Correlation of Severity and Morbidity in Odontogenic Infections and the Administration of Appropriate Empirical Antibiotic Therapy.
Abstract: Aim: Our goal in this study was to develop an infection severity score system that would help physicians to predict the severity of odontogenic head and neck space infections and accordingly provide timely and effective treatment, that will hopefully result in reduced patient morbidity, mortality and cost of healthcare. Introduction: Morbidity and mortality associated with severe odontog... read moreenic head and neck space infections remain a concern in healthcare. Identification of morbidity prognostic factors empowers practitioners to provide timely and effective treatment that can reduce adverse outcomes. The purpose of this study was to identify morbidity prognostic factors and effective empirical antimicrobial treatment that can be used by physicians to provide timely and more effective care, thus decreasing morbidity and mortality. Methods: In this retrospective cross sectional study, 109 patients who had been treated for odontogenic infections were evaluated. The relationships between independent prognostic variables and variables that define morbidity have been tested. The independent prognostic variables that showed a statistically significant association with the morbidity variables were incorporated into a newly developed infection severity score system (SPDA ) which predicts the degree of expected morbidity for each patient. Analyzing the culture and sensitivity tests, the effectiveness of different antimicrobial agents that had been used as empirical treatment was examined and the most effective agent to be used was introduced. Results: The predictor variables (dyspnea, dysphagia, trismus and incorrect administration of initial antibiotics) displayed a statistically significant association with the dependent morbidity variables (need for surgical intensive care, need for re-operation, and spread of infection to a distal facial space). The presence of each risk factor (dyspnea, dysphagia, trismus and incorrect administration of initial antibiotics), increases the odds of Surgical Intensive Care Unit (SICU) admission by 2.382 times (95% CI: 1.489, 3.822) (p=0.0003) and the odds of re-operation by 3.184 times (95% CI: 1.695, 5.981) (p=0.0003). Furthermore, this study showed that the group of patients who developed severe morbidity had a mean SPDA score >15.9, the group of patients who developed moderate morbidity had a mean SPDA score of 12.6, and the group of patients who developed mild morbidity had a mean SPDA < 6.8. Ampicillin/Sulbactam was found to be the most effective empirical antimicrobial agent used for treatment of these infections. Conclusion: The evaluation and appreciation of the above significant variables into clinical assessment of the patients with odontogenic head and neck space infections and their incorporation into a severity score system empowers clinicians to more appropriately and effectively initiate treatment for these challenging infections
Thesis (M.S.)--Tufts University, 2012.
Submitted to the Dept. of Oral and Maxillofacial Surgery.
Advisor: Maria Papageorge.
Committee: Constantinos Laskarides, William Gilmore, and Paul Stark.
Keywords: Medicine, and Immunology.read less