Shimizu Yuichi, Hidaka Hiroshi, Ozawa Daiki, Kakuta Risako, Nomura Kazuhiro, Yano Hisakazu, Watanabe Ken-Ichi, Katori Yukio
Department of Otolaryngology - Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Department of Otolaryngology - Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Int J Pediatr Otorhinolaryngol. 2017 Aug;99:95-99. doi: 10.1016/j.ijporl.2017.05.028. Epub 2017 Jun 5.
Deep neck infections (DNIs) can lead to life-threatening disease. However, the detailed pathophysiology remains unclear due to its rarity and only a few reports have directly compared DNIs in children and adults. This study aimed to reveal the clinical differences between DNIs in children and adults.
We retrospectively reviewed 123 patients who suffered from DNIs at Tohoku University Hospital from August 2005 to July 2015. We extracted data on patient sex, age, antecedent illness, extension of infections, operative procedures, and bacteriology results. The patients were categorized into pediatric (≤18 years) and adult (>18 years) groups. Fisher's exact test was performed to determine significant differences between the two groups.
Fifteen children (6 males and 9 females) and 108 adults (71 males and 37 females) were identified. The most common antecedent illness in pediatric patients was lymphadenitis, which was the least common in adult patients (73% vs 7%, p < 0.0001). The incidence of DNIs extending below the hyoid bone was significantly lower in pediatric patients than in adult patients (20% vs 53%, p < 0.05). Regarding bacterial culture analysis, Staphylococcus species was the most common pathogen in children (60%), whereas only 9% of adults were positive for Staphylococcus (p < 0.001). Streptococcus species were significantly less common in children than in adults (27% vs 56%, p = 0.05). Anaerobes were also significantly less common in children than in adults (13% vs 45%, p < 0.01). Concerning surgical intervention, 53% of pediatric patients underwent external incision compared with 70% of adults. Specifically, tracheostomy was significantly less frequently performed in children than in adults (7% vs 54%, p < 0.01).
DNIs in children feature different characteristics from those in adults regarding severity, antecedent illness, bacteriology, and clinical management.
颈部深部感染（DNIs）可导致危及生命的疾病。然而，由于其罕见性，详细的病理生理学仍不清楚，仅有少数报告直接比较了儿童和成人的颈部深部感染。本研究旨在揭示儿童和成人颈部深部感染的临床差异。
我们回顾性分析了2005年8月至2015年7月在东北大学医院患有颈部深部感染的123例患者。我们提取了患者的性别、年龄、既往疾病、感染范围、手术操作和细菌学结果等数据。患者被分为儿童组（≤18岁）和成人组（>18岁）。采用Fisher精确检验确定两组之间的显著差异。
共确定15名儿童（6名男性和9名女性）和108名成人（71名男性和37名女性）。儿童患者最常见的既往疾病是淋巴结炎，而成人患者中最不常见（73%对7%，p<0.0001）。儿童患者颈部深部感染延伸至舌骨以下的发生率显著低于成人患者（20%对53%，p<0.05）。关于细菌培养分析，葡萄球菌属是儿童中最常见的病原体（60%），而只有9%的成人葡萄球菌呈阳性（p<0.001）。儿童中链球菌属的发生率显著低于成人（27%对56%，p=0.05）。厌氧菌在儿童中的发生率也显著低于成人（13%对45%，p<0.01）。关于手术干预，53%的儿童患者接受了外部切口，而成人患者为70%。具体而言，儿童气管切开术的实施频率显著低于成人（7%对54%，p<0.01）。
儿童颈部深部感染在严重程度、既往疾病、细菌学和临床管理方面具有与成人不同的特征。
