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 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 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.

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.

Retrospective Analysis in Lower Limb Reconstruction: Propeller Perforator Flaps versus Free Flaps

2017 ◽  
Vol 33 (S 01) ◽  
pp. S34-S39 ◽  
Author(s):  
Marta Cajozzo ◽  
Alessandro Innocenti ◽  
Massimiliano Tripoli ◽  
Giovanni Zabbia ◽  
Salvatore D'Arpa ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Retrospective Analysis ◽  
Revision Surgery ◽  
Lower Limb ◽  
Lower Extremities ◽  
Free Flaps ◽  
Soft Tissue Defects ◽  
Perforator Flaps ◽  
Hospitalization Period ◽  
Tissue Defects

Background Technical advancements and increasing experience in the management of soft tissue defects in lower extremities have led to the evolution of decisional reconstructive algorithms. Both propeller perforator flaps (PPFs) and free flaps (FFs) proved to be useful methods of reconstruction for lower extremities defects, offering alternative reconstructive tools. We present a case series of PPFs and FFs for reconstruction of lower limbs defects, analyzing and comparing treatment and outcomes. Methods Through a retrospective analysis, we report our experience in performing PPFs or FFs for reconstruction of soft tissue defects of the lower extremities, in patients admitted between 2010 and 2015 at the Department of Plastic and Reconstructive Surgery, University of Palermo. In these patients, we evaluated location and causes of defects, types of flaps used, recipient vessels, complications, time to healing, and aesthetic outcome. Results A primary healing rate was obtained in 13 patients for PPF and 16 cases for FF. Revision surgery for partial skin necrosis was required in eight cases (PPF: four and FF: four). Recovery time and hospitalization period were eventually shorter in patients with FFs, due to lower rate of complications and revision surgery. Conclusion In the past years, our indications for reconstruction with PPFs in the lower limb have become more restricted, while we favor reconstruction with FFs. Recommendations are provided to orient surgical treatment in small, medium, and large lower limb defects.

Clostridium difficile infection in patients hospitalized in the gastroenterology ward – retrospective analysis

2018 ◽  
Vol 90 (1) ◽  
pp. 7-12
Author(s):  
Kinga Podlaszewska ◽  
Ewa Małecka‑Panas ◽  
Anita Gąsiorowska
Keyword(s):  
Clostridium Difficile ◽  
Retrospective Analysis ◽  
Clostridium Difficile Infection ◽  
Clinical Course ◽  
Significant Risk ◽  
Epidemiological Data ◽  
Significant Risk Factor ◽  
Medical Documentation ◽  
Hospitalization Period ◽  
Future Outbreak

INTRODUCTION. Clostridium difficile associated colitis became over last years a worldwide medical issue. It involves patients of the Polish hospitals too. The aim of the study was the analysis of CDAD incidence and the course of infection in Gastroenterology Ward of Regional Specialist Hospital of Zgierz, 2012-2015. MATERIAL AND METHODS. Retrospective analysis of the medical documentation of 79 patients with CDAD was performed. Demographic and epidemiological data and the clinical course of infection were analyzed. RESULTS. The study group comprised of women in 59,5% and men in 40,5%. The patients’ average age was 70,5 years. The average hospitalization period was 10,3 days. CDAD infection seasonality was proved, with statistically significant peak in springtime. 73% of patients were previously hospitalized and 85% - had co-morbidities. 76% of patients underwent antibiotherapy, whilst 29% - used PPI prior to CDAD diagnosis. 50,6% of patients had severe CDAD diagnosed. The recurrence reached 14%. In 19% of patients CDAD resulted in death. DISCUSSION. The results of the study confirm increase of the incidence of the patients with CDAD in Gastroenterology Ward over 4-years’ observation. The prevalence was higher among 65+ patients, after prior hospitalization and antibiotherapy. The co-morbidities was a significant risk factor, especially common in severe cases. CONCLUSION. The results we obtained confirm substantial importance of Clostridium difficile infection leading to antibiotherapy- associated diarrhea among adults, causing prolonged hospitalization, increased prevalence and mortality of patients. Getting to know and minimizing the risk factors will prevent the future outbreak of the disease.

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

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