Deep Neck Space Infection among Diabetic and Non Diabetic Patients: A Prospective Cohort Study

Abstract

Introduction: Deep Neck Space Infections (DNSI) were first described by Galen in the second century. They refer to infections of potential spaces and fascial planes of the neck and are a cause of significant morbidity and mortality. Additionally, the presence of Diabetes Mellitus (DM) increases the possibility of life-threatening complications. Aim: To compare the clinical characteristics, bacteriological spectrum, aetiological aspects, biochemical parameters, treatment protocol, complications, and mortality rate among diabetic and non diabetic patients with DNSIs. Materials and Methods: A prospective cohort study was conducted in the Department of Otorhinolaryngology, Mysore Medical College and Research Institute, Mysuru, Karnataka, India from January 2022 to December 2022. 52 patients with DNSIs were grouped into diabetics and non diabetics. The age group of the patients included in the study was 18-65 years. A detailed history, clinical examination, haematological investigations, and Contrast-enhanced Computed Tomography (CECT) were performed. Patients were either treated conservatively or underwent incision and drainage, depending on the presentation. The data obtained were analysed using the Statistical Package for the Social Sciences (SPSS) version 20.0. Results: The age range was 18 to 65 years, with a mean age of 51 years (51.35±13.46 years) in the diabetic group and 37 years (37.9±13.2 years) in the non diabetic group. Patients were divided into 26 (50%) diabetics and 26 (50%) non diabetics. Of the 52 patients, 34 (65.3%) were males and 18 (34.7%) were females. Multiple space involvement was present in eight patients among the diabetic group and three patients in the non diabetic group. Odontogenic infections constituted the leading foci in 17 (65.4%) of diabetics and 13 (50%) of non diabetics. In diabetics, 12 (46%) patients had high levels (>6.5%) of HbA1c, and Klebsiella was the causative organism in 9 (39%). A total of 23 (88.5%) diabetic patients underwent incision and drainage, while 13 (50%) non diabetic patients were treated conservatively. Among the diabetics, 21 (80.8%) patients had a hospital stay of >7 days, 7 (27%) patients had complications, and the mortality rate was observed in 5 (19.2%) patients. Conclusion: The study emphasises a definitive association of DM in the occurrence of DNSIs. Hence, the need for early detection and treatment of primary infections is highlighted, insisting on appropriate management of blood sugar levels.