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

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.

Transnasal Endoscopy and Combined Approach to Infratemporal Fossa Abscess and Parapharyngeal Abscess

“…It is worth mentioning that the patients in both cases were diabetic with poor glycemic control and had decreased immune function, which may be one of the reasons for the rapid progression of infections in the patients, causing serious complications. Therefore, in addition to timely incision and debridement, it is important to select empirical antibiotics adequately 8. In the latest report, the top 3 most common pathogens involved in deep cervical infections in diabetic patients were K. pneumoniae , Viridans streptococci , and methicillin-sensitive Staphylococcus aureus 8.…”

“…Therefore, in addition to timely incision and debridement, it is important to select empirical antibiotics adequately. 8 In the latest report, the top 3 most common pathogens involved in deep cervical infections in diabetic patients were K. pneumoniae, Viridans streptococci, and methicillin-sensitive Staphylococcus aureus. 8 In case 1 of this report, the culture of the pathogenic bacteria showed K. pneumoniae, consistent with the above results, while case 2 showed E. faecalis.…”

“…8 In the latest report, the top 3 most common pathogens involved in deep cervical infections in diabetic patients were K. pneumoniae, Viridans streptococci, and methicillin-sensitive Staphylococcus aureus. 8 In case 1 of this report, the culture of the pathogenic bacteria showed K. pneumoniae, consistent with the above results, while case 2 showed E. faecalis. The antibiotic treatment was given according to the susceptibility results, and the effect was significant.…”

Analyzing the risk of osteoporosis and fracture in rheumatoid arthritis patients who have been treated with various biologics

“…This database has been used to perform several large-scale retrospective studies of various diseases and has reproduced a large quantity of real-world evidence-based research. [11][12][13][14] We designed a retrospective with a continuous observational experiment, by analyzing the aforementioned data, mainly to identify the risk factors among patients with RA before and after being diagnosed with osteoporosis, and to identify those who developed osteoporosis later or had greater incidences of fractures between different treatment combinations. This study aims to link between the different kinds of biologic treatment choices and the incidence of osteoporosis or osteoporotic fracture in each RA patient in the CGRD registry.…”

“…In this study, we used the research database from the largest medical center in Taiwan, the Chang Gung Memorial Hospital (CGMH), to perform a more thorough analysis. This database has been used to perform several large‐scale retrospective studies of various diseases and has reproduced a large quantity of real‐world evidence‐based research 11–14 . We designed a retrospective with a continuous observational experiment, by analyzing the aforementioned data, mainly to identify the risk factors among patients with RA before and after being diagnosed with osteoporosis, and to identify those who developed osteoporosis later or had greater incidences of fractures between different treatment combinations.…”