scholarly journals Severe odontogenic infections with septic progress - a constant and increasing challenge

2019 ◽  
Author(s):  
Hannes Weise ◽  
Andreas Naros ◽  
Christina Weise ◽  
Siegmar Reinert ◽  
Sebastian Hoefert
Keyword(s):  
Antibiotic Treatment ◽  
Circulatory Arrest ◽  
Severe Disease ◽  
Neck Region ◽  
Severe Exacerbation ◽  
Imaging Data ◽  
Incision And Drainage ◽  
Odontogenic Infections ◽  
First Choice ◽  
Hospitalization Period

Abstract Objective More than 90% of all infections of the head and neck region can be traced back to an odontogenic origin. In rare cases they can lead to sepsis, which may pose a vital threat to the patient. The purpose of this study was to analyse characteristics concerning etiology and progress of severe odontogenic infections with a fulminant development. Patients and Methods In a retrospective analysis from 02/2012 to 09/2017 all patients with odontogenic infections requiring hospital admission were included. Among 483 patients 16 patients (13 male, 3 female) showed severe exacerbation with septic progress. The average age was 52.8 years. All patients underwent at least one surgical procedure that involved an extraoral incision and drainage as well as high volume irrigation intraoperatively. At least one revision was required for 4 of the patients. 3 patients showed an exceedingly severe disease progression with multiorgan dysfunction syndrome (MODS) and circulatory arrest. Antibiotic treatment was adjusted according to the results of an antibiogram and resistogram. Irrigation with saline was done multiple times daily. Results 16 patients showed odontogenic infections that spread over multiple maxillo-facial and cervical regions accompanied by septic laboratory signs. All these patients needed intensive care and a tracheostomy. The hospitalization period on the average was 27.8 days. In 16 cases risk factors e.g. for the development of odontogenic abscesses were present. Intraoperative swabs showed a typical polymicrobial aerobic and anaerobic spectrum of oral bacterias, especially anaerobes and streptococci, mainly Streptocococcus viridans. Conclusion Odontogenic infections with fulminant progression should be treated according to clinical and imaging data with immediate surgical incision and drainage including elimination of odontogenic focus and intensified intra- and postoperative irrigation. If needed, repeated imaging followed by further incisions must be performed. Immediate antibiotic treatment adapted to the antibiogram is of most importance. Clinical relevance For abscesses that spread over multiple levels with initial signs of severe infections a combination of tazobactam and piperacillin has proven to be a good first choice and can be recommended as such.

scholarly journals Severe odontogenic infections with septic progress - a constant and increasing challenge: a retrospective analysis

2019 ◽  
Author(s):  
Hannes Weise ◽  
Andreas Naros ◽  
Christina Weise ◽  
Siegmar Reinert ◽  
Sebastian Hoefert
Keyword(s):  
Retrospective Analysis ◽  
Antibiotic Treatment ◽  
Circulatory Arrest ◽  
Severe Disease ◽  
Oral Bacteria ◽  
Severe Exacerbation ◽  
Incision And Drainage ◽  
Odontogenic Infections ◽  
First Choice ◽  
Hospitalization Period

Abstract ABSTRACT Background More than 90% of all infections in the head and neck region can be traced back to an odontogenic origin. In rare cases they can lead to sepsis, which may pose a vital threat to the patient. The purpose of this study was to analyse characteristics concerning etiology and progress of severe odontogenic infections with a fulminant development. Methods All patients with odontogenic infections requiring hospital admission were included in a retrospective analysis conducted from 02/2012 to 09/2017. Of 483 patients 16 patients (13 male, 3 female) showed severe exacerbation with septic progress. The average age was 52.8 years. All patients underwent at least one surgical procedure that involved an extraoral incision and drainage as well as high volume irrigation intraoperatively. At least one revision was required for four of the patients. Three patients showed an exceedingly severe disease progression with multiorgan dysfunction syndrome (MODS) and circulatory arrest. Antibiotic treatment was adjusted according to the results of an antibiogram and resistogram. Irrigation with saline was done several times a day. Results Sixteen patients showed odontogenic infections that spread over multiple maxillo-facial and cervical regions accompanied by septic laboratory signs. All these patients needed intensive care and a tracheostomy. The hospitalization period was 27.8 days on average. In 16 cases risk factors for the development of odontogenic abscesses like diabetes mellitus, obesity, chronic alcohol and nicotine abuse, rheumatism and poor oral hygiene were present. Intraoperative swabs showed a typical polymicrobial aerobic and anaerobic spectrum of oral bacteria, especially anaerobes and streptococci, mainly Streptocococcus viridans. Conclusion Odontogenic infections with fulminant progression should be treated based on clinical and imaging data with immediate surgical incision and drainage including elimination of odontogenic foci as well as intensified intra- and postoperative irrigation. If needed, repeat imaging followed by further incisions should be performed. Immediate antibiotic treatment adapted to the antibiogram is of utmost importance. A combination of tazobactam and piperacillin has proven to be a good first choice and can be recommended for abscesses that spread over multiple levels with initial signs of severe infections.

scholarly journals Severe odontogenic infections with septic progress - a constant and increasing challenge: a retrospective analysis

2019 ◽  
Author(s):  
Hannes Weise ◽  
Andreas Naros ◽  
Christina Weise ◽  
Siegmar Reinert ◽  
Sebastian Hoefert
Keyword(s):  
Retrospective Analysis ◽  
Antibiotic Treatment ◽  
Circulatory Arrest ◽  
Severe Disease ◽  
Oral Bacteria ◽  
Severe Exacerbation ◽  
Incision And Drainage ◽  
Odontogenic Infections ◽  
First Choice ◽  
Hospitalization Period

Abstract ABSTRACT Background More than 90% of all infections in the head and neck region can be traced back to an odontogenic origin. In rare cases they can lead to sepsis, which may pose a vital threat to the patient. The purpose of this study was to analyse characteristics concerning etiology and progress of severe odontogenic infections with a fulminant development. Methods All patients with odontogenic infections requiring hospital admission were included in a retrospective analysis conducted from 02/2012 to 09/2017. Of 483 patients 16 patients (13 male, 3 female) showed severe exacerbation with septic progress. The average age was 52.8 years. All patients underwent at least one surgical procedure that involved an extraoral incision and drainage as well as high volume irrigation intraoperatively. At least one revision was required for four of the patients. Three patients showed an exceedingly severe disease progression with multiorgan dysfunction syndrome (MODS) and circulatory arrest. Antibiotic treatment was adjusted according to the results of an antibiogram and resistogram. Irrigation with saline was done several times a day. Results Sixteen patients showed odontogenic infections that spread over multiple maxillo-facial and cervical regions accompanied by septic laboratory signs. All these patients needed intensive care and a tracheostomy. The hospitalization period was 27.8 days on average. In 16 cases risk factors for the development of odontogenic abscesses like diabetes mellitus, obesity, chronic alcohol and nicotine abuse, rheumatism and poor oral hygiene were present. Intraoperative swabs showed a typical polymicrobial aerobic and anaerobic spectrum of oral bacteria, especially anaerobes and streptococci, mainly Streptocococcus viridans. Conclusion Odontogenic infections with fulminant progression should be treated based on clinical and imaging data with immediate surgical incision and drainage including elimination of odontogenic foci as well as intensified intra- and postoperative irrigation. If needed, repeat imaging followed by further incisions should be performed. Immediate antibiotic treatment adapted to the antibiogram is of utmost importance. A combination of tazobactam and piperacillin has proven to be a good first choice and can be recommended for abscesses that spread over multiple levels with initial signs of severe infections.

scholarly journals Knowledge and Practice towards Management of Space Infections among Dental Practitioners

2020 ◽  
Vol 11 (SPL3) ◽  
pp. 967-971
Author(s):  
Ahmed Hilal Sheriff ◽  
Dhanraj Ganapathy ◽  
Subhashree Rohinikumar
Keyword(s):  
Odontogenic Infection ◽  
Incision And Drainage ◽  
Odontogenic Infections ◽  
Space Infection ◽  
Periodontal Infection ◽  
First Choice ◽  
Dental Practitioners ◽  
Knowledge And Practice ◽  
Essential Knowledge ◽  
Supporting Structures

An odontogenic infection is an alveolar, jaw, or facial infection that is caused by a tooth or its supporting structures and is one of the most common infections. Dental caries, heavy restorations or unsuccessful endodontic treatment, pericoronitis and periodontal infection are by far the most likely reasons for odontogenic infections. Infections are typically clustered around teeth and may stay concentrated to the region where it began, and may propagate to neighbouring or distant locations. The questionnaire included questions regarding essential knowledge and understanding of the Management of odontogenic space infections. Responses were obtained, and the data were analyzed. 72% of the respondents have said streptococcus viridans is the most common microorganisms in odontogenic infection, 57% said they would give antibiotics, incision and drainage for canine space infection, 63% said they would give antibiotics, incision and drainage for submandibular infection space infection, 57% said their first choice of antibiotic in managing space infection is Amoxicillin, and 53% said clindamycin is the choice of antibiotics in patients allergic to Amoxicillin. Most of the dental practitioners in this study did not have complete knowledge regarding the new generations of cephalosporins rather; they were aware of the 3rd and 4th generation cephalosporins. More education and understanding will improve the effectiveness of use and solve the difficulties faced in dentistry.

scholarly journals Odontogenic Head and Neck Region Infections Requiring Hospitalization: An 18-Month Retrospective Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ewa Zawiślak ◽  
Rafał Nowak
Keyword(s):  
Head And Neck ◽  
Maxillofacial Surgery ◽  
Family Doctor ◽  
Neck Region ◽  
University Hospital ◽  
Head And Neck Region ◽  
Odontogenic Infections ◽  
Protein Levels ◽  
Reactive Protein ◽  
Hospitalization Period

The aim of this study was to comprehensively review our experience with odontogenic infections in the head and neck region requiring treatment at a national referral center. We retrospectively reviewed 85 patients treated at the Chair and Clinic of Maxillofacial Surgery of the University Hospital in Wrocław between January 2018 and June 2019. We excluded patients with nonondontogenic infections or other than purulent clinical forms of dentivitis in the head and neck region. Several demographic, clinicopathological, and treatment variables were assessed. The majority of patients were men who were referred for inpatient treatment by a dentist or family doctor, presented to the Hospital Emergency Ward (SOR) by themselves, or transported to the SOR by paramedics SOR from their home or another hospital. All patients were treated in accordance with the current guidelines for head and neck region odontogenic infections. An incision was made and the abscess was drained. The odontogenic cause was removed followed by the collection of tissue for microbiological examination. The course of infection was monitored by means of laboratory parameters such as leukocyte counts and c-reactive protein levels. Odontogenic infections in the head and neck region are a persistent and common problem. Rapid, accurate diagnosis and treatment minimizes the risk of life-threatening complications, shortens the hospitalization period, and lowers treatment costs.

scholarly journals CULTURE SENSITIVITY OF ODONTOGENIC INFECTIONS IN THE HEAD AND NECK REGION.

2016 ◽  
Vol 4 (12) ◽  
pp. 2377-2383
Author(s):  
SrinivasSaketh G ◽  
◽  
N.V.V.Satya Bhushan ◽  
U. Siva Kalyan ◽  
KhoChai Chiang ◽  
...  
Keyword(s):  
Head And Neck ◽  
Neck Region ◽  
Head And Neck Region ◽  
Odontogenic Infections ◽  
Culture Sensitivity

Eikenella corrodens Osteomyelitis

PEDIATRICS ◽  
1982 ◽  
Vol 70 (3) ◽  
pp. 462-463
Author(s):  
Kenneth Polin ◽  
Stanford T. Shulman
Keyword(s):  
Antibiotic Treatment ◽  
Pure Culture ◽  
Oral Secretions ◽  
Eikenella Corrodens ◽  
Puncture Wound ◽  
Incision And Drainage

A 9-year-old boy developed osteomyelitis of the calcaneus following a puncture wound by a toothpick. Culture of the bone yielded a pure culture of Eikenella corrodens, an organism that is normally found in oral secretions. Recovery was complete following incision and drainage and antibiotic treatment with penicillins.

scholarly journals 452. Antibiotic Duration, but Not Size, Impacts Clinical Cure of Limited Skin and Soft-Tissue Infection After Incision and Drainage

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S222-S223
Author(s):  
Jason G Lake ◽  
Stephanie Fritz
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Clinical Cure ◽  
Day Treatment ◽  
Treatment Protocol ◽  
Chi Square ◽  
Incision And Drainage ◽  
Exact Test ◽  
Days Of Therapy ◽  
Antibiotic Duration

Abstract Background Incision and drainage (I&D) is the most common treatment for skin abscesses. A recent randomized clinical trial (RCT) of outpatients with limited (≤5 cm) skin abscesses demonstrated antibiotic therapy with clindamycin or trimethoprim-sulfamethoxazole (TMP-SMX) was superior to I&D alone. We performed a subgroup analysis to measure the effect of antibiotic duration and abscess size on clinical cure at 7–10 days after antibiotic completion. Methods Participants with complete data regarding adherence to the 10-day treatment were included. Demographic and baseline clinical features were compared using t-test, Pearson’s chi-square or Fisher’s exact test, or a non-parametric equivalent where appropriate. Largest abscess dimension (cm) was dichotomized by median size. The effect of antibiotic duration, abscess size (≤ median vs. >median) and covariates on clinical cure were measured using logistic regression. Breslow-Day Test for Homogeneity was used to assess the interaction between treatment and abscess size. Results Of 786 participants in the intention-to-treat analysis, complete adherence data were available for 680 (87%) participants. Of these, 463 (68%) received either antibiotic: 421 (91%) completed 10 days of therapy, 29 (6.3%) ≤7 days and 20 (4.3%) ≤5 days. Only antibiotic treatment duration was associated with clinical cure (table). Odds of clinical cure were 1.7 (95% CI: 1.5, 2.0) times higher for each additional day of treatment. Median abscess size was 2.5 cm (range: 0.2–5); 364 participants had abscesses ≤ median vs. 316 >median. Assessed continuously, abscess size was not associated with cure within antibiotic groups (table) or between placebo and treatment groups (OR 0.94, 95% CI: 0.58–1.5). Stratifying on size, no significant interaction was observed with antibiotic treatment (Breslow-Day P = 0.13). Conclusion Adherence to the treatment protocol was high. These data suggest that longer courses of antibiotic therapy in conjunction with I&D are associated with successful treatment of limited skin abscesses. Size was not associated with clinical cure. Prospective RCTs to determine the optimal length of treatment are needed. Disclosures All authors: No reported disclosures.

scholarly journals Antibiotic Prescribing Practices of Endodontic Postgraduate Trainees in Karachi, Pakistan

2021 ◽  
Vol 30 (03) ◽  
pp. 183-188
Author(s):  
Azam Muhammad Aliuddin ◽  
◽  
Sarosh Sadruddin Morani ◽  
Abubakar Sheikh ◽  
Saqib Rashid ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Apical Periodontitis ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Duration Of Treatment ◽  
Cross Sectional ◽  
Post Graduate ◽  
Odontogenic Infections ◽  
First Choice ◽  
Graduate Trainees

OBJECTIVE: The aim of this study was to assess the knowledge of Endodontic Postgraduate trainees regarding clinically relevant situations where an antibiotic cover is needed and is focused on the prescription patterns of various antibiotics depending on the clinical evaluation of the patients. METHODOLOGY: A cross sectional study was performed in which data was collected from five different dental institutes offering post-graduate residency in endodontics all over Karachi, Pakistan. Preferred antibiotic for odontogenic infections and the duration for the antibiotic coverage were evaluated amongst postgraduate clinicians. A total of 100 questionnaires were distributed out of which only 82 questionnaires came back with responses. The study was conducted for a period of one month from August 2018- September 2018. The data collected was analyzed by SPSS version 21. RESULTS: A combination of amoxicillin with Clavulanic acid was the first choice of antibiotic in patients with no known allergies to penicillin (40.6%), whereas erythromycin was the first choice of antibiotic in patients having allergic reactions to penicillin (39.3%). The duration of treatment on average was 5 days. In clinical situations of irreversible pulpitis, with or without apical periodontitis, 74.3% and 67% of the respondents prescribed antibiotics. 78 % of respondents have prescribed antibiotics in cases of necrotic pulp with acute apical periodontitis. CONCLUSION: Our study concludes that antibiotic over prescription is very common amongst post graduate trainees and is contributing towards a larger issue of antibiotic resistance. Proper protocols of prescription should be followed by professionals and further refinement is required focusing on need, duration and choice of the antibiotic being used. KEYWORDS: Antibiotics, Odontogenic infections, Endodontics, Microbial resistance

scholarly journals Intralesional Sclerotherapy with Polidocanol in the Management of Head and Neck Vascular Lesions

2016 ◽  
Vol 24 (3) ◽  
pp. 136-140
Author(s):  
Arindam Das ◽  
Anindita Sengupta ◽  
Debashis Ghosh ◽  
Deepjoy Bose ◽  
Subhadip Dhara ◽  
...  
Keyword(s):  
Head And Neck ◽  
Local Anesthetic ◽  
Tertiary Care ◽  
Neck Region ◽  
Cost Effective ◽  
Surgical Excision ◽  
Vascular Lesions ◽  
Care Hospital ◽  
Therapeutic Modalities ◽  
First Choice

Introduction Vascular lesions (Hemangioma or vascular malformation) in the head and neck region are quite common and need therapeutic intervention if they become symptomatic or cosmetically unacceptable. Different therapeutic modalities including cryotherapy, corticosteroids, laser therapy, sclerotherapy, surgery and/or embolization are available. Advances in laser surgery as well as sclerotherapy techniques have improved our ability to treat extensive lesions. Surgical excision sometimes becomes very difficult due to massive per-operative bleeding and proximity to major neurovascular structures. In this study we have tried to find a simpler, easily available, safe and cost-effective therapy to treat these vascular lesions. Materials and Method         A pilot case study was conducted in a tertiary care hospital in Kolkata for a period of one year. Polidocanol was selected as the sclerosing agent for treatment of head and neck vascular lesions for its safety and its local anesthetic effect. 3% Polidocanol was injected in 20 lesions. Result 20 patients with head and neck vascular lesions treated with polidocanol sclerotherapy were followed up for 12 months. The study included 20 patients (12 female and 8 male) with mean age 20.3 years (range 6-62 years). Of these 20 patients 14 had 90% to 100% result and in 6 patients we obtained only mild improvement. Discussion Sclerotherapy is now becoming the first choice of treatment in head and neck vascular lesions. Polidocanol is a mixture of 5% ethyl alcohol and 95% hydroxypolyethoxydodecane, the detergent action of which induces a rapid overhydration of endothelial cells, leading to vascular injury and regression of vascular lesions. As the same time it is a local anesthetic, so treatment is painless. Conclusion It is a less invasive, cost effective, painless OPD based management for head and neck vascular lesions having good functional and aesthetic outcome.

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