Luan Chih-Wei, Liu Chia-Yen, Yang Yao-Hsu, Tsai Ming-Shao, Tsai Yao-Te, Hsu Cheng-Ming, Wu Ching-Yuan, Chang Pey-Jium, Chang Geng-He
Department of Otorhinolaryngology-Head and Neck Surgery, Lo Sheng Sanatorium and Hospital Ministry of Health and Welfare, New Taipei City 24257, Taiwan.
Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan.
Microorganisms. 2021 Sep 29;9(10):2059. doi: 10.3390/microorganisms9102059.
Deep neck infection (DNI) is a lethal emergent condition. Patients with types 1 and 2 diabetes mellitus (T1DM and T2DM, respectively) are predisposed to DNI and have poorer prognoses. The mainstay of the treatment is surgical drainage and antibiotics; however, the pathogenic bacteria of T1DM-DNI have not been studied before. We obtained the data of 8237 patients with DNI who were hospitalized from 2004 to 2015 from the Chang Gung Research Database, which contains multi-institutional medical records in Taiwan. Using diagnostic codes, we classified them into T1DM-DNI, T2DM-DNI, and non-DM-DNI and analyzed their pathogenic bacteria, disease severity, treatment, and prognosis. The top three facultative anaerobic or aerobic bacteria of T1DM-DNI were (KP, 40.0%), (VS, 22.2%), and methicillin-sensitive (MSSA, 8.9%), similar for T2DM (KP, 32.2%; VS, 23.3%; MSSA, 9.5%). For non-DM-DNI, it was VS (34.6%), KP (9.8%), and coagulase-negative (8.7%). The order of anaerobes for the three groups was , , and . Patients with T1DM-DNI and T2DM-DNI had higher white blood cell (WBC) counts and C-reactive protein (CRP) levels, more cases of surgery, more cases of tracheostomy, longer hospital stays, more mediastinal complications, and higher mortality rates than those without DM-DNI. Patients in the death subgroup in T1DM-DNI had higher WBC counts, band forms, and CRP levels than those in the survival subgroup. Patients with DM-DNI had more severe disease and higher mortality rate than those without DM-DNI. KP and are the leading pathogens for both patients with T1DM-DNI and those with T2DM-DNI. Clinicians should beware of high serum levels of infection markers, which indicate potential mortality.
深部颈部感染（DNI）是一种致命的紧急情况。1型和2型糖尿病（分别为T1DM和T2DM）患者易患DNI且预后较差。治疗的主要方法是手术引流和使用抗生素；然而，此前尚未对T1DM-DNI的病原菌进行过研究。我们从长庚研究数据库中获取了2004年至2015年期间住院的8237例DNI患者的数据，该数据库包含台湾多机构的医疗记录。利用诊断编码，我们将他们分为T1DM-DNI、T2DM-DNI和非糖尿病性DNI，并分析了他们的病原菌、疾病严重程度、治疗情况和预后。T1DM-DNI的前三类兼性厌氧或需氧菌为肺炎克雷伯菌（KP，40.0%）、金黄色葡萄球菌（VS，22.2%）和甲氧西林敏感金黄色葡萄球菌（MSSA，8.9%），T2DM的情况类似（KP，32.2%；VS，23.3%；MSSA，9.5%）。对于非糖尿病性DNI，依次为VS（34.6%）、KP（9.8%）和凝固酶阴性葡萄球菌（8.7%）。三组厌氧菌的顺序为消化链球菌属、普雷沃菌属和梭杆菌属。与非糖尿病性DNI患者相比，T1DM-DNI和T2DM-DNI患者的白细胞（WBC）计数和C反应蛋白（CRP）水平更高，手术病例更多，气管切开病例更多，住院时间更长，纵隔并发症更多，死亡率更高。T1DM-DNI死亡亚组患者的WBC计数、杆状核细胞和CRP水平高于存活亚组患者。糖尿病性DNI患者的疾病比非糖尿病性DNI患者更严重，死亡率更高。KP和金黄色葡萄球菌是T1DM-DNI患者和T2DM-DNI患者的主要病原体。临床医生应警惕感染标志物的高血清水平，这表明可能存在死亡风险。
