11527, Athens, Greece.
| | - Maria Fyrgiola
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "G. Gennimatas", Leoforos Mesogion 154, 11527, Athens, Greece.
| | - Violetta Lianou
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "G. Gennimatas", Leoforos Mesogion 154, 11527, Athens, Greece.
| | - Dimitrios Triantafylou
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "G. Gennimatas", Leoforos Mesogion 154, 11527, Athens, Greece.
| | - Ioannis Dimopoulos
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "G. Gennimatas", Leoforos Mesogion 154, 11527, Athens, Greece.
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López-González E, Vitales-Noyola M, González-Amaro AM, Méndez-González V, Hidalgo-Hurtado A, Rodríguez-Flores R, Pozos-Guillén A. Aerobic and anaerobic microorganisms and antibiotic sensitivity of odontogenic maxillofacial infections. Odontology 2019; 107:409-417. [PMID: 30758697 DOI: 10.1007/s10266-019-00414-w] [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: 12/01/2018] [Accepted: 01/27/2019] [Indexed: 12/21/2022]
Abstract
This study aimed to identify the aerobic and anaerobic causal microorganisms of odontogenic infections and their antibiotic sensitivity. Purulent exudates were taken from patients with odontogenic infections by transdermal puncture, and aerobic and anaerobic microorganisms were identified using biochemical tests. Susceptibility to antibiotics was tested using the Kirby-Bauer method; the inhibition halos were measured according to NCCLS, and based on the results, the microorganisms were classified as susceptible, intermediate or resistant to each antibiotic. Frequencies of species and percentages of resistance were calculated. The microorganisms associated with odontogenic infections were principally anaerobic (65.3% anaerobic vs. 35.7% aerobic), and the susceptibility to antibiotics was higher in anaerobic than in aerobic microorganisms. The majority of isolated microorganisms (82%) showed susceptibility to amoxicillin/clavulanic acid. The causal agents of odontogenic infections were anaerobic microorganisms, which exhibited high resistance to antibiotics.
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Affiliation(s)
- Emmanuel López-González
- Endodontics Posgraduated Program, Faculty of Dentistry, San Luis Potosí University, San Luis Potosí, SLP, Mexico
| | - Marlen Vitales-Noyola
- Endodontics Posgraduated Program, Faculty of Dentistry, San Luis Potosí University, San Luis Potosí, SLP, Mexico
| | - Ana María González-Amaro
- Endodontics Posgraduated Program, Faculty of Dentistry, San Luis Potosí University, San Luis Potosí, SLP, Mexico
| | - Verónica Méndez-González
- Endodontics Posgraduated Program, Faculty of Dentistry, San Luis Potosí University, San Luis Potosí, SLP, Mexico
| | - Antonio Hidalgo-Hurtado
- Department of Oral and Maxillofacial Surgery, Hospital "Ignacio Morones Prieto", San Luis Potosí, SLP, Mexico
| | - Rosaura Rodríguez-Flores
- Department of Oral and Maxillofacial Surgery, Hospital No. 50 of Mexican Social Security Institute, San Luis Potosí, SLP, Mexico
| | - Amaury Pozos-Guillén
- Basic Sciences Laboratory, Faculty of Dentistry, San Luis Potosi University, Zona Universitaria, Av. Manuel Nava 2, 78290, San Luis Potosí, SLP, Mexico.
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Alegbeleye BJ. Deep neck infection and descending mediastinitis as lethal complications of dentoalveolar infection: two rare case reports. J Med Case Rep 2018; 12:195. [PMID: 29980234 PMCID: PMC6035394 DOI: 10.1186/s13256-018-1724-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background We report two cases of innocuous dentoalveolar infections which rapidly progressed to deep neck abscesses complicated by descending mediastinitis in a resource-constrained rural mission hospital in the Cameroon. Case presentation The clinical presentations of a 35-year-old man and a 32-year-old woman both of Fulani origin in the Northern region of Cameroon were similar with submandibular fluctuant and tender swelling and differential warmth to palpation. The patients had tachycardia, high grade pyrexia, and normal blood pressure. Further physical and neurological examinations were unremarkable. An ultrasound scan of the neck swellings showed submandibular turbid collections. Plain chest radiographs confirmed empyema thoraces. Our patients had serial drainage of the neck abscesses as well as closed thoracostomy tube drainage which were connected to pleurovac and suctioning machines, with significant amount of pus drainage. Both patients were admitted to our intensive care unit for close monitoring. The first patient continued to make satisfactory clinical progress and was discharged by the fourth week of admission. The patient who had human immunodeficiency viral infection died on the fifth postoperative day. Conclusions The possibility of lethal complications and the associated morbidity and mortality portray this clinical entity as an important public health concern. Clinicians taking care of patients with dentoalveolar and oropharyngeal infections need to be sensitized to these potentially fatal complications. Alternatively, strategies to improve oral health and reduce the incidence of dental caries, the main cause of dental abscess, would maximize use of resources; especially in resources-constrained centers like ours in Banso Baptist Hospital.
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Is there need for technical investigations in order to predict potential length of hospital stay of oral infections? Am J Emerg Med 2018; 37:231-236. [PMID: 29898830 DOI: 10.1016/j.ajem.2018.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 05/13/2018] [Accepted: 05/14/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Oral and maxillofacial infections are generally treated by primary dental or medical caregivers. Nevertheless, because these infections are known to have life-threatening complications, there is a need of clear indicators for emergency services medical staff, particularly in determining when morbidity can be expected and when in-hospital treatment is required. This retrospective study aimed to identify variables that were observable at admission, which could indicate high complication rates, long hospital stays, and/or a need for tracheostomy. MATERIALS AND METHODS We examined data from all cases of severe oral and maxillofacial infections that were treated at the University Hospital of Leuven, between January 2013 and June 2017. 64 cases were identified after applying exclusion criteria. Uni- and multivariate analyses were performed. RESULTS A univariate analysis showed that body temperature, C-reactive protein (CRP) levels, white blood cell counts, and positive bacterial cultures were significantly associated with longer hospital stays, which indicated potential future morbidity. A multivariate analysis showed that dyspnoea, age, and CRP comprised the most significant combination for predicting the length of hospital stay. CONCLUSION Based on the statistical analysis of this population, the research group concludes that a thorough anamnesis and clinical examination should be accompanied by a blood analysis of CRP and white blood cell counts. Only then can a well-founded decision be reached on the severity of the case and the need for hospital admission. In an acute setting, radiological imaging is not required for assessing future morbidity, but it should be performed when accessible.
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Gams K, Shewale J, Demian N, Khalil K, Banki F. Characteristics, length of stay, and hospital bills associated with severe odontogenic infections in Houston, TX. J Am Dent Assoc 2017; 148:221-229. [PMID: 28129825 DOI: 10.1016/j.adaj.2016.11.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/18/2016] [Accepted: 11/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND There were 2 main purposes of this retrospective chart review study. The first was to describe the demographic, social, and financial characteristics of patients with severe odontogenic infections. The second was to assess the relationships among several demographic, social, and treatment variables and length of stay (LOS) in the hospital and hospital bill (charges). METHODS The authors conducted a retrospective chart review for patients admitted to the hospital and taken to the operating room for treatment of severe odontogenic infections at 3 hospitals in Houston, TX (Ben Taub, Memorial Hermann Hospital, and Lyndon B. Johnson) from January 2010 through January 2015. RESULTS The authors included data from severe odontogenic infections in 298 patients (55% male; mean age, 38.9 years) in this study. In this population, 45% required admission to the intensive care unit, and the mean LOS was 5.5 days. Most patients (66.6%) were uninsured. The average cost of hospitalization for this patient population was $13,058, and the average hospital bill was $48,351. At multivariable analysis, age (P = .011), preadmission antibiotic use (P = .012), diabetes mellitus (P = .004), and higher odontogenic infection severity score (P < .001) were associated with increased LOS. Higher odontogenic infection severity score, diabetes mellitus, and an American Society of Anesthesiologists score of 3 or more were associated with an increased charge of hospitalization. CONCLUSIONS Severe odontogenic infections were associated with substantial morbidity and cost in this largely unsponsored patient population. The authors identified variables associated with increased LOS and charge of hospitalization. PRACTICAL IMPLICATIONS Clinicians should consider these findings in their decision-making processes and prioritize early treatment of odontogenic infections potentially to decrease the number of patients admitted to the hospital, LOS, and overall costs of treatment for these infections.
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Abstract
Mediastinitis occurs as a severe complication of thoracic and cardiac surgical interventions and is the result of traumatic esophageal perforation, conducted infections or as a result of lymphogenic and hematogenic spread of specific infective pathogens. Treatment must as a rule be accompanied by antibiotics, whereby knowledge of the spectrum of pathogens depending on the pathogenesis is indispensable for successful antibiotic therapy. Polymicrobial infections with a high proportion of anaerobes are found in conducted infections of the mediastinum and after esophageal perforation. After cardiac surgery Staphylococci are the dominant pathogens and a nasal colonization with Staphylococcus aureus seems to be a predisposing risk factor. Fungi are the predominant pathogens in immunocompromised patients with consumptive underlying illnesses and can cause acute or chronic forms with granulomatous inflammation. Resistant pathogens are increasingly being found in high-risk patient cohorts, which must be considered for a calculated therapy. For calculated antibiotic therapy the administration of broad spectrum antibiotics, mostly beta-lactams alone or combined with metronidazole is the therapy of choice for both Gram-positive and Gram-negative bacteria inclusive of anaerobes. For patients at risk, additional antibiotic classes with a spectrum against methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) can be administered. Increasing rates of multidrug-resistant Gram-negative bacteria (e.g. Enterobacteriaceae) and non-fermenting bacteria (e.g. Pseudomonas and Acinetobacter) in individual cases necessitates the use of polymyxins (e.g. colistin), new tetracyclines (e.g. glycylglycines) and newly developed combinations of beta-lactams and beta-lactam inhibitors. For treatment of fungal infections (e.g. Candida, Aspergillus and Histoplasma) established and novel azoles, amphotericin B and echinocandins seem to be successful; however, detection of Candida, particularly in mixed infections does not always necessitate treatment. Mediastinitis is still a severe infectious disease with a high mortality, which necessitates an early and broad spectrum antibiotic therapy; however, with respect to optimal duration of therapy and selection of antibiotics, data from good quality comparative studies are lacking.
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Affiliation(s)
- A Ambrosch
- Institut für Laboratoriumsmedizin, Mikrobiologie und Krankenhaushygiene, Krankenhaus Barmherzige Brüder, Prüfeningerstraße 86, 93049, Regensburg, Deutschland.
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Deep Neck Infection and Descending Mediastinitis as a Complication of Propionibacterium acnes Odontogenic Infection. Case Rep Infect Dis 2015; 2015:190134. [PMID: 26693363 PMCID: PMC4677009 DOI: 10.1155/2015/190134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 11/09/2015] [Indexed: 12/14/2022] Open
Abstract
Propionibacterium acnes is an anaerobic, Gram-positive bacterium which causes numerous types of infections. Isolated Propionibacterium acnes deep neck infections are very rare. We present an interesting case of deep neck infection complicated by descending mediastinitis of isolated Propionibacterium acnes infection.
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