Analysis Of Risk Factors In Descending Necrotizing Mediastinitis From Multi-space Infection In The Maxillofacial Region

Objective: To analysis the risk factors of descending necrotizing mediastinitis(DNM)secondary to multi-space infection in the maxillofacial region(MSI).Method: Eighty inpatients with multi-space infection from 2015 to 2019 were included in the study.They were divided into a secondary mediastinitis group(DNM,n =11)and nonsecondary mediastinitis group(non-DNM,n =69).We collected information like age,gender,systemic comorbidities,the cause and space of infection,the number of space,bacteria culture data,laboratory examination results.Univariate analysis(Mann-Whitney U test and Fisher exact test)and logistic regression analysis were applied to deal with the data,to identify independent risk factors of DNM secondary to MSI before treatment.Results: 1.General data: there were 8 males and 3 females in DNM group,with a male-tofemale ratio of 2.67:1.There were 41 males and 28 females in non-DNM group,with a male-to-female ratio of 1.46 :1.The largest number of patients in the DNM group were40-49 years old and 60-69 years old,both of which were 4 cases(36.36%).non-DNM group,the largest number of patients were in the 50-59 age group,15 cases(21.74%).The number of cases in the DNM group was the highest in autumn and winter,with 7 cases(63.63%).In the non-DNM group,which was the most in summer,with 20 cases(28.99%).The highest detection rate of Gram-positive bacteria in the two groups was Streptococcus constellation,3 cases(27.27 %)in DNM group and 4 cases(12.50 %)in non-DNM group.The highest detection rate of Gram-negative bacteria was Klebsiella pneumoniae,1 case(9.09 %)in DNM group and 3 cases(9.38%)in non-DNM group.2.Univariate analysis showed that there was no significant difference in age,sex,foundational disease and course of disease between non-DNM group and DNM group(P>0.05).The number of infection spaces in DNM group was higher than that in non-DNM group(P<0.05).Ten spaces in eitgteen spaces we collected can promote DNM secondary to MSI(P<0.05).Odontogenic infection was dominant in both groups,and which had a great influence on DNM secondary to MSI(P<0.05).The level of CRP in DNM group was higher than that in non-DNM group(P<0.05).3.Logistic regression analysis showed that the OR value of pterygoid-mandibular space and retropharyngeal space infection were 10.012 and 28.304,respectively,which were independent risk factors for DNM secondary to MSI(P<0.05).Conclusions: 1.MSI secondary DNM is not associated with age and sex.The incidence of DNM is mainly in autumn and winter.Odontogenic infection is the main infection route of secondary mediastinitis.2.Whether MSI secondary to DNM or not,the highest detection rate of Gram-positive bacteria is Streptococcus constellation,the highest detection rate of Gram-negative bacteria is Klebsiella pneumoniae.3.Pterygomandibular space and retropharyngeal space are independent risk factors for DNM caused by MSI.