Deep neck space infections among patients attending Mulago National Referral Hospital: clinical presentation, bacterial etiology and antimicrobial susceptibility

Abstract

Introduction: Deep neck space infection (DNSI) is inflammation often with abscess collection within the potential fascial spaces in the head and neck region. Their occurrence has been falling since the advent of antibiotics but they still occur. In Uganda, there is limited data on this disease yet it causes considerable morbidity, raw data from admission registries in MNRH showed 81 patients were admitted with DNSI in 2019. This study sought to determine the clinical presentation and bacterial etiology with antimicrobial susceptibility of bacterial pathogens causing deep neck space infections among patients in MNRH. Methods: This was a descriptive cross-sectional study conducted in the ENT, accident and emergency, pediatric surgery, and oral maxillofacial wards of MNRH. The study population comprised 66 patients of all age groups with DNSIs. Upon consent/assent, an interviewer-administered questionnaire was filled. A pus sample was taken off for culture and sensitivity. The samples were processed from the Makerere College of Health sciences microbiology laboratory. Data analysis was performed using descriptive statistics. Results: Majority of patients with DNSI were males (59.1%) with a mean age of 21.6years. Neck swelling (100%) and pain (95.5%) were the most common presentation The study participants were divided into two major groups; 29 patients belonged to the pediatric group, while 37 patients belonged to the adult group. Odontogenic source was the most common predisposing factor in the adult group and nonodontogenic sources for the pediatric group. In both groups the submandibular space (48.4%) was the most common site of presentation. Staphylococcus aureus (34.5%) was the most common isolated organism in the pediatric group, MRSA were 46.1%. Viridans streptococci (37.8%) most common in the adult group with no resistance to Clindamycin. Conclusion: DNSI are still common in our setting and patients commonly present with pain and neck swelling. Community awareness about the importance of oral hygiene and proper treatment of upper respiratory tract infections can aid DNSI prevention. Staphylococcus aureus and Viridans streptococci are the most common etiologies in DNSI.It is important to perform antibiotic susceptibility tests to tailor antibiotic treatment for all DNSI patients.