Otorhinolaryngology Hospital, First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, Guangdong, People's Republic of China.
Department of Otorhinolaryngology-Head and Neck Surgery, First People's Hospital of Foshan, Foshan, Guangdong, People's Republic of China.
BMC Infect Dis. 2022 Mar 23;22(1):280. doi: 10.1186/s12879-022-07259-9.
Deep neck space abscess (DNSA) is a serious infection in the head and neck. Antibiotic therapy is an important treatment in patients with DNSA. However, the results of bacterial culture need at least 48 h, and the positive rate is only 30-50%, indicating that the use of empiric antibiotic treatment for most patients with DNSA should at least 48 h or even throughout the whole course of treatment. Thus, how to use empiric antibiotics has always been a problem for clinicians. This study analyzed the distribution of bacteria based on disease severity and clinical characteristics of DNSA patients, and provides bacteriological guidance for the empiric use of antibiotics.
We analyzed 433 patients with DNSA who were diagnosed and treated at nine medical centers in Guangdong Province between January 1, 2015, and December 31, 2020. A nomogram for disease severity (mild/severe) was constructed using least absolute shrinkage and selection operator-logistic regression analysis. Clinical characteristics for the Gram reaction of the strain were identified using multivariate analyses.
92 (21.2%) patients developed life-threatening complications. The nomogram for disease severity comprised of seven predictors. The area under the receiver operating characteristic curves of the nomogram in the training and validation cohorts were 0.951 and 0.931, respectively. In the mild cases, 43.2% (101/234) had positive culture results (49% for Gram-positive and 51% for Gram-negative strains). The positive rate of cultures in the patients with severe disease was 63% (58/92, 37.9% for Gram-positive, and 62.1% for Gram-negative strains). Diabetes mellitus was an independent predictor of Gram-negative strains in the mild disease group, whereas gas formation and trismus were independent predictors of Gram-positive strains in the severe disease group. The positivity rate of multidrug-resistant strains was higher in the severe disease group (12.1%) than in the mild disease group (1.0%) (P < 0.001). Metagenomic sequencing was helpful for the bacteriological diagnosis of DNSA by identifying anaerobic strains (83.3%).
We established a DNSA clinical severity prediction model and found some predictors for the type of Gram-staining strains in different disease severity cases. These results can help clinicians in effectively choosing an empiric antibiotic treatment.
深部咽旁间隙脓肿（DNSA）是头颈部的一种严重感染。抗生素治疗是 DNSA 患者的重要治疗方法。然而，细菌培养结果至少需要 48 小时，阳性率仅为 30-50%，这表明对于大多数 DNSA 患者，经验性抗生素治疗至少应持续 48 小时甚至整个治疗过程。因此，如何使用经验性抗生素一直是临床医生面临的问题。本研究基于 DNSA 患者的疾病严重程度和临床特征分析了细菌分布，为经验性使用抗生素提供了细菌学指导。
我们分析了 2015 年 1 月 1 日至 2020 年 12 月 31 日期间在广东省 9 家医疗中心诊断和治疗的 433 例 DNSA 患者。使用最小绝对收缩和选择算子-逻辑回归分析构建疾病严重程度（轻度/重度）的列线图。使用多变量分析确定菌株革兰氏反应的临床特征。
92 例（21.2%）患者发生危及生命的并发症。疾病严重程度的列线图由 7 个预测因素组成。在训练和验证队列中，列线图的受试者工作特征曲线下面积分别为 0.951 和 0.931。在轻症病例中，43.2%（101/234）培养阳性（革兰阳性 49%，革兰阴性 51%）。重症患者的培养阳性率为 63%（58/92，革兰阳性 37.9%，革兰阴性 62.1%）。糖尿病是轻症组革兰氏阴性菌的独立预测因素，而气体形成和牙关紧闭是重症组革兰氏阳性菌的独立预测因素。重症组多重耐药菌株的阳性率（12.1%）高于轻症组（1.0%）（P<0.001）。宏基因组测序有助于通过鉴定厌氧菌（83.3%）对 DNSA 的细菌学诊断。
我们建立了 DNSA 临床严重程度预测模型，并发现了不同疾病严重程度病例中革兰氏染色菌株类型的一些预测因素。这些结果有助于临床医生有效选择经验性抗生素治疗。
