Factors associated with complications among deep neck infection in the community-based hospital in Thailand

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Prompt and accurate diagnosis, coupled with appropriate management, can mitigate the severity of these infections. Methods We conducted a retrospective cohort study of patients over 15 years old diagnosed with DNIs at a community-based hospital in Thailand from January 2017 to December 2021. The study aimed to evaluate the epidemiology, clinical features, and risk factors associated with complications in patients diagnosed with DNIs. Results A total of 226 patients were included, with 135 (59.7%) males and a median age of 39.5 years (IQR 29–58). Comorbidities were present in 87 patients (38.5%), with hypertension (20.4%) and diabetes mellitus (19.0%) being the most common. Odontogenic infections were the leading cause of DNIs (54.9%), and the primary presenting symptoms were neck pain and swelling (67.7%). The buccal space was the most frequent infection site (22.6%), followed by the peritonsillar space (20.4%) and the submandibular space (19.9%). Klebsiella pneumoniae was the most identified pathogen (20%), followed by Staphylococcus spp. and Viridans streptococcus (each 6.2%). Among the patients, 44.6% underwent incision and drainage, 12.4% underwent simple aspiration, and 42.9% received conservative treatment with intravenous antibiotics. Complications were observed in 16.4% of the patients, with airway obstruction being the most common (7.1%), followed by sepsis (4.9%). Multiple logistic regression analysis revealed significant risk factors for complications: involvement of the parapharyngeal space (odds ratio 43.3, p = 0.006), multiple space involvement (odds ratio 7.98, p < 0.001), and involvement of the submental space (odds ratio 5.5, p = 0.017). Additionally, presenting symptoms such as fever (odds ratio 6.1, p = 0.008), anemia (odds ratio 37.4, p = 0.024), and neck pain and swelling (odds ratio 0.2, p = 0.045) were associated with higher complication rates. Conclusions Odontogenic infections are the most common cause of DNIs. Complications are significantly associated with infections involving the parapharyngeal, submental, and multiple spaces. Early diagnosis and prompt management, especially in patients with identified risk factors, are crucial in reducing life-threatening complications. Deep neck infection complication neck infection. Figures Figure 1 Introduction Deep neck infection (DNI) is not just a medical condition, it's a potentially life-threatening situation. [ 1 – 3 ]DNIs are defined by the presence of inflammation with or without pus in the deep spaces and fasciae of the head and neck. It's characterized by the spread of infection into the deep spaces of the neck, including parapharyngeal, retropharyngeal, and submandibular spaces.[ 4 , 5 ] DNIs can arise from various sources, including odontogenic, pharyngeal, and salivary gland infections, and can lead to severe complications, including airway obstruction, descending mediastinitis, great vessel thrombosis, necrotizing fasciitis, sepsis, and septic shock.[ 6 – 8 ] The severity of DNIs refers to the risk of dissemination to the mediastinum through these spaces and fascial planes, especially the posterior, producing descending necrotizing mediastinitis. Tracheostomy rates in DNIs have been reported to be up to 30%, with mortality around 5% and mortality rates rising to 17.5–50% if necrotizing mediastinitis occurs.[ 6 , 9 – 13 ] The timely diagnosis and appropriate management of DNIs are paramount to prevent the progression of infection and reduce associated morbidity and mortality. However, the diagnosis of DNIs can be challenging due to nonspecific clinical manifestations and the potential for rapid disease progression. While several studies have investigated the epidemiology and risk factors of DNIs, comprehensive analyses are still needed to understand better the clinical characteristics and predictors of complications in affected patients. Therefore, this study aimed to evaluate the epidemiology, clinical features, and risk factors associated with complications in patients diagnosed with DNIs. Methods and participants This retrospective cohort study was conducted at Chaopraya Abhaibhubejr Hospitals in Prachinburi, Thailand, between January 2017 and December 2021. Patients aged 15 years and older diagnosed with DNIs during the study period were included in the analysis. Data collected from electronic medical records included demographic characteristics, comorbidities, presenting symptoms, etiology, site of infection, identified pathogens, treatment modalities, length of hospital stay, and complications, including at least one or more of the following conditions: 1) upper airway obstruction, 2) sepsis or septic shock, 3) pneumonia detected by chest radiograph, 4) death. Patients' characteristics were described using mean with standard deviation (SD), median with interquartile range (IQR), and frequencies (%). Categorical variables were compared between groups using Chi-square or Fisher's exact test, and continuous variables were compared using the student's t-test and Mann-Whitney U test. Logistic regression was used to determine the association between factors and complications. A multivariate logistic regression model considered variables with p < 0.10 after assessing multicollinearity using variance inflation factors. Backward stepwise selection was used in the multiple logistic regression model, retaining variables that attained statistical significance. A p-value < 0.05 was considered statistically significant. All statistical analyses were performed using Stata statistical software version 18.0. Results A total of 226 patients diagnosed with DNI were included in the study. The patients were from a diverse range of backgrounds and included both inpatients and outpatients. Of these patients, 135 (59.7%) were male. The median age was 39.5 years (interquartile range [IQR]: 29–58). Comorbidities were present in 87 patients (38.5%), with hypertension (20.3%) and diabetes mellitus (19.0%) being the most common. Odontogenic infection was the most prevalent etiology (54.9%), followed by pharyngeal and salivary gland infections. The primary presenting symptoms were neck pain and swelling (67.7%), fever (30.9%), and dysphagia (14.6%). The buccal space was the most frequently affected site (22.6%), followed by the peritonsillar space (20.3%) and the submandibular space (19.9%). Klebsiella pneumoniae was the most identified pathogen (20%), followed by Staphylococcus spp. and Viridans streptococcus. (Fig. 1 ) Treatment modalities included incision and drainage (44.6%), simple aspiration (12.4%), and conservative management with intravenous antibiotics (42.9%). The choice of treatment was based on the severity of the infection, the patient's overall health status, and the presence of any complications. Focus on complication and no complication groups (Table 1 , Table 2 ). The median age of patients with complications was significantly higher (52 years, IQR: 31–63) compared to those without complications (37 years, IQR: 29–56) (p = 0.0423). Patients with complications had a higher prevalence of underlying medical conditions (62.16%) compared to those without complications (33.86%) (p = 0.001), with diabetes mellitus being more common in the complication group (37.48%) than in the no complication group (15.34%) (p = 0.001). Neck swelling was significantly more common in patients with complications (84.49%) compared to those without complications (64.02%) (p = 0.008). Fever was more frequently observed in the complication group (54.05%) compared to the no complication group (26.46%) (p = 0.001). Difficulty breathing was exclusively observed in the complication group (21.62%) and was absent in patients without complications (p < 0.001). The overall mortality rate was 0.89%. Multiple space involvement defined by at least two space involvement was significantly higher in the complication group (64.86%) compared to the no complication group (18.52%) (p < 0.001). Submandibular space involvement was more common in the complication group (40.54%) compared to the no-complication group (15.87%) (p = 0.001). Submental space involvement was also significantly higher in patients with complications (21.62%) compared to those without (7.94%) (p = 0.012). Buccal space involvement was more frequent in the complication group (35.14%) compared to the no-complication group (20.11%) (p = 0.046). Temporal space involvement was observed only in the complication group (3.5%) and not in the no-complication group (p < 0.001). Lingual space involvement was higher in the complication group (10.81%) compared to the no-complication group (3.17%) (p = 0.039). Ludwig space involvement was significantly more common in the complication group (13.51%) compared to the no-complication group (1.59%) (p < 0.001). Our findings regarding treatment modalities indicate that 44.6% of patients underwent incision and drainage, 12.4% underwent simple aspiration, and 42.9% received conservative treatment with intravenous antibiotics. Complications occurred in 16.4% of cases, with airway obstruction being the most common (7.1%), followed by sepsis (4.9%). The median length of hospital stay was significantly longer for patients with complications (14 days, IQR: 9–22) compared to those without complications (4 days, IQR: 3–6) (p < 0.001). Sepsis at admission was present in 29.73% of patients with complications and absent in those without complications (p < 0.001). Pneumonia occurred in 16.22% of the complication group and was absent in the no complication group (p < 0.001). Upper airway obstruction occurred in 43.24% of patients with complications and was absent in those without complications (p < 0.001). Emergency tracheostomy due to upper airway obstruction was required in 5.41% of patients with complications (p < 0.001). The overall mortality rate was 0.88% (5.4% in the complication group and 0% in the no complication group (p < 0.001). Multiple logistic regression analysis was performed to identify the factors associated with complications. This analysis considers the potential influence of multiple variables on the outcome. The factors found to be significantly associated with complications were space involvement in the parapharyngeal space (odds ratio 43.3, p = 0.006), involvement of multiple spaces (odds ratio 7.98, p < 0.001), and involvement of the submental space (odds ratio 5.5, p = 0.017). The presenting symptoms of fever (odds ratio 6.1, p = 0.008), anemia (odds ratio 37.4, p = 0.024), and neck pain and swelling (odds ratio 0.2, p = 0.045) were also associated with complications. Discussion This study provides valuable insights into the epidemiology, clinical characteristics, and risk factors associated with complications in patients diagnosed with DNIs in the Community-based tertiary care setting. The findings highlight the importance of early recognition and appropriate management to prevent the development of life-threatening complications.[ 2 , 10 , 14 ] Consistent with previous studies, odontogenic infections were identified as the most common etiology of DNIs.[ 1 , 8 , 10 , 15 , 16 ] This underscores the importance of dental hygiene and timely treatment of dental infections to prevent the spread of infection to deeper neck spaces.[ 17 ] In our study, the microorganisms isolated were Klebsiella pneumoniae , Staphylococcus spp., and Viridans streptococcus, whereas previous studies have also demonstrated that S. pyogenes, S. aureus, Streptococcus viridans, and Haemophilus influenza are the most common bacterial species.[ 10 , 13 , 15 , 16 , 18 – 20 ] Appropriate to a previous study, multiple space involvement tends to cause more complications than single-space involvement; the association between space involvement and complications emphasizes the need for careful evaluation and monitoring of patients with extensive neck involvement.[ 3 , 16 , 21 , 22 ] Prompt surgical intervention, such as incision and drainage, may be necessary to prevent the progression of infection and alleviate airway compromise.[ 2 , 6 , 17 , 23 ] Furthermore, having diabetes mellitus, identifying fever, anemia, neck pain, and swelling as significant risk factors for complications underscores the importance of recognizing these clinical features early in the disease course.[ 2 , 16 , 24 , 25 ] Patients with these symptoms should undergo a thorough evaluation and close monitoring to prevent adverse outcomes. This study's limitations include its retrospective design and reliance on electronic medical records, which may have introduced bias and limited the availability of certain data variables. Additionally, the study was conducted at a single institution, which may limit the generalizability of the findings. In conclusion, this study contributes to our understanding of the epidemiology and risk factors of DNIs. Early diagnosis and prompt management, particularly in patients with identified risk factors, are essential to reduce the morbidity and mortality associated with this severe condition. Further research is warranted to validate these findings and explore additional factors that may influence outcomes in patients with DNIs. Conclusion Odontogenic infection is the leading cause of deep neck infection. Early diagnosis and prompt management, especially in patients with risk factors, may help reduce life-threatening complications. And prevent adverse sequelae. Table 1 Baseline Characteristics and Clinical Presentation of Deep Neck Infection Patients Factors Overall N = 226 No Complication group N = 189 Complication group N = 37 P-value Age at diagnosis, years (Median (IQR)) 39.5 (29–58) 37 (29–56) 52 (31–63) 0.0423 Age more than 65, n (%) 37 (16.37) 28 (75.68) 9 (24.32) 0.153 Male, n (%) 135(59.7%) 110 (58.2) 25 (67.5) 0.288 Having an underlying medical condition, n (%) 87 (38.5) 64 (33.86) 23 (62.16) 0.001 - Diabetes mellitus, n (%) 43 (19.03) 29 (15.34) 14 (37.48) 0.001 - Hypertension, n (%) 46 (20.3) 36 (19.05) 10 (27.03) 0.27 - Chronic kidney disease, n (%) 4 (1.77) 3 (1.59) 1 (2.7) 0.638 - Patient living with HIV, n (%) 5 (2.2) 5 (2.65) 0 (0) 0.317 - Old Cerebral infarction, n (%) 4 (1.8) 3 (1.59) 1 (2.7) 0.638 - Atherosclerotic heart disease, n (%) 2 (0.9) 2 (1.06) 0 (0) 0.93 Presenting Symptoms, n (%) - Neck swelling 153 (67.7) 121 (64.02) 32 (84.49) 0.008 - Fever 70 (30.9) 50 (26.46) 20 (54.05) 0.001 - Dysphagia 33 (14.6) 27 (14.29) 6 (16.22) 0.761 - Pain while swallowing 72 (31.8) 63 (33.33) 9 (24.32) 0.282 - Trismus 30 (13.2) 25 (13.23) 5 (13.51) 0.963 - Difficult to breath 8 (3.5) 0 (0) 8 (21.62) < 0.001 Table 2 Site of infection and Clinical Outcomes of Deep Neck Infection Patients Factors Overall N = 226 No Complication group N = 189 Complication group N = 37 P-value Neck space involvement, n (%) Single space involvement 167 (73.9) 154 (81.48) 13 (35.14) < 0.001 Multiple space involvement 59 (26.11) 35 (18.52) 24 (64.86) 0.000 Submandibular space 45 (19.9) 38 (15.87) 15 (40.54) 0.001 Submental space 23 (10.18) 15 (7.94) 8 (21.62) 0.012 Buccal space 51 (22.5) 38 (20.11) 13 (35.14) 0.046 Masticator space 10 (4.42) 7 (3.7) 3 (8.11) 0.234 Canine space 25 (11) 24 (12.7) 1 (2.7) 0.076 Temporal space 5 (2.2) 0 (0) 5 (3.5) 0.000 Lingual space 10 (4.4) 6 (3.17) 4 (10.81) 0.039 Pterygomandibular space 37 (16.37) 27 (14.29) 10 (27.03) 0.055 Peritonsillar space 46(20.3) 44 (23.28) 2 (5.41) 0.014 Parotid space 14 (6.1) 12 (6.35) 2 (5.41) 0.828 Retropharyngeal space 11 (4.87) 7 (3.7) 4 (10.81) 0.066 Parapharyngeal space 8 (3.54) 2 (1.06) 6 (16.22) 0.27 Ludwig space 8 (3.5) 3 (1.59) 5 (13.51) < 0.001 Origin of infection Dental origin 124 (54.87) 102 (53.97) 22 (59.46) 0.539 Tonsil origin 48 (21.24) 47 (24.87) 1(2.7) 0.003 Parotid gland origin 16 (7.08) 12 (6.35) 4 (10.81) 0.333 Foreign body 7 (3.11) 5 (2.65) 2 (5.4) 0.376 Outcomes Length of stay, days, (Median (IQR)) 5 (3–8) 4 (3–6) 14 (9–22) 10 days, n (%) 39 (17.26) 14 (7.41) 25 (67.57) < 0.001 Sepsis in admission, n (%) 11 (4.87) 0 11 (29.73) < 0.001 Pneumonia, n (%) 6 (2.69) 0 6 (16.22) < 0.001 Mediastinitis, n (%) 1 (0.44) 0 1 (2.7) 0.024 Upper airway obstruction, n (%) 16 (7.08) 0 16 (43.24) < 0.001 Upper airway obstruction required emergency tracheostomy, n (%) 2 (0.88) 0 2 (5.41) < 0.001 Death, n (%) 2 (0.88) 0 2 (5.41) < 0.001 Declarations Acknowledgments : We thank pulmonologist, Dr. Chalalai Klaipim, at Chaophya Abhaibhubejhr Hospital, for the interpretation of the chest radiograph Author contributions : S.P. and W.K. collected, analyzed, and interpreted the data. S.P. and W.K. wrote, edited the manuscript, and prepared figures and tables. All authors read and approved the final manuscript. Funding : No funding. Data availability: Not applicable. Ethical approval: This study was approved by Chaophya Abhaibhubejhr Hospital institutional Review Board (CPA IRB), Chaophya Abhaibhubejhr Hospital Consent for publication : Not applicable Competing interests : The authors declare no competing interests. References Gujrathi AB, Ambulgekar V, Kathait P. Deep neck space infection - A retrospective study of 270 cases at tertiary care center. World J Otorhinolaryngol Head Neck Surg. 2016;2(4):208–13. Trevino-Gonzalez JL, Maldonado-Chapa F, Gonzalez-Larios A, Morales-Del Angel JA, Soto-Galindo GA, Zafiro Garcia-Villanueva JM. Deep Neck Infections: Demographic and Clinical Factors Associated with Poor Outcomes. ORL J Otorhinolaryngol Relat Spec. 2022;84(2):130–8. Reynolds SC, Chow AW. Life-threatening infections of the peripharyngeal and deep fascial spaces of the head and neck. Infect Dis Clin North Am 2007, 21(2):557–576, viii. Bakir S, Tanriverdi MH, Gun R, Yorgancilar AE, Yildirim M, Tekbas G, Palanci Y, Meric K, Topcu I. Deep neck space infections: a retrospective review of 173 cases. Am J Otolaryngol. 2012;33(1):56–63. Santos Gorjon P, Blanco Perez P, Morales Martin AC, Del Pozo de Dios JC, Estevez Alonso S. Calle de la Cabanillas MI: Deep neck infection. Review of 286 cases. Acta Otorrinolaringol Esp. 2012;63(1):31–41. Vieira F, Allen SM, Stocks RM, Thompson JW. Deep neck infection. Otolaryngol Clin North Am. 2008;41(3):459–83. vii. Suehara AB, Goncalves AJ, Alcadipani FA, Kavabata NK, Menezes MB. Deep neck infection: analysis of 80 cases. Braz J Otorhinolaryngol. 2008;74(2):253–9. Igoumenakis D, Gkinis G, Kostakis G, Mezitis M, Rallis G. Severe odontogenic infections: causes of spread and their management. Surg Infect (Larchmt). 2014;15(1):64–8. Larawin V, Naipao J, Dubey SP. Head and neck space infections. Otolaryngol Head Neck Surg. 2006;135(6):889–93. Sheikh Z, Yu B, Heywood E, Quraishi N, Quraishi S. The assessment and management of deep neck space infections in adults: A systematic review and qualitative evidence synthesis. Clin Otolaryngol. 2023;48(4):540–62. Prado-Calleros HM, Jimenez-Fuentes E, Jimenez-Escobar I. Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description. Head Neck. 2016;38(Suppl 1):E2275–2283. Priyamvada S, Motwani G. A Study on Deep Neck Space Infections. Indian J Otolaryngol Head Neck Surg. 2019;71(Suppl 1):912–7. Buckley J, Harris AS, Addams-Williams J. Ten years of deep neck space abscesses. J Laryngol Otol. 2019;133(4):324–8. Boscolo-Rizzo P, Stellin M, Muzzi E, Mantovani M, Fuson R, Lupato V, Trabalzini F, Da Mosto MC. Deep neck infections: a study of 365 cases highlighting recommendations for management and treatment. Eur Arch Otorhinolaryngol. 2012;269(4):1241–9. Bottin R, Marioni G, Rinaldi R, Boninsegna M, Salvadori L, Staffieri A. Deep neck infection: a present-day complication. A retrospective review of 83 cases (1998–2001). Eur Arch Otorhinolaryngol. 2003;260(10):576–9. Lee YQ, Kanagalingam J. Deep neck abscesses: the Singapore experience. Eur Arch Otorhinolaryngol. 2011;268(4):609–14. Weise H, Naros A, Weise C, Reinert S, Hoefert S. Severe odontogenic infections with septic progress - a constant and increasing challenge: a retrospective analysis. BMC Oral Health. 2019;19(1):173. Almutairi DM, Alqahtani RM, Alshareef N, Alghamdi YS, Al-Hakami HA, Algarni M. Deep Neck Space Infections: A Retrospective Study of 183 Cases at a Tertiary Hospital. Cureus. 2020;12(2):e6841. Beka D, Lachanas VA, Doumas S, Xytsas S, Kanatas A, Petinaki E, Skoulakis C. Microorganisms involved in deep neck infection (DNIs) in Greece: detection, identification and susceptibility to antimicrobials. BMC Infect Dis. 2019;19(1):850. Jayagandhi S, Cheruvu SC, Manimaran V, Mohanty S. Deep Neck Space Infection: Study of 52 Cases. Indian J Otolaryngol Head Neck Surg. 2019;71(Suppl 1):923–6. Lee JK, Kim HD, Lim SC. Predisposing factors of complicated deep neck infection: an analysis of 158 cases. Yonsei Med J. 2007;48(1):55–62. Suehara AB, Rodrigues AAN, Kavabata NK, Menezes MB, Ramos EA, Kawamukai JN, GonCalves AJ. Predictive factors of lethality and complications of deep fascial space infections of the neck. Rev Col Bras Cir. 2020;47:e20202524. Velhonoja J, Laaveri M, Soukka T, Irjala H, Kinnunen I. Deep neck space infections: an upward trend and changing characteristics. Eur Arch Otorhinolaryngol. 2020;277(3):863–72. Wang LF, Kuo WR, Tsai SM, Huang KJ. Characterizations of life-threatening deep cervical space infections: a review of one hundred ninety-six cases. Am J Otolaryngol. 2003;24(2):111–7. Srivanitchapoom C, Sittitrai P, Pattarasakulchai T, Tananuvat R. Deep neck infection in Northern Thailand. Eur Arch Otorhinolaryngol. 2012;269(1):241–6. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 03 Jul, 2024 Editor assigned by journal 03 Jul, 2024 Submission checks completed at journal 02 Jul, 2024 First submitted to journal 30 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4663172","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":322007888,"identity":"a68016d6-3ccd-4594-9f7f-2d5c3d62916b","order_by":0,"name":"Subencha Pinsai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzklEQVRIiWNgGAWjYFACHhBxgIEfRCUUkKJFsgGkxYAULQYHQDQxWuRn5B58XFBzR974/OrEDw8MGOT5xQ7g12JwIy/ZeMaxZ4bbbrzdLAF0mOHM2QkEtEjkmEnzNhxm3Hbj7AaQlgSD2wS0yM/IMf8N1GK/ecbZzT+I0sJwI8eMGaglcQN/7zbibDE48y5ZmufY4eQZN3i3WSQYSBD2i3x77sHPPDWHbfv7z26++aPCRp5fmpDD4EACrFKCWOUgwH+AFNWjYBSMglEwkgAAUYlHlev8SM0AAAAASUVORK5CYII=","orcid":"","institution":"Chaophya Abhaibhubejhr Hospital","correspondingAuthor":true,"prefix":"","firstName":"Subencha","middleName":"","lastName":"Pinsai","suffix":""},{"id":322007889,"identity":"b1fced51-20ac-4d47-89e7-8de8b58268ad","order_by":1,"name":"Wuttipat Keeratitadapong","email":"","orcid":"","institution":"Chaophya Abhaibhubejhr Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wuttipat","middleName":"","lastName":"Keeratitadapong","suffix":""},{"id":322007890,"identity":"0386f71f-245d-46a8-806a-16df334c7294","order_by":2,"name":"Jiraporn Trakarnchansiri","email":"","orcid":"","institution":"Chaophya Abhaibhubejhr Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jiraporn","middleName":"","lastName":"Trakarnchansiri","suffix":""}],"badges":[],"createdAt":"2024-06-30 14:30:46","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4663172/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4663172/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61185367,"identity":"f4fa9349-807e-419b-aeae-014b14ab739c","added_by":"auto","created_at":"2024-07-26 17:24:46","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":175352,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eIdentified pathogens from intraoperative tissue samples (N= 65)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4663172/v1/aca0eadc1b6ff1b9c44983aa.jpeg"},{"id":61185368,"identity":"ef8b34e0-c8c9-455b-bf2d-0a8a85ccd899","added_by":"auto","created_at":"2024-07-26 17:24:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":673765,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4663172/v1/3241e340-296d-4603-9ada-29afcc2f4c76.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors associated with complications among deep neck infection in the community-based hospital in Thailand","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDeep neck infection (DNI) is not just a medical condition, it's a potentially life-threatening situation. [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]DNIs are defined by the presence of inflammation with or without pus in the deep spaces and fasciae of the head and neck. It's characterized by the spread of infection into the deep spaces of the neck, including parapharyngeal, retropharyngeal, and submandibular spaces.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] DNIs can arise from various sources, including odontogenic, pharyngeal, and salivary gland infections, and can lead to severe complications, including airway obstruction, descending mediastinitis, great vessel thrombosis, necrotizing fasciitis, sepsis, and septic shock.[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] The severity of DNIs refers to the risk of dissemination to the mediastinum through these spaces and fascial planes, especially the posterior, producing descending necrotizing mediastinitis. Tracheostomy rates in DNIs have been reported to be up to 30%, with mortality around 5% and mortality rates rising to 17.5\u0026ndash;50% if necrotizing mediastinitis occurs.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10 CR11 CR12\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] The timely diagnosis and appropriate management of DNIs are paramount to prevent the progression of infection and reduce associated morbidity and mortality. However, the diagnosis of DNIs can be challenging due to nonspecific clinical manifestations and the potential for rapid disease progression. While several studies have investigated the epidemiology and risk factors of DNIs, comprehensive analyses are still needed to understand better the clinical characteristics and predictors of complications in affected patients. Therefore, this study aimed to evaluate the epidemiology, clinical features, and risk factors associated with complications in patients diagnosed with DNIs.\u003c/p\u003e"},{"header":"Methods and participants","content":"\u003cp\u003eThis retrospective cohort study was conducted at Chaopraya Abhaibhubejr Hospitals in Prachinburi, Thailand, between January 2017 and December 2021. Patients aged 15 years and older diagnosed with DNIs during the study period were included in the analysis. Data collected from electronic medical records included demographic characteristics, comorbidities, presenting symptoms, etiology, site of infection, identified pathogens, treatment modalities, length of hospital stay, and complications, including at least one or more of the following conditions: 1) upper airway obstruction, 2) sepsis or septic shock, 3) pneumonia detected by chest radiograph, 4) death. Patients' characteristics were described using mean with standard deviation (SD), median with interquartile range (IQR), and frequencies (%). Categorical variables were compared between groups using Chi-square or Fisher's exact test, and continuous variables were compared using the student's t-test and Mann-Whitney U test. Logistic regression was used to determine the association between factors and complications. A multivariate logistic regression model considered variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.10 after assessing multicollinearity using variance inflation factors. Backward stepwise selection was used in the multiple logistic regression model, retaining variables that attained statistical significance. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. All statistical analyses were performed using Stata statistical software version 18.0.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 226 patients diagnosed with DNI were included in the study. The patients were from a diverse range of backgrounds and included both inpatients and outpatients. Of these patients, 135 (59.7%) were male. The median age was 39.5 years (interquartile range [IQR]: 29\u0026ndash;58). Comorbidities were present in 87 patients (38.5%), with hypertension (20.3%) and diabetes mellitus (19.0%) being the most common. Odontogenic infection was the most prevalent etiology (54.9%), followed by pharyngeal and salivary gland infections. The primary presenting symptoms were neck pain and swelling (67.7%), fever (30.9%), and dysphagia (14.6%).\u003c/p\u003e \u003cp\u003eThe buccal space was the most frequently affected site (22.6%), followed by the peritonsillar space (20.3%) and the submandibular space (19.9%). \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e was the most identified pathogen (20%), followed by Staphylococcus spp. and Viridans streptococcus. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) Treatment modalities included incision and drainage (44.6%), simple aspiration (12.4%), and conservative management with intravenous antibiotics (42.9%). The choice of treatment was based on the severity of the infection, the patient's overall health status, and the presence of any complications. Focus on complication and no complication groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The median age of patients with complications was significantly higher (52 years, IQR: 31\u0026ndash;63) compared to those without complications (37 years, IQR: 29\u0026ndash;56) (p\u0026thinsp;=\u0026thinsp;0.0423). Patients with complications had a higher prevalence of underlying medical conditions (62.16%) compared to those without complications (33.86%) (p\u0026thinsp;=\u0026thinsp;0.001), with diabetes mellitus being more common in the complication group (37.48%) than in the no complication group (15.34%) (p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eNeck swelling was significantly more common in patients with complications (84.49%) compared to those without complications (64.02%) (p\u0026thinsp;=\u0026thinsp;0.008). Fever was more frequently observed in the complication group (54.05%) compared to the no complication group (26.46%) (p\u0026thinsp;=\u0026thinsp;0.001). Difficulty breathing was exclusively observed in the complication group (21.62%) and was absent in patients without complications (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The overall mortality rate was 0.89%.\u003c/p\u003e \u003cp\u003eMultiple space involvement defined by at least two space involvement was significantly higher in the complication group (64.86%) compared to the no complication group (18.52%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Submandibular space involvement was more common in the complication group (40.54%) compared to the no-complication group (15.87%) (p\u0026thinsp;=\u0026thinsp;0.001). Submental space involvement was also significantly higher in patients with complications (21.62%) compared to those without (7.94%) (p\u0026thinsp;=\u0026thinsp;0.012). Buccal space involvement was more frequent in the complication group (35.14%) compared to the no-complication group (20.11%) (p\u0026thinsp;=\u0026thinsp;0.046).\u003c/p\u003e \u003cp\u003eTemporal space involvement was observed only in the complication group (3.5%) and not in the no-complication group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Lingual space involvement was higher in the complication group (10.81%) compared to the no-complication group (3.17%) (p\u0026thinsp;=\u0026thinsp;0.039). Ludwig space involvement was significantly more common in the complication group (13.51%) compared to the no-complication group (1.59%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eOur findings regarding treatment modalities indicate that 44.6% of patients underwent incision and drainage, 12.4% underwent simple aspiration, and 42.9% received conservative treatment with intravenous antibiotics.\u003c/p\u003e \u003cp\u003eComplications occurred in 16.4% of cases, with airway obstruction being the most common (7.1%), followed by sepsis (4.9%). The median length of hospital stay was significantly longer for patients with complications (14 days, IQR: 9\u0026ndash;22) compared to those without complications (4 days, IQR: 3\u0026ndash;6) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Sepsis at admission was present in 29.73% of patients with complications and absent in those without complications (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Pneumonia occurred in 16.22% of the complication group and was absent in the no complication group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Upper airway obstruction occurred in 43.24% of patients with complications and was absent in those without complications (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Emergency tracheostomy due to upper airway obstruction was required in 5.41% of patients with complications (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The overall mortality rate was 0.88% (5.4% in the complication group and 0% in the no complication group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eMultiple logistic regression analysis was performed to identify the factors associated with complications. This analysis considers the potential influence of multiple variables on the outcome. The factors found to be significantly associated with complications were space involvement in the parapharyngeal space (odds ratio 43.3, p\u0026thinsp;=\u0026thinsp;0.006), involvement of multiple spaces (odds ratio 7.98, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and involvement of the submental space (odds ratio 5.5, p\u0026thinsp;=\u0026thinsp;0.017). The presenting symptoms of fever (odds ratio 6.1, p\u0026thinsp;=\u0026thinsp;0.008), anemia (odds ratio 37.4, p\u0026thinsp;=\u0026thinsp;0.024), and neck pain and swelling (odds ratio 0.2, p\u0026thinsp;=\u0026thinsp;0.045) were also associated with complications.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides valuable insights into the epidemiology, clinical characteristics, and risk factors associated with complications in patients diagnosed with DNIs in the Community-based tertiary care setting. The findings highlight the importance of early recognition and appropriate management to prevent the development of life-threatening complications.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eConsistent with previous studies, odontogenic infections were identified as the most common etiology of DNIs.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] This underscores the importance of dental hygiene and timely treatment of dental infections to prevent the spread of infection to deeper neck spaces.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] In our study, the microorganisms isolated were \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e, Staphylococcus spp., and Viridans streptococcus, whereas previous studies have also demonstrated that S. pyogenes, S. aureus, Streptococcus viridans, and \u003cem\u003eHaemophilus influenza\u003c/em\u003e are the most common bacterial species.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] Appropriate to a previous study, multiple space involvement tends to cause more complications than single-space involvement; the association between space involvement and complications emphasizes the need for careful evaluation and monitoring of patients with extensive neck involvement.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] Prompt surgical intervention, such as incision and drainage, may be necessary to prevent the progression of infection and alleviate airway compromise.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] Furthermore, having diabetes mellitus, identifying fever, anemia, neck pain, and swelling as significant risk factors for complications underscores the importance of recognizing these clinical features early in the disease course.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] Patients with these symptoms should undergo a thorough evaluation and close monitoring to prevent adverse outcomes.\u003c/p\u003e \u003cp\u003eThis study's limitations include its retrospective design and reliance on electronic medical records, which may have introduced bias and limited the availability of certain data variables. Additionally, the study was conducted at a single institution, which may limit the generalizability of the findings.\u003c/p\u003e \u003cp\u003eIn conclusion, this study contributes to our understanding of the epidemiology and risk factors of DNIs. Early diagnosis and prompt management, particularly in patients with identified risk factors, are essential to reduce the morbidity and mortality associated with this severe condition. Further research is warranted to validate these findings and explore additional factors that may influence outcomes in patients with DNIs.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOdontogenic infection is the leading cause of deep neck infection. Early diagnosis and prompt management, especially in patients with risk factors, may help reduce life-threatening complications. And prevent adverse sequelae.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics and Clinical Presentation of Deep Neck Infection Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;226\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo Complication group\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;189\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eComplication group\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;37\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at diagnosis, years (Median (IQR))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39.5 (29\u0026ndash;58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (29\u0026ndash;56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52 (31\u0026ndash;63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0423\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge more than 65, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (16.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (75.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (24.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.153\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e135(59.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110 (58.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (67.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.288\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaving an underlying medical condition, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87 (38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (33.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (62.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Diabetes mellitus, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (19.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (15.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (37.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Hypertension, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46 (20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (19.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (27.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Chronic kidney disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (1.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (1.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.638\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Patient living with HIV, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (2.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.317\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Old Cerebral infarction, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (1.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.638\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Atherosclerotic heart disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresenting Symptoms, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Neck swelling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e153 (67.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121 (64.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (84.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Fever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70 (30.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (26.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (54.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Dysphagia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33 (14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (14.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (16.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.761\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Pain while swallowing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e72 (31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (33.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (24.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Trismus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (13.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (13.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.963\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Difficult to breath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (21.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSite of infection and Clinical Outcomes of Deep Neck Infection Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;226\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo Complication group\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;189\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eComplication group\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;37\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeck space involvement, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle space involvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e167 (73.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e154 (81.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (35.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple space involvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (26.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (18.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (64.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubmandibular space\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (19.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (15.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (40.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubmental space\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (10.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (7.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (21.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBuccal space\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (20.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (35.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMasticator space\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (4.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (8.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.234\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanine space\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTemporal space\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLingual space\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (3.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (10.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePterygomandibular space\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (16.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (14.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (27.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeritonsillar space\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46(20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (23.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (5.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParotid space\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (6.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (5.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.828\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetropharyngeal space\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (4.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (10.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParapharyngeal space\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (3.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (16.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLudwig space\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (1.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (13.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOrigin of infection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDental origin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e124 (54.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102 (53.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (59.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.539\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTonsil origin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (21.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (24.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParotid gland origin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (7.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (6.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (10.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForeign body\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (3.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (2.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.376\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOutcomes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay, days, (Median (IQR))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (3\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (3\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (9\u0026ndash;22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay\u0026thinsp;\u0026gt;\u0026thinsp;10 days, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (17.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (7.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (67.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSepsis in admission, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (4.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (29.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePneumonia, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (2.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (16.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMediastinitis, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper airway obstruction, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (7.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (43.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper airway obstruction required emergency tracheostomy, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (5.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (5.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e: \u0026nbsp;We thank pulmonologist, Dr. Chalalai Klaipim, at Chaophya Abhaibhubejhr Hospital, for the interpretation of the chest radiograph\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e: S.P. and W.K. collected, analyzed, and interpreted the data. S.P. and W.K. wrote, edited the manuscript, and prepared figures and tables. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: No funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval:\u0026nbsp;\u003c/strong\u003eThis study was approved by Chaophya Abhaibhubejhr Hospital institutional Review Board (CPA IRB), Chaophya Abhaibhubejhr Hospital\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: \u0026nbsp;The authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGujrathi AB, Ambulgekar V, Kathait P. Deep neck space infection - A retrospective study of 270 cases at tertiary care center. World J Otorhinolaryngol Head Neck Surg. 2016;2(4):208\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrevino-Gonzalez JL, Maldonado-Chapa F, Gonzalez-Larios A, Morales-Del Angel JA, Soto-Galindo GA, Zafiro Garcia-Villanueva JM. Deep Neck Infections: Demographic and Clinical Factors Associated with Poor Outcomes. ORL J Otorhinolaryngol Relat Spec. 2022;84(2):130\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReynolds SC, Chow AW. Life-threatening infections of the peripharyngeal and deep fascial spaces of the head and neck. \u003cem\u003eInfect Dis Clin North Am\u003c/em\u003e 2007, 21(2):557\u0026ndash;576, viii.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBakir S, Tanriverdi MH, Gun R, Yorgancilar AE, Yildirim M, Tekbas G, Palanci Y, Meric K, Topcu I. Deep neck space infections: a retrospective review of 173 cases. Am J Otolaryngol. 2012;33(1):56\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantos Gorjon P, Blanco Perez P, Morales Martin AC, Del Pozo de Dios JC, Estevez Alonso S. Calle de la Cabanillas MI: Deep neck infection. Review of 286 cases. Acta Otorrinolaringol Esp. 2012;63(1):31\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVieira F, Allen SM, Stocks RM, Thompson JW. Deep neck infection. Otolaryngol Clin North Am. 2008;41(3):459\u0026ndash;83. vii.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSuehara AB, Goncalves AJ, Alcadipani FA, Kavabata NK, Menezes MB. Deep neck infection: analysis of 80 cases. Braz J Otorhinolaryngol. 2008;74(2):253\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIgoumenakis D, Gkinis G, Kostakis G, Mezitis M, Rallis G. Severe odontogenic infections: causes of spread and their management. Surg Infect (Larchmt). 2014;15(1):64\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLarawin V, Naipao J, Dubey SP. Head and neck space infections. Otolaryngol Head Neck Surg. 2006;135(6):889\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheikh Z, Yu B, Heywood E, Quraishi N, Quraishi S. The assessment and management of deep neck space infections in adults: A systematic review and qualitative evidence synthesis. Clin Otolaryngol. 2023;48(4):540\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrado-Calleros HM, Jimenez-Fuentes E, Jimenez-Escobar I. Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description. Head Neck. 2016;38(Suppl 1):E2275\u0026ndash;2283.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePriyamvada S, Motwani G. A Study on Deep Neck Space Infections. Indian J Otolaryngol Head Neck Surg. 2019;71(Suppl 1):912\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuckley J, Harris AS, Addams-Williams J. Ten years of deep neck space abscesses. J Laryngol Otol. 2019;133(4):324\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoscolo-Rizzo P, Stellin M, Muzzi E, Mantovani M, Fuson R, Lupato V, Trabalzini F, Da Mosto MC. Deep neck infections: a study of 365 cases highlighting recommendations for management and treatment. Eur Arch Otorhinolaryngol. 2012;269(4):1241\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBottin R, Marioni G, Rinaldi R, Boninsegna M, Salvadori L, Staffieri A. Deep neck infection: a present-day complication. A retrospective review of 83 cases (1998\u0026ndash;2001). Eur Arch Otorhinolaryngol. 2003;260(10):576\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee YQ, Kanagalingam J. Deep neck abscesses: the Singapore experience. Eur Arch Otorhinolaryngol. 2011;268(4):609\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeise H, Naros A, Weise C, Reinert S, Hoefert S. Severe odontogenic infections with septic progress - a constant and increasing challenge: a retrospective analysis. BMC Oral Health. 2019;19(1):173.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlmutairi DM, Alqahtani RM, Alshareef N, Alghamdi YS, Al-Hakami HA, Algarni M. Deep Neck Space Infections: A Retrospective Study of 183 Cases at a Tertiary Hospital. Cureus. 2020;12(2):e6841.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeka D, Lachanas VA, Doumas S, Xytsas S, Kanatas A, Petinaki E, Skoulakis C. Microorganisms involved in deep neck infection (DNIs) in Greece: detection, identification and susceptibility to antimicrobials. BMC Infect Dis. 2019;19(1):850.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJayagandhi S, Cheruvu SC, Manimaran V, Mohanty S. Deep Neck Space Infection: Study of 52 Cases. Indian J Otolaryngol Head Neck Surg. 2019;71(Suppl 1):923\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee JK, Kim HD, Lim SC. Predisposing factors of complicated deep neck infection: an analysis of 158 cases. Yonsei Med J. 2007;48(1):55\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSuehara AB, Rodrigues AAN, Kavabata NK, Menezes MB, Ramos EA, Kawamukai JN, GonCalves AJ. Predictive factors of lethality and complications of deep fascial space infections of the neck. Rev Col Bras Cir. 2020;47:e20202524.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVelhonoja J, Laaveri M, Soukka T, Irjala H, Kinnunen I. Deep neck space infections: an upward trend and changing characteristics. Eur Arch Otorhinolaryngol. 2020;277(3):863\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang LF, Kuo WR, Tsai SM, Huang KJ. Characterizations of life-threatening deep cervical space infections: a review of one hundred ninety-six cases. Am J Otolaryngol. 2003;24(2):111\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSrivanitchapoom C, Sittitrai P, Pattarasakulchai T, Tananuvat R. Deep neck infection in Northern Thailand. Eur Arch Otorhinolaryngol. 2012;269(1):241\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Deep neck infection, complication, neck infection.","lastPublishedDoi":"10.21203/rs.3.rs-4663172/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4663172/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDeep neck infections (DNIs) are medical emergencies that can result in severe complications and even death. Prompt and accurate diagnosis, coupled with appropriate management, can mitigate the severity of these infections.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a retrospective cohort study of patients over 15 years old diagnosed with DNIs at a community-based hospital in Thailand from January 2017 to December 2021. The study aimed to evaluate the epidemiology, clinical features, and risk factors associated with complications in patients diagnosed with DNIs.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 226 patients were included, with 135 (59.7%) males and a median age of 39.5 years (IQR 29\u0026ndash;58). Comorbidities were present in 87 patients (38.5%), with hypertension (20.4%) and diabetes mellitus (19.0%) being the most common. Odontogenic infections were the leading cause of DNIs (54.9%), and the primary presenting symptoms were neck pain and swelling (67.7%). The buccal space was the most frequent infection site (22.6%), followed by the peritonsillar space (20.4%) and the submandibular space (19.9%). \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e was the most identified pathogen (20%), followed by Staphylococcus spp. and Viridans streptococcus (each 6.2%). Among the patients, 44.6% underwent incision and drainage, 12.4% underwent simple aspiration, and 42.9% received conservative treatment with intravenous antibiotics. Complications were observed in 16.4% of the patients, with airway obstruction being the most common (7.1%), followed by sepsis (4.9%). Multiple logistic regression analysis revealed significant risk factors for complications: involvement of the parapharyngeal space (odds ratio 43.3, p\u0026thinsp;=\u0026thinsp;0.006), multiple space involvement (odds ratio 7.98, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and involvement of the submental space (odds ratio 5.5, p\u0026thinsp;=\u0026thinsp;0.017). Additionally, presenting symptoms such as fever (odds ratio 6.1, p\u0026thinsp;=\u0026thinsp;0.008), anemia (odds ratio 37.4, p\u0026thinsp;=\u0026thinsp;0.024), and neck pain and swelling (odds ratio 0.2, p\u0026thinsp;=\u0026thinsp;0.045) were associated with higher complication rates.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOdontogenic infections are the most common cause of DNIs. Complications are significantly associated with infections involving the parapharyngeal, submental, and multiple spaces. Early diagnosis and prompt management, especially in patients with identified risk factors, are crucial in reducing life-threatening complications.\u003c/p\u003e","manuscriptTitle":"Factors associated with complications among deep neck infection in the community-based hospital in Thailand","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-26 17:16:42","doi":"10.21203/rs.3.rs-4663172/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-03T04:48:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-03T04:42:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-03T00:00:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2024-06-30T14:29:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b4bbd906-5d8f-4f0b-bea6-f7dcfed541d6","owner":[],"postedDate":"July 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-23T09:26:24+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-26 17:16:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4663172","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4663172","identity":"rs-4663172","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}