{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T02:42:56Z","timestamp":1783996976519,"version":"3.55.0"},"reference-count":45,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T00:00:00Z","timestamp":1644364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Deep neck infection (DNI) is a severe disease of the deep neck spaces, which has the potential for airway obstruction. Cervical necrotizing fasciitis (CNF) is a fatal infection of the diffuse soft tissues and fascia with a high mortality rate. This study investigated risk factors in patients with concurrent DNI and CNF. A total of 556 patients with DNI were included in this study between August 2016 and December 2021. Among these patients, 31 had concurrent DNI and CNF. The relevant clinical variables were assessed. In univariate analysis, age (&gt; 60 years, odds ratio (OR) = 2.491, p = 0.014), C-reactive protein (CRP, OR = 1.007, p &lt; 0.001), blood sugar (OR = 1.007, p &lt; 0.001), and diabetes mellitus (DM, OR = 4.017, p &lt; 0.001) were significant risk factors for concurrent DNI and CNF. In multivariate analysis, CRP (OR = 1.006, p &lt; 0.001) and blood sugar (OR = 1.006, p = 0.002) were independent risk factors in patients with concurrent DNI and CNF. There were significant differences in the length of hospital stay and therapeutic management (intubation, tracheostomy, incision and drainage) between DNI patients with and without CNF (all p &lt; 0.05). While there were no differences in pathogens between the DNI alone and concurrent DNI and CNF groups (all p &gt; 0.05), the rate of specific pathogen non-growth from blood cultures was 16.95% (89\/525) in the DNI alone group, in contrast to 0% (0\/31) in the concurrent DNI and CNF group (p = 0.008). Higher CRP and blood sugar levels were independent risk factors for the concurrence of DNI and CNF. With regard to prognosis, there were significant differences in the length of hospital stay and therapeutic management between the groups with and without CNF. While there were no significant differences in pathogens (all p &gt; 0.05), no cases in the concurrent DNI and CNF group showed specific pathogen non-growth, in contrast to 89\/525 patients in the group with DNI alone.<\/jats:p>","DOI":"10.3390\/diagnostics12020443","type":"journal-article","created":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T21:19:06Z","timestamp":1644441546000},"page":"443","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Factors Affecting Patients with Concurrent Deep Neck Infection and Cervical Necrotizing Fasciitis"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4051-4009","authenticated-orcid":false,"given":"Shih-Lung","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou 333, Taiwan"},{"name":"School of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shy-Chyi","family":"Chin","sequence":"additional","affiliation":[{"name":"School of Medicine, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Chien","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou 333, Taiwan"},{"name":"School of Medicine, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"Department of Otorhinolaryngology & Head and Neck Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5629-527X","authenticated-orcid":false,"given":"Chia-Ying","family":"Ho","sequence":"additional","affiliation":[{"name":"School of Medicine, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1007\/s00405-019-05742-9","article-title":"Deep neck space infections: An upward trend and changing characteristics","volume":"277","author":"Velhonoja","year":"2020","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Chen, S.L., Young, C.K., Liao, C.T., Tsai, T.Y., Kang, C.J., and Huang, S.F. (2021). Parotid Space, a Different Space from Other Deep Neck Infection Spaces. Microorganisms, 9.","DOI":"10.3390\/microorganisms9112361"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3767","DOI":"10.1007\/s00405-017-4694-5","article-title":"Comparison of intubation and tracheotomy in patients with deep neck infection","volume":"274","author":"Tapiovaara","year":"2017","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1177\/0145561319877281","article-title":"The Factors Contributing to Efficiency in Surgical Management of Purulent Infections of Deep Neck Spaces","volume":"100","author":"Rzepakowska","year":"2021","journal-title":"Ear Nose Throat J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1159\/000093095","article-title":"Deep neck infections: A constant challenge","volume":"68","author":"Marchiori","year":"2006","journal-title":"ORL J. Otorhinolaryngol. Relat. Spec."},{"key":"ref_6","first-page":"E2275","article-title":"Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description","volume":"38","year":"2016","journal-title":"Head Neck"},{"key":"ref_7","first-page":"149","article-title":"Two cases of deep neck infection with esophageal perforation","volume":"26","author":"Aizawa","year":"2013","journal-title":"J.-STAGE"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Ho, C.-Y., Wang, Y.-C., Chin, S.-C., and Chen, S.-L. (2022). Factors Affecting Patients with Concurrent Deep Neck Infection and Acute Epiglottitis. Diagnostics, 12.","DOI":"10.3390\/diagnostics12010029"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1067\/mhn.2001.118182","article-title":"Craniocervical necrotizing fasciitis: An 11-year experience","volume":"125","author":"Bahu","year":"2001","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.anorl.2013.08.006","article-title":"Cervical necrotizing fasciitis: Report of 6 cases and review of literature","volume":"131","author":"Farre","year":"2014","journal-title":"Eur. Ann. Otorhinolaryngol. Head Neck Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1177\/0145561319839789","article-title":"Aggressive Necrotizing Fasciitis of the Head and Neck Resulting in Massive Defects","volume":"98","author":"Ferzli","year":"2019","journal-title":"Ear Nose Throat J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"189","DOI":"10.5624\/isd.2011.41.4.189","article-title":"Application of radiographic images in diagnosis and treatment of deep neck infections with necrotizing fasciitis: A case report","volume":"41","author":"Kim","year":"2011","journal-title":"Imaging Sci. Dent."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1177\/0145561319874017","article-title":"Necrotizing Fasciitis of the Neck","volume":"100","author":"Wang","year":"2021","journal-title":"Ear Nose Throat J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1148\/radiology.202.2.9015076","article-title":"Necrotizing fasciitis of the head and neck: Role of CT in diagnosis and management","volume":"202","author":"Becker","year":"1997","journal-title":"Radiology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2147\/IDR.S3554","article-title":"Deep neck abscess: An analysis of microbial etiology and the effectiveness of antibiotics","volume":"1","author":"Yang","year":"2008","journal-title":"Infect. Drug Resist."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/S0196-0709(00)85019-X","article-title":"Deep neck infections in diabetic patients","volume":"21","author":"Chen","year":"2000","journal-title":"Am. J. Otolaryngol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1007\/s00405-009-1007-7","article-title":"Necrotizing fasciitis of the head and neck: 34 cases of a single institution experience","volume":"267","author":"Lanisnik","year":"2010","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4587","DOI":"10.1007\/s00405-021-06653-4","article-title":"Early detecting cervical necrotizing fasciitis from deep neck infections: A study of 550 patients","volume":"278","author":"Sideris","year":"2021","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1056\/NEJMra1600673","article-title":"Necrotizing Soft-Tissue Infections","volume":"377","author":"Stevens","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"20180093","DOI":"10.1259\/bjr.20180093","article-title":"Necrotizing fasciitis of the lower extremity: Imaging pearls and pitfalls","volume":"91","author":"Tso","year":"2018","journal-title":"Br. J. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/S1042-3699(02)00083-3","article-title":"Diagnosis and treatment of necrotizing fasciitis in the head and neck region","volume":"15","author":"McGurk","year":"2003","journal-title":"Oral Maxillofac Surg. Clin. N. Am."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1086\/511638","article-title":"Necrotizing soft-tissue infection: Diagnosis and management","volume":"44","author":"Anaya","year":"2007","journal-title":"Clin. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.bj.2019.08.002","article-title":"Necrotizing fasciitis of the entire head and neck: Literature review and case report","volume":"43","author":"Chou","year":"2020","journal-title":"Biomed. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2094","DOI":"10.1002\/hed.25184","article-title":"Cervical necrotizing fasciitis: Systematic review and analysis of 1235 reported cases from the literature","volume":"40","author":"Gunaratne","year":"2018","journal-title":"Head Neck"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1001\/jama.1979.03290340021019","article-title":"Necrotizing fasciitis. Importance of roentgenographic studies for soft-tissue gas","volume":"241","author":"Fisher","year":"1979","journal-title":"JAMA"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1148\/radiology.203.3.9169717","article-title":"Necrotizing fasciitis: CT characteristics","volume":"203","author":"Wysoki","year":"1997","journal-title":"Radiology"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Chen, S.L., Young, C.K., Tsai, T.Y., Chien, H.T., Kang, C.J., Liao, C.T., and Huang, S.F. (2021). Factors Affecting the Necessity of Tracheostomy in Patients with Deep Neck Infection. Diagnostics, 11.","DOI":"10.3390\/diagnostics11091536"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1017\/S0950268809002532","article-title":"The epidemiology of necrotizing fasciitis including factors associated with death and amputation","volume":"137","author":"Dworkin","year":"2009","journal-title":"Epidemiol. Infect."},{"key":"ref_29","first-page":"1","article-title":"Necrotizing fasciitis: Risk factors of mortality","volume":"8","author":"Khamnuan","year":"2015","journal-title":"Risk Manag. Healthc. Policy"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Cheng, N.C., Tai, H.C., Chang, S.C., Chang, C.H., and Lai, H.S. (2015). Necrotizing fasciitis in patients with diabetes mellitus: Clinical characteristics and risk factors for mortality. BMC Infect. Dis., 15.","DOI":"10.1186\/s12879-015-1144-0"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.1097\/01.prs.0000259040.71478.27","article-title":"Mortality in patients with necrotizing fasciitis","volume":"119","author":"Golger","year":"2007","journal-title":"Plast Reconstr. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.numecd.2009.03.018","article-title":"Glucose toxicity: The leading actor in the pathogenesis and clinical history of type 2 diabetes\u2014Mechanisms and potentials for treatment","volume":"19","author":"Giaccari","year":"2009","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1016\/j.joms.2011.07.010","article-title":"Is there association between severe multispace infections of the oral maxillofacial region and diabetes mellitus?","volume":"70","author":"Zheng","year":"2012","journal-title":"J. Oral Maxillofac Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1080\/23772484.2016.1266636","article-title":"Necrotising fasciitis of the neck: Unusual presentation with aggressive management\u2014Case report with review of literature","volume":"2","author":"Taneja","year":"2017","journal-title":"Acta Oto-Laryngol. Case Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1007\/s10096-008-0491-9","article-title":"Cervical necrotizing fasciitis: 8-years\u2019 experience of microbiology","volume":"27","author":"Fihman","year":"2008","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1016\/0278-2391(90)90298-G","article-title":"Necrotizing soft-tissue infections of dental origin","volume":"48","author":"Fliss","year":"1990","journal-title":"J. Oral Maxillofac Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/S0278-2391(00)90327-6","article-title":"Cervical necrotizing fasciitis of odontogenic origin: A case report and review of 12 cases","volume":"58","author":"Whitesides","year":"2000","journal-title":"J. Oral Maxillofac Surg"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.otc.2008.01.002","article-title":"Deep neck infection","volume":"41","author":"Vieira","year":"2008","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1016\/j.joms.2003.12.043","article-title":"Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses","volume":"62","author":"Brook","year":"2004","journal-title":"J. Oral Maxillofac Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1159\/000096715","article-title":"Parapharyngeal abscess: Comprehensive management protocol","volume":"69","author":"Oh","year":"2007","journal-title":"ORL J. Otorhinolaryngol. Relat. Spec."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1111\/j.1601-0825.2008.01496.x","article-title":"Cervico-facial necrotizing fasciitis","volume":"15","author":"Ord","year":"2009","journal-title":"Oral Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1002\/bjs.6935","article-title":"Optimal treatment of cervical necrotizing fasciitis associated with descending necrotizing mediastinitis","volume":"97","author":"Karkas","year":"2010","journal-title":"Br. J. Surg."},{"key":"ref_43","first-page":"4630809","article-title":"Streptococcus constellatus Causing Empyema and Sepsis, Necessitating Early Surgical Decortication","volume":"2020","author":"Chrastek","year":"2020","journal-title":"Case Rep. Infect. Dis."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2183","DOI":"10.1002\/lary.21083","article-title":"Supraglottitis in the era following widespread immunization against Haemophilus influenzae type B: Evolving principles in diagnosis and management","volume":"120","author":"Guardiani","year":"2010","journal-title":"Laryngoscope"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1186\/1752-1947-2-368","article-title":"Cervical necrotising fasciitis and descending mediastinitis secondary to unilateral tonsillitis: A case report","volume":"2","author":"Islam","year":"2008","journal-title":"J. Med. Case Rep."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/2\/443\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:16:46Z","timestamp":1760134606000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/2\/443"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,9]]},"references-count":45,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["diagnostics12020443"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics12020443","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,9]]}}}