Ríos DC, Narváez BM, Pacheco OL, Ordoñez LM, Guevara SM

Language: Spanish
References: 26
Page: 101-105
PDF size: 353.45 Kb.

ABSTRACT

Background: Deep neck infections need urgent diagnostic and treatment because of potential complications and mortality.
Objectives: To review our experience in the management of patients with this disease, to know the most common germs and to analyze the factors associated with complications and hospital stay.
Patients and method: We retrospectively analyzed 46 patients who attended the Carlos Andrade Marín Hospital in Quito, Ecuador, from January 2005 to June 2009.
Results: 63% were men and median age was 33 years. 50% of patients received previous antibiotic treatment. The most affected area was the submaxilar (68%), two compartments were affected in 11%. 13% of patients had co-morbidities. In 48% the cause was related to dental disease. The symptoms found were cervical tumor, pain and fever. Computed tomography was performed in 22% of cases. The antibiotics used were: β-lactamics + β-lactamase inhibitors in 65% and clindamycin + penicillin G in 17%. 28% of patients received corticosteroids as adjunctive therapy. The hospital stay was 9 days. The surgical approach was performed in 48%. The most frequently isolated bacterium was Staphylococcus aureus. Complications occurred in 33% and we had no mortality.
Conclusions: Dental infection is our main etiology, which is related to topographic compartments affected. The bacteria Staphylococcus aureus was the most frequently found. The antibiotic regimen used was highly effective and steroid use decreased hospital stay. We found few co-morbidities in our patients which could explain the absence of mortality in our series.

REFERENCES

1. Vieira F, Allen S, Stocks R, Thompson J. Deep neck infection. Otolaryngol Clin North Am 2008;41:459-483.

2. Weed H, Forest L. Deep neck infection. In: Cummings C, Flint P, Harker L, editors. Cummings otolaryngology head and neck surgery. 4th ed. St. Louis: Mosby-Elsevier; 2005:2515-2524.

3. C respo AN, Chone CT, Fonseca AS, Montenegro MC, et al. Clinical versus computed tomography evaluation in the diagnosis and management of deep neck infection. Sao Paulo Med J 2004;122(6):259-263.

4. C ampos L, Hernández D, Barrón M. Frecuencia y topografía de abscesos profundos de cuello. An Orl Mex 2009;54(4):129-134.

5. Boscolo P, Da Mosto M. Submandibular space infection: a potentially lethal infection. Int J Infect Dis 2009;13:327-333.

6. Regueiro S, Vásquez J, Herranz J. Infecciones cervicales profundas: etiología, bacteriología y terapéutica. Acta Otorrinolaringol Esp 2006;57:324-328.

7. Plaza G, Martínez J, Martínez A. Is conservative treatment of deep neck space infections appropriate? Head Neck 2001;23:126-133.

8. Hope J, Morales M. Microbiología y factores predisponentes en abscesos profundos de cuello. An Orl Mex 2009;54(3):85-91.

9. Lee J, Kim H, Lim S. Predisposing factors of complicated deep neck infection: an analysis of 158 cases. Yonsei Med J 2007;48(1):55-62.

10. Parhiscar A, Har-El G. Deep neck abscess: a retrospective review of 210 cases. Ann Otol Rhinol Laryngol 2001;110(11):1051-1054.

11. Eftekharian A, Roozbahany NA, Vaezeafshar R, Narimani N. Deep neck infections: a retrospective review of 112 cases. Eur Arch Otorhinolaryngol 2009;266:273-277.

12. Daramola OO, Flanagan CE, Maisel RH, Odland RM. Diagnosis and treatment of deep neck space abscesses. Otolaryngol Head Neck Surg 2009;141(1):123-130.

13. Schuler P, Cohnen M, Greve J, Ptettenberg C, et al. Surgical management of retropharyngeal abscesses. Acta Oto Laryngol 2009;129:1274-1279.

14. Ridder GJ, Technau-Ihling K, Sander A, Boedeker CC . Spectrum and management of deep neck space infections: an 8-year experience of 234 cases. Otolaryngol Head Neck Surg 2005;133:709-714.

15. Wang L, Kuo W, Tsai S, Huang K. Characterizations of life-threatening deep cervical space infections: a review of one hundred ninety-six cases. Am J Otolaryngol 2003;24(2):111-117.

16. Yang SW, Lee MH, Lee YS, Huang SH, et al. Analysis on life-threatening complications of deep neck abscess and the impact of empiric antibiotics. ORL J Otorhinolaryngol Relat Spec 2008;70:249-256.

17. Huang T, Liu T, Chen P, Tseng F, et al. Deep neck infection: analysis of 185 cases. Head Neck 2004;26:854-860.

18. Marioni G, Rinaldi R, Staffieri C, Marchense R, et al. Deep neck infection with dental origin: analysis of 85 consecutive cases (2000-2006). Acta Oto Laryngol 2008;128:201-206.

19. Boscolo-Rizzo P, Marchiori C, Montolli F, Vaglia A, Da Mosto MC. Deep neck infections. A constant challenge. ORL J Otorhinolaryngol Relat Spec 2006;68:259-265.

20. Huang T, Tseng F, Liu T, Hsu C, Chen Y. Deep neck infection in diabetic patients: comparison of clinical picture and outcomes with nondiabetic patients. Otolaryngol Head Neck Surg 2005;132:943-947.

21. Huang T, Tseng F, Yen T, Hsu C, Chen Y. Factors affecting the bacteriology of deep neck infection: a retrospective study of 128 patients. Acta Oto Laryngol 2006;126:396-401.

22. Freling N, Roele E, Schaefer C. Prediction of deep neck abscesses by contrast-enhanced computerized tomography in 76 clinically suspect consecutive patients. Laryngoscope 2009;119(9):1745-1752.

23. Manzo E, Méndez G, Hernández G, Salvatierra A, Vásquez M. Abscesos profundos de cuello. Etiopatogenia y morbimortalidad. Rev Asoc Mex Med Crit y Terap Int 2005;19(2):54-59.

24. Freeman R, Vallieres E, Verrier E, Karmy R, Wood D. Descending necrotizing mediastinitis: an analysis of the effects of serial surgical debridement on patient mortality. J Thorac Cardiovasc Surg 2000;119:260-267.

25. Mora R, Jankowska B, Catrambone U, Passali GC, et al. Descending necrotizing mediastinitis: ten-years’ experience. Ear Nose Throat J 2004;83(11):774, 776-780.

26. Chen K, Chen J, Kuo S, Huang O, et al. Descending necrotizing mediastinitis: a 10-year surgical experience in a single institution. J Thorac Cardiovasc Surg 2008;136:191-198.