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C-reactive protein in predicting the need for reoperation in odontogenic maxillofacial infections requiring hospital care

Abstract number: R2526

Seppänen L., Lauhio A., Lindqvist C., Rautemaa R.

Objectives: Odontogenic infections may lead to hospitalisation and severe infection complications. Although management of these infections with antimicrobial therapy and surgical intervention has a good prognosis, reoperation is occasionally essential for resolution of the infection. Our aim was to find a marker that would identify those patients subsequently requiring reoperation.

Methods: In this retrospective study the medical records of 101 consecutive patients admitted to the Helsinki University Central Hospital due to an odontogenic infection were analysed. This patient series covers all cases of severe odontogenic infections in the Helsinki and Uusimaa Hospital District during 2004 (1.4 million inhabitants). Age, gender, occupational social class, body temperature, WBC counts, CRP levels, focus, fascial spaces involved, need for reoperation, need for intensive care, APACHE II score and length of stay were reviewed.

Results: CRP levels and WBC counts were higher on admission in patients later requiring reoperation (P < 0.0001 and P = 0.0337, respectively), and cut-off values of CRP level >120 mg/L and WBC count >14.0 103/mL were significantly associated with a higher incidence of reoperation (P = 0.0002 and P = 0.0019, respectively). These patients also reached higher CRP levels and WBC counts than patients not requiring reoperation. Interestingly, they reached the maximal body temperature one day later, although admission body temperatures showed no difference. The length of stay was longer and the need for and duration of intensive care were higher in reoperated patients (all P < 0.0001). A multiple space involvement was present more often in patients requiring reoperation (P = 0.0006).

Conclusion: This study shows that C-reactive protein is a valuable diagnostic marker with a cut-off value of 120 mg/L on admission in identifying patients subsequently requiring reoperation due to severe odontogenic maxillofacial infection. A combination of CRP and WBC measurements showed to be more reliable than measurements of WBC only. Fever on admission was not found to be useful in identifying patients later requiring reoperation. These patients are more often in need of intensive care and require longer intensive care and hospital stay. Multiple space involvement was found to predispose to reoperation.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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