Are Deep Odontogenic Infections Associated With an Increased Risk for Sepsis?

Austin T Bond; Yasmine S Soubra; Umaymah Aziz; Andrew M Read-Fuller; Likith V Reddy; Matthew J Kesterke; Dina Amin

doi:10.1016/j.joms.2024.03.028

Are Deep Odontogenic Infections Associated With an Increased Risk for Sepsis?

J Oral Maxillofac Surg. 2024 Mar 28:S0278-2391(24)00210-6. doi: 10.1016/j.joms.2024.03.028. Online ahead of print.

Authors

Austin T Bond¹, Yasmine S Soubra², Umaymah Aziz², Andrew M Read-Fuller³, Likith V Reddy⁴, Matthew J Kesterke⁵, Dina Amin⁶

Affiliations

¹ Dental Student Researcher, Department of Oral & Maxillofacial Surgery, Texas A&M School of Dentistry, Dallas, TX.
² Medical Student Researcher, Department of Surgery, Texas A&M School of Medicine, Dallas, TX.
³ Clinical Assistant Professor, Residency Program Director, Department of Oral and Maxillofacial Surgery, Texas A&M University, Dallas, TX.
⁴ Clinical Professor, Chair of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Texas A&M University, Dallas, TX.
⁵ Assistant Professor, Director of Research, Department of Orthodontics, Texas A&M University School of Dentistry, Dallas, TX.
⁶ Associate Professor, Residency Program Director, Department of Oral and Maxillofacial Surgery, University of Rochester, Rochester, NY. Electronic address: drdamin3@gmail.com.

PMID: 38621664
DOI: 10.1016/j.joms.2024.03.028

Abstract

Background: Quick Sequential Organ Failure Assessment (qSOFA) is recommended to identify sepsis. Odontogenic infection (OI) can progress to sepsis, causing systematic inflammatory complications or organ failure.

Purpose: The purpose of the study was to measure the association between OI location and risk for sepsis at admission.

Study design, setting, and sample: This retrospective cohort study included subjects treated for OI at Baylor University Medical Center in Dallas, TX, from January 9, 2019 to July 30, 2022. Subjects > 18 years old who were treated under general anesthesia were included. OI limited to periapical, vestibular, buccal, and/or canine spaces were excluded from the sample.

Predictor variable: The primary predictor variable was OI anatomic location (superficial or deep). Superficial OI infection includes submental, submandibular, sublingual, submasseteric, and/or superficial temporal spaces. Deep OI includes pterygomandibular, deep temporal, lateral pharyngeal, retropharyngeal, pretracheal, and/or prevertebral.

Main outcome variables: The primary outcome variable was risk for sepsis measured using a qSOFA score (0 to 3). A higher score (>0) indicates the patient has a high risk for sepsis.

Covariates: Covariates were demographics, clinical, laboratory, and radiological findings, antibiotic route, postoperative endotracheal intubation, tracheostomy, intensive care unit, admission, and length of stay.

Analyses: Descriptive and bivariate analyses were performed. A χ² test was used for categorical variables. The Mann-Whitney U test was used for continuous variables. Statistical significance was P < .05.

Results: The sample was composed of 168 subjects with a mean age of 42.8 ± 21.5 and 69 (48.6%) subjects were male. There were 11 (6.5%) subjects with a qSOFA score > 0. The relative risk of a qSOFA > 0 for a deep OI is 5.4 times greater than for a superficial OI (136 (95.8) versus 21 (80.8%): RR (95% confidence interval): 5.4 (1.51 to 19.27), P = .004). After adjusting for age, sex, American Society of Anesthesiologists score, and involved anatomical spaces, there was a significant correlation between laterality and the number of involved anatomical spaces and qSOFA score (odd ratio = 9.13, 95% confidence interval: 2.48 to 33.55, adjusted P = <.001).

Conclusion and relevance: The study findings suggest that the OI location is associated with the qSOFA score >0.