Deep odontogenic infections-identifying risk factors for nosocomial pneumonia.
Deep neck infection
Dental abscess
Nosocomial pneumonia
Odontogenic infection
Risk factors
Journal
Clinical oral investigations
ISSN: 1436-3771
Titre abrégé: Clin Oral Investig
Pays: Germany
ID NLM: 9707115
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
13
05
2020
accepted:
04
08
2020
pubmed:
14
8
2020
medline:
19
3
2021
entrez:
14
8
2020
Statut:
ppublish
Résumé
To evaluate occurrence and risk factors for pneumonia in patients with deep odontogenic infection (OI). All patients treated for deep OIs and requiring intensive care and mechanical ventilation were included. The outcome variable was diagnosis of nosocomial pneumonia. Primary predictor variables were re-intubation and duration of mechanical ventilation. The secondary predictor variable was length of hospital stay (LOHS). The explanatory variables were gender, age, current smoking, current heavy alcohol and/or drug use, diabetes, and chronic pulmonary disease. Ninety-two patients were included in the analyses. Pneumonia was detected in 14 patients (15%). It was diagnosed on postoperative day 2 to 6 (median 3 days, mean 3 days) after primary infection care. Duration of mechanical ventilation (p = 0.028) and LOHS (p = 0.002) correlated significantly with occurrence of pneumonia. In addition, re-intubation (p = 0.004) was found to be significantly associated with pneumonia; however, pneumonia was detected in 75% of these patients prior to re-intubation. Two patients (2%) died during intensive care unit stay, and both had diagnosed nosocomial pneumonia. Smoking correlated significantly with pneumonia (p = 0.011). Secondary pneumonia due to deep OI is associated with prolonged hospital care and can predict the risk of death. Duration of mechanical ventilation should be reduced with prompt and adequate OI treatment, whenever possible. Smokers with deep OI have a significantly higher risk than non-smokers of developing pneumonia. Nosocomial pneumonia is a considerable problem in OI patients with lengthy mechanical ventilation. Prompt and comprehensive OI care is required to reduce these risk factors.
Identifiants
pubmed: 32789814
doi: 10.1007/s00784-020-03500-4
pii: 10.1007/s00784-020-03500-4
pmc: PMC7966200
doi:
Types de publication
Journal Article
Langues
eng
Pagination
1925-1932Références
Qu L, Liang X, Jiang B, Qian W, Zhang W, Cai X (2018) Risk factors affecting the prognosis of descending necrotizing Mediastinitis from Odontogenic infection. J Oral Maxillofac Surg 76(6):1207–1215
doi: 10.1016/j.joms.2017.12.007
Sittitrai P, Srivanitchapoom C, Reunmakkaew D (2018) Deep neck infection in patients with and without human immunodeficiency virus: a comparison of clinical features, complications, and outcomes. Br J Oral Maxillofac Surg 56(10):962–967
doi: 10.1016/j.bjoms.2018.11.004
Huang TT, Liu TC, Chen PR, Tseng FY, Yeh TH, Chen YS (2004) Deep neck infection: analysis of 185 cases. Head Neck 26(10):854–860. https://doi.org/10.1002/hed.20014
doi: 10.1002/hed.20014
pubmed: 15390207
Chi TH, Tsao YH, Yuan CH (2014) Influences of patient age on deep neck infection: clinical etiology and treatment outcome. Otolaryngol Head Neck Surg 151(4):586–590
doi: 10.1177/0194599814542589
Seppänen L, Lauhio A, Lindqvist C, Suuronen R, Rautemaa R (2008) Analysis of systemic and local odontogenic infection complications requiring hospital care. J Infect 57(2):116–122
doi: 10.1016/j.jinf.2008.06.002
Seppänen L, Rautemaa R, Lindqvist C, Lauhio A (2010) Changing clinical features of odontogenic maxillofacial infections. Clin Oral Investig 14(4):459–465
doi: 10.1007/s00784-009-0281-5
Glen P, Morrison J (2016) Diffuse descending necrotising mediastinitis and pleural empyema secondary to acute odontogenic infection resulting in severe dysphagia. BMJ Case Rep 2016:bcr2015212145. Published 2016 Mar 24. https://doi.org/10.1136/bcr-2015-212145
doi: 10.1136/bcr-2015-212145
pubmed: 27013653
pmcid: 4823561
Haraden BM, Zwemer FL (1997) Descending necrotizing mediastinitis: complication of a simple dental infection. Ann Emerg Med 29(5):683–686
doi: 10.1016/S0196-0644(97)70258-0
Velhonoja J, Lääveri M, Soukka T, Irjala H, Kinnunen I (2020) Deep neck space infections: an upward trend and changing characteristics. Eur Arch Otorhinolaryngol 277(3):863–872
doi: 10.1007/s00405-019-05742-9
Cariati P, Cabello-Serrano A, Monsalve-Iglesias F, Roman-Ramos M, Garcia-Medina B (2016) Meningitis and subdural empyema as complication of pterygomandibular space abscess upon tooth extraction. J Clin Exp Dent 8(4):e469–e472
pubmed: 27703619
pmcid: 5045698
Greenstein A, Witherspoon R, Leinkram D, Malandreni M (2015) An unusual case of a brain abscess arising from an odontogenic infection. Aust Dent J 60(4):532–535
doi: 10.1111/adj.12266
Maria A, Rajnikanth K (2010) Cervical necrotizing fasciitis caused by dental infection: a review and case report. Natl J Maxillofac Surg 1(2):135–138
doi: 10.4103/0975-5950.79215
Noy D, Rachmiel A, Dan LF, Emodi O (2015) Lemierre’s syndrome from odontogenic infection: review of the literature and case description. Ann Maxillofac Surg 5(2):219–225
doi: 10.4103/2231-0746.175746
Ylijoki S, Suuronen R, Jousimies-Somer H, Meurman JH, Lindqvist C (2001) Differences between patients with or without the need for intensive care due to severe odontogenic infections. J Oral Maxillofac Surg 59(8):867–872
doi: 10.1053/joms.2001.25017
Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, Moreno R, Lipman J, Gomersall C, Sakr Y, Reinhart K, EPIC II Group of Investigators (2009) International study of the prevalence and outcomes of infection in intensive care units. Jama 302(21):2323–2329
doi: 10.1001/jama.2009.1754
Papazian L, Klompas M, Luyt CE (2020) Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med 46(5):888–906. https://doi.org/10.1007/s00134-020-05980-0
doi: 10.1007/s00134-020-05980-0
pubmed: 32157357
Michetti CP, Fakhry SM, Ferguson PL, Cook A, Moore FO, Gross R, AAST Ventilator-Associated Pneumonia Investigators (2012) Ventilator-associated pneumonia rates at major trauma centers compared with a national benchmark: a multi-institutional study of the AAST. J Trauma Acute Care Surg 72(5):1165–1173
doi: 10.1097/TA.0b013e31824d10fa
Decelle L, Thys F, Zech F, Verschuren F (2013) Ventilation-associated pneumonia after intubation in the prehospital or the emergency unit. Eur J Emerg Med 20(1):61–63
doi: 10.1097/MEJ.0b013e3283501677
Torres A, Gatell JM, Aznar E, el-Ebiary M, Puig de la Bellacasa J, González J, Ferrer M, Rodriguez-Roisin R (1995) Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med 152(1):137–141
doi: 10.1164/ajrccm.152.1.7599812
Gao F, Yang LH, He HR, Ma XC, Lu J, Zhai YJ, Guo LT, Wang X, Zheng J (2016) The effect of reintubation on ventilator-associated pneumonia and mortality among mechanically ventilated patients with intubation: a systematic review and meta-analysis. Heart Lung 45(4):363–371
doi: 10.1016/j.hrtlng.2016.04.006
Kung SC, Lin WT, Tsai TC, Lin MH, Chang CH, Lai CC, Chao CM (2017) Epidemiologic characteristics and outcomes of major trauma patients requiring prolonged mechanical ventilation. Medicine (Baltimore) 96(52):e9487
doi: 10.1097/MD.0000000000009487
Wolkewitz M, Palomar-Martinez M, Alvarez-Lerma F, Olaechea-Astigarraga P, Schumacher M (2019) Analyzing the impact of duration of ventilation, hospitalization, and ventilation episodes on the risk of pneumonia. Infect Control Hosp Epidemiol 40(3):301–306
doi: 10.1017/ice.2018.360
Rello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm L, Redman R, Kollef MH, VAP Outcomes Scientific Advisory Group (2002) Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 122(6):2115–2121
doi: 10.1378/chest.122.6.2115
Tapiovaara L, Bäck L, Aro K (2017) Comparison of intubation and tracheotomy in patients with deep neck infection. Eur Arch Otorhinolaryngol 274(10):3767–3772
doi: 10.1007/s00405-017-4694-5
Terragni PP, Antonelli M, Fumagalli R, Faggiano C, Berardino M, Pallavicini FB, Miletto A, Mangione S, Sinardi AU, Pastorelli M, Vivaldi N, Pasetto A, Della Rocca G, Urbino R, Filippini C, Pagano E, Evangelista A, Ciccone G, Mascia L, Ranieri VM (2010) Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. Jama 303(15):1483–1489
doi: 10.1001/jama.2010.447
Du JY, Weinberg DS, Moore TA, Vallier HA (2020) Smoking is associated with longer intensive care unit stays in spine trauma patients. J Orthop Trauma 34(7):e250–e255. https://doi.org/10.1097/BOT.0000000000001739
doi: 10.1097/BOT.0000000000001739
pubmed: 31972710
Barber BR, Dziegielewski PT, Biron VL, Ma A, Seikaly H (2014) Factors associated with severe deep neck space infections: targeting multiple fronts. J Otolaryngol Head Neck Surg 43(1):35
doi: 10.1186/s40463-014-0035-5
Xu Y, Lai C, Xu G, Meng W, Zhang J, Hou H, Pi H (2019) Risk factors of ventilator-associated pneumonia in elderly patients receiving mechanical ventilation. Clin Interv Aging 14:1027–1038
doi: 10.2147/CIA.S197146
Chang L, Dong Y, Zhou P (2017) Investigation on risk factors of ventilator-associated pneumonia in acute cerebral hemorrhage patients in intensive care unit. Can Respir J 2017:7272080–7272084. https://doi.org/10.1155/2017/7272080
doi: 10.1155/2017/7272080
pubmed: 29391844
pmcid: 5748108
Wu HP, Chu CM, Lin CY et al (2016) Liver cirrhosis and diabetes mellitus are risk factors for Staphylococcus aureus infection in patients with healthcare-associated or hospital-acquired pneumonia. Pulm Med 2016:4706150–4706156. https://doi.org/10.1155/2016/4706150
doi: 10.1155/2016/4706150
pubmed: 26998356
pmcid: 4779838
Rubin BK et al (2011) Respiratory care year in review 2010: Part 1. Asthma, COPD, pulmonary function testing, ventilator-associated pneumonia. Respir Care 56(4):488
doi: 10.4187/respcare.01286
López-de-Andrés A, Perez-Farinos N, de Miguel-Díez J et al (2019) Type 2 diabetes and postoperative pneumonia: an observational, population-based study using the Spanish Hospital Discharge Database, 2001-2015. PLoS One 14(2):e0211230 Published 2019 Feb 6. https://doi.org/10.1371/journal.pone.0211230
doi: 10.1371/journal.pone.0211230
pubmed: 30726277
pmcid: 6364970
de Oliveira TFL et al (2011) Factors associated with nosocomial pneumonia in hospitalized individuals. Rev Assoc Med Bras 57(6):630–636
doi: 10.1590/S0104-42302011000600008
NanZhu Y, Xin L, Xianghua Y, Jun C, Min L (2019) Risk factors analysis of nosocomial pneumonia in elderly patients with acute cerebral infraction. Medicine (Baltimore) 98(13):e15045. https://doi.org/10.1097/MD.0000000000015045
doi: 10.1097/MD.0000000000015045
Nobahar M, Razavi MR, Malek F, Ghorbani R (2016) Effects of hydrogen peroxide mouthwash on preventing ventilator-associated pneumonia in patients admitted to the intensive care unit. Braz J Infect Dis 20(5):444–450
doi: 10.1016/j.bjid.2016.06.005
Hua F, Xie H, Worthington HV, Furness S, Zhang Q, Li C (2016) Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev 10(10):CD008367. Published 2016 Oct 25. https://doi.org/10.1002/14651858.CD008367.pub3
doi: 10.1002/14651858.CD008367.pub3
pubmed: 27778318
Lefcoe MS, Fox GA, Leasa DJ, Sparrow RK, McCormack DG (1994) Accuracy of portable chest radiography in the critical care setting - diagnosis of pneumonia based on quantitative cultures obtained from protected brush catheter. Chest 105(3):885–887
doi: 10.1378/chest.105.3.885