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European Archives of Oto-Rhino-Laryngology

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26-12-2023 | Antibiotic | Head and Neck

Microbiological analysis and antibiotic selection strategy in neck abscesses among patients with diabetes mellitus

Authors: Weili Kong, Xiaoyun Zhang, Mei Li, Hui Yang

Published in: European Archives of Oto-Rhino-Laryngology | Issue 3/2024

Abstract

Purpose

This study aimed to analyze the clinical characteristics, pathogen distribution, drug sensitivity, and antibiotic treatment strategies of patients with neck abscesses with or without diabetes.

Methods

A retrospective analysis was conducted on 2194 patients who underwent neck abscess surgery at our hospital over the past 13 years. Patients were grouped as NA_withDM (neck abscess with diabetes mellitus) or NA_withoutDM (neck abscess without diabetes mellitus). Clinical features, pathogen distribution, and antibiotic sensitivity were compared between the groups. Venn diagrams were used to illustrate the antibiotics effective against all three predominant pathogens.

Results

A total of 2194 patients with neck abscesses were included in this study, with 579 patients (26.43%) in the NA_withDM group and 1612 patients (73.51%) in the NA_withoutDM group. There were no significant differences in sex or age distribution between the two groups (all P > 0.05). However, there were significant differences in BMI, length of hospital stays, occurrence of laryngeal obstruction, hypertension, and hypoalbuminemia between the two groups (all P < 0.05). In the NA_withoutDM group, the top three pathogens were Streptococcus constellatus, Klebsiella pneumoniae, and Staphylococcus aureus. The antibiotics that were simultaneously effective against all three pathogens were ceftriaxone, moxifloxacin, and ampicillin/sulbactam. In the NA_withDM group, the top three pathogens were Streptococcus pyogenes, Streptococcus pneumoniae, and Streptococcus constellatus. The antibiotics that were simultaneously effective against all three pathogens were compound sulfamethoxazole, cefuroxime, levofloxacin, ciprofloxacin, vancomycin, and imipenem.

Conclusion

Neck abscess patients with diabetes have distinct clinical features. Therefore, it is crucial to pay attention to these clinical features and manage them accordingly during the treatment process. Empirical antibiotic treatment should be tailored to individual patient groups. Sulfamethoxazole-methoxazole is recommended for neck abscess patients with diabetes, while ceftriaxone or moxifloxacin is recommended for those without diabetes.

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Bal KK, Unal M, Delialioglu N, Oztornaci RO, Ismi O, Vayisoglu Y (2022) Diagnostic and therapeutic approaches in deep neck infections: an analysis of 74 consecutive patients. Braz J Otorhinolaryngol 88:511–522. https://doi.org/10.1016/j.bjorl.2020.07.002CrossRefPubMed

Bigus S, Russmüller G, Starzengruber P, Reitter H, Sacher CL (2023) Antibiotic resistance of the bacterial spectrum of deep space head and neck infections in oral and maxillofacial surgery—a retrospective study. Clin Oral Investig. https://doi.org/10.1007/s00784-023-05095-yCrossRefPubMed

Chung HF, Al Mamun A, Huang MC, Long KZ, Huang YF, Shin SJ, Hwang SJ, Hsu CC (2017) Obesity, weight change, and chronic kidney disease in patients with type 2 diabetes mellitus: a longitudinal study in Taiwan. J Diabetes 9:983–993. https://doi.org/10.1111/1753-0407.12514CrossRefPubMed

Emdin CA, Rahimi K, Neal B, Callender T, Perkovic V, Patel A (2015) Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysis. JAMA 313:603–615. https://doi.org/10.1001/jama.2014.18574CrossRefPubMed

Gao W, Lin Y, Yue H, Chen W, Liu T, Ye J, Cai Q, Ye F, He L, Xie X (2022) Bacteriological analysis based on disease severity and clinical characteristics in patients with deep neck space abscess. BMC Infect Dis 22:280. https://doi.org/10.1186/s12879-022-07259-9CrossRefPubMedPubMedCentral

Hidaka H, Yamaguchi T, Hasegawa J, Yano H, Kakuta R, Ozawa D, Nomura K, Katori Y (2015) Clinical and bacteriological influence of diabetes mellitus on deep neck infection: systematic review and meta-analysis. Head Neck 37:1536–1546. https://doi.org/10.1002/hed.23776CrossRefPubMed

Hirano T (2014) Abnormal lipoprotein metabolism in diabetic nephropathy. Clin Exp Nephrol 18:206–209. https://doi.org/10.1007/s10157-013-0880-yCrossRefPubMed

Ho C-Y, Chan K-C, Wang Y-C, Chin S-C, Chen S-L (2023) Assessment of factors associated with long-term hospitalization in patients with a deep neck infection. Ear Nose Throat J. https://doi.org/10.1177/01455613231168478CrossRefPubMed

Hodgson K, Morris J, Bridson T, Govan B, Rush C, Ketheesan N (2015) Immunological mechanisms contributing to the double burden of diabetes and intracellular bacterial infections. Immunology 144:171–185. https://doi.org/10.1111/imm.12394CrossRefPubMedPubMedCentral

10.

Jicman D, Sârbu N, Rebegea L-F, Crăescu M, Niculeț E, Țuța M-D, Nechita A, Nicolescu AC, Tatu AL (2023) Principles of treatment and clinical-evolutionary peculiarities of deep cervical spaces suppurations—clinical study. Life 13:535. https://doi.org/10.3390/life13020535ADSCrossRef

11.

Kauffmann P, Cordesmeyer R, Tröltzsch M, Sömmer C, Laskawi R (2017) Deep neck infections: a single-center analysis of 63 cases. Medicina oral, patologia oral y cirugia bucal 22:e536. https://doi.org/10.4317/medoral.21799CrossRefPubMedPubMedCentral

12.

Lim H-K, Wang J-M, Hung S-T, Ku H-C (2021) A dangerous cause of airway obstruction: deep neck infection. Signa Vitae 17:4–9. https://doi.org/10.22514/sv.2020.16.0101CrossRef

13.

Luan C-W, Liu C-Y, Yang Y-H, Tsai M-S, Tsai Y-T, Hsu C-M, Wu C-Y, Chang P-J, Chang G-H (2021) The pathogenic bacteria of deep neck infection in patients with type 1 diabetes, type 2 diabetes, and without diabetes from Chang Gung Research Database. Microorganisms 9:2059. https://doi.org/10.3390/microorganisms9102059CrossRefPubMedPubMedCentral

14.

Maurer FP, Christner M, Hentschke M, Rohde H (2017) Advances in rapid identification and susceptibility testing of bacteria in the clinical microbiology laboratory: implications for patient care and antimicrobial stewardship programs. Infect Dis Rep 9:6839. https://doi.org/10.3390/microorganisms9102059CrossRefPubMedPubMedCentral

15.

McDowell RH, Hyser MJ (2017) Neck abscess. StatPearls. StatPearls Publishing, Treasure Island

16.

Mettler J, Simcock M, Sendi P, Widmer AF, Bingisser R, Battegay M, Fluckiger U, Bassetti S (2007) Empirical use of antibiotics and adjustment of empirical antibiotic therapies in a university hospital: a prospective observational study. BMC Infect Dis 7:1–10. https://doi.org/10.1186/1471-2334-7-21CrossRef

17.

Rijal S, Romdhoni AC (2018) Bacteria pattern, results of antibiotic sensitivity test, and complications of deep neck abscess patients in Dr. Soetomo General Hospital. Biomol Health Sci J 1:124. https://doi.org/10.20473/bhsj.v1i2.9832CrossRef

18.

Schutta MH (2007) Diabetes and hypertension: epidemiology of the relationship and pathophysiology of factors associated with these comorbid conditions. J Cardiometab Syndr 2:124–130. https://doi.org/10.1111/j.1559-4564.2007.06368.xCrossRefPubMed

19.

Velhonoja J, Lääveri M, Soukka T, Irjala H, Kinnunen I (2020) Deep neck space infections: an upward trend and changing characteristics. Eur Arch Otorhinolaryngol 277:863–872. https://doi.org/10.1007/s00405-019-05742-9CrossRefPubMed

20.

Wu C-L, Tsai M-S, Lee T-J, Wang Y-T, Liu C-Y, Yang Y-H, Tsai Y-T, Hsu C-M, Wu C-Y, Chang P-J (2021) Type 2 diabetes mellitus increases peritonsillar abscess susceptibility: real-world evidence. Clin Exp Otorhinolaryngol 14:347–354. https://doi.org/10.21053/ceo.2020.02257CrossRefPubMedPubMedCentral

21.

Huttner B et al (2010) Characteristics and outcomes of public campaigns aimed at improving the use of antibiotics in outpatient settings in high-income countries. Lancet Infect Dis 10(1):17–31. https://doi.org/10.1016/S1473-3099(09)70305-6CrossRefPubMed

Title: Microbiological analysis and antibiotic selection strategy in neck abscesses among patients with diabetes mellitus
Authors: Weili Kong
Xiaoyun Zhang
Mei Li
Hui Yang
Publication date: 26-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Antibiotic
Streptococci
Moxifloxacin
Ceftriaxone
Ampicillin
Imipenem
Ciprofloxacin
Diabetes
Levofloxacin
Vancomycin
Published in: European Archives of Oto-Rhino-Laryngology / Issue 3/2024
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-023-08396-w

ERS Congress 2024

Springer Medicine

Microbiological analysis and antibiotic selection strategy in neck abscesses among patients with diabetes mellitus

Abstract

Purpose

Methods

Results

Conclusion

ERS Congress 2024

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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