Risk Factor Associated Complication of Deep Neck Infection on Elderly Patients and Outcomeof Treatment
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Abstract
Background : Deep neck infections could be seriously threatened by life-threatening complications. Such that, early diagnosis and correct treatment planning can save the patient’s life and prevent complications of disease extension.
Objective : To study risk factors and predictor factors associated with complicated treatment outcomes of deep neck infection on elderly patients in Chaiyaphum hospital.
Methods : This is an analytical retrospective study with 110 the reviewed medical records of those patients 60 years old who had deep neck infection between 1st. January 2016 to 31st. December 2018. General data were analyzed using Chi-square test, Fisher exact test, independent sample t-test, and odds ratio with 95% confidence interval and binary logistic regression analysis (adjusted odds ratio-OR), 95% confidence interval p-value<0.05.
Results : There were 110 patients included to analysis, females 50.9%, mean age 71.0±8.3 years. It can occur in the elderly group in the sixth decade of life (53.6%). The mean duration of hospital stay was 5.8±4.0 days. The patients usually presented with pain in the face or neck (48.2%). The odontogenic infection was the most common caused (39.1%). The comorbidities were diabetic mellitus (30%) and hypertension (10%). Submandibular space was the most frequent space of infection (23.6%). The most common aerobe organisms isolated from pus were staphylococcus aureus (15.5%) and beta-hemolytic streptococcus (10%). Surgical and antibiotics treatment was performed in 65.4% of cases, successful 95.5%, and dead 4.5%. Among all complicated treatment outcomes, sepsis was the most common (13.6%). The main risk factors were multiple space involvement (OR,12.6; 95% 0,4.3-36.9), dyspnea (OR, 7.7; 95% CI, 2.6-22.8), dysphagia (OR, 3.3; 95% CI,1.2-9.1), fever (OR, 2.9; 95% CI, 1.2-7.0), hypertension (OR, 4.9; 95% 0,1.3-18.2), diabetic mellitus (OR, 3.3; 95% CI,1.4-7.9), duration of hospital stay 10 days (OR, 6.3; 95% 0,1.9-20.2). The binary logistic regression analysis were performed predictors of risk factor and significantly; mean age patients 72.8±9.9 years (AOR, 1.1; 95% CI, 1.0-1.3), duration of hospital stay 10 days (AOR, 0.2; 95% CI,0.0-0.9), multiple space involvement (AOR, 0.1; 95% CI, 0.0-0.3), Parotid space (AOR, 0.1; 95% CI, 0.1-0.8), Retropharyngeal space (AOR, 0.1; 95% 0, 0.0-0.9), diabetic mellitus (AOR,0.2; 95% CI,0.1-0.7), hypertension (AOR,0.1; 95% CI,0.0-0.7)
Conclusion : Deep neck infection on elderly patients was still a problem and could be life-threatening, major etiological factors from odontogenic infection, multiple space involvement. Causes of dead were sepsis comorbidities disease from diabetic mellitus and hypertension. In additions, diabetic mellitus and hypertension were risk factors influencing complicated treatment outcomes and prolong the length of stay though received antibiotics, surgical drainage. So that, prevention disease was important by providing knowledge of oral care for elderly patients and caregiver, if maybe sick please went to treatment as soon as reduced incidence.
Keywords : Risk factor influencing, Complicated treatment outcomes, Deep neck infection on elderly patients
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References
Chow AW. Life-threatening infections of the head, neck, and upper respiratory tract. In: Hall JB, Schmidt GA, Wood LD, Eds. Principles of Critical Care. New York : Me Graw-Hill; 2008: 881-95.
Kirov G, Benchev R, stoianov S. [Complications of the deep infections of the neck] [Article in Bulgarian], Khirurgiia (Sofiia) 2006;(3):28-31.
Vieira F, Allen SM, Stocks RM, Thompson JW. Deep neck infection. Otolaryngol Clin North Am 2008;41(3):459-83, vii
Chen MK, Wen YS, Chang CC, Huang MT, Hsiao HC. Predisposing factors of life-threat ening deep neck infection : logistic regression analysis of 214 cases. J Otolaryngol 1998;27(3):141-4.
Hasegawa J, Hidaka H, Tateda M, Kudo T, Sagai S, Miyazaki M, et al. An analysis of clinical risk factors of deep neck infection. Auris Nasus Larynx 2011;38(1):101-7.
Nour YA, Hassan MH, Gaafar A, Eldaly A. Deep neck infections of congenital causes. Otolaryngol Head Neck Surg 2011;144(3): 365-71.
Marioni G, Castegnaro E, staffieri C, Rinaldi R, Giacomelli L, Boninsegna M, Deep neck infection in elderly patients. A single institution experience (2000-2004). Aging Clin Exp Res 2006;18(2):127-32.
Motahari SJ, Poormoosa R, Nikkhah M, Bahari M, Shirazy SM, Khavarinejad F. Treatment and prognosis of deep neck infections. Indian J Otolaryngol Head Neck Surg 2015;67(Suppl 1):134-7.
Suehara AB, Gonpalves AJ, Alcadipani FA, Kavabata NK, Menezes MB. Deep neck infection: analysis of 80 cases. Braz J Otorhinolaryngol 2008;74(2):253-9.
Huang TT, Tseng FY, Liu TC, Hsu CJ, Chen YS. Deep neck infection in diabetic patients: comparison of clinical picture and outcomes with nondiabetic patients. Otolaryngol Head Neck Surg 2005;132(6):943-7.
Alaani A, Griffiths H, Minhas SS, Olliff J, Le AB. Parapharyngeal abscess: diagnosis, complications and management in adults. Eur Arch Otorhinolaryngol 2005;262(4): 345-50.
Butcher SK, Killampalli V, Chahal H, Kaya Alpar E, Lord JM. Effect of age on susceptibility to post-traumatic infection in the elderly. Biochem Soc Trans 2003;31(2):449-51.
กลุ่มงานโสต ศอ นาสิก โรงพยาบาลชัยภูมิ. สถิติผู้ใช้บริการ ปี 2559-2561. ชัยภูมิ : โรงพยาบาลชัยภูมิ; 2561.
Kelsey JL. Methods in Observational Epidemiology. 2nd ed. Oxford University Press; 1996.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240(2):205-13
World Health Organization. Nutritional anemia. Report of a WHO scientific group. 1968. [Internet], [cited 2020 june 10]. Available from:URL: https://apps. who. int/iris/bitstream/handle/10665/40707/ WHO_TRS_405.pdfJsessionid=E5FDD6AABA 22D58D935B55A61507BCEF?sequence=l
กรภัทร์ เอกัคคตาจิต. ลักษณะการติดเชื้อลำคอส่วนลึกของผู้ป่วยในโรงพยาบาลบุรีรัมย์. วารสารการแพทย์ โรงพยาบาลศรีสะเกษ สุรินทร์ บุรีรัมย์ 2562:34(3): 321-32.
Colbert KAR, Devakumari S. Diagnosis and Management of Deeper Neck Infections - A Review. IOSR Journals 2013;9(5):36-41.
Sakarya EU, Kulduk E, Gundogan O, Soy FK, Dundar R, Kilavuz AE, et al. Clinical features of deep neck infection: analysis of 77 patients. Kulak Burun Bogaz Ihtis Derg 2015;25(2): 102-8.
Kataria G, Saxena A, Bhagat S, Singh B, Kaur M, Kaur G. Deep Neck Space Infections: A Study of 76 Cases. Iran J Otorhinolaryngol 2015;27(81):293-9.
Eftekharian A, Roozbahany NA, Vaezeafshar R, Narimani N. Deep neck infections : a retrospective review of 112 cases. Eur Arch Otorhinolaryngol 2009;266(2):273-7.
Regueiro Villarin S, Vazquez Barro JC, Herranz Gonzalez-Botas J. [Deep neck infections: etiology, bacteriology and treatment], [Article in Spanish]. Acta Otorrinolaringol Esp 2006;57(7):324-8.
Suetrong S, Reechaipichitkul พ, Chainansamit S, PatornPiromchai P. Deep Neck Infection in Adults : Factors Associated with Complicated Treatment Outcomes. J Med Assoc Thai 2017;100(Suppl.6):179-88.
Suesongtham P, Charoensombatamorn S, Ungkhara G, Deep Neck Infection in Faculty of Medicine Vajira Hospital, Navamindradhiraj University. Vajira Med J 2018;62(5):365-74
Yang W, Hu L, Wang Z, Nie G, Li X, Lin D et al. Deep Neck Infection: A Review of 130 Cases in Southern China. Medicine (Baltimore) 2015;94(27):e994.
Yang SW, Lee MH, See LC, Huang SH, Chen TM, Chen TA. Deep neck abscess: an analysis of microbial etiology and the effectiveness of antibiotics. Infect Drug Resist 2008;1:1-8
Barber BR, Dziegielewski PT, Biron VL, Ma A, Seikaly H. Factors associated with severe deep neck space infections: targeting multiple fronts. J Otolaryngol Head Neck Surg 2014;43(1):35.
Abshirini H, Alavi SM, Rekabi H, Hosseinnejad F, Ghazipour A, Yavari M, et al. Predisposing Factors for the Complications of Deep Neck Infection. Iran J Otorhinolaryngol 2010;20(60): 97-102.
Chi TH, Tsao YH, Yuan CH. Influences of patient age on deep neck infection : clinical etiology and treatment outcome. Otolaryngol Head Neck Surg 2014;151(4):586-90.
staffieri C, Fasanaro E, Favaretto N, La Torre FB, Sanguin S, Giacomelli L, et al. Multivariate approach to investigating prognostic factors in deep neck infections. Eur Arch Otorhinolaryngo 2014;271(7):2061-7.
