Basic and patient-oriented research
Severe Odontogenic Infections, Part 2: Prospective Outcomes Study

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Purpose

The purpose of this study was to identify significant predictors of 4 outcomes in patients with severe odontogenic infections: abscess formation, penicillin therapeutic failure (PTF), length of hospital stay (LOS), and need for reoperation.

Patients and Methods

We used a prospective case series study design and enrolled 37 consecutive patients admitted for severe odontogenic infection between March 1996 and June 1999. Treatment consisted of intravenous penicillin (PCN) or clindamycin in PCN-allergic patients, surgical incision and drainage, and extraction(s) as soon as possible. Study variables were categorized as demographic, preadmission, time-related, preoperative, anatomic, treatment, microbiologic, and complications. The primary outcome variables were abscess formation, PTF, LOS, and reoperation. Multivariate linear and logistic regression techniques were used to measure associations between study variables and the outcome variables.

Results

The sample consisted of 37 subjects (23 male, 14 female) with a mean age of 34.9 ± 15.8 years. Multivariate analyses, controlling for confounding variables, indicated that culture of Peptostreptococci was a negative predictor of abscess formation. LOS was predicted by the number of infected spaces and duration of operation. There was no significant predictor of PTF or reoperation on multivariate analysis, although PCN-resistant organisms were isolated in all cases of PTF.

Conclusion

Increased LOS in severe odontogenic infections is predicted by the anatomic extent and severity of the infection and the occurrence of complications such as PTF and the need for reoperation. PTF is significantly associated with later identification of PCN-resistant organisms. The role of Peptostreptococci in abscess formation warrants further investigation.

Section snippets

Study design/sample

In this study we used a prospective case series design in which consecutive patients with OIs severe enough to justify hospitalization were treated with intravenous (IV) penicillin (PCN) or clindamycin (in PCN-allergic patients) and surgical incision and drainage (I&D) of all anatomic deep fascial spaces affected by cellulitis or abscess as soon as possible during their hospital stay.

The subjects enrolled in this study presented for care between March 1996 and June 1999 at 1 of 4 large urban

Results

The descriptive statistical results in this study have been reported in detail separately.7 A brief summary of those results can be found in Table 2, Table 3, Table 4, Table 5. Selected data for each case are reported in Table 6.

Discussion

The specific aim of this study was to identify predictors of abscess formation, PTF, LOS, and complications in patients with severe OI.

A limitation of this study may be the inability to detect statistically and clinically significant differences because of the small sample size (type II statistical error). Our sample size was limited by the exclusion of relatively minor infections, which were treated on an outpatient basis, by the clinical need to avoid PCN in 4 cases, by the availability of

Acknowledgment

The authors thank Drs Richard Kraut, Norman Trieger, Arthur Adamo, Mauricio Wiltz, and all of the Oral and Maxillofacial Surgery residents at the Montefiore Medical Center for their assistance in the care of patients and gathering of data.

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    Supported in part by the Montefiore Medical Center Department of Dentistry and the Massachusetts General Hospital Department of Oral and Maxillofacial Surgery Education and Research Fund.

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