RSU MF studentu Lindas Veideres un Marka Roņa pētījums. Uzstājās Rīga Stradiņš University Student International Conference "Health and Social Sciences" 2015 un 3rd International Helath Sciences Conference Lietuvā.

1. Authors:
Linda Veidere, Rīga Stradiņš University
Marks Ronis, Rīga Stradiņš University
Scientific research supervisor:
Gunta Sumeraga MD, Otorinolaryngologist, P.Stradins Clinical University hospital

2. Deep neck space infections are life threatening infections which
occur in the spaces between the muscles of the neck.
Fast antibacterial and surgical treatment can prevent serious
complications such as mediastinitis, thrombosis of the jugular
vein and sepsis.
There is no statistical data about the situation in Latvia.
World data does not give accurate epidemiological view (Sichel
JY et al, 2006) or are outdated and with small population (C.
Stan, C. Drӑgulescu, N. Bacalbaşa, 2014).

3. • To obtain information about incidence of deep neck infection
in CUH (2012-2014) and find out if it is statistically correct to
adjust results to Latvia’s population.
• To find out :
—age and gender of patients,
—duration of hospitalisation ,
—used treatment,
—bacterial culture,
—antibacterial sensitivity/resistance
—comorbidities that could have had a connection with the
development of the infection.

4. • A retrospective study.
• Conducted at P.Stradins Clinical University hospital, Latvia,
using data from 2012 to 2014.
• Statistical analysis was conducted using SPSS 19.0 –
nonparametric tests as Chi-Square Tests, Mann-Whitney U
Tests, Crosstabs, Spearmans correlations and descriptive
statistics.

5. 53.1
%
46.9
%
Gender
Male
Female
Age:
• Minimum 20 years.
• Maximum 86 years.
• Mean 51 years.
• Median 56 years.
• Std. Deviation 19 years.
Gender:
• Male 34, 53,1%.
• Female 30, 46,9%.
• Patients with dental infection most
frequently were males (p=0,037) –
20,6% males, 3,3% females.
Age

6. Lenghtofhospitalstay Physical therapy
• Minimum 2 days.
• Maximum 54 days.
• Mean 14 days.
• Median 12 days.
• Std. Deviation 10 days.
• Patients with tracheostomy (p<0,001) and
revision and drainage of
mediastinum(p=0,025) had a longer hospital
stay.
• Patients who received physical therapy had
a longer hospital stay (p=0,018). Lenghtofhospitalstay

7. •Patients with acute tonsillitis (p=0,0013) or laryngeal
stenosis (p=0,02) had a longer hospital stay.
•Patients with pneumonia (p=0,016), mediastinitis
(p<0,001), phlegmon of the base of the mouth (p=0,035)
or paraphayngeal abscess (p=0,030) as complication had
a longer hospital stay.

8. •Most frequent month – July (11 times).
•P=0,544 – there was no statistical differece
between months of hospitalisation.

9. 1. Acute phlegmonous laryngitis 43,8% (28 patients):
—Age minimum 20 years
—Age maximum 74 years
—Mean age 54 years
—Std. Deviation 15 years
2. Chronic decompensated tonsillitis 21,9% (14 patients):
—Age minimum 28 years
—Age maximum 86 years
—Mean age 53 years
—Std. Deviation 19 years
3. Dental infection 12,5% (8 patients):
—Age minimum 27 years
—Age maximum 82 years
—Mean age 42 years
—Std. Deviation 19 years

10. 1. Deep neck infection 85,9% (55 patients)
2. Peritonsillar abscess 26,6% (17 patients)
3. Mediastinitis 12,5% (8 patients)
4. Pneumonia 6,3% (4 patients)
5. Phlegmon of the floor of the mouth 6,3% (4
patients)
6. Parapharyngeal abscess 6,3% (4 patients)
7. Retropharyngeal abscess 6,3% (4 patients)

11. 1. Primary arterial hypertension 21,9% (14 patients)
2. Diabetes mellitus 12,5% (8 patients)
3. Coronary heart disease 12,5% (8 patients)
4. Atrial fibrillation 7,8% (5 patients)
5. Chronic heart failure 6,3% (4 patients)
• Patients with primary arterial hypertension (p<0,001), chronic heart
failure (p=0,038), atrial fibrillation (p=0,014) were of older age.
• There was a tendency that women most frequently had
primary arterial hypertension (30%, p=0,140), diabetes
(20%, p=0,088), coronary heart disease (20%, p=0,088),
atrial fibrillation (13,3%, p=0,122) and chronic heart failure
(13,3%, p=0,028) as a comorbidity.

12. Countofreceived
antibiotics
Lenght of hospital
stay
During the hospitalisation period the usage of the antibiotics varied from 1 to 8 per patient.
• 2 antibiotics 37,5% (24 patients)
—Minimal lenght of hospital stay 2 days
—Maximum 8 days
—Mean 6 days
• 3 antibiotics 29,7% (19 patients)
—Minimal lenght of hospital stay 6 days
—Maximum 24 days
—Mean 13 days
• 5 antibiotics 10,9% (7 patients)
—Minimal lenght of hospital stay 14 days
—Maximum 31 days
—Mean 19 days
• Patients with longer hospital stay (p<0,001, correlation coeficient 0,794-close correlation)
received a larger number of antibiotics.

13. 1. Sol.Metronidazoli 300mg/24h 48,4% (31 patients,
mean for 8 days).
2. Sol.Amoxicillini/Acidi clavulanici 3,6g/24h 46,9% (28
patients, mean for 5 days).
3. Sol.Ceftriaxoni 4g/24h 40,6% (26 patients, mean for
7 days).
4. Sol.Metronidazoli 1,5g 37,5% (24 patients, mean for 8
days).
5. Sol.Ceftriaxoni 2g 32,8% (21 patients, mean for 10
days).

14. •61 out of 64 patients received surgical treatment.
•Incision and drainage of deep neck infection 76,6% (49
patients)
•Tonsillectomy 34,4% (22 patients)
•Tracheostomy 31,3% (20 patients)
•Revision and drainage of mediastinum 6,3% (4 patients)
•Patients with tracheostomy were admitted to the ICU
(p=0,051).

15. •48 patients received surgical treatment for deep neck
infection as soon as they were admitted to the hospital.
•13 of them had reoperation.
•Patients with reoperation had a longer hospital stay
(p<0,001), received more antibiotics (p<0,001) and were
admitted to the ICU(p<0,001).
•60% of the patients with reoperation were admitted to
the ICU.
•There was a tendency that patients who had reopeation
were of older age (p=0,135).

16. •Bacterial culture was taken from all the patients who
received surgical treatment.
•19 patients had a positive result (microorganism and
antibacterial sensitivity).
•In 15 cases out of 19 there was a change of the antibacterial
treatment after the results of bacterial culture.
•In 4 cases there was no change in antibacterial treatment.

17. 1. Acinetobacter baumanii (8 patients, 12 times)
2. Methicillin-sensitive coagulase negative Staphylococcus aureus
(7 patients, 8 times)
3. Methicillin-sensitive Staphylococcus (4 patients, 4 times)
4. Enterococcus species (4 patients, 4 times)
5. Candida albicans (4 patients, 5 times)
• Patients with Acinetobacter baumanii (p<0,001), methicillin-
sensitive coagulase negative Staphylococcus aureus (p=0,035),
Candida albicans (p=0,001), Enterococcus species (p=0,001) and
Pseudomonas aeruginosa (p=0,001) had been at the ICU.
•There was no correlations between patients who had
diabetes as comorbidity and any of these
microorganisms (p=0,253-0,587).

18. 1. Ceftazidime (17 bacterial cultures)
1. Trimethoprim/Sulfamethoxazole (17 bacterial cultures)
2. Piperacin/Tazobactam (14 bacterial cultures)
2. Gentamicin (14 bacterial cultures)
3. Imipenem (12 bacterial cultures)
4. Ciprofloxacin (10 bacterial cultures)
Additional resistance:
• Acinetobacter baumanii – Cefepime, Amikacin, Gentamicin, Ampicillin/Sulbactam.
—Previous resistance against Trimetoprim/Sulfametaxozole, Ceftazidime, Imipenem,
Piperacin/Tazobactam.
• Methicillin-resistant coagulase negative Staphylococcus aureus – Meticilin,
Gentamicin, Erythromycin, Ciprofloxacin, Clindamycin,
Trimethoprim/Sulfamethoxazole.
—Previous methicillin-sensitive coagulase negative Staphylococcus aureus, no resistance.
• Enterobacter cloacae – Piperacin/Tazobactam.
—Previous resistance against Ampicillin, Amoxicillin/Clavulanate, Ceftazidime, Cefotaxime,
Trimethoprim/Sulfamethoxazole.

19. • Stay at the hospital per day 13,52 EUR
• CT 14,23 EUR
• MRI 28,46 EUR
• IV contrast 7,11 EUR
• Patients payment for surgery 42,69 EUR.
—11 patients didn’t pay for the surgery although 8 of them had a surgery.
• Total discount 3135,37 EUR (13 patients).
—3 patients had 100% discount.
• Sum that patients actually paid 12804,80 EUR.
—Mean 203,25 EUR.
• From government budget:
—For 1 patient who had a surgery 597,32 EUR.
—For 1 patient who had a surgery since 2014 – 629,56 EUR.
—For 1 patient from foreign country who had a surgery 3476,79 EUR.
—For 1 patient who didn’t have a surgery till 2014 – 264,51 EUR.

20. 590,42 EUR.
Neck
CT
14,23
EUR
Chest
CT
14,23
EUR
Head
CT
14,23
EUR
Abdominal
CT
14,23
EUR
Breast
CT
14,23
EUR
Neck
MRI
28,46
EUR
Chest
MRI
28,46
EUR
IV
contrast
7,11
EUR
Investigation
Status
86 43 9 2 1 2 2 93 Actually
performed
62 42 7 2 1 1 1 68 In the bill
24 1 2 0 0 1 1 25 Missing from
the bill
341,52 14,23 28,46 0 0 14,23 14,23 177,75 Unpaid

21. • Incidence of deep neck infections in CUH is about 21 patients per
year and affects both genders equaly.
• Patients are middle age.
• There is no statistical difference between months of hospitalisation.
• The most frequent diagnosis are acute phlegmonous laryngitis,
chronic decompensated tonsillitis and dental infection.
• Patients with acute tonsillitis or laryngeal stenosis have a longer
hospital stay althought these are not the most frequent diagnosis.
• The most frequent complications (except deep neck infection) are
peritonsillar abscess and mediastinitis.
• Dental infection is not Nr.1 diagnosis in CUH (as it is in other country
data).
• There are no correlations between patients who have diabetes and
any of cultivated microorganisms.