Microorganisms involved in deep neck infection (DNIs) in Greece: detection, identification and susceptibility to antimicrobials

Background: To determine, from October 2010 to October 2018, the epidemiology of Deep Neck Infections (DNIs), regarding the detection, the identification and the susceptibility to antimicrobials of causative microorganisms, in Thessaly-Central Greece. Methods: An analysis of data from a prospective database was conducted on 610 consecutive patients with DNIs treated in the Otolaryngology / Head & Neck Surgery Department of University Hospital of Larissa. Demographics, clinical features and microbiological data were analyzed. Results: Among the 610 patients (1,9/1 male to female ratio, mean age: 39,24 ± 17,25) with DNIs, 579 had a single space (94,9%), while the remaining 31 had a multi-space (5,1%) DNI. The most common areas affected were the peritonsillar space (84,6%) followed by the submandibular space (6,5%). Clinical samples were obtained from 462 patients, and were tested by culture and by the application of 16S rRNA PCR. Two hundred fifty-five samples (55,2%) gave positive cultures, in which Streptococcus pyogenes and Staphylococcus aureus were predominant. The application of the 16S rRNA PCR revealed that 183 samples (39,6%) were positive for bacterial DNA; 22 of them, culture negative, were found to be positive for anaerobic (Fusobacterium necrophorum, Actinomyces israellii etc) and for fastidious microorganisms (Brucella mellitensis, Mycobacterium avium). Conclusion: DNIs represent a medical and surgical emergency and evidence-guided empirical treatment with intravenous infusion of antibiotics at the time of diagnosis is mandatory, highlighting the importance of epidemiological studies regarding the causative microorganisms. Although, in our study, the predominant pathogens were S. pyogenes and S. aureus, the combination of culture and molecular assay revealed that anaerobic bacteria play also a significant role in the pathogenesis of DNIs. Based on the local epidemiology, we propose as empirical therapy the intravenous use of a beta-lactam /beta-lactamase inhibitor; metronidazole or clindamycin can be added only in specific cases such as in immunocompromised patients

Arabic translation and validation of SNOT-22

Abstract Objective The objective of the study was to translate the Sino-Nasal Outcome Test 22 (SNOT-22) into Arabic and to check its reliability and validity in Arabic-speaking patients. Patients and methods The study included 178 patients with confirmed chronic rhinosinusitis (CRS) and 95 asymptomatic individuals as a control group. All participants completed the Arabic SNOT-22 (A-SNOT-22) questionnaire. The scores of the two groups were compared for validity analysis. Eighty-two patients completed the questionnaire twice, 1 week apart, for test-to-test reliability analysis. The A-SNOT-22 scores of 60 CRS patients were correlated with Lund–Mackay scores for criterion validity analysis. The preoperative and postoperative scores of 73 patients were compared for responsiveness analysis. Results All participants completed the questionnaire with no or minimal assistance. Internal consistency (α=0.90) and test-to-test reliability (intraclass correlation=0.78) were good. The differences between the scores of CRS patients and asymptomatic individuals were significant (P<0.005). There was a positive moderate correlation between A-SNOT-22 and Lund–Mackay scores. Preoperative A-SNOT-22 scores were significantly higher than postoperative scores. Conclusion A-SNOT-22 questionnaire is a reliable and valid outcome measure for CRS patients. The questionnaire is responsive to changes in the state of the disease and is recommended for clinical practice and outcome research

The use of harmonic scalpel versus knot tying for conventional open thyroidectomy: results of a prospective randomized study

Purpose. We evaluated the safety and cost-effectiveness of the harmonic scalpel (HS) during conventional open thyroidectomy (CT). Materials and methods. Two hundred patients scheduled for conventional total thyroidectomy (TT) were included in the study and randomly assigned to TT with the use of HS (HS group) or with knot tying technique (KT group). Results. Mean operative time was significantly shorter in the HS group (P\u2009<\u20090.001), as well as the total operative room occupation time (P\u2009<\u20090.001). The cost of the disposable materials is significantly higher in the HS group (420.1\u2009\ub1\u200923.2 vs 137.8\u2009\ub1\u200925.3 euros; P\u2009<\u20090.001). Conversely, drugs, personnel and operative room charges were significantly higher in KT group patients (P\u2009<\u20090.001). Overall, no significant difference was found between the two groups concerning the charges of the hospitalisation (P\u2009=\u2009NS). Conclusions. HS is a safe alternative to KT, allowing for a significant reduction of operative time without increasing complications rate and overall costs and probably better utilization of health resources