Prognostic Factors for Predicting Treatment Management and Complications in Deep Neck Infections: A Retrospective Study

Abstract

Purpose of Review: Deep neck infections (DNI) are serious infections that can have fatal complications and may have unpredictable outcomes despite parenteral antibiotic therapy. We aimed to investigate the prognostic factors determinig the success of empirical parenteral antibiotic therapy when it is employed together with surgical drainage in patients diagnosed with DNI. Recent Findings: A retrospective study was conducted on 112 patients who underwent surgical drainage due to DNI between September 15, 2019, and September 15, 2024 at the Otorhinolaryngology Department of our hospital. 77 patients with complete blood counts and culture results were included in the study. Complications, including necrotizing fasciitis (on admission) and tracheotomy (within the first 48 h), occurred in 9.1% of cases. 38% of patients who were treated with empirical Primary Group Antibiotic combinations (penicillins, cephalosporins, quinolones, clindamycin, metronidazol) required a switch to Secondary Group Antibiotic combinations (vancomycin, teicoplanin, linezolid, carbapenems, piperacillin-tazobactam). There were significant differences in terms of abscess extent, neutrophil count and duration of hospitalization between patients requiring treatment change and those for whom empirical treatment was sufficient. Complications were significantly higher in patients with multi-region abscesses, higher systemic immune-inflammatory (SII) index and neutrophil counts. (p < 0.05). Summary: In patients with multi-region abscessess and an SII index cut-off value of 1616.5 according to ROC analysis, initiation of broad-spectrum Secondary Group Antibiotic combinations together with surgical drainage of abscesses can effectively reduce complication rates and shorten the duration of hospital stay.