Evaluating the Role of Staphylococcus aureus Nasal PCR in Pediatric Head and Neck Infections

OBJECTIVE Vancomycin is often empirically used in the management of head and neck infections (HNIs) in children. The objective of this study was to determine the utility of Staphylococcus aureus (SA) nasal PCR to facilitate de-escalation of vancomycin for pediatric HNIs. METHODS This was a single-center, retrospective cohort study of pediatric patients who received empiric intravenous vancomycin for a diagnosis of HNIs between January 2010 and December 2019. Subjects were excluded if they met any of the following: confirmed/suspected coinfection of another site, dialysis, immunocompromised status, admission to the NICU, alternative diagnosis that did not require antibiotics, or readmission for HNIs within 30 days of previous admission. The primary outcome was time to de-escalation of vancomycin. Total duration of antibiotics, treatment failure, hospital length of stay (LOS), and incidence of acute kidney injury (AKI) were also assessed. RESULTS Of the 575 patients identified, 124 patients received an SA nasal PCR. The median time to de-escalation was 39.5 hours in those patients compared with 53.7 hours in patients who did not have a SA nasal PCR (p = 0.002). No difference was noted in total duration of all methicillin-resistant Staphylococcus aureus antibiotics, hospital LOS, treatment failure, and AKI. CONCLUSIONS In a large cohort of pediatric patients with HNIs, those who underwent testing with an SA nasal PCR spent less time receiving intravenous vancomycin, although their LOS was not significantly reduced. Further investigation is needed to better define the role of SA nasal PCRs in determining antibiotic therapy for HNIs.

MANAGEMENT OF ODONTOGENIC INFECTION OF PRIMARY TEETH IN CHILD THAT EXTENDS TO THE SUBMANDIBULAR AND SUBMENTAL SPACES

Odontogenic infections are infections originating from the teeth or the supporting tissues of the teeth. This infection can spread to the alveolar processes, the deeper tissues of the face, oral cavity, head, and neck. Infections that spread to a child's facial area can progress rapidly, producing significant systemic symptoms, such as fever, malaise, dehydration, dysphagia, and respiratory distress. The purpose of this case report is to describe the management of odontogenic infection of primary teeth in child that extends to the submandibular and submental spaces. Case Report:A 5-year-old boy patient came to the Emergency Department of Hasan Sadikin Hospital Bandung with complaints of swelling in the right submental and submandibular for seven days. The patient complained of toothache, fever, and trismus. The diagnosis of this case was submandibular abscess extending to the submental area due to dental infection 85.. Patient care includes administering Ceftraxone inj 325 mg IV, Metronidazole inf 170 mg IV, Paracetamol inf 195 mg IV, tooth extraction 85, drainage incision through and through the right mandibular to submental, and installation of a Penrose drain. Conclusion:Odontogenic infections in children can originate from primary teeth and can extend to the maxillofacial space. Prompt and appropriate treatment of severe odontogenic infections in children needs to be done to prevent further complications

Medullary brain abscess secondary to dental procedure caused by Streptococcus intermedius

Brainstem abscess is an uncommon occurrence in itself and an abscess in the medulla oblongata is even rarer. Although these abscesses have established association with head and neck infections, we report the first known case of medullary abscess that was found to be strongly associated with dental procedure. Important point to note is that a simple procedure like tooth extraction can predispose spread of infective seeding to distant sites. High clinical index of suspicion and early diagnosis are essential, as if left untreated, the brainstem abscess is almost always fatal otherwise.

The Characteristics of Capnocytophaga Infection: 10 Years of Experience

Background Capnocytophaga is a Gram-negative, facultative anaerobe. Human infection is rare but can lead to devastating outcomes. C. canimorsus can cause sepsis following an animal bite, whereas human-oral associated Capnocytophaga infections were reported in immunocompromised patients. Current data on these infections is not robust. Our goal is to provide a contemporary description of a unique characteristic of Capnocytophaga infections. Methods We performed a retrospective review of all patients with Capnocytophaga infection from January 2010 to August 2020 at three main hospitals of Mayo Clinic in Rochester, Minnesota, Scottsdale, Arizona, and Florida. We collected baseline demographic data, clinical characteristics, microbiological data, and outcomes of C. canimorsus and human-oral associated Capnocytophaga infection. Results Among 82 patients with Capnocytophaga infection, 46 patients (56.0%) had bacteremia. The most common species identified in this group was C. sputigena (57.9%), followed by C. canimorsus (34.8%). Patients with human-oral associated Capnocytophaga bacteremia were often immunocompromised, presented with neutropenic fever, and had worse six months all-cause mortality compared to C. canimorsus bacteremia (36.4% vs. 6.2%, p=.03). They also had a higher beta-lactamase production rate (36.4% vs. 0.0%, p=.02). Among patients without bacteremia, the main clinical syndrome was polymicrobial head and neck infections (47.2%). Conclusions Human-oral associated Capnocytophaga bacteremia occurs primarily in immunocompromised patients, particularly those with hematologic malignancy. In contrast, C. canimorsus bacteremia is more likely to present with community-onset infection related to zoonotic exposure. Human-oral associated Capnocytophaga infection without bacteremia is frequently isolated in polymicrobial infection; this phenomenon's significance is yet to be fully understood.

Evaluation of Microbial Culture and Antibiogram in Patients With Head and Neck Infections Who Referred to Shahid Rajaee Hospital of Shiraz Between 1392 to 1398

Background: Head and neck infections happen due to different reasons and different microorganisms are responsible for them. These infections can be treated with various antibiotics. The purpose of this study was to specify most frequent etiology of infection, dominant bacterial species and most effective antibiotic in patients with head and neck infections who referred to Shahid Rajaee hospital of Shiraz.Methods: This study has been carried out in cross-sectional pattern from 2019-May to 2020-Oct in Oral & Maxillofacial Ward of Rajaee Hospital of Shiraz. Consent to access data and archive files was taken from the ethics committee of Shiraz University of Medical Sciences. Age, sex, etiology of infection, bacterial species, sensitivity or resistance reaction to Antibiotics and most frequently used antibiotic in patients who referred to this ward between 1392-Apr to 1398-Mar were collected on the basis of laboratory’s results. Data were analyzed with Chi-Square test.Results: statistical analysis showed that, 56 of patients were men (54.9%) and 46 were women (45.1%). The average of age was 38+/−17 and the minimum age was 6 and maximum age was 73. The most frequent etiology was odontogenic infections. Moreover, there was no statistically significant relationship between etiology and bacterial species (p-value=0.38) and Cefazolin had the most frequency in odontogenic infection group. Top three frequent bacterial species were respectively: Staphylococcus DNase & Coagulase Negative, Enterococci Sp., Streptococci Viridians and Klebsiella Sp. . There was no statistically significant relationship between bacterial species and sex (p-value=0.55). 94 (48.7 %) of bacterial species had Sensitive reaction to antibiotics. 21 (10.9 %) of them had Intermediate reactionand 78 (40%) of them had Resistant reaction and Cefazolin had the most frequency in sensitive group.Conclusion: The dominant bacterial species in head and neck infections are Staphylococcus DNase & coagulase negative. And, Cefazolin had the most sensitive reaction in odontogenic infections.

Microbiological justification of the application of cyprofloxacin and tinidazole combination for antimicrobial chemistry in dentistry

Relevance. According to modern concepts, virulent representatives of periodontal pathogenic bacteria are actively involved in the development of both periodontal pathology and various forms of odontogenic infection. The species diversity of these pathogens determines the need for a combined approach when choosing antimicrobial drugs.The aim of the work is to provide a microbiological substantiation of the use of a combined dosage form of ciprofloxacin and tinidazole for the treatment of periodontal and odontogenic infections based on the determination of the spectrum of action and the characteristics of the activity of the components.Materials and methods. Determination of the sensitivity of various strains of periodontal and odontogenic infection pathogens (P. intermedia, S. constellatus; S. sanguis, K. pneumoniae, S. aureus – MRSA) was carried out by the method of automated cultivation of strains with different concentrations of the tested drugs – ciprofloxacin and tinidazole.Results. Differences in the activity of the components of the combined preparation ciprofloxacin and tinidazole were found in terms of the sensitivity of strains of aerobic and anaerobic pathogens to them. Aerobic strains, including MRSA, were inhibited by ciprofloxacin in a low concentration range (6.25 μg / ml), but for some anaerobic strains the activity of ciprofloxacin was borderline (12.5 μg / ml). This confirmed the need to include tinidazole in the composition of the complex preparation.Conclusion. The combination of ciprofloxacin and tinidazole provides coverage of the full spectrum of periodontal and odontogenic infections and can be used as the agent of choice in the antimicrobial chemotherapy algorithm for head and neck infections.