Correlation of Severity and Morbidity in Odontogenic Infections and the Administration of  Appropriate Empirical Antibiotic Therapy as Documented by a 5-Year Retrospective Analysis

Neophytos Ch Demetriades, MD,DDS,MSC; Alireza Ashrafi, DMD; Constantinos  Laskarides, DDS,DMD,PharmD; Maria Papageorge, DMD,MSc

TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE

Mortality and morbidity associated with severe odontogenic, head & neck  space infections remain a concern in healthcare. Identification of prognostic factors can lead to reduction of adverse outcomes. The purpose of this study was to identify such factors for improving patient care in terms of morbidity and mortality and to introduce a severity score system that will be incorporated in the initial patient evaluation. 

METHODS: In this retrospective cross sectional study, 109 patients who had been treated for odontogenic infections were evaluated. The relationships between morbidity prognostic variables and outcome of treatment variables, have been tested. A new severity score was created which utilized the number of risk factors, among predictor variables, that can increase morbidity for each patient. Results: The prediction variables (incorrect administration of initial antibiotics, trismus, dysphagia and dyspnea) displayed statistically significant association with the morbidity outcomes. Overall, presence of each risk factor (dyspnea, dysphagia, trismus and incorrect administration of initial antibiotics), increases the odds of Surgical Intensive Care Unit(SICU)  admission by 2.382 times (95% CI: 1.489, 3.822) (p=0.0003). In addition the presence of each additional risk factor increases the odds for need of reoperation by 3.184 times (95% CI: 1.695, 5.981) (p=0.0003). 

Conclusion: The evaluation and appreciation of the above significant variables into clinical assessment of the patients with odontogenic head and neck space infections and their incorporation  into a severity score system, as introduced in this study, empowers clinicians to more appropriately and effectively initiate treatment for these challenging infections.