Deep Neck Space Infections: Changing Trends in Pediatric Versus Adult Patients

Abstract

We studied the clinical presentation and microbiology of patients with deep neck space infection in a developing nation to aid in determining the relevant, appropriate, and effective empirical antimicrobial treatment. We have also described the demographic data of pediatric versus adult patients and the predominant age-related subtypes of deep neck space infections. A retrospective review of the data from patients with deep neck space infections during a 5.5-year period was conducted at the academic teaching hospitals in Johannesburg, South Africa. The diagnosis of deep neck space infection was determined from the clinical, radiographic, and laboratory findings. All the patients had undergone abscess drainage via needle aspiration or surgical drainage using a sterile technique. Aerobic and anaerobic bacterial cultures and cultures for Mycobacterium tuberculosis were performed. The results were recorded, and statistical analysis was performed. A total of 107 children and 52 adults with deep neck space infections were included in the present study, with 121 and 70 pus specimens retrieved. The male/female ratio was 1.14:1 for the pediatric group (57 boys [53%] and 50 girls [47%]). The adult group included 33 men (63%) and 19 women (37%). The male/female ratio for the adult group was 1.74:1. In the pediatric group, the mean age was 5.8years (range, 2months to 15years). The age distribution was subcategorized into younger than 2, 2 to 10, and older than 10years. Of the 107 children, 51 were younger than 2, 50 were aged 2 to 10, and 6 were older than 10years. The age of the adult patients ranged from 19 to 77years (mean, 40.9±15.5). Multispace involvement of the deep neck infection was present in 8 pediatric cases (7.5%) and 31 adult cases (59.6%). The submandibular space was the most commonly affected site (73.9%) in both groups. Deep neck space infections differ in clinical presentation and microbiology between adults and children. The specimens from the pediatric group predominantly cultured Staphylococcus aureus. In contrast, the specimens from the adult group were mainly polymicrobial. The adult population had poorer patient outcomes, with a greater number of intensive care unit admissions, operating theater visits, and prolonged hospital stays.