Odontogene pyogene Infektionen im Mund-, Kiefer- und Gesichtsbereich. Eine retrospektive Studie von 2004 bis 2014 in der Klinik für Mund-, Kiefer- und Gesichtschirurgie - Plastische Operationen - am HELIOS Klinikum Erfurt GmbH

The present study provides a retrospective analysis of a series of patients suffering from odontogenic pyogenic infections at the HELIOS Hospital in Erfurt from January 1st, 2004 to December 31st, 2014 by comparing these cases to previously reported findings from January 1st, 1987 until December 31st, 1997. Data collection included demographic information such as age, gender distribution, and specifications regarding the frequency of diagnoses and the occurrence of medical co-morbidities. Particular attention was paid to in-patient subjects with communicable diseases and the analysis of the prevailing therapeutic treatment with regard to the common pathogen spectrum, pathogen sensitivity and type and number of administered antibiotics. A total of 1744 patients with odontogenic infections were identified from 2004 to 2014. 686 of these were treated on an outpatient basis. Further in-patient procedures were necessary in 1058 cases. In both reviewed periods, the primary surgical treatment performed indicated an association with the administration of broad-spectrum antibiotic medication. With regard to age and gender patterns of both hospital records, differences in peak age (from 31-40 years) and the male to female ratio (1,6 : 1) could not be recognized. Nevertheless, there were deviations in age distribution to the earlier observation period. Thus, 5% more infants from 0-10 years, 9% more adolescents from 11-20 years and 25% more elderly persons received treatment in the more recent observation period. From 1987-1997, the peri- and submandibular spaces (25%) were most often subject to infections. In contrast, extensive submucosal abscesses were most frequently encountered (39%) from 2004-2014. Particularly striking during this recent period was the increase of in-patient cases of about 44% during a significant decrease in the length of hospital stay of about 51%. Simultaneously, a considerable increase in medical co-morbidities like cardiovascular diseases, diabetes mellitus and neurological conditions was recorded. The specific microbiological spectrum in both considered periods involved mainly viridians group streptococci (40% each), followed by staphylococci (27% and 7%,) and the streptococcus anginosus group (7% and 4%). From 1987-1997, the predominantly strict anaerobes were represented by peptostreptococci strains (9%); from 2004-2014, mainly prevotella species (24%) were isolated. Other bacterial species occurred on a mere sporadic basis. The administered antibiotics showed high efficacy against the common pathogens and therefore were congruent to the recommendations of the expert associations. Thus, from 1987-1997, the preferred antibiotic treatment consisted of aminopenicillins in combination with Beta-Lactamase inhibitors (38%) in cases that showed a high sensitivity rate of 91%. Thereafter, the Tetrazyklines (21%) followed with 80% pathogen sensitivity. In 2004-2014, the administration of cephalosporins and metronidazole with (44%) or without metronidazole (39%) was implemented most frequently. Macrolides and Lincosamines were administered in fairly equal amounts in both hospital records and even showed a decrease of 20% in resistance rates. In both time segments, Carbapenems represented the lowest rate of resistance antibiotics; therefore, they were rarely applied or only administered as a “last resort”. In conclusion, the paradigm shift in the usage of Beta-Lactam antibiotics, which has taken place over the last four decades, should be observed critically. A high success rate in the antibiotic treatment of odontogenic pyogenic infections through medication with cephalosporines of the 2nd generation is undisputable, considering the high efficacy against common pathogens. Nevertheless, due to the severe selection pressure those substances apply on ESBL-producing bacterial strains, a steady periodic review of the current treatment strategies at the HELIOS Hospital Erfurt is recommendable.