Bacterial etiology, antimicrobial susceptibility, and clinical outcomes in cervicofacial space infections before, during, and after the COVID-19 pandemic: a 10-year single-centre study.

Abstract

Objective: To investigate epidemiological trends of cervicofacial space infections in Western China, including pathogen distribution, antimicrobial resistance, and the impact of the COVID-19 pandemic on pathogen susceptibility and patient outcomes.

Methods: Clinical data from 542 hospitalized patients with severe cervicofacial space infections who underwent open surgery at a tertiary hospital over the past decade were analyzed. Data on bacterial strains, antibiotic susceptibility, drug resistance, and treatment outcomes were recorded. Statistical analyses included one-way ANOVA, chi-square tests, Fisher's exact tests, logistic regression, and multiple regression.

Results: From January 2014 to June 2024, the annual number of hospitalized CFI cases declined initially but later increased. Bacterial growth was observed in 400 cases (73.8%). Based on the frequency of isolation in positive pus cultures, Streptococcus spp. and Klebsiella spp. were the most frequently identified organisms. The five antimicrobial agents with the highest in vitro susceptibility rates were levofloxacin (66.3%), vancomycin (63.8%), cefepime (61.0%), ceftriaxone (59.5%), and cefotaxime (58.5%). Compared to the pre-pandemic period, Patients treated during the pandemic and post-pandemic periods had higher odds of in-hospital complications than those treated during the pre-pandemic period (OR = 7.28, 95% CI:3.67 ~ 14.45; P < 0.001; OR = 4.96, 95% CI:2.16 ~ 11.41; P < 0.001), including pulmonary infections, and coagulopathy etc. CONCLUSIONS: Based on the prevalent pathogen profile and local susceptibility patterns observed in this study, cephalosporins are the preferred empirical choice for cervicofacial space infections in our region. Fluoroquinolones may be considered as an alternative in patients with beta-lactam allergy, but should be used judiciously to preserve their activity for resistant organisms. Antibiotic therapy should be tailored based on culture and susceptibility results as soon as they become available. Additionally, patients treated during and after the COVID-19 pandemic had higher odds of in-hospital complications, which may reflect healthcare system disruptions and delayed presentation.

Clinical trial number: Not applicable.