A STUDY OF BACTERIOLOGICALASSOCIATION AND ANTIBIOTIC SENSITIVITY IN PATIENTS OF NECK ABSCESSES.

INTRODUCTION: Deep neck infections which play an important role among neck abscesses have been described rstly by Galen and currently their incidence rates have ranged between 9 to 12/1,00,000. Usually the results of cultures are polymicrobial but as a whole, Streptococcus are the organisms most commonly cultured from deep neck abscesses.The incidence of deep neck infections is decreasing with the use of antibiotics.In this study we have tried to nd out association of microorganisms in neck abscess patients and their antibiotic sensitivity. AIM AND OBJECTIVE: AIM OFTHE STUDY1.Find out association of various microorganisms with neck abscesses 2.To determine antibiotic sensitivity of various microorganisms associated with neck abscess formation. OBJECTIVE OFTHE STUDY- To nd out a proper knowledge regarding role of microorganisms in neck abscess patients so that denitive treatment lines can be established. METHODOLOGY: :Aprospective study was performed in 90 cases of neck abscesses in a tertiary care hospital for a period of 1.5years from February 2019 to July 2020 to nd out association between neck abscesses with bacteriological factors and antibiotic sensitivity of the microorganisms. RESULT: It was found that klebsiella pneumoniae was higher proportion in associated bacteria.The antibiotic sensitivity testings revealed proper medical treatment path by directing necessary antibiotics for specic microorganisms involved in cases of neck abscess. Thus a multidisciplinary treatment approach is always advisable.

1366. Deep Neck Infections: Bacteriology and Antimicrobial Susceptibilities, Akron Children’s Experience

Background Deep neck infections (DNI’s) are uncommon (~45,000 US cases annually) but, potentially serious. Published data regarding bacteriology and antibiotic usage for DNI’s in children is limited. In addition, geographic variation in the incidence of pathogens and their antimicrobial susceptibility limits generalization of treatment guidance. Reviewing our practice at Akron childrens we noted considerable variation in the choice of empiric antibiotics (ampicillin-sulbactam vs piperacillin-tazobactam vs Ceftriaxone and Clindamycin/vancomycin/linezolid). Admission unit (floors vs intensive care) and service (hospitalist vs infectious diseases) were some important determinants that influenced choice of empiric antibiotics. This retrospective study aimed to review local data and come up with standard guidance for empiric therapy. Summary of the predominant bacterial isolates. Methods We reviewed records of 125 patients who underwent surgical drainage of DNI’s from 1/2015 – 12/2019. In addition to demographic data we gathered information on bacterial isolates and their susceptibilities. Chart review was performed for patients with staphylococcus aureus, to look for any unique presenting features. Results Up on reviewing the data- peritonsillar abscesses were common in older children (Median age 11 years). As expected, retropharyngeal and parapharyngeal infections were common in younger ones (< 5 years). Group A streptococcus remained the most common aerobic isolate followed by Hemophilus influenzae/parainfluenzae. MRSA was detected in ~7 % of all cultures (see enclosed table). Notably, none of the MRSA isolates were clindamycin resistant. However, MSSA resistance to clindamycin was about 20%. No clinical characters predicted isolation of S. aureus. Anaerobic infections (polymicrobial) were overwhelmingly common across all abscess types. Conclusion Based on our review, Ampicillin-Sulbactam is a good empiric choice antibiotic for deep neck infections in our institution. Ceftriaxone with clindamycin is another option. Clindamycin monotherapy seems to be inadequate. Staph aureus and especially MRSA, were only isolated in a small percentage of cases. Unless a patient is ill appearing, vancomycin use seems unnecessary. Clinical presentation was not helpful to suspect infection with Staph aureus. Disclosures All Authors: No reported disclosures

Deep Neck Infections: decisional algorithm for patients with multiple spaces involvement

Background: Deep Neck Infections (DNIs) spread along fascial planes and involve neck spaces. Recently, their incidence has decreased due to the introduction of antibiotics; nevertheless, complications related to DNIs are often life-threatening. Objective: The purpose of this article is focused on the identification of predisposing factors of these complications, as well as on the development of a reliable therapeutic algorithm. Method: Sixty patients with DNIs were enrolled from 2006 to 2019 for a retrospective study. The exclusion criteria for the present study was cellulitis, small abscesses responding to empiric or specific antibiotic therapy or with involvement of only one deep neck space. During the analysis the following parameters of interest have been evaluated: gender, age, site of origin, pathways of spread, comorbidities, clinical features, bacteriology data, type of surgical approach required, complications, duration of hospitalization and mortality rate. On admission, microbial swab analysis was performed. Results: Diabetes Mellitus (DM), Chronic Obstructive Pulmonary Disease (COPD), iron deficiency anemia and the involvement of multiple spaces have been associated with a significantly higher risk of developing complications. Most of our patients had polymicrobial infections. All patients underwent surgical drainage. The complication rate had occurred in 56.6% of patients, while death in 18.3%. Conclusion: DNIs represent a medical and surgical emergency with potential serious complications, thus avoiding diagnostic delay is mandatory.

Deep Neck Infections: Demographic and Clinical Factors Associated with Poor Outcomes

<b><i>Introduction:</i></b> Deep neck infections (DNIs) are abscesses located in the profound spaces of the neck and constitute one of the most common otolaryngological life-threatening emergencies. The aim of this study is to review the clinical and demographic data of patients with DNI and identify factors associated with prolonged hospitalization, reoperation, and mortality. <b><i>Methods:</i></b> Retrospective review and analysis of 75 patients with DNI admitted from January 2015 to December 2019 in a tertiary referral hospital. <b><i>Results:</i></b> Of 75 patients, 50 (66.6%) were males and 25 (33.3%) females. Age ranged from 18 to 91 years with a mean of 41.79 (±15.48). DNIs were odontogenic in 49 patients (65.3%). History of diabetes mellitus (DM) was positive in 26 patients (34.6%). The submandibular space was involved in 57 patients (76%). <i>Streptococcus</i> spp. were isolated in 35 patients (46%). Intubation for airway preservation was needed in 21 patients (28%) and tracheostomy in 6 (8%). Mediastinitis presented in 8 patients (10.67%), with a mortality rate of 62.5% (<i>n</i> = 5). Mean hospital stay was 9.13 days (±7.2). DM (<i>p</i> = 0.016), age (<i>p</i> = 0.001), BMI classification 3, 4, and 6 (<i>p</i> = 0.041), and intensive care unit (ICU) admission (<i>p</i> = 0.009) were associated with a longer stay. Surgical drainage was performed after 1.71 days (±1.65). Surgical reintervention was needed in 6 cases (8%) and was associated with temporal (<i>p</i> = 0.001) and masticator (<i>p</i> = 0.002) space involvement and DM (<i>p</i> = 0.009). Overall mortality was 8% and decreased to 1.5% when mediastinitis was excluded. Mediastinitis (<i>p</i> = 0.001), ICU admission (<i>p</i> &#x3c; 0.0001), <i>Streptococcus</i> spp. (<i>p</i> = 0.019), and low hemoglobin levels (<i>p</i> = 0.004) were associated with mortality. <b><i>Discussion/Conclusion:</i></b> DNIs are entities associated with high morbimortality. Mediastinitis and airway obstruction are life-threatening possible complications and should be promptly evaluated. Low HB could be used as a predicting factor for mortality.

Case Report Series: Clinical Analysis of Severe Deep Neck Space Infection

BackgroundSevere deep neck space infection is rare and critical.The objective is to deepen the understanding of severe deep neck space infection and improve the level of clinical diagnosis and treatment. Case presentationA retrospective analysis of the diagnosis and treatment of 5 cases of serious deep neck infections admitted to our department. The 5 patients were all diagnosed by cervical CT and surgical exploration. 3 patients with diabetes, 2 patients with diabetic ketoacidosis, 3 patients with mediastinal infection; 3 patients underwent tracheotomy and 2 patients with tracheal intubation; All patients were treated by neck incision, drainage, dressing change and targeted antibiotics. ConclusionsSevere deep neck infections are prone to occur in patients with diabetes and other systemic basic diseases. Early diagnosis, timely neck incision exploration, drainage to maintain airway patency and targeted antibiotic treatment are the keys to diagnosis and treatment.

Deep neck infections with and without mediastinal involvement: treatment and outcome in 218 patients

Purpose Infections of the deep neck, although becoming scarcer due to the widespread use of antibiotics, still represent a dangerous and possibly deadly disease, especially when descending into the mediastinum. Due to the different specialities involved in the treatment and the heterogenous presentation of the disease, therapeutic standard is still controversial. This study analyzes treatment and outcome in these patients based on a large retrospective review and proposes a therapeutic algorithm. Methods The cases of 218 adult patients treated with deep neck abscesses over a 10-year period at a tertiary university hospital were analyzed retrospectively. Clinical, radiological, microbiological and laboratory findings were compared between patients with and without mediastinal involvement. Results Forty-five patients (20.64%) presented with abscess formation descending into the mediastinum. Those patients had significantly (all items p < 0.0001) higher rates of surgical interventions (4.27 vs. 1.11) and tracheotomies (82% vs. 3.4%), higher markers of inflammation (CRP 26.09 vs. 10.41 mg/dl), required more CT-scans (3.58 vs. 0.85), longer hospitalization (39.78 vs 9.79 days) and more frequently needed a change in antibiotic therapy (44.44% vs. 6.40%). Multi-resistant pathogens were found in 6.67% vs. 1.16%. Overall mortality rate was low with 1.83%. Conclusion Despite of the high percentage of mediastinal involvement in the present patient collective, the proposed therapeutic algorithm resulted in a low mortality rate. Frequent CT-scans, regular planned surgical revisions with local drainage and lavage, as well as an early tracheotomy seem to be most beneficial regarding the outcome.

Changing trends of deep neck infections in southern China: A review of 127 cases

This study aimed to review our experience with the clinical characteristics and management of deep neck infections (DNIs) and determine the changing trends of their characteristics over time in southern China. Patients diagnosed with a DNI between January 2009 and December 2018 were screened retrospectively for their demographic characteristics, etiology of infection, site of infection, microbiology, treatment, and complications. In total, 127 patients were included: 41 (32.3%) were treated between 2009 and 2013 (group A), and 86 (67.7%) were treated between 2014 and 2018 (group B). The most common site of infection in group A was the parapharyngeal space (15 patients, 36.6%), while that in group B involved multiple spaces (36 patients, 41.9%). The leucocyte count (×109 cells/L) was 13.23 ± 4.19 in group A and 16.04 ± 4.33 in group B ( p < 0.001). Streptococcus viridans was the most common bacteria in both groups. The mean hospital stay was 21.46 ± 33.09 days in group A and 10.44 ± 6.19 days in group B. The rate of diabetes mellitus (DM) in group A was lower than that in group B (8/41 and 33/86, respectively; p = 0.034). Airway obstruction was the most common complication in both groups. DNIs are more likely to show multi-space involvement, affect more DM patients, and be associated with higher leucocyte counts over time. We infer that the duration from morbidity to admission and that from admission to operation play roles in the successful management of DNIs, possibly causing fewer complications, lower mortality rates, and shorter hospital stays. DM patients require increased attention.