Comparison of clinical course and outcome between diabetic and non-diabetic patients

Abstract

Objective : To compare the difference in the clinical features, outcomes and prognosis of deep neck infections between the diabetic and non-diabetic patients.

Patients and Methods : Retrospective review of 77 patients with deep neck infections treated at the Department of Otolaryngology of Pathumthani Hospital between 2007 to 2011, twenty four patients with diabetes mellitus were enrolled for further analysis (DM group) comparing with the other 53 patients without diabetes mellitus (non-DM group) in demographies, etiologies, bacteriologies, treatment, duration of hospital stay, complications and outcomes.

Result : The parapharyngeal space and submandibular space were most commonly involved in both groups. Odontogenic and upper airway infection were also the two leading causes of deep neck infections in 2 groups. Deep neck infection had more prevalence in the DM patients over 50 years of age than in the non-DM patients (older age). Streptococcus viridians was the most common organism in the non-DM group. Whereas, the most common organism in the DM group was Klebsiella pneumoniae. Surgical drainage was performed more frequently in the DM group than in the non-DM group. The DM group had a significantly higher complication rate, mortality rate, longer hospital stay and tracheostomy/intubation than the non-DM group.

Conclusion : In deep neck infection patients with DM, the clinical course is more severe and tend to have higher complication and a longer duration of hospital stay. Thus, in treating them, we should keep closed observation and appropriate control of diabetes, detect the life-threatening complication early and perform aggressive surgical treatment if fluctuation or complication occurs and empirical antibiotics should cover Klebsiella pneumoniae.