Recent trends in the microbiology and antimicrobial susceptibility patterns of deep neck space infections, a descriptive analysis

Abstract

Deep Neck Space Infections (DNSI) present healthcare institutions with a significant clinical conundrum and an ever-present public health concern. Rapid progression of disease and potential for immediate life-threatening complications warrants an aggressive approach to diagnostic and therapeutic interventions in DNSI. The current standard of care involves securing the airway, incision and drainage of collections and source control. Broad-spectrum empiric antibiotics needs to be initiated at first contact with healthcare services and continued until culture identification and sensitivity results allows for de-escalation, or clinical improvement is noted. Unfortunately, antimicrobial susceptibility among organisms commonly implicated in DNSI are shifting under pressure. Current literature reports an observed absolute increase in the prevalence of resistant bacterial strains, especially in lower socioeconomic environments. Recommendations regarding choice of empiric agents should be informed by observing locoregional trends. In their pursuit of enhancing clinical outcomes and curbing the emergence of resistant pathogens the authors sought to determine the profile of organisms currently encountered in DNSI and whether co-amoxiclav still constitutes an effective choice. A retrospective review is presented, reporting on the organisms identified and their antimicrobial susceptibility trends over five years within four tertiary hospitals in Johannesburg, South Africa. Basic demographic indicators and specimen references were obtained by perusing theatre records for procedures related to “incision and drainage of neck abscess.” Findings within the cohort are congruent with previous literature on the topic and co-amoxiclav may still be recommended as an effective first- line empiric agent in DNSI. However, a subtle shift toward increasing antimicrobial resistance is noted in the susceptibility trends, indicating a substantial evolving future public health concern.