Ludwig's Angina: Higher Incidence and Worse Outcomes Associated With the Onset of the Coronavirus Disease 2019 Pandemic.
Ludwig's Angina: Higher Incidence and Worse Outcomes Associated With the Onset of the Coronavirus Disease 2019 Pandemic.
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路德维希心绞痛：与 2019 年冠状病毒病大流行相关的更高发病率和更糟糕的结果。
DOI：
10.1089/sur.2023.163
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发表时间：
2023
影响因子：
2
通讯作者：
Hoofnagle,Mark
中科院分区：
文献类型：
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作者：
Canas,Melissa;Fonseca,Ricardo;DeFilippis,Alejandro;Diaz,Leonardo;Afzal,Hussain;Day,Aaron;Leonard,Jennifer;Bochicchio,Kelly;Bochicchio,GrantV;Hoofnagle,Mark
背景：路德维希心绞痛（LA）是颌下间隙及邻近组织的弥漫性蜂窝织炎。在 2019 年冠状病毒病 (COVID-19) 大流行期间，由于采取了避免病毒传播的安全措施，牙源性治疗经常被推迟。我们假设，与 COVID-19 大流行爆发相关的牙源性治疗延迟可能与 LA 发病率增加以及与这些感染相关的更差结局有关。 患者和方法：纳入了 2018 年 6 月至 2022 年 6 月期间计算机断层扫描图像提示 LA 并经耳鼻喉 (ENT) 会诊证实的患者。我们抽象了人口统计、结果、临床管理和微生物学。患者被分为新冠肺炎前和新冠肺炎发病期。我们的主要结局，即 LA 发生率，定义为：（新发 LA 病例）÷（口腔或牙齿感染的 ED 评估 × 1.5 年）。结果：在 COVID 前组中，我们在 1,301 名患者中确定了 32 名 LA 发生率每年为 0.02。 641 名患者中有 41 名是新冠肺炎发病组，发病率为每年 0.04 例。在新冠肺炎发病组中，进展为坏死性筋膜炎的可能性更大（0% vs. 15%；p<0.024），并且他们返回手术室进行重复清创（3% vs. 22%；p<0.020）。同样，住院时间、重症监护病房 (ICU) 住院时间和呼吸机天数也更长（4.3±3.5 比 9.5±11.3；1.1±1.2 比 9.5±7.1；0.3±11 比 3.6±7.1； p < 0.001）。结论：虽然早期诊断的牙齿感染的预后通常良好，但我们观察到在 COVID-19 大流行爆发后 LA 的发病率显着增加。此外，在新冠疫情爆发时期，这些感染引起的并发症变得更加严重。具体来说，坏死性筋膜炎的可能性显着增加，伴随着呼吸衰竭和纵隔炎的风险增加。
Background:Ludwig's angina (LA) is a diffuse cellulitis of the submandibular space and adjacent tissues. During the coronavirus disease 2019 (COVID-19) pandemic, odontogenic treatments were often delayed because of the implementation of safety measures to avoid the spread of the virus. We hypothesized that delayed odontogenic treatments associated with the onset of the COVID-19 pandemic would be associated with an increase in the incidence of LA and worse outcomes related to these infections.Patients and Methods:Patients from June 2018 to June 2022 with computed tomography images suggestive of LA and confirmed by ear, nose, throat (ENT) consult were included. We abstracted demographics, outcomes, clinical management, and microbiology. Patients were stratified into pre-COVID and COVID-onset. Our primary outcome, incidence of LA, was defined as: (new LA cases) ÷ (ED evaluations of oral or dental infections × 1.5 years).Results:In the pre-COVID group, we identified 32 of 1,301 patients with LA for an incidence of 0.02 per year. The COVID-onset group consisted of 41 of 641 patients, with an incidence of 0.04 per year. In the COVID-onset group, progression to necrotizing fasciitis was more likely (0% vs. 15%; p < 0.024), and they returned to the operating room for repeated debridement (3% vs. 22%; p < 0.020). Likewise, hospital length of stay, intensive care unit (ICU) length of stay, and ventilator days were higher (4.3 ± 3.5 vs. 9.5 ± 11.3; 1.1 ± 1.2 vs. 9.5 ± 7.1; 0.3 ± 1 vs. 3.6 ± 7.1; p < 0.001).Conclusions:Although the prognosis for dental infections diagnosed early is generally favorable, we observed a notable increase in the incidence of LA after the onset of the COVID-19 pandemic. Moreover, complications stemming from these infections became more severe in the COVID-onset era. Specifically, the likelihood of necrotizing fasciitis showed a substantial increase, accompanied by an increased risk of respiratory failure and mediastinitis.