Chen M K, Wen Y S, Chang C C, Lee H S, Huang M T, Hsiao H C
Department of Otorhinolaryngology, Head and Neck Surgery, Changhua Christian Hospital, Taiwan.
Am J Otolaryngol. 2000 May-Jun;21(3):169-73. doi: 10.1016/s0196-0709(00)85019-x.
Deep neck infections may be lethal if life-threatening complications occur, especially in immunocompromised hosts such as diabetic patients. This study was undertaken to better define the clinical features and prognosis of deep neck infections in the diabetic patients with special emphasis on the use of empirical antibiotics and the role and timing of surgical management.
A retrospective analysis of 105 consecutive patients treated at a single institution during a 9-year period was conducted. Of these, 30 patients also presented with diabetes mellitus.
Compared with the nondiabetic patients, the unique features of deep neck infections in diabetic patients were as follows: (1) older age, (2) tendency of unclear infection source, (3) tendency to involve multiple spaces, (4) required more aggressive surgical intervention, (5) prolonged hospitalization, and (6) higher complication rate. The differences were statistically significant (P< .05). There were no significant differences in the complete blood count/ differential count positive findings and fever between the 2 groups (P> .05). Bacterial cultures showed that Klebsilla pneumoniae was the most common causative pathogen in diabetic patients.
In deep neck infection patients with diabetes mellitus, the clinical course is more severe and there is a poorer prognosis. Thus, in treating them, we should keep close observation, appropriately control the diabetes, detect the life-threatening complications early, perform aggressive surgical treatment if fluctuation or complication occurs, and take into account the preponderance of K pneumoniae when administering the empirical antibiotics.
如果发生危及生命的并发症，颈部深部感染可能是致命的，尤其是在糖尿病患者等免疫功能低下的宿主中。本研究旨在更好地明确糖尿病患者颈部深部感染的临床特征和预后，特别强调经验性抗生素的使用以及外科治疗的作用和时机。
对一家机构在9年期间连续治疗的105例患者进行回顾性分析。其中，30例患者同时患有糖尿病。
与非糖尿病患者相比，糖尿病患者颈部深部感染的独特特征如下：（1）年龄较大，（2）感染源不明的倾向，（3）累及多个间隙的倾向，（4）需要更积极的手术干预，（5）住院时间延长，以及（6）并发症发生率更高。差异具有统计学意义（P<0.05）。两组之间的全血细胞计数/分类计数阳性结果和发热情况无显著差异（P>0.05）。细菌培养显示，肺炎克雷伯菌是糖尿病患者中最常见的致病病原体。
在糖尿病合并颈部深部感染的患者中，临床病程更为严重，预后较差。因此，在治疗他们时，我们应密切观察，适当控制糖尿病，早期发现危及生命的并发症，如果出现病情波动或并发症则进行积极的手术治疗，并在使用经验性抗生素时考虑肺炎克雷伯菌的优势。
