Sharma Kalpana, Das Devjani, Joshi Manish, Barman Dipjyoti, Sarma A J
Department of Ent and Head and Neck Surgery, Gmch, Room No-311, P G GIRLS HOSTEL NO-6, Bhangagarh, Guwahati, 781032 India.
Indian J Otolaryngol Head Neck Surg. 2018 Mar;70(1):22-27. doi: 10.1007/s12070-017-1196-0. Epub 2017 Sep 5.
This study is intended to analyze the clinical profile and outcomes of deep neck space infection in diabetic patients in our tertiary care centre. A prospective study of 1 year duration from 30th September 2015 to 30th September 2016 at department of Otorhinolaryngology, Gauhati Medical College and Hospital, Guwahati. A total of 45 diabetic patients who presented with DNSI are included in this study. Their demographic profile, etiology, bacteriology, treatment, duration of hospital stay, complications and outcomes have been analyzed. 45 patients were recorded; 32 (71.11%) were men, and 13 (45%) were women, with a mean age of 63.27 ± 7.55 years. There were 30 patients (66.67%) who had associated systemic diseases apart from diabetes mellitus. The parapharyngeal space in 13 patients (28.89%) was the most commonly involved space. Odontogenic infections in 18 patients (40%) and upper airway infections 9 patients (20%) were the two most common causes. Klebsiella pneumonia in 29 patients (64.44%), was the commonest organism isolated through pus cultures. All the patients except one (97.78%) came with abscess and underwent surgical drainage. One patient (2.22%) with carbuncle underwent regular dressing. Six patients (13.33%) had major complications. Those patients with other underlying systemic diseases or complications tended to have a longer hospital stay and were older. No cases of death has been reported. (mortality rate, 0%). DNSI patients with diabetes have a more severe clinical course. They are likely to have complications more frequently and a longer duration of hospital stay. In clinical practices while dealing with these patients more vigilance is required. On admission empirical antibiotics should cover K. pneumonia. Early surgical drainage remains the main method of treatment. Primary prevention can be achieved by orodental hygiene, regular dental check ups and in this part of the country by avoidance of substance abuse like tobacco chewing.
本研究旨在分析我院三级医疗中心糖尿病患者深部颈部间隙感染的临床特征及预后。这是一项前瞻性研究，于2015年9月30日至2016年9月30日在高哈蒂医学院和医院耳鼻喉科进行，为期1年。本研究共纳入45例出现深部颈部间隙感染的糖尿病患者。分析了他们的人口统计学特征、病因、细菌学、治疗方法、住院时间、并发症及预后。记录了45例患者；其中32例（71.11%）为男性，13例（45%）为女性，平均年龄为63.27±7.55岁。有30例患者（66.67%）除糖尿病外还患有其他全身性疾病。13例患者（28.89%）的咽旁间隙是最常受累的间隙。18例患者（40%）的牙源性感染和9例患者（20%）的上呼吸道感染是两个最常见的病因。通过脓液培养分离出的最常见病原体是肺炎克雷伯菌，共29例患者（64.44%）。除1例患者（97.78%）外，所有患者均伴有脓肿并接受了手术引流。1例患有痈的患者（2.22%）接受了定期换药。6例患者（13.33%）出现了严重并发症。那些患有其他潜在全身性疾病或并发症的患者往往住院时间更长且年龄更大。未报告死亡病例（死亡率为0%）。糖尿病深部颈部间隙感染患者的临床病程更为严重。他们更易出现并发症，住院时间更长。在临床实践中，处理这些患者时需要更高的警惕性。入院时经验性使用的抗生素应覆盖肺炎克雷伯菌。早期手术引流仍然是主要的治疗方法。一级预防可通过口腔卫生、定期牙科检查以及在该国这一地区避免诸如嚼烟草等物质滥用来实现。
