Microbiology and Antibiotic Sensitivity of Head and Neck Space Infections of Odontogenic Origin

Abstract

Potential patients were identified from an ICD 9 code search of OR records during this time period using all codes that could be descriptors for odontogenic infections of the head and neck. These data were then cross-referenced with written reports of culture data that are provided to the OMFS department on a routine basis to ensure maximum data capture. Once these patients were identified, a chart review was performed to analyze for culture and sensitivity data, length of stay, spaces involved, admission white blood cell count, admission temperature, airway compromise requiring urgent or emergent control of the airway, time of year, medical co-morbidities, gender, patient age, number of trips to the operating room, and complications. Method of Data Analysis: N/A Results: 92 patients were identified from OR records over the five year review. Of these, 26 did not have adequate specimens to be sent for culture. 7 of these patients had specimens considered contaminated by microbiology lab services and thus were not further characterized. 6 of these patients had specimens which failed to yield any bacterial growth. 3 of these patients had 1 contaminated specimen and 1 without any bacterial growth. This left 50 patients with adequate culture data for analysis. There were no deaths in the sample. The age range of the study group was 6 to 63 years with the following breakdown: 0-12 years, 4 patients; 13-17 years, 3 patients; 18-50 years, 38 patients; greater than 50 years, 5 patients. Average length of stay in the hospital was 4.3 days, with a range of 0-23 days. Leukocytosis or leukopenia was present in 36 out of 50 patients. 6 patients required urgent or emergent airway management during their hospital course. Five were intubated while 1 required a cricothyroidotomy. 43 patients were afebrile at presentation, while 3 had a temperature of 38.6 Celsius or greater. 4 patients did not have a temperature recorded at presentation. The majority of patients required one I&D. A subset of 4 patients required multiple I&Ds in the OR for repeat drainage. Microbio-logic data demonstrated polymicrobial (2-4 microbes) infections in 14 patients with the remaining 36 patients having a single isolate identified. Streptococcus milleri was the most commonly identified organism. A total of 70 microbes were identified from the 50 patients. 16 patients (32%) were resistant to at least 1 antibiotic. Out of the 16 patients, 10 were resistant to clindamycin, 6 were resistant to one of the penicillin family antibiotics and 3 presented with flora more typically associated with nosocomial infections (MRSA, MRSE and E. cloa-cae). Conclusion: In our review of patients with odonto-genic infections requiring incision and drainage in the operating room, antibiotic resistance was rather common , presenting in 32% of patients. Furthermore, a large percentage of patients, 20%, were resistant to clindamy-cin, our current first line empiric antibiotic selection for odontogenic infections. In contrast, 12% were resistant to penicillins. Antibiotic resistan...

Maxillofacial infection. A retrospective evaluation of eight years

“…Other authors state that basic beta lactum antibiotics are key antibiotics to start treating odontogenic infections, as these infections are predominantly of gram-positive aerobes [19][20] . On the other hand, some authors 21 described the organisms causing infection as aerobes (68.2%), mixed (13.6%) and anaerobes (9.1%), and they state that according to their results the microflora-causing maxillofacial infection did not change, and penicillin remains the drug of choice in treating these infections 21 .…”

Severe neck infections that require wide external drainage: clinical analysis of 17 consecutive cases

“…Likewise, the diversity of the primary infections and the affected neck spaces, we identified a wide variety of corresponding bacteria that reflects the literature [8,21]. Remarkably, anaerobes were present in 35 % of the cultures that were predominant in those cases where peritonsillar abscess was the primary infection.…”

“…Moreover, this process even allowed to attempt conservative treatment alone in selected cases [4,5]. However, surgical drainage remained the mainstay of the treatment of deep neck infections [6][7][8], that must be performed sometimes even repeatedly due to relapses [9], also pointing to the potential severity of this disease.…”

Role of culture of postoperative drainage fluid in the prediction of infection of the surgical site after major oncological operations of the head and neck

“…The estimation of the final sample size was conducted taking similar studies as references. 8,9 Our results are valid only for patients with SCC of the head and neck who fit the inclusion criteria, which is the main limitation of our study. Our main finding was that if the drainage culture grew no pathogens on postoperative day 3, patients would have a low risk of deep infection of the surgical site and consequently could be discharged earlier.…”