Basic and patient-oriented researchSevere Odontogenic Infections, Part 1: Prospective Report
Section snippets
Study design/sample
In this study we used a prospective case series design, in which all consecutive patients with OI severe enough to justify hospitalization were treated with intravenous PCN (unless allergic) and incision and drainage of all affected anatomic deep fascial spaces as soon as possible during the hospital stay.
The subjects enrolled in this study presented for care between March 1996 and June 1999 at 1 of 4 large urban hospitals served by the Montefiore Medical Center Department of Dentistry,
Results
A total of 37 subjects (23 male, 14 female) from 14 to 76 years of age (mean 34.9 ± 15.8) were enrolled in this study. There were 20 (54%) African-American/black, 8 (22%) Hispanic, 8 (22%) Caucasian, and 1 (3%) Asian patient (Table 2).
Three subjects (8%) were PCN-allergic, 3 (8%) had immunocompromising diseases (2 insulin-dependent diabetics and 1 HIV-seropositive individual with a CD4 count of 400 cells/μL). There were 15 (41%) smokers, although this variable was not recorded for 4 subjects
Discussion
In this study we prospectively evaluated 37 consecutive patients with severe OI and managed them with a standardized protocol of high-dose intravenous PCN (unless the patient was PCN allergic) and early incision and drainage. We encountered a PTF rate of 21% in severe OI requiring hospitalization. Such a failure rate is clinically unacceptable. The isolation of 1 or more PCN-resistant strains in OI has risen steadily in 4 recent studies, from 33% of cases in 1991 to 55% in 1995, and 54% of
Acknowledgments
The authors wish to acknowledge Mauricio Wiltz, DDS, 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. This study was 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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