{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T05:34:30Z","timestamp":1763098470274,"version":"3.45.0"},"reference-count":33,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T00:00:00Z","timestamp":1738281600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2025,7]]},"abstract":"\n Objective<\/jats:title>\n This study aims to investigate the differences in pathogenic bacterial spectra between patients with deep neck infection (DNI) with and without liver cirrhosis (LC). The goal is to identify specific pathogens prevalent in LC\u2010DNI to guide the selection of empiric antibiotics, improving treatment outcomes and prognosis.<\/jats:p>\n <\/jats:sec>\n \n Study Design<\/jats:title>\n This is a retrospective study.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The Chang Gung Research Database (CGRD) is a deidentified medical database encompassing seven hospitals within Taiwan's largest medical system. We analyzed data from 2004 to 2018 on DNI patients hospitalized with or without LC, categorizing them into these two groups. This study primarily focused on comparing the bacterial culture results of these groups, alongside an analysis of their treatment modalities (medication alone or surgery) and prognostic outcomes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n From a total of 11,455 DNI patients identified in the CGRD, 76 LC\u2010DNI patients and 11,178 non\u2010LC\u2010DNI patients met the inclusion criteria after exclusions. The LC group had significantly higher rates of surgical debridement (34.2% vs. 19.4%,\n p<\/jats:italic>\n \u2009=\u20090.002), ICU admission (22.4% vs. 10.7%,\n p<\/jats:italic>\n \u2009=\u20090.004), and mediastinal complications (7.9% vs. 2.1%,\n p<\/jats:italic>\n \u2009=\u20090.005). Although the overall mortality rates were not significantly different between the two groups (6.6% vs. 4.6%,\n p<\/jats:italic>\n \u2009=\u20090.401), the mediastinitis\u2010related mortality rate was significantly higher in the LC\u2010DNI group (2.6% vs. 0.2%,\n p<\/jats:italic>\n \u2009=\u20090.015). Bacterial culture analysis revealed that LC\u2010DNI patients predominantly presented with\n Klebsiella pneumoniae<\/jats:italic>\n (KP) as the primary facultative anaerobic pathogen, whereas non\u2010LC\u2010DNI patients were most infected with\n Viridans streptococcus<\/jats:italic>\n (VS). For anaerobic bacteria, both groups consistently cultured\n Peptostreptococcus micros<\/jats:italic>\n and\n Prevotella intermedia<\/jats:italic>\n as the predominant species.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n LC\u2010DNI patients are predominantly infected with KP, a Gram\u2010negative bacillus, unlike the Gram\u2010positive cocci, VS, in non\u2010LC\u2010DNI. Anaerobic pathogens were similar in both groups. Empiric antibiotics for LC\u2010DNI should target KP and anaerobes to improve outcomes.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n \n 3\n Laryngoscope<\/jats:italic>\n , 135:2299\u20132305, 2025\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/lary.32028","type":"journal-article","created":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T02:29:26Z","timestamp":1738376966000},"page":"2299-2305","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pathogens and Prognosis of Deep Neck Infection in Patients With Liver Cirrhosis"],"prefix":"10.1002","volume":"135","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0361-0090","authenticated-orcid":false,"given":"Ang","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Chang Gung Memorial Hospital Chiayi 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Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3792-3784","authenticated-orcid":false,"given":"Cheng\u2010Ming","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Chang Gung Memorial Hospital Chiayi Taiwan"},{"name":"Faculty of Medicine, College of Medicine Chang Gung University Taoyuan Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine Chang Gung University Taoyuan Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yao\u2010Hsu","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine Chang Gung Memorial Hospital Chiayi Taiwan"},{"name":"School of Traditional Chinese Medicine, College of Medicine Chang Gung University Taoyuan Taiwan"},{"name":"Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital Chiayi 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