Bacteriology of Deep Neck Abscesses: A Retrospective Review of 96 Cases

Abstract

ObjectiveReview the microbiology of deep neck abscesses and identify the factors that influence their occurrence.MethodRetrospective chart review of 96 patients diagnosed with deep neck abscesses in the Department of ENT at Tan Tock Seng Hospital, Singapore between 2004 and 2009. Logistic regression was applied to analyze and compare the incidence of common organisms in various conditions (age, gender, etiology, and effect of diabetes).ResultsOf the 96 patients recruited, 18 had polymicrobial cultures. The leading pathogens cultured were Klebsiella pneumoniae (27.1%), Streptococcus milleri group (SMG) bacteria (21.9%), anaerobic bacteria ‐ not otherwise specified (NOS) (20.8%). Klebsiella pneumoniae (50.0%) was over‐represented in the diabetic group. SMG bacteria (68.8%) and anaerobic bacteria ‐ NOS (43.8%) were most commonly isolated in patients with odontogenic infections. Klebsiella pneumoniae was found more commonly among the female patients (39.3%). Klebsiella pneumoniae was the most common organism cultured in parapharyngeal space abscesses, while the submandibular space and parotid space most commonly isolated SMG bacteria and Staphylococcus aureus respectively.ConclusionBroad‐spectrum antibiotics are recommended for treating deep neck abscesses. Empirical antibiotic coverage against Klebsiella pneumoniae infection in diabetic patients and SMG and anaerobic bacteria in patients with an odontogenic infection is advocated. Routine antibiotic coverage against gram‐negative bacteria is not paramount.