Chen Shih-Lung, Chin Shy-Chyi, Wang Yu-Chien, Ho Chia-Ying
Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou 333, Taiwan.
School of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
Diagnostics (Basel). 2022 Feb 9;12(2):443. doi: 10.3390/diagnostics12020443.
Deep neck infection (DNI) is a severe disease of the deep neck spaces, which has the potential for airway obstruction. Cervical necrotizing fasciitis (CNF) is a fatal infection of the diffuse soft tissues and fascia with a high mortality rate. This study investigated risk factors in patients with concurrent DNI and CNF. A total of 556 patients with DNI were included in this study between August 2016 and December 2021. Among these patients, 31 had concurrent DNI and CNF. The relevant clinical variables were assessed. In univariate analysis, age (> 60 years, odds ratio (OR) = 2.491, = 0.014), C-reactive protein (CRP, OR = 1.007, < 0.001), blood sugar (OR = 1.007, < 0.001), and diabetes mellitus (DM, OR = 4.017, < 0.001) were significant risk factors for concurrent DNI and CNF. In multivariate analysis, CRP (OR = 1.006, < 0.001) and blood sugar (OR = 1.006, = 0.002) were independent risk factors in patients with concurrent DNI and CNF. There were significant differences in the length of hospital stay and therapeutic management (intubation, tracheostomy, incision and drainage) between DNI patients with and without CNF (all < 0.05). While there were no differences in pathogens between the DNI alone and concurrent DNI and CNF groups (all > 0.05), the rate of specific pathogen non-growth from blood cultures was 16.95% (89/525) in the DNI alone group, in contrast to 0% (0/31) in the concurrent DNI and CNF group ( = 0.008). Higher CRP and blood sugar levels were independent risk factors for the concurrence of DNI and CNF. With regard to prognosis, there were significant differences in the length of hospital stay and therapeutic management between the groups with and without CNF. While there were no significant differences in pathogens (all > 0.05), no cases in the concurrent DNI and CNF group showed specific pathogen non-growth, in contrast to 89/525 patients in the group with DNI alone.
深部颈部感染（DNI）是一种累及深部颈部间隙的严重疾病，有导致气道梗阻的风险。颈部坏死性筋膜炎（CNF）是一种累及弥漫性软组织和筋膜的致命感染，死亡率很高。本研究调查了同时患有DNI和CNF患者的危险因素。2016年8月至2021年12月期间，本研究共纳入了556例DNI患者。在这些患者中，31例同时患有DNI和CNF。对相关临床变量进行了评估。单因素分析中，年龄（>60岁，比值比（OR）=2.491，P = 0.014）、C反应蛋白（CRP，OR = 1.007，P < 0.001）、血糖（OR = 1.007，P < 0.001）和糖尿病（DM，OR = 4.017，P < 0.001）是同时患有DNI和CNF的显著危险因素。多因素分析中，CRP（OR = 1.006，P < 0.001）和血糖（OR = 1.006，P = 0.002）是同时患有DNI和CNF患者的独立危险因素。患有和未患有CNF的DNI患者在住院时间和治疗管理（插管、气管切开、切开引流）方面存在显著差异（均P < 0.05）。虽然单纯DNI组和同时患有DNI和CNF组之间的病原体无差异（均P > 0.05），但单纯DNI组血培养特定病原体未生长率为16.95%（89/525），而同时患有DNI和CNF组为0%（0/31）（P = 0.008）。较高的CRP和血糖水平是DNI和CNF并发的独立危险因素。关于预后，患有和未患有CNF的组在住院时间和治疗管理方面存在显著差异。虽然病原体无显著差异（均P > 0.05），但同时患有DNI和CNF组无病例显示特定病原体未生长，而单纯DNI组有89/525例患者出现这种情况。
