Rational diagnostic and therapeutic management of deep neck infections: analysis of 233 consecutive cases.
OBJECTIVE
Although deep neck infections are less common nowadays because of the widespread use of antibiotics, they continue to carry significant morbidity and mortality rates.


METHODS
Between 2000 and 2008, deep neck infections were treated in 233 patients at the University of Padova. Cases of peritonsillar abscess, superficial infections, infections due to external neck injuries, and infections in head and neck tumors were excluded. Clinical, radiologic, laboratory, and microbiological assessments were analyzed.


RESULTS
The site of origin was identified in 189 of the 233 cases (81.1%), and the most common cause of deep neck infection was dental infection (39.5%). Intravenous antibiotic therapy was given to 78 patients, and 155 required both medical and surgical procedures. The bacteria most often isolated were gram-positive anaerobic cocci. None of our patients died of the deep neck infection or its complications.


CONCLUSIONS
It is worth emphasizing that airway support is the priority in patients with deep neck infections. Empirical antibiotic treatments must cover gram-positive and gram-negative aerobic and anaerobic pathogens. Surgical exploration and drainage may be mandatory in selected cases at presentation or in cases that fail to respond to parenteral antibiotics within the first 24 to 48 hours. It is important to perform cultures during operation to establish the pathogen(s) involved and to obtain an antibiogram to tailor the antibiotic treatment.
Marioni
Gino
G
Dept of Medical and Surgical Specialties, Otolaryngology Section, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
Staffieri
Alberto
A
Parisi
Saverio
S
Marchese-Ragona
Rosario
R
Zuccon
Andrea
A
Staffieri
Claudia
C
Sari
Marianna
M
Speranzoni
Chiara
C
de Filippis
Cosimo
C
Rinaldi
Roberto
R
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001420:Bacteria, Aerobic / Q000302:isolation & purification; D003937:Diagnosis, Differential; D004322:Drainage / Q000379:methods*; D004724:Endoscopy; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D006801:Humans; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009333:Neck; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents