Deep Neck Infection in Adults: Factors Associated with Complicated Treatment Outcomes

Objective: 1) describe clinical characteristics of deep neck infection (DNI) and 2) evaluate associations between clinical riskfactors and complicated treatment outcomes of DNI in adults. Material and Method: Eighty-nine consecutive medical records of DNI patients, older than 18 years of age, at a university hospital between January, 2009 and December, 2015 were retrospectively reviewed. Studied clinical data were collected and recorded. Descriptive statistics were reported as mean, frequency or percentage. Analytical statistics (Fisher’s exact test and Odds ratio) were used to identify associations between categorical variables. Results: Patients’ ages ranged between 22-89 years (mean of 51.3 + 16.6 years). Diabetes mellitus was the most common comorbidity (31.5%). Dental origin was the most common etiology (60.7%). Streptococcus viridans group was the most common causative organism (27.8%), followed by Burkholderia pseudomallei (22.2%). Surgical drainage was performed in 70.2% of cases. Among all complications (22.5%), airway obstruction was the most common (15.7%). Co-morbidities, Dyspnea, fever, retropharyngeal DNI, visceral-vascular space DNI, multiple space DNI, need for surgical drainage, and prolonged hospitalization were significantly associated with complications. Fever, visceral-vascular space, multiple space DNI and prolonged hospital stays were significantly associated with surgery required DNI. Parapharyngeal, retropharyngeal, visceral-vascular spaces and prolonged hospital stays were significantly related to multiple space DNI. The respective risks for complications and multiple space involvement in melioidosis DNI patients were 2.44-fold and 2.28-fold higher than those of other DNI patients Conclusion: Complicated treatment outcomes of DNI in adults including complications, need for surgical drainage and prolonged hospitalization had significant associations with comorbidities, fever, dyspnea, multiple space DNI, parapharyngeal, retropharyngeal DNI and visceral-vascular spaceDNI. Melioidosis should be suspected in cases of severe DNI, especially if patients originating from or returning from travel in endemic areas. Keywords: Deep neck infection, Complications, Risk factors, Treatment, Adult