Severe odontogenic infections, part 2: prospective outcomes study.
OBJECTIVE
The purpose of this study was to identify significant predictors of 4 outcomes in patients with severe odontogenic infections: abscess formation, penicillin therapeutic failure (PTF), length of hospital stay (LOS), and need for reoperation.


METHODS
We used a prospective case series study design and enrolled 37 consecutive patients admitted for severe odontogenic infection between March 1996 and June 1999. Treatment consisted of intravenous penicillin (PCN) or clindamycin in PCN-allergic patients, surgical incision and drainage, and extraction(s) as soon as possible. Study variables were categorized as demographic, preadmission, time-related, preoperative, anatomic, treatment, microbiologic, and complications. The primary outcome variables were abscess formation, PTF, LOS, and reoperation. Multivariate linear and logistic regression techniques were used to measure associations between study variables and the outcome variables.


RESULTS
The sample consisted of 37 subjects (23 male, 14 female) with a mean age of 34.9 +/- 15.8 years. Multivariate analyses, controlling for confounding variables, indicated that culture of Peptostreptococci was a negative predictor of abscess formation. LOS was predicted by the number of infected spaces and duration of operation. There was no significant predictor of PTF or reoperation on multivariate analysis, although PCN-resistant organisms were isolated in all cases of PTF.


CONCLUSIONS
Increased LOS in severe odontogenic infections is predicted by the anatomic extent and severity of the infection and the occurrence of complications such as PTF and the need for reoperation. PTF is significantly associated with later identification of PCN-resistant organisms. The role of Peptostreptococci in abscess formation warrants further investigation.
Flynn
Thomas R
TR
Harvard School of Dental Medicine, Boston, MA 02115, USA. thomas_flynn@hsdm.harvard.edu
Shanti
Rabie M
RM
Hayes
Catherine
C
D000038:Abscess / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D003731:Dental Caries / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D005882:Gingival Diseases / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008964:Molar, Third / Q000382:microbiology / Q000473:pathology; D010406:Penicillins / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D014076:Tooth Diseases / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D017211:Treatment Failure; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D010406:Penicillins