title: Deep neck infections: a study of 365 cases highlighting recommendations for management and treatment.
abstract: The aims of this investigation were to review the clinical behavior of deep neck infections (DNIs) treated in our institution in order to identify the predisposing factors of life-threatening complications and propose valuable recommendations for management and treatment. A total of 365 adult patients with DNIs were retrospectively identified. One-hundred and thirty-nine patients (38.1%) underwent surgical drainage. Overall, 226 patients (61.9%) responded effectively to intravenous antimicrobial therapy only. There were 67 patients (18.4%) developing life-threatening complications. Diabetes mellitus (odd ratio 5.43; P < 0.001) and multiple deep neck spaces involvement (odd ratio 4.92; P < 0.001) were the strongest independent predictors of complications. The mortality rate was 0.3%. Airway obstruction and descending mediastinitis are the most troublesome complications of DNIs. In selected patients, a trial of intravenous antibiotic therapy associated with an intensive computed tomography-based wait-and-watch policy may avoid an unnecessary surgical procedure. However, about one-fourth of patients present significant comorbidities, which may negatively affect the course of the infection. In these cases and in patients with large or multiple spaces infections, a more aggressive surgical strategy is mandatory.
authors.affiliation: Department of Medical and Surgical Specialities, University of Padua, School of Medicine, Padua, Italy. paolo.boscolorizzo@unipd.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Boscolo-Rizzo
authors.forename: Marco
authors.initials: M
authors.lastname: Stellin
authors.forename: Enrico
authors.initials: E
authors.lastname: Muzzi
authors.forename: Monica
authors.initials: M
authors.lastname: Mantovani
authors.forename: Roberto
authors.initials: R
authors.lastname: Fuson
authors.forename: Valentina
authors.initials: V
authors.lastname: Lupato
authors.forename: Franco
authors.initials: F
authors.lastname: Trabalzini
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Da Mosto
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009333:Neck; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents