Çocukluk Yaş Grubunda Derin Boyun Enfeksiyonlarının Değerlendirilmesi

Year 2012, Volume: 6 Issue: 4, 197 - 205, 01.04.2012

Esma Ehsan Kaya Medine Ayşin Taşar Yıldız Dallar Bilge

Abstract

Giriş ve Amaç: Derin boyun enfeksiyonları derin servikal fasya yaprakları arasındaki potansiyel boşluklarda enfeksiyon gelişmesi ile karakterize bir durumdur. Antibiyotik kullanımının artması ile görülme sıklığı azalmasına rağmen halen ciddi hastalık ve ölüm riski taşımaktadır.Gereç ve Yöntemler: Derin boyun enfeksiyonlarına tanı ve tedavi yaklaşımının değerlendirilmesi amacıyla yapılan bu çalışmaya 2005-2008 yılları arasında Ankara Eğitim ve Araştırma Hastanesi Çocuk Kliniği’nde izlenen 86 hasta ileriye dönük olarak alındı. Hastalara öykü ve fizik muayene bulgularına göre derin boyun enfeksiyonu tanısı konuldu. Tüm hastalara tam kan, C-Reaktif Protein, eritrosit sedimentasyon hızı, viral göstergeler, Brucella ve Salmonella aglutinasyon testleri yapıldı; akciğer grafileri çekildi ve boyun ultrasonografisi yapıldı.Bulgular: Çalışmaya alınan hastaların 37’si (% 43) kızdı. Hastaların yaş ortalaması 3.1±2.5 yıldı. En sık başvuru şikayetleri boyunda şişlik (%100) ve ateşti (%74.4). Ortalama hastanede yatış süresi 6.6±3.9 gün olarak bulundu.Boyun ultrasonografi bulgularına göre en sık submandibular bölgenin (%45.3) tutulduğu görüldü. Etiyolojide en sık tonsillofarenjit (%45.3) saptandı. Odontojenik nedenler (%5.8), doğumsal nedenler (%2.3) ve suçiçeği (%1.2) tespit edilen diğer etiyolojik faktörlerdi.Bütün hastalara ampirik olarak parenteral antibiyotik tedavisi başlandı. En sık verilen antibiyotik sulbaktam ampisilin ve sulbaktam ampisilinin-metronidazol kombinasyonudu. Hastalardan 67’sinde (%77.9) tek başına medikal tedavi ile iyileşme sağlanırken 19 (%22.1) hastaya cerrahi drenaj uygulandı. Bu hastalardan 8’inin (%9.3) drenaj materyalinde Staphylococcus aureus üredi.Komplikasyon olarak 1 (%1.2) hastada bakteriyemi gelişti. Çalışmamızda ölen hasta olmadı.Sonuç: Ciddi hastalık ve ölüm nedeni olabilen derin boyun enfeksiyonları erken tanı ve etkin antibiyotiklerin kullanımıyla yüksek oranda tedavi edilebilir. Ancak gereken hastalarda da gecikmeden cerrahi drenaj uygulanmalıdır.

Keywords

Derin boyun enfeksiyonu, çocuklar, tedavi

EVALUTION OF DEEP NECK INFECTIONS IN PEDIATRIC PATIENTS

Abstract

Introduction and Aim: Deep neck infections are characterized by the infections in the potential spaces of the fascial planes of the neck. Although the incidence of these infections decreased with the widespread use of antibiotics, they still lead to serious morbidity and mortality. In this study; we aimed to assess the diagnosis, management, and treatment of deep neck infections.Material and Methods: Eighty-six patients with deep neck infections admitted to the Pediatrics Clinics of Ankara Training and Research Hospital, between 2005 and 2008 were included in this study. All patients diagnosed as deep neck infections with complaints and physical examinations. Complete blood count, CReactive Protein, erythrocyte sedimentation rate, viral markers, Brucella and Salmonella agglutination tests, chest radiography, and cervical ultrasonography were performed for all patients.Results: All patients included in this study, 37(43%) were girls. The mean age was 3.1±2.5 years. The most common symptoms at presentation were neck swelling (100%) and fever (74.4%). The mean duration of hospital stay was 6.6±3.9 days.Cervical ultrasonography findings showed that the submandibular space was the most affected region. The most common etiology was tonsillopharangitis (45.3%). The other common etiological factors were odontogenic infections (5.8%), congenital disorders (2.3%), and varicella infection (1.2%). All patients were initially received parenteral empirical antibiotics. Sulbactam-ampicillin alone or in combination with metronidazole was the most common used antibiotics. Sixty-seven (77.9%) patients recovered with only medical treatment. Surgical drainage was performed in 19 (22.1%) cases. Staphylococcus aureus was isolated from 8 (9.3%) patients’ drainage samples.Bacteriemia was developed only in one patient (1.2%) as a complication. No mortality was observed in our study.Conclusion: Deep neck infections which have serious morbidity and mortality can be treated with early diagnosis and effective antibiotics. However; surgical drainage must be performed immediately if it is necessary

Keywords

Deep neck infections, children, treatment

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