Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore 119228.
Singapore Med J. 2011 May;52(5):351-5.
This study aimed to review the microbiology of deep neck abscesses and identify the factors that influence their occurrence.
A retrospective chart review was done of patients diagnosed with deep neck abscesses at the Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore between 2004 and 2009. The data of 131 deep neck abscess patients were reviewed, and those with positive pus culture were included in the study. Logistic regression was applied to analyse and compare the incidence of common organisms in various conditions (age, gender, aetiology and effects of diabetes mellitus).
Of the 96 patients recruited, 18 had polymicrobial cultures. The leading pathogens cultured were Klebsiella (K.) pneumoniae (27.1 percent), Streptococcus milleri group (SMG) bacteria (21.9 percent) and anaerobic bacteria-not otherwise specified (NOS) (20.8 percent). K. pneumoniae (50.0 percent) was over-represented in the diabetic group. SMG bacteria (68.8 percent) and anaerobic bacteria-NOS (43.8 percent) were most commonly isolated in patients with odontogenic infections. K. pneumoniae was found more commonly among female patients (39.3 percent). The distribution of the three leading pathogens between patients aged below 50 years and those 50 years and above was comparable. K. pneumoniae was the commonest organism cultured in parapharyngeal space abscesses, while the submandibular space and parotid space most commonly isolated SMG bacteria and Staphylococcus aureus, respectively.
Broad-spectrum antibiotics are recommended for treating deep neck abscesses. Empirical antibiotic coverage against K. pneumoniae infection in diabetic patients, and SMG and anaerobic bacteria in patients with an odontogenic infection, is advocated. Routine antibiotic coverage against Gram-negative bacteria is not paramount.
本研究旨在回顾深部脓肿的微生物学特征，并确定影响其发生的因素。
对新加坡陈笃生医院耳鼻喉科 2004 年至 2009 年间诊断为深部脓肿的患者进行回顾性病历分析。共分析了 131 例深部脓肿患者的数据，其中纳入了有阳性脓液培养结果的患者。采用逻辑回归分析比较了不同条件（年龄、性别、病因和糖尿病的影响）下常见病原体的发生率。
共纳入 96 例患者，其中 18 例为混合培养。培养出的主要病原体包括肺炎克雷伯菌（K. pneumoniae）（27.1%）、米勒链球菌组（SMG）细菌（21.9%）和厌氧菌-NOS（20.8%）。糖尿病组中 K. pneumoniae （50.0%）的比例过高。在牙源性感染患者中，SMG 细菌（68.8%）和厌氧菌-NOS（43.8%）最常被分离。K. pneumoniae 在女性患者中更为常见（39.3%）。这三种主要病原体在 50 岁以下和 50 岁以上患者中的分布相似。K. pneumoniae 是咽旁间隙脓肿中最常见的培养病原体，而下颌下间隙和腮腺间隙最常分离出 SMG 细菌和金黄色葡萄球菌。
建议使用广谱抗生素治疗深部脓肿。对于糖尿病患者，应根据经验用抗生素覆盖治疗 K. pneumoniae 感染，对于牙源性感染患者，应根据经验用抗生素覆盖治疗 SMG 细菌和厌氧菌感染。常规抗生素覆盖革兰氏阴性菌并非首要考虑。
