The Pathogenic Bacteria of Deep Neck Infection in Patients with Type 1 Diabetes, Type 2 Diabetes, and Without Diabetes from Chang Gung Research Database.

Chih-Wei Luan,Yao-Hsu Yang,Cheng-Ming Hsu,Geng-He Chang,Yao-Te Tsai,Chia-Yen Liu,Ming-Shao Tsai,Ching-Yuan Wu,Pey-Jium Chang

doi:10.3390/microorganisms9102059

Abstract

Deep neck infection (DNI) is a lethal emergent condition. Patients with types 1 and 2 diabetes mellitus (T1DM and T2DM, respectively) are predisposed to DNI and have poorer prognoses. The mainstay of the treatment is surgical drainage and antibiotics; however, the pathogenic bacteria of T1DM-DNI have not been studied before. We obtained the data of 8237 patients with DNI who were hospitalized from 2004 to 2015 from the Chang Gung Research Database, which contains multi-institutional medical records in Taiwan. Using diagnostic codes, we classified them into T1DM-DNI, T2DM-DNI, and non-DM-DNI and analyzed their pathogenic bacteria, disease severity, treatment, and prognosis. The top three facultative anaerobic or aerobic bacteria of T1DM-DNI were Klebsiella pneumoniae (KP, 40.0%), Viridans Streptococci (VS, 22.2%), and methicillin-sensitive Staphylococcus aureus (MSSA, 8.9%), similar for T2DM (KP, 32.2%; VS, 23.3%; MSSA, 9.5%). For non-DM-DNI, it was VS (34.6%), KP (9.8%), and coagulase-negative Staphylococci (8.7%). The order of anaerobes for the three groups was Peptostreptococcus micros, Prevotella intermedia, and Peptostreptococcus anaerobius. Patients with T1DM-DNI and T2DM-DNI had higher white blood cell (WBC) counts and C-reactive protein (CRP) levels, more cases of surgery, more cases of tracheostomy, longer hospital stays, more mediastinal complications, and higher mortality rates than those without DM-DNI. Patients in the death subgroup in T1DM-DNI had higher WBC counts, band forms, and CRP levels than those in the survival subgroup. Patients with DM-DNI had more severe disease and higher mortality rate than those without DM-DNI. KP and Peptostreptococcus micros are the leading pathogens for both patients with T1DM-DNI and those with T2DM-DNI. Clinicians should beware of high serum levels of infection markers, which indicate potential mortality.

Highlights

Deep neck infection (DNI) is a common, life-threatening infectious disease that is usually encountered at the emergency department and requires aggressive treatment
According to the ICD diagnostic codes, from 1 January 2004, to 31 December 2015, a total of 8237 patients who were hospitalized for DNI were identified from the Chang-Gung Research Database (CGRD)
According to the diagnosis code of DM, those patients with DNI were classified into groups of 73 patients with type 1 diabetes mellitus (T1DM)-DNI, 1989 patients with type 2 diabetes mellitus (T2DM)-DNI, and 6175 patients with non-DM-DNI

Summary

Introduction

Past studies have reported that type 2 diabetes mellitus (T2DM) is a risk factor for DNI and could lead to higher mortality, longer hospital stays, and many complications compared with non-DM patients [1,2]. Because of the lack of laboratory data on bacterial cultures in the national database we used before to confirm T1DM is a risk for DNI, it is impossible to further analyze the pathogenic bacteria of T1DM-DNI as a reference for clinical antibiotic selection. We used a multi-medical institutional database in Taiwan, the Chang-Gung Research Database (CGRD), which contains a large number of original medical records, to investigate significant information on DNI in patients with T1DM, T2DM, and non-DM, including the pathogenic bacterial speculum, disease manifestation, and prognosis

Methods

Results

Conclusion