Deep neck infections in patients at risk for acquired immunodeficiency syndrome

The acquired immunodeficiency syndrome epidemic has introduced an increasing population of immune-compromised patients susceptible to infections by unusual pathogens. To evaluate the role of traditional antibiotic therapy for deep neck infections in high-risk patients, we reviewed the records of 73 patients with deep neck infections. Forty-six had or were at risk for acquired immunodeficiency syndrome, and nine were diabetics. Staphylococcal infections were more common in the at-risk group, and 24% of staphylococcal isolates in intravenous drug abusers were methicillin-sodium resistant. In addition, Klebsiella was isolated in two of nine diabetic patients. No other clinical differences were noted, and no unusual organisms were isolated from any other patients. Although traditional antibiotic therapy is appropriate for deep neck infections in patients at risk for acquired immunodeficiency syndrome, vancomycin hydrochloride should be considered when staphylococcal infections are suspected in intravenous drug abusers. Since diabetics appear to be susceptible to infections by gram-negative rods, broader antibiotic coverage must be considered in this population.