Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
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Analysis of glycosylated hemoglobin (HbA1c) level on maxillofacial fascial space infection in diabetic patients

  • Jang, Jong-Won (Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University) ;
  • Kim, Chul-Hwan (Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University) ;
  • Kim, Moon-Young (Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University)
  • Received : 2015.05.18
  • Accepted : 2015.07.12
  • Published : 2015.10.31
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Abstract

Objectives: This study was performed to evaluate the impact of glycosylated hemoglobin (HbA1c) level on characteristics and prognosis of maxillofacial fascial infection in diabetic patients. Materials and Methods: We reviewed the medical records of 72 patients (35 patients with HbA1c lower than 7.0% and 37 patients with HbA1c higher than 7.0%) diagnosed with maxillofacial fascial space infection and hospitalized for treatment at the Department of Oral and Maxillofacial Surgery in Dankook University Hospital (Cheonan, Korea) from January 2005 to February 2014. We compared demographics, parameters of glucoregulation (HbA1c), laboratory parameters of inflammation (white blood cell [WBC], C-reactive protein [CRP] count), type and number of involved spaces, type and number of antibiotics, period of hospitalization, number of surgical operations, need for tracheostomy, complications, computed tomography (CT), and microorganisms between the two groups. Results: Compared with the well-controlled diabetes mellitus (DM) group (HbA1c <7.0%), patients in the poorly-controlled (HbA1c ${\geq}7.0%$) DM group had the following characteristics: longer hospitalization periods, higher values of laboratory parameters of inflammation (WBC, CRP count) at the time of admission, higher number of antibiotics prescribed, more frequent complications, frequent deep neck space involvement, and distinctive main causative microorganisms. As the HbA1c level increases, hospitalization periods and incidence of complications increase gradually. Conclusion: This retrospective study suggests that regulation of DM significantly impacts maxillofacial fascial infection. Poorly controlled DM with high HbA1c level negatively influences the prognosis of infection.

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References

  1. Chang CM, Lu FH, Guo HR, Ko WC. Klebsiella pneumoniae fascial space infections of the head and neck in Taiwan: emphasis on diabetic patients and repetitive infections. J Infect 2005;50:34-40. https://doi.org/10.1016/j.jinf.2003.11.014
  2. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2014;37 Suppl 1:S81-90. https://doi.org/10.2337/dc14-S081
  3. International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 2009;32:1327-34. https://doi.org/10.2337/dc09-9033
  4. Delamaire M, Maugendre D, Moreno M, Le Goff MC, Allannic H, Genetet B. Impaired leucocyte functions in diabetic patients. Diabet Med 1997;14:29-34. https://doi.org/10.1002/(SICI)1096-9136(199701)14:1<29::AID-DIA300>3.0.CO;2-V
  5. Muller LM, Gorter KJ, Hak E, Goudzwaard WL, Schellevis FG, Hoepelman AI, et al. Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis 2005;41:281-8. https://doi.org/10.1086/431587
  6. Tanaka Y. Immunosuppressive mechanisms in diabetes mellitus. Nihon Rinsho 2008;66:2233-7.
  7. Rohlfing CL, Little RR, Wiedmeyer HM, England JD, Madsen R, Harris MI, et al. Use of GHb (HbA1c) in screening for undiagnosed diabetes in the U.S. population. Diabetes Care 2000;23:187-91. https://doi.org/10.2337/diacare.23.2.187
  8. Shah BR, Hux JE. Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care 2003;26:510-3. https://doi.org/10.2337/diacare.26.2.510
  9. Infante-Cossio P, Fernandez-Hinojosa E, Mangas-Cruz MA, Gonzalez-Perez LM. Ludwig's angina and ketoacidosis as a first manifestation of diabetes mellitus. Med Oral Patol Oral Cir Bucal 2010;15:e624-7.
  10. Huang TT, Tseng FY, Yeh TH, Hsu CJ, Chen YS. Factors affecting the bacteriology of deep neck infection: a retrospective study of 128 patients. Acta Otolaryngol 2006;126:396-401. https://doi.org/10.1080/00016480500395195
  11. Chandu A, Macisaac RJ, Smith AC, Bach LA. Diabetic ketoacidosis secondary to dento-alveolar infection. Int J Oral Maxillofac Surg 2002;31:57-9. https://doi.org/10.1054/ijom.2001.0140
  12. Huang TT, Tseng FY, Liu TC, Hsu CJ, Chen YS. Deep neck infection in diabetic patients: comparison of clinical picture and outcomes with nondiabetic patients. Otolaryngol Head Neck Surg 2005;132:943-7. https://doi.org/10.1016/j.otohns.2005.01.035
  13. Sim YB, Park SH, Kang YJ, Kim SM, Lee JK, Jung JS, et al. The regulation of blood glucose level in physical and emotional stress models: possible involvement of adrenergic and glucocorticoid systems. Arch Pharm Res 2010;33:1679-83. https://doi.org/10.1007/s12272-010-1018-3
  14. Lippi G, Mattiuzzi C, Targher G. Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. N Engl J Med 2010;362:2030; author reply 2031. https://doi.org/10.1056/NEJMc1003829
  15. Alexander M, Krishnan B, Shenoy N. Diabetes mellitus and odontogenic infections: an exaggerated risk? Oral Maxillofac Surg 2008;12:129-30. https://doi.org/10.1007/s10006-008-0118-4
  16. Carton JA, Maradona JA, Nuno FJ, Fernandez-Alvarez R, Perez-Gonzalez F, Asensi V. Diabetes mellitus and bacteraemia: a comparative study between diabetic and non-diabetic patients. Eur J Med 1992;1:281-7.
  17. Stoeckle M, Kaech C, Trampuz A, Zimmerli W. The role of diabetes mellitus in patients with bloodstream infections. Swiss Med Wkly 2008;138:512-9.
  18. Geerlings SE, Hoepelman AI. Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol 1999;26:259-65. https://doi.org/10.1111/j.1574-695X.1999.tb01397.x
  19. Rao DD, Desai A, Kulkarni RD, Gopalkrishnan K, Rao CB. Comparison of maxillofacial space infection in diabetic and nondiabetic patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:e7-12.
  20. Chang JS, Yoo KH, Yoon SH, Ha J, Jung S, Kook MS, et al. Odontogenic infection involving the secondary fascial space in diabetic and non-diabetic patients: a clinical comparative study. J Korean Assoc Oral Maxillofac Surg 2013;39:175-81. https://doi.org/10.5125/jkaoms.2013.39.4.175
  21. Zheng L, Yang C, Zhang W, Cai X, Kim E, Jiang B, et al. Is there association between severe multispace infections of the oral maxillofacial region and diabetes mellitus? J Oral Maxillofac Surg 2012;70:1565-72. https://doi.org/10.1016/j.joms.2011.07.010
  22. Koracevic G, Vasiljevic S, Velickovic-Radovanovic R, Sakac D, Obradovic S, Damjanovic M, et al. Stress hyperglycemia in acute myocardial infarction. Vojnosanit Pregl 2014;71:858-69. https://doi.org/10.2298/VSP121103017K
  23. Burekovic A, Dizdarevic-Bostandzic A, Godinjak A. Poorly regulated blood glucose in diabetic patients-predictor of acute infections. Med Arch 2014;68:163-6. https://doi.org/10.5455/medarh.2014.68.163-166
  24. Jupiter DC, Humphers JM, Shibuya N. Trends in postoperative infection rates and their relationship to glycosylated hemoglobin levels in diabetic patients undergoing foot and ankle surgery. J Foot Ankle Surg 2014;53:307-11. https://doi.org/10.1053/j.jfas.2013.10.003
  25. Halkos ME, Puskas JD, Lattouf OM, Kilgo P, Kerendi F, Song HK, et al. Elevated preoperative hemoglobin A1c level is predictive of adverse events after coronary artery bypass surgery. J Thorac Cardiovasc Surg 2008;136:631-40. https://doi.org/10.1016/j.jtcvs.2008.02.091
  26. Dronge AS, Perkal MF, Kancir S, Concato J, Aslan M, Rosenthal RA. Long-term glycemic control and postoperative infectious complications. Arch Surg 2006;141:375-80. https://doi.org/10.1001/archsurg.141.4.375
  27. Lee JK, Kim HD, Lim SC. Predisposing factors of complicated deep neck infection: an analysis of 158 cases. Yonsei Med J 2007;48:55-62. https://doi.org/10.3349/ymj.2007.48.1.55
  28. Rega AJ, Aziz SR, Ziccardi VB. Microbiology and antibiotic sensitivities of head and neck space infections of odontogenic origin. J Oral Maxillofac Surg 2006;64:1377-80. https://doi.org/10.1016/j.joms.2006.05.023
  29. Wills PI, Vernon RP Jr. Complications of space infections of the head and neck. Laryngoscope 1981;91:1129-36.
  30. Beck HJ, Salassa JR, McCaffrey TV, Hermans PE. Life-threatening soft-tissue infections of the neck. Laryngoscope 1984;94:354-62.
  31. Zheng L, Yang C, Kim E, Zhang W, Cai X, Jiang B, et al. The clinical features of severe multi-space infections of the head and neck in patients with diabetes mellitus compared to non-diabetic patients. Br J Oral Maxillofac Surg 2012;50:757-61. https://doi.org/10.1016/j.bjoms.2012.01.019
  32. Liu R, Desta T, He H, Graves DT. Diabetes alters the response to bacteria by enhancing fibroblast apoptosis. Endocrinology 2004;145:2997-3003. https://doi.org/10.1210/en.2003-1601
  33. Naguib G, Al-Mashat H, Desta T, Graves DT. Diabetes prolongs the inflammatory response to a bacterial stimulus through cytokine dysregulation. J Invest Dermatol 2004;123:87-92. https://doi.org/10.1111/j.0022-202X.2004.22711.x
  34. Huang TT, Liu TC, Chen PR, Tseng FY, Yeh TH, Chen YS. Deep neck infection: analysis of 185 cases. Head Neck 2004;26:854-60. https://doi.org/10.1002/hed.20014
  35. Sahly H, Podschun R, Ullmann U. Klebsiella infections in the immunocompromised host. Adv Exp Med Biol 2000;479:237-49.
  36. Leibovici L, Yehezkelli Y, Porter A, Regev A, Krauze I, Harell D. Influence of diabetes mellitus and glycaemic control on the characteristics and outcome of common infections. Diabet Med 1996;13:457-63. https://doi.org/10.1002/(SICI)1096-9136(199605)13:5<457::AID-DIA83>3.0.CO;2-T
  37. Gallacher SJ, Thomson G, Fraser WD, Fisher BM, Gemmell CG, MacCuish AC. Neutrophil bactericidal function in diabetes mellitus: evidence for association with blood glucose control. Diabet Med 1995;12:916-20. https://doi.org/10.1111/j.1464-5491.1995.tb00396.x

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