Pathogens and Prognosis of Deep Neck Infection in Patients With Liver Cirrhosis

IF 2 3区医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Laryngoscope Pub Date : 2025-01-31 DOI:10.1002/lary.32028

Ang Lu MD, Yao-Te Tsai MD, Ming-Shao Tsai MD, Cheng-Ming Hsu MD, PhD, Yao-Hsu Yang MD, PhD, Chia-Yen Liu MS, Geng-He Chang MD, PhD

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Abstract

Objective

This study aims to investigate the differences in pathogenic bacterial spectra between patients with deep neck infection (DNI) with and without liver cirrhosis (LC). The goal is to identify specific pathogens prevalent in LC-DNI to guide the selection of empiric antibiotics, improving treatment outcomes and prognosis.

Study Design

This is a retrospective study.

Methods

The Chang Gung Research Database (CGRD) is a deidentified medical database encompassing seven hospitals within Taiwan's largest medical system. We analyzed data from 2004 to 2018 on DNI patients hospitalized with or without LC, categorizing them into these two groups. This study primarily focused on comparing the bacterial culture results of these groups, alongside an analysis of their treatment modalities (medication alone or surgery) and prognostic outcomes.

Results

From a total of 11,455 DNI patients identified in the CGRD, 76 LC-DNI patients and 11,178 non-LC-DNI patients met the inclusion criteria after exclusions. The LC group had significantly higher rates of surgical debridement (34.2% vs. 19.4%, p = 0.002), ICU admission (22.4% vs. 10.7%, p = 0.004), and mediastinal complications (7.9% vs. 2.1%, p = 0.005). Although the overall mortality rates were not significantly different between the two groups (6.6% vs. 4.6%, p = 0.401), the mediastinitis-related mortality rate was significantly higher in the LC-DNI group (2.6% vs. 0.2%, p = 0.015). Bacterial culture analysis revealed that LC-DNI patients predominantly presented with Klebsiella pneumoniae (KP) as the primary facultative anaerobic pathogen, whereas non-LC-DNI patients were most infected with Viridans streptococcus (VS). For anaerobic bacteria, both groups consistently cultured Peptostreptococcus micros and Prevotella intermedia as the predominant species.

Conclusions

LC-DNI patients are predominantly infected with KP, a Gram-negative bacillus, unlike the Gram-positive cocci, VS, in non-LC-DNI. Anaerobic pathogens were similar in both groups. Empiric antibiotics for LC-DNI should target KP and anaerobes to improve outcomes.

Level of Evidence

3 Laryngoscope, 135:2299–2305, 2025

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肝硬化患者深颈部感染的病原菌及预后。

目的：探讨伴有肝硬化（LC）和不伴有肝硬化（LC）的深颈部感染（DNI）患者病原菌谱的差异。目的是确定LC-DNI中流行的特定病原体，以指导经验性抗生素的选择，改善治疗结果和预后。研究设计：这是一项回顾性研究。方法：长庚研究数据库（CGRD）是一个包含台湾最大医疗系统内七家医院的鉴定医学数据库。我们分析了2004年至2018年住院的患有或不患有LC的DNI患者的数据，将其分为这两组。本研究主要集中在比较这些组的细菌培养结果，同时分析他们的治疗方式（单独用药或手术）和预后结果。结果：在CGRD中确定的11,455例DNI患者中，76例LC-DNI患者和11,178例非LC-DNI患者在排除后符合纳入标准。LC组手术清创率（34.2%比19.4%,p = 0.002）、ICU入院率（22.4%比10.7%,p = 0.004）和纵隔并发症（7.9%比2.1%,p = 0.005）均显著高于LC组。尽管两组间的总死亡率无显著差异（6.6% vs. 4.6%, p = 0.401），但LC-DNI组的纵隔炎相关死亡率显著较高（2.6% vs. 0.2%, p = 0.015）。细菌培养分析显示，LC-DNI患者主要以肺炎克雷伯菌（KP）为主要兼性厌氧病原体，而非LC-DNI患者以绿绿链球菌（VS）感染最多。对于厌氧菌，两组均一致培养微型胃链球菌和中间普雷沃氏菌为优势菌种。结论：LC-DNI患者主要感染革兰氏阴性杆菌KP，而非LC-DNI患者感染革兰氏阳性球菌VS。两组的厌氧病原菌相似。用于LC-DNI的经验性抗生素应针对KP和厌氧菌，以改善预后。证据等级：3喉镜，2025。

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来源期刊

Laryngoscope 医学-耳鼻喉科学

CiteScore

6.50

自引率

7.70%

发文量

500

审稿时长

2-4 weeks

期刊介绍： The Laryngoscope has been the leading source of information on advances in the diagnosis and treatment of head and neck disorders since 1890. The Laryngoscope is the first choice among otolaryngologists for publication of their important findings and techniques. Each monthly issue of The Laryngoscope features peer-reviewed medical, clinical, and research contributions in general otolaryngology, allergy/rhinology, otology/neurotology, laryngology/bronchoesophagology, head and neck surgery, sleep medicine, pediatric otolaryngology, facial plastics and reconstructive surgery, oncology, and communicative disorders. Contributions include papers and posters presented at the Annual and Section Meetings of the Triological Society, as well as independent papers, "How I Do It", "Triological Best Practice" articles, and contemporary reviews. Theses authored by the Triological Society’s new Fellows as well as papers presented at meetings of the American Laryngological Association are published in The Laryngoscope. • Broncho-esophagology • Communicative disorders • Head and neck surgery • Plastic and reconstructive facial surgery • Oncology • Speech and hearing defects