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

Abstract

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.

Management of Deep Neck Space Infections: A Large Tertiary Center Experience

“…In fact, in our series, we found a male predominance of DNI patients, as widely recognized in many studies, even though the cause of such a prevalence remains largely unclear [9]. The mean age of our patients was 50.5 years, and this is consistent with the data presented in the literature [10].…”

Deep neck space infection extending to the mediastinum that was treated conservatively

“…Mediastinal collection is more often associated with oesophageal perforation or cardiothoracic surgery, but can develop in 3% of DNSIs 1 6. It is associated with neck pain, neck swelling, odynophagia, dysphagia, difficulty in breathing and tachycardia 1…”

Early Diagnosis and Antibiotic Treatment Combined with Multicomponent Hemodynamic Support for Addressing a Severe Case of Lemierre’s Syndrome

“…Regardless of the technique used, in Lemierre’s syndrome source control is mandatory. In a recent analysis of 218 patients with deep neck infection with or without mediastinal involvement, the authors showed that immediate surgical drainage, broad empiric antibiotic therapy, surgical revision, antiseptic wound lavage, and early tracheostomy are the cornerstones of therapy [ 18 ]. Early tracheostomy is important to facilitate surgical revision and reduce sedation time and artificial ventilation duration [ 19 , 20 ].…”