Clinical predictors of descending necrotizing mediastinitis after deep neck infections

Abstract

Objectives/Hypothesis: To identify the clinical predictors of descending necrotizing mediastinitis (DNM) secondary to deep neck infections (DNIs) before treatment. Study Design: Retrospective case series. Methods: We reviewed 73 patients with DNIs who had been treated with external drainage at our institute between April 2009 and March 2019. We divided these patients into either a DNI group without mediastinitis (n = 55) or a DNM group secondary to DNI (n = 18). We collected clinical data and compared them between the groups, conducting univariate and multiple logistic regression analysis to identify the predictors of DNM. Results: We identified age, C-reactive protein (CRP), neutrophil percentage, lymphocyte percentage, neutrophil to lymphocyte ratio (NLR), presence of comorbidities, presence of gas, and abscess extension below the hyoid bone as statistically significant by univariate analysis. Moreover, multiple logistic regression analysis showed that age ≥55 years, NLR ≥13, and CRP ≥30 mg/dL were statistically significant. Conclusions: We identified age ≥55, NLR ≥13, and CRP ≥30 before DNI treatment as clinical predictors of a DNM complication.

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

“…Streptococcus viridans, staphylococcus aureus and ß-hemolytic streptococci make up for the majority of microorganisms causative for deep neck infections in the present study as well as in most of the literature [14,15]. Likewise, in severe cases with mediastinal involvement or necrotizing fasciitis, higher percentages of gram-negative and/or anaerobic bacteria as well as more polymicrobial infections have been described [9,12,21], which could also be shown in the present study. The relatively high proportion of patients with no bacterial growth in culture is also in accordance with the majority of studies regarding this topic [1,9,14] and might also be related to prior antibiotic outpatient treatment.…”

“…This variation in the reported pathogeneses suggest regional or demographic differences [12,18,23,24], or may be caused by patient selection due to the different specialities involved [16,25,26]. According to the literature, in 17-67% of all patients no focus of infection could be identified [21,22,25], which is in accordance to the present study's 27.91% and may be related to prior outpatient treatment of the original infection [12]; however, in our patients with mediastinal involvement, a focus of infection could be found in every patient.…”

“…The main etiology in the present study were teeth, tonsils and salivary glands, with a higher percentage of tonsillar infections in patients with mediastinal involvement. While several authors reported on predominantly dental infections, especially in severe cases with mediastinal infections or necrotizing fasciitis [1,9,20], others demonstrate higher percentages of tonsillar [15,21] or salivary [22] origins of infection, or a connection to injection drug use [23]. This variation in the reported pathogeneses suggest regional or demographic differences [12,18,23,24], or may be caused by patient selection due to the different specialities involved [16,25,26].…”

“…The factors best predicting a severe clinical course were mediastinal involvement of the abscesses and the initial CRP and PCT values. Mediastinal abscess formation has been shown as an independent risk factor by several authors [ 4 , 11 , 15 , 36 ], while a higher initial CRP was also correlated to severe clinical courses [ 21 ]. PCT has not been described in this regard, possibly because it is not regularly analyzed for all patients with cervical abscesses in many institutions.…”

Staphylococcus aureus mediastinitis following a skin infection in a non‑immunocompromised patient: A case report

“…Common findings in mediastinitis are leukocytosis and elevations in CRP levels ( 6 , 7 ). In certain cases of acute mediastinitis, high levels of CRP are associated with a greater risk of death ( 6 , 7 ). In the present case report, the patient also presented with increased levels of CRP.…”