This study retrospectively reviewed the medical records of 981 patients diagnosed with deep neck infection who were admitted to Chang Gung Memorial Hospital in Keelung, Taiwan between April 2001 and October 2006. Diagnostic imaging procedures included computed tomography (CT), ultrasonography (US), and plain radiography. Patients with superficial skin infection or abscess, deep neck infection without evidence of abscess formation, or limited intraoral space infection were excluded. The study enrolled 100 patients. All these patients received abscess drainage via US-guided needle aspiration, or via a surgical incision, or both, with sterilization of intact skin.
Aerobic and anaerobic bacterial cultures were performed for all cases under aseptic field and technique. Patients were treated with empiric antibiotic therapy covering aerobic and anaerobic bacteria. Intravenous broad-spectrum antibiotics were administered before the results of abscess culture became available. Pathogen-directed antibiotic therapy was done when the final results of bacterial cultures were obtained. Abscess specimens were taken and sent by sterile transport swab (Copan, Italy). Then every specimen was inoculated onto 5% sheep’s blood agar, chocolate agar, and eosin-methylene blue (EMB) agar plates for the culture of aerobic and facultative organisms. The plates were incubated at 37 °C aerobically, under 5% carbon dioxide, and were examined at 48 and 72 hours. For anaerobes, the material was inoculated onto anaerobic blood agar (CDC) (BBL, USA), whose nutrition base was tryptic soy agar supplemented with yeast extract, vitamin K3, hemin, and 5% sheep blood. The anaerobic plates were incubated in anaerobic chambers (Concept Plus, Anaerobic Workstation; Ruskinn technology, UK) and examined at 72 and 120 hours. β-lactamase activity was measured for all isolates with a cefinase disc (chromogenic cephalosporin nitrocefin).
The antimicrobial susceptibility testing was determined by disk diffusion with Mueller-Hinton (MH) agar plates. Additionally, M100-S18 was used for aerobic bacteria. The disks used for gram-positive aerobic bacteria included penicillin, oxacillin, erythromycin, trimethoprim/sulfamethoxazole, clindamycin, chloramphenicol, teicoplanin, and vancomycin. The disks for gram-negative bacteria comprised ampicillin, piperacillin, cefazolin, cefuroxime, ceftriaxone, ceftazidime, imipenem, aztreonam, gentamicin, amikacin trimethoprim/sulfamethoxazole, and ciprofloxacin. In some situations, cefepime, flomoxef, and meropenem were added to the tests for gram-negative aerobes. As for anaerobic pathogens, M11-A7 was the method used for antimicrobial susceptibility testing of anaerobic bacteria. The antibiotic test consisted of penicillin, piperacillin, clindamycin, chloramphenicol, and metronidazole.
Various empiric antibiotics for deep neck infection have been proposed previously (Table 1 ) (Brondbo et al 1983 (link); Gates 1983 (link); Nagy et al 1997 (link); Sakaguchi et al 1997 (link); Chen et al 1998 (link), 2000 (link); Simo et al 1998 (link); Parhiscar and Har-El 2001 (link); Plaza Mayor et al 2001 (link); Sichel et al 2002 (link); McClay et al 2003 (link)). Five different empiric antibiotics were determined: regimen 1 (penicillin G and clindamycin and gentamicin), regimen 2 (ceftriaxone and clindamycin), regimen 3 (ceftriaxone and metronidazole), regimen 4 (cefuroxime and clindamycin), and regimen 5 (penicillin and metronidazole), and were analyzed with descriptive statistics (Chi square, degree of freedom, probability value). The cultured bacteria that were susceptible to the antibiotic regimen were defined as sensitive, while those resistant to antibiotics were defined as resistant. Regimen coverage rate is defined as the number of cases with sensitive results divided by the total number of cases.
Descriptive statistics, for example frequency and percentage, were used. Since abscess specimens were all tested with these five regimens, the McNemar test was made to compare the coverage among different antimicrobial regimens. The level of significance was 0.005 due to Bonferrori adjustment (alpha divided by number of pairwise comparison) for multiple comparisons in order to maintain type I error of 0.05 (Bland and Altman 1995 (link)).
Aerobic and anaerobic bacterial cultures were performed for all cases under aseptic field and technique. Patients were treated with empiric antibiotic therapy covering aerobic and anaerobic bacteria. Intravenous broad-spectrum antibiotics were administered before the results of abscess culture became available. Pathogen-directed antibiotic therapy was done when the final results of bacterial cultures were obtained. Abscess specimens were taken and sent by sterile transport swab (Copan, Italy). Then every specimen was inoculated onto 5% sheep’s blood agar, chocolate agar, and eosin-methylene blue (EMB) agar plates for the culture of aerobic and facultative organisms. The plates were incubated at 37 °C aerobically, under 5% carbon dioxide, and were examined at 48 and 72 hours. For anaerobes, the material was inoculated onto anaerobic blood agar (CDC) (BBL, USA), whose nutrition base was tryptic soy agar supplemented with yeast extract, vitamin K3, hemin, and 5% sheep blood. The anaerobic plates were incubated in anaerobic chambers (Concept Plus, Anaerobic Workstation; Ruskinn technology, UK) and examined at 72 and 120 hours. β-lactamase activity was measured for all isolates with a cefinase disc (chromogenic cephalosporin nitrocefin).
The antimicrobial susceptibility testing was determined by disk diffusion with Mueller-Hinton (MH) agar plates. Additionally, M100-S18 was used for aerobic bacteria. The disks used for gram-positive aerobic bacteria included penicillin, oxacillin, erythromycin, trimethoprim/sulfamethoxazole, clindamycin, chloramphenicol, teicoplanin, and vancomycin. The disks for gram-negative bacteria comprised ampicillin, piperacillin, cefazolin, cefuroxime, ceftriaxone, ceftazidime, imipenem, aztreonam, gentamicin, amikacin trimethoprim/sulfamethoxazole, and ciprofloxacin. In some situations, cefepime, flomoxef, and meropenem were added to the tests for gram-negative aerobes. As for anaerobic pathogens, M11-A7 was the method used for antimicrobial susceptibility testing of anaerobic bacteria. The antibiotic test consisted of penicillin, piperacillin, clindamycin, chloramphenicol, and metronidazole.
Various empiric antibiotics for deep neck infection have been proposed previously (
Descriptive statistics, for example frequency and percentage, were used. Since abscess specimens were all tested with these five regimens, the McNemar test was made to compare the coverage among different antimicrobial regimens. The level of significance was 0.005 due to Bonferrori adjustment (alpha divided by number of pairwise comparison) for multiple comparisons in order to maintain type I error of 0.05 (Bland and Altman 1995 (link)).