Space-occupying and life-threatening infections of the head, neck, and thorax

Klebsiella pneumoniae fascial space infections of the head and neck in Taiwan: emphasis on diabetic patients and repetitive infections

OBJECTIVES

To assess the epidemiological features, clinical characteristics, treatment, and outcome of head and neck infections caused by Klebsiella pneumoniae.

METHODS

We reviewed records of four common aerobic pathogens isolated by the microbiological laboratory of a teaching hospital in Taiwan from July 1995 to December 1999. Patients aged 14 or older with community-acquired fascial space infections of head and neck were identified by review of medical records and included in the study.

RESULTS

A total of 100 cases were identified, and K. pneumoniae was the most common pathogen of monomicrobial infections (48%), followed by viridans streptococci (15%). Polymicrobial infections were noted in 35 cases. In comparison with patients with infections not caused by K. pneumoniae, those with monomicrobial K. pneumoniae infections were older (P = 0.04) and had a higher prevalence of diabetes mellitus (P < 0.001), a longer duration of antimicrobial therapy (P = 0.007), a longer hospital stay (P = 0.001), and more repetitive infections (P = 0.001). All but one of K. pneumoniae isolates were susceptible to first generation cephalosporins and aminoglycosides.

CONCLUSIONS

K. pneumoniae is an important endemic pathogen of fascial space infections of head and neck in Taiwan, especially among diabetics. Physicians should be aware of the tendency of this organism to cause repetitive infection.

Critical care of the head and neck patient

The patient with head and neck disease has several peculiarities that need to be recognized for the treating team to offer optimal care. These arise from the primary disorders (eg, head and neck cancer or injuries) and the morbidity they might cause, the associated comorbidities, and the possible complications of treatment. A team approach involving the surgeon, the intensivist, and other caretaking personnel is essential to achieve high-quality care and ensure the best results possible.

Deep Neck Infections

Deep neck infections are less common in the antibiotic era, but when they do occur they remain serious infections. Historically, these infections carried significant morbidity and mortality due to the proximity of the airway, mediastinum, and other vital structures. Deep neck infections were once routinely treated with penicillin, and if infection progressed to abscess, surgical drainage was performed. In recent years the standard medical, surgical, and diagnostic approaches to deep neck infection have changed, and they continue to evolve. Physicians must be aware of these changes to optimally manage patients with deep neck infections.