Deep Neck Space Infections
Infection Deep neck space infections Brief outline/clinical setting Deep neck space infection (DNI) is defined as an infection in the potential spaces and actual fascial planes of the neck. Once the natural resistance of fascial planes is overcome, spread of infection occurs along communicating fascial boundaries. More recent trends include the increasing prevalence of resistant bacterial strains
| Infection | Deep neck space infections |
| Brief outline/clinical setting | Deep neck space infection (DNI) is defined as an infection in the potential spaces and actual fascial planes of the neck. Once the natural resistance of fascial planes is overcome, spread of infection occurs along communicating fascial boundaries. More recent trends include the increasing prevalence of resistant bacterial strains, a decline in DNIs caused by pharyngitis or tonsillitis, and a relative increase in DNIs of odontogenic origin. Most DNIs are polymicrobial. Only 5% are purely aerobic and 25% with isolated anaerobes. |
| Aetiologies/organisms | Streptococcus viridans, coagulase-negative staphylococcus, S aureus, and Klebsiella pneumoniae were found to be the most prevalent aerobic organisms. Bacteroides, Peptostreptococcus, Fusobacterium, and Prevotella were the most prevalent anaerobes, in descending order |
| Optimal antimicrobial selection | Empiric antibiotic therapy with a combination of penicillin plus a beta-lactamase inhibitor, eg, amoxicillin/clavulanate, is recommended among other options, providing sufficient coverage for both anaerobic and aerobic bacteria. Clindamycin may no longer be considered a first-line antibiotic in DNIs, as current resistance rates among Bacteroides fragilis strains reach 20% to 50% or more, worldwide |
| Duration | 10-14 days |
| Alternative if allergic/not available | Amoxicillin- clavulanate 1g IVI 8hrly Consider broader spectrum for patients with risk factors for MDR pathogens (Diabetes, HIV, recent hospitalization, elderly) – discuss optimal alternate agent with Micro |
| Rationale | |
| Level of evidence | |
| Link to Guideline |
NICE Guidance on Deep neck infection Maharaj S, Mungul S, Ahmed S. Deep Neck Space Infections: Changing Trends in Pediatric Versus Adult Patients. J Oral Maxillofac Surg. 2020 Mar;78(3):394-399. doi: 10.1016/j.joms.2019.11.028. Epub 2019 Dec 2. PMID: 31881171. Maharaj S, Ahmed S, Pillay P. Deep Neck Space Infections: A Case Series and Review of the Literature. Clin Med Insights Ear Nose Throat. 2019 Aug 29;12:1179550619871274. doi: 10.1177/1179550619871274. PMID: 31496858; PMCID: PMC6716171. |