1
|
Kong W, Zhang X, Li M, Yang H. Microbiological analysis and antibiotic selection strategy in neck abscesses among patients with diabetes mellitus. Eur Arch Otorhinolaryngol 2024; 281:1515-1523. [PMID: 38145982 DOI: 10.1007/s00405-023-08396-w] [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: 08/16/2023] [Accepted: 12/06/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE This study aimed to analyze the clinical characteristics, pathogen distribution, drug sensitivity, and antibiotic treatment strategies of patients with neck abscesses with or without diabetes. METHODS A retrospective analysis was conducted on 2194 patients who underwent neck abscess surgery at our hospital over the past 13 years. Patients were grouped as NAwithDM (neck abscess with diabetes mellitus) or NAwithoutDM (neck abscess without diabetes mellitus). Clinical features, pathogen distribution, and antibiotic sensitivity were compared between the groups. Venn diagrams were used to illustrate the antibiotics effective against all three predominant pathogens. RESULTS A total of 2194 patients with neck abscesses were included in this study, with 579 patients (26.43%) in the NAwithDM group and 1612 patients (73.51%) in the NAwithoutDM group. There were no significant differences in sex or age distribution between the two groups (all P > 0.05). However, there were significant differences in BMI, length of hospital stays, occurrence of laryngeal obstruction, hypertension, and hypoalbuminemia between the two groups (all P < 0.05). In the NAwithoutDM group, the top three pathogens were Streptococcus constellatus, Klebsiella pneumoniae, and Staphylococcus aureus. The antibiotics that were simultaneously effective against all three pathogens were ceftriaxone, moxifloxacin, and ampicillin/sulbactam. In the NAwithDM group, the top three pathogens were Streptococcus pyogenes, Streptococcus pneumoniae, and Streptococcus constellatus. The antibiotics that were simultaneously effective against all three pathogens were compound sulfamethoxazole, cefuroxime, levofloxacin, ciprofloxacin, vancomycin, and imipenem. CONCLUSION Neck abscess patients with diabetes have distinct clinical features. Therefore, it is crucial to pay attention to these clinical features and manage them accordingly during the treatment process. Empirical antibiotic treatment should be tailored to individual patient groups. Sulfamethoxazole-methoxazole is recommended for neck abscess patients with diabetes, while ceftriaxone or moxifloxacin is recommended for those without diabetes.
Collapse
Affiliation(s)
- Weili Kong
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyun Zhang
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mei Li
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Yang
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
2
|
Bal KK, Gür H, Demir I, Ismi O, Vayisoglu Y, Gorur K, Ozcan C, Unal M. Mortal condition in an unusual localization, analysis of isolated tongue and tongue base abscesses. World J Clin Cases 2023; 11:7778-7784. [PMID: 38073684 DOI: 10.12998/wjcc.v11.i32.7778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/18/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Tongue abscess (TA) is a very rare clinical condition and its treatment is very important. Surgical drainage is at the forefront in the treatment. Our study includes patients with tongue and tongue base abscesses.
AIM To discuss the clinical and laboratory findings of these patients emphasizing the underlying causes and treatment options with the largest patient series in the English literature.
METHODS We included patients with isolated TA who applied to our clinic between January 1, 2020 and January 1, 2023. Those who lack the recorded data, those who are not between the ages of 18-66, those who have not undergone surgery-interventional procedure, and those who have infection and/or abscess in another place were excluded from the study.
RESULTS There were two female (18%) and nine male (82%) patients in our series consisting of 11 patients. Their ages ranged from 18 to 66, and the mean ± SD was 48.63 ± 16.3. Considering the localization of the abscess, three anterior abscesses (27%), two lateral abscesses (18%), and six abscesses at the base of the tongue (54%) were detected.
CONCLUSION Tongue abscesses can cause acute upper airway obstruction and respiratory collapse. It may be necessary to act quickly for the tracheotomy procedure and this procedure can usually be performed under local anesthesia as intubation cannot be achieved. When we encounter an abscess in an unexpected organ, difficulties may be encountered in the management of the patient.
Collapse
Affiliation(s)
- Kemal Koray Bal
- Department of Otorhinolaryngology, Mersin University, Mersin 33160, Mersin, Turkey
| | - Harun Gür
- Department of Otorhinolaryngology, Mersin University, Mersin 33160, Mersin, Turkey
| | - Ibrahim Demir
- Department of Otorhinolaryngology, Mersin University, Mersin 33160, Mersin, Turkey
| | - Onur Ismi
- Department of Otorhinolaryngology, Mersin University, Mersin 33160, Mersin, Turkey
| | - Yusuf Vayisoglu
- Department of Otorhinolaryngology, Mersin University, Mersin 33160, Mersin, Turkey
| | - Kemal Gorur
- Department of Otorhinolaryngology, Mersin University, Mersin 33160, Mersin, Turkey
| | - Cengiz Ozcan
- Department of Otorhinolaryngology, Mersin University, Mersin 33160, Mersin, Turkey
| | - Murat Unal
- Department of Otorhinolaryngology, Mersin University, Mersin 33160, Mersin, Turkey
| |
Collapse
|
3
|
Weng NC, Yu WL. Isolation of Mycoplasma salivarium in the empyema of a diabetic patient with deep neck infection and necrotizing mediastinitis: A case report. IDCases 2023; 34:e01915. [PMID: 37886697 PMCID: PMC10597854 DOI: 10.1016/j.idcr.2023.e01915] [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: 09/06/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
Mycoplasma species (spp.) are predominantly found in the human oropharynx, and extracavity infections are rare. Conventional culture limitations hinder Mycoplasma spp. recovery, potentially causing overlooked infections. Molecular techniques reveal their roles in various infections. Mycoplasma pneumoniae causes pneumonia, while Mycoplasma salivarium (M. salivarium) in empyema is scarcely reported. We present a case of a 61-year-old man who suffered from tonsillitis, deep neck infection, necrotizing mediastinitis, and bilateral pleural infections. Mixed pathogens, mainly M. salivarium, were implicated.
Collapse
Affiliation(s)
- Ning-Chun Weng
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Wen-Liang Yu
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Medicine, school of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
4
|
Xu Y, Shi Q, Ying H. Lemierre's syndrome complicating deep neck abscess: a case report. Thromb J 2023; 21:97. [PMID: 37715238 PMCID: PMC10504738 DOI: 10.1186/s12959-023-00543-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/10/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Lemierre's Syndrome is a severe medical condition that can result from oropharyngeal infection, typically caused by Fusobacterium necrophorum, leading to sepsis, internal jugular vein thrombosis, and metastatic septic emboli. However, there is limited literature on this syndrome caused by Streptococcus anginosus, and few previous cases have been reported to have deep neck space infection. We present the first case of Lemierre's Syndrome caused by Streptococcus anginosus with deep neck abscess. CASE PRESENTATION A 53-year-old male patient with no significant medical history presented with right neck pain after accidentally swallowing a fish bone one month ago. Laryngoscopy did not reveal any abnormalities. Five days prior to admission, the patient developed high fever. Imaging studies showed internal jugular vein thrombosis and a neck abscess surrounding the carotid artery sheath. Blood culture results were positive for Streptococcus anginosus infection, and the patient was diagnosed with Lemierre's syndrome. The patient underwent surgical drainage and received antibiotics and anticoagulant therapy, and had satisfactory clinical progress. He was discharged after a 16-day hospitalization. CONCLUSIONS Although Lemierre's syndrome is rare, it needs attention because it can lead to serious complications and requires timely treatment. Deep neck space infections can be life-threatening and doctors must be aware of its potential severity.
Collapse
Affiliation(s)
- Yi Xu
- Department of Otolaryngology, Ningbo No.2 Hospital, Ningbo, 315000, Zhejiang, China.
| | - Qingyuan Shi
- Department of Otolaryngology, Ningbo No.2 Hospital, Ningbo, 315000, Zhejiang, China
| | - Haiyue Ying
- Department of Otolaryngology, Ningbo No.2 Hospital, Ningbo, 315000, Zhejiang, China
| |
Collapse
|
5
|
Bal KK, Balta O, Coşkun Ekiz CG, Gür H, İsmi O, Özgür ES. Rare Cause of Severe Dyspnea After Tracheotomy-Negative Pressure Pulmonary Edema. Turk Arch Otorhinolaryngol 2023; 61:138-141. [PMID: 38020409 PMCID: PMC10652052 DOI: 10.4274/tao.2023.2023-4-13] [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: 04/25/2023] [Accepted: 06/22/2023] [Indexed: 12/01/2023] Open
Abstract
Deep neck infections are serious conditions and can present with acute upper airway obstruction. Our priority in the treatment is to ensure airway safety, and tracheotomy may be needed to overcome the upper airway obstruction. Unceasing dyspnea after tracheotomy should suggest serious pulmonary pathologies in patients with upper airway obstruction due to deep neck infection. Acute/chronic obstruction resolved after tracheotomy or upper respiratory tract surgical procedures of obstructive sleep apnea patients can turn into severe dyspnea with pulmonary edema. In this report, we present a 46-year-old male patient with negative pressure pulmonary edema as a complication of tracheotomy. The tracheotomy was performed due to severe upper airway obstruction secondary to a deep neck infection. The importance of early diagnosis and prompt treatment of this rare entity after unceasing dyspnea despite tracheotomy is discussed in the light of the current literature.
Collapse
Affiliation(s)
- Kemal Koray Bal
- Department of Otorhinolaryngology, Mersin University Faculty of Medicine Hospital, Mersin, Turkey
| | - Ozan Balta
- Department of Otorhinolaryngology, Mersin University Faculty of Medicine Hospital, Mersin, Turkey
| | | | - Harun Gür
- Department of Otorhinolaryngology, Mersin University Faculty of Medicine Hospital, Mersin, Turkey
| | - Onur İsmi
- Department of Otorhinolaryngology, Mersin University Faculty of Medicine Hospital, Mersin, Turkey
| | - Eylem Sercan Özgür
- Department of Pulmonology, Mersin University Faculty of Medicine Hospital, Mersin, Turkey
| |
Collapse
|
6
|
Tao X, Hua H, Liu Y. A novel model for predicting mortality in the management of deep neck infections. EAR, NOSE & THROAT JOURNAL 2022:1455613221133245. [PMID: 36318220 DOI: 10.1177/01455613221133245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES Deep neck infections (DNIs) are a common and intractable disease encountered in ENT clinics that impose a significant medical and financial burden on affected individuals and their families. However, insufficient data are currently available for predicting outcomes in cases of DNI. The present study thus sought to develop a novel model capable of predicting treatment outcomes of DNI patients just using indicators at the visit. METHODS Patients with DNIs treated from 2010 to 2022 were included in the present study. Patient data were retrospectively collected from medical records. Risk factors associated with mortality were identified using logistic regression models. A predictive model was constructed based on odds ratios for factors calculated using a multivariate regression model. RESULTS In total, 153 patients were enrolled in the present study. Risk factors associated with mortality included age >50 years, residence in a rural area, dyspnea at visit, the involvement of multiple infected sites, serum albumin<34 g/L, renal insufficiency, mediastinitis, pulmonary infection, and septic shock. A multivariate regression model revealed that mediastinitis (OR: 7.308, P < 0.001), serum creatinine>95 μmol/L (OR: 23.363, P < 0.05), and serum albumin<34 g/L (OR: 13.837, P < 0.05) were independent predictors of mortality in deep neck infection patients, with serum creatinine>95 μmol/L being particularly critical to the outcomes. Diabetes was not the predictor of mortality but was associated with long-term hospitalization (P < 0.001). CONCLUSIONS In summary, the model constructed in the present study was capable of estimating the potential for poor outcomes in DNI patients before the initiation of treatment. These findings may help improve doctor-patient communication, especially for those struggling financially.
Collapse
Affiliation(s)
- Xiaoyao Tao
- Otorhinolaryngology Head and Neck Surgery Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hongting Hua
- Otorhinolaryngology Head and Neck Surgery Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yehai Liu
- Otorhinolaryngology Head and Neck Surgery Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|