Ho Chia-Ying, Chan Kai-Chieh, Wang Yu-Chien, Chin Shy-Chyi, Chen Shih-Lung
Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
School of Medicine, Chang Gung University, Taoyuan, Taiwan.
Ear Nose Throat J. 2023 Apr 3:1455613231168478. doi: 10.1177/01455613231168478.
Deep neck infection (DNI) is a severe infectious disorder of deep neck spaces that can cause serious complications. Long-term hospitalization is when a patient spends more time in the hospital than originally expected for a disease. There are few studies assessing the risk factors associated with long-term hospitalization for a DNI. This study investigated the factors causing DNI patients to experience long-term hospitalization.
Long-term hospitalization is defined as a length of hospital stay exceeding 28 days (> 4 weeks) in this research. A total of 362 subjects with a DNI between October 2017 and November 2022 were recruited. Among these patients, 20 required long-term hospitalization. The relevant clinical variables were assessed.
In a univariate analysis, C-reactive protein (odds ratio [OR] = 1.003, 95% CI: 1.000-1.007, = .044), involvement of ≥3 deep neck spaces (OR = 2.836, 95% CI: 1.140-7.050, = .024), and mediastinitis (OR = 8.102, 95% CI: 3.041-21.58, < .001) were significant risk factors for long-term hospitalization in DNI patients. In a multivariate analysis, mediastinitis (OR = 6.018, 95% CI: 2.058-17.59, = .001) was a significant independent risk factor for long-term hospitalization for a DNI. There were no significant differences in pathogens between the patients with and without long-term hospitalization (all > .05). However, the rates of no growth of specific pathogens were significantly different between patients with and without long-term hospitalization, and those with long-term hospitalization had greater rates of growth of specific pathogens ( = .032). The rate of tracheostomy in patients with long-term hospitalization was higher than for those without ( < .001). Nevertheless, the rates of surgical incision and drainage between patients with and without long-term hospitalization did not achieve statistical significance ( = .069).
Deep neck infection (DNI) is a critical, life-threatening disease that could lead to long-term hospitalization. The higher CRP and involvement of ≥3 deep neck spaces were significant risk factors in univariate analysis, while concurrent mediastinitis was an independent risk factor associated with long-term hospitalization. We suggest intensive care and prompt airway protection for DNI patients with concurrent mediastinitis.
颈部深部感染（DNI）是一种严重的颈部深部间隙感染性疾病，可导致严重并发症。长期住院是指患者在医院的停留时间超过某种疾病原本预期的时间。很少有研究评估与DNI长期住院相关的危险因素。本研究调查了导致DNI患者长期住院的因素。
在本研究中，长期住院定义为住院时间超过28天（>4周）。共招募了2017年10月至2022年11月期间362例DNI患者。其中，20例需要长期住院。评估了相关临床变量。
单因素分析中，C反应蛋白（比值比[OR]=1.003，95%可信区间：1.000-1.007，P=.044）、累及≥3个颈部深部间隙（OR=2.836，95%可信区间：1.140-7.050，P=.024）和纵隔炎（OR=8.102，95%可信区间：3.041-21.58，P<.001）是DNI患者长期住院的显著危险因素。多因素分析中，纵隔炎（OR=6.018，95%可信区间：2.058-17.59，P=.001）是DNI长期住院的显著独立危险因素。长期住院和未长期住院患者的病原体无显著差异（均P>.05）。然而，长期住院和未长期住院患者特定病原体无生长率有显著差异，长期住院患者特定病原体生长率更高（P=.032）。长期住院患者的气管切开率高于未长期住院患者（P<.001）。然而，长期住院和未长期住院患者手术切开引流率未达到统计学意义（P=.069）。
颈部深部感染（DNI）是一种危急的、危及生命的疾病，可导致长期住院。较高的CRP和累及≥3个颈部深部间隙在单因素分析中是显著危险因素，而并发纵隔炎是与长期住院相关的独立危险因素。我们建议对并发纵隔炎的DNI患者进行重症监护并及时保护气道。
