{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T12:02:21Z","timestamp":1789646541213,"version":"4.0.0"},"reference-count":24,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2021,9,29]],"date-time":"2021-09-29T00:00:00Z","timestamp":1632873600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012553","name":"Chang Gung Memorial Hospital","doi-asserted-by":"publisher","award":["CGRPG6J0031"],"award-info":[{"award-number":["CGRPG6J0031"]}],"id":[{"id":"10.13039\/100012553","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Deep neck infection (DNI) is a lethal emergent condition. Patients with types 1 and 2 diabetes mellitus (T1DM and T2DM, respectively) are predisposed to DNI and have poorer prognoses. The mainstay of the treatment is surgical drainage and antibiotics; however, the pathogenic bacteria of T1DM-DNI have not been studied before. We obtained the data of 8237 patients with DNI who were hospitalized from 2004 to 2015 from the Chang Gung Research Database, which contains multi-institutional medical records in Taiwan. Using diagnostic codes, we classified them into T1DM-DNI, T2DM-DNI, and non-DM-DNI and analyzed their pathogenic bacteria, disease severity, treatment, and prognosis. The top three facultative anaerobic or aerobic bacteria of T1DM-DNI were Klebsiella pneumoniae (KP, 40.0%), Viridans Streptococci (VS, 22.2%), and methicillin-sensitive Staphylococcus aureus (MSSA, 8.9%), similar for T2DM (KP, 32.2%; VS, 23.3%; MSSA, 9.5%). For non-DM-DNI, it was VS (34.6%), KP (9.8%), and coagulase-negative Staphylococci (8.7%). The order of anaerobes for the three groups was Peptostreptococcus micros, Prevotella intermedia, and Peptostreptococcus anaerobius. Patients with T1DM-DNI and T2DM-DNI had higher white blood cell (WBC) counts and C-reactive protein (CRP) levels, more cases of surgery, more cases of tracheostomy, longer hospital stays, more mediastinal complications, and higher mortality rates than those without DM-DNI. Patients in the death subgroup in T1DM-DNI had higher WBC counts, band forms, and CRP levels than those in the survival subgroup. Patients with DM-DNI had more severe disease and higher mortality rate than those without DM-DNI. KP and Peptostreptococcus micros are the leading pathogens for both patients with T1DM-DNI and those with T2DM-DNI. Clinicians should beware of high serum levels of infection markers, which indicate potential mortality.<\/jats:p>","DOI":"10.3390\/microorganisms9102059","type":"journal-article","created":{"date-parts":[[2021,9,30]],"date-time":"2021-09-30T00:03:42Z","timestamp":1632960222000},"page":"2059","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["The Pathogenic Bacteria of Deep Neck Infection in Patients with Type 1 Diabetes, Type 2 Diabetes, and Without Diabetes from Chang Gung Research Database"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4855-8156","authenticated-orcid":false,"given":"Chih-Wei","family":"Luan","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Lo Sheng Sanatorium and Hospital Ministry of Health and Welfare, New Taipei City 24257, Taiwan"},{"name":"Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8350-2684","authenticated-orcid":false,"given":"Chia-Yen","family":"Liu","sequence":"additional","affiliation":[{"name":"Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8080-0504","authenticated-orcid":false,"given":"Yao-Hsu","family":"Yang","sequence":"additional","affiliation":[{"name":"Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"},{"name":"Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"},{"name":"School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9314-5940","authenticated-orcid":false,"given":"Ming-Shao","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"},{"name":"Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"},{"name":"Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao-Te","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"},{"name":"Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"},{"name":"Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3792-3784","authenticated-orcid":false,"given":"Cheng-Ming","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"},{"name":"Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching-Yuan","family":"Wu","sequence":"additional","affiliation":[{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"},{"name":"Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"},{"name":"School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6492-0346","authenticated-orcid":false,"given":"Pey-Jium","family":"Chang","sequence":"additional","affiliation":[{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5939-9747","authenticated-orcid":false,"given":"Geng-He","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"},{"name":"Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan"},{"name":"Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,29]]},"reference":[{"key":"ref_1","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_2","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1016\/j.otohns.2005.01.035","article-title":"Deep neck infection in diabetic patients: Comparison of clinical picture and outcomes with nondiabetic patients","volume":"132","author":"Huang","year":"2005","journal-title":"Otolaryngol.\u2014Head Neck Surg. Off. J. Am. Acad. Otolaryngol.-Head Neck Surg."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Chang, G.H., Ding, M.C., Yang, Y.H., Lin, Y.H., Liu, C.Y., Lin, M.H., Wu, C.Y., Hsu, C.M., and Tsai, M.S. (2018). High risk of deep Neck infection in patients with type 1 diabetes mellitus: A Nationwide population-based cohort study. J. Clin. Med., 7.","DOI":"10.3390\/jcm7110385"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2034","DOI":"10.2337\/dc14-1140","article-title":"Type 1 diabetes through the life span: A position statement of the American Diabetes Association","volume":"37","author":"Chiang","year":"2014","journal-title":"Diabetes Care"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Chang, G.-H., Tsai, M.-S., Liu, C.-Y., Lin, M.-H., Tsai, Y.-T., Hsu, C.-M., and Yang, Y.-H. (2017). End-stage renal disease: A risk factor of deep neck infection\u2014A nationwide follow-up study in Taiwan. BMC Infect. Dis., 17.","DOI":"10.1186\/s12879-017-2531-5"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/0030-4220(94)90221-6","article-title":"Changing trends in deep neck abscess. A retrospective study of 110 patients","volume":"77","author":"Aroesty","year":"1994","journal-title":"Oral Surg. Oral Med. Oral Pathol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1080\/00016480500395195","article-title":"Factors affecting the bacteriology of deep neck infection: A retrospective study of 128 patients","volume":"126","author":"Huang","year":"2006","journal-title":"Acta Oto-Laryngol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1017\/S0022215106001149","article-title":"Influence of diabetes mellitus on deep neck infection","volume":"120","author":"Lin","year":"2006","journal-title":"J. Laryngol. Otol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.bj.2017.08.002","article-title":"Chang Gung Research database: A multi-institutional database consisting of original medical records","volume":"40","author":"Tsai","year":"2017","journal-title":"Biomed. J."},{"key":"ref_10","first-page":"1307","article-title":"Real-world evidence for increased deep neck infection risk in patients with rheumatoid arthritis","volume":"130","author":"Chang","year":"2019","journal-title":"Laryngoscope"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"4133","DOI":"10.1038\/s41598-020-61049-4","article-title":"Deep Neck Infection in Systemic Lupus Erythematosus Patients: Real-World Evidence","volume":"10","author":"Chang","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Tsai, M.S., Chang, G.H., Chen, W.M., Liu, C.Y., Lin, M.H., Chang, P.J., Huang, T.Y., Tsai, Y.T., Wu, C.Y., and Hsu, C.M. (2019). The association between decompensated liver cirrhosis and deep neck infection: Real-world evidence. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16203863"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1002\/hed.20014","article-title":"Deep neck infection: Analysis of 185 cases","volume":"26","author":"Huang","year":"2004","journal-title":"Head Neck"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1080\/00016480701387157","article-title":"Deep neck infection with dental origin: Analysis of 85 consecutive cases 2000\u20132006","volume":"128","author":"Marioni","year":"2008","journal-title":"Acta Oto-Laryngol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1177\/000348940111001111","article-title":"Deep neck abscess: A retrospective review of 210 cases","volume":"110","author":"Parhiscar","year":"2001","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_16","first-page":"31","article-title":"Deep neck infection. Review of 286 cases","volume":"63","year":"2012","journal-title":"Acta Otorrinolaringol. Esp."},{"key":"ref_17","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. Off. J. Am. Assoc. Oral Maxillofac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.oooo.2017.02.003","article-title":"Bacterial and histopathological findings in deep head and neck infections: A retrospective analysis","volume":"124","author":"Cordesmeyer","year":"2017","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"401","DOI":"10.3389\/fcimb.2017.00401","article-title":"Comparison of diabetic and non-diabetic human leukocytic responses to different capsule types of Klebsiella pneumoniae responsible for causing pyogenic liver abscess","volume":"7","author":"Lee","year":"2017","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Lin, Y.T., Wang, F.D., Wu, P.F., and Fung, C.P. (2013). Klebsiella pneumoniae liver abscess in diabetic patients: Association of glycemic control with the clinical characteristics. BMC Infect. Dis., 13.","DOI":"10.1186\/1471-2334-13-56"},{"key":"ref_21","first-page":"589","article-title":"The role of bacterial interference in the increased prevalence of oropharyngeal gram-negative bacilli among alcoholics and diabetics","volume":"120","author":"Mackowiak","year":"1979","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.amjoto.2011.01.003","article-title":"Deep neck space infections: A retrospective review of 173 cases","volume":"33","author":"Bakir","year":"2012","journal-title":"Am. J. Otolaryngol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s00405-008-0734-5","article-title":"Deep neck infections: A retrospective review of 112 cases","volume":"266","author":"Eftekharian","year":"2009","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"102","DOI":"10.5606\/kbbihtisas.2015.76500","article-title":"Clinical features of deep neck infection: Analysis of 77 patients","volume":"25","author":"Sakarya","year":"2015","journal-title":"Kulak Burun Bogaz Ihtis. Derg."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/9\/10\/2059\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:07:16Z","timestamp":1760166436000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/9\/10\/2059"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,29]]},"references-count":24,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["microorganisms9102059"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms9102059","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,29]]}}}