Differences in characteristics and infection severity between odontogenic and other bacterial oro-naso-pharyngeal infections

Abstract

Background Different bacterial infections of the oro-naso-pharyngeal (ONP) region may progress and require hospital care. The present study clarified differences in infection characteristics between hospitalized patients with odontogenic infections (OIs) and other bacterial ONP infections. The specific aim was to evaluate clinical infection variables and infection severity according to infection aetiology, particularly regarding features of OIs compared with other ONPs. Methods Records of patients aged ≥16 years requiring hospital care for an acute bacterial ONP infection in the emergency units of Otorhinolaryngology or Oral and Maxillofacial Surgery at the Helsinki University Hospital (Helsinki, Finland) during 2019 were evaluated retrospectively. The main outcome variables were need for intensive care unit (ICU) treatment and length of hospital stay. The primary predictor variable was infection category, defined as OI or other ONP. The secondary predictor variable was specific ONP infection group. Additional predictor variables were primary clinical infection signs, infection parameters at hospital admission, and delay from beginning of symptoms to hospitalization. Explanatory variables were sex, age, current smoking, heavy alcohol use or substance abuse, and immunosuppressive disease, immunosuppressive medication, or both. Comparison of study groups was performed using Fisher’s exact test, student’s t-test, and Mann-Whitney U. Results A total of 415 patients with bacterial ONPs fulfilled the inclusion criteria. The most common infections were oropharyngeal (including peritonsillar, tonsillar, and parapharyngeal infections; 51%) followed by infections from the odontogenic origin (24%). Clinical features of OIs differed from other ONPs. Restricted mouth opening, skin redness, or facial or neck swelling (or both) were found significantly more often in OIs (p < 0.001). OIs required ICU care significantly more often than other ONPs (p < 0.001) and their hospital stay was longer (p = 0.017). Conclusions Infections originating from the tonsillary and dental origin had the greatest need for hospitalization. Clinical features of OIs differed; the need for ICU treatment was more common and hospital stay was longer compared with other ONPs. Preventive care should be emphasized regarding OIs, and typical infection characteristics of ONP infection subgroups should be highlighted to achieve early and prompt diagnosis and treatment and to reduce hospitalization time.

Maxillofacial infections of dental origin

“…Considering the staying lenght of hospitalization, the highest average number of days is found in patients with diabetes mellitus (3.6% of the 146 hospitalized patients). This result is important, as it is known that compromised immune systems can lead to the opportunistic progression of apparently minor infections, increasing the chances of superficial oral abscesses into the deep neck infections 27,28 . It is in accordance with the found data of our study.…”

When is surgical intervention needed in oral and maxillofacial space infection patients? A retrospective case control study in 46 patients

“…20 Multiple studies have indicated that male patients face a higher risk of hospitalization following surgeries and a greater likelihood of requiring intensive care unit (ICU) treatment. 14,21 However, there were also studies showing little correlation between gender and OMSI severity in terms of length and cost of hospitalization, severe complications and reoperation risk. 3,10,17 The nal regression model of our study retained gender as a risk factor associated with the outcome.…”