Evaluation of Antibiotic Appropriateness Assessed by Changes in C-Reactive Protein (CRP) Levels in Patients with Deep Neck Abscesses
DOI:
https://doi.org/10.65310/bf0cdr25Keywords:
Deep Neck Abscess, C-Reactive Protein, Antibiotic Appropriateness, Microbiological Concordance, Inflammatory Kinetics.Abstract
Deep neck abscesses are potentially life-threatening infections requiring prompt surgical drainage and appropriate antimicrobial therapy. This retrospective analytic study evaluated antibiotic appropriateness using early changes in C-reactive protein (CRP) levels as a biomarker of therapeutic response. From 38 eligible cases, 19 patients with confirmed bacterial isolates and documented antibiotic sensitivity results were included. Patients were stratified according to concordance between empirical antibiotics and culture sensitivity findings. Gram-positive organisms predominated (68.42%), with Streptococcus anginosus identified most frequently (36.84%). In the culture-concordant group, mean CRP decreased from 23.10 mg/L to 10.13 mg/L within 72 hours (mean reduction 12.97 mg/L; p=0.001), exceeding the minimal clinically important difference (2.85 mg/L). In contrast, the discordant group demonstrated a non-significant reduction from 14.10 mg/L to 9.43 mg/L (mean reduction 4.67 mg/L; p=0.206). These findings indicate that CRP kinetics provide quantifiable evidence of antibiotic appropriateness and may serve as an objective adjunct in guiding early antimicrobial stewardship in deep neck abscess management.
Downloads
References
Al-jumah, R., Gill, J., & Simopoulos, T. (2022). Interventional Pain Medicine Cervical spinal cord stimulator trial complicated by epidural abscess. Interventional Pain Medicine, 1(4), 100156. https://doi.org/10.1016/j.inpm.2022.100156
Almuqamam, M., Gonzalez, F. J., & Kondamudi, N. P. (2024). Deep neck infections. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513262/
Almekkawi, A. K., Caruso, J. P., Anand, S., Hawkins, A. M., Rauf, R., Al-shaikhli, M., Aoun, S. G., & Bagley, C. A. (2025). Comparative Analysis of Large Language Models and Spine Surgeons in Surgical Decision-Making and Radiological Assessment for Spine Pathologies. World Neurosurgery, 194, 123531. https://doi.org/10.1016/j.wneu.2024.11.114
Alvarado, A. P., Machado, J. A. L., Martin, E. C., Quintero, J. Z., Rodriguez, I. A., & Lizarraga, L. L. (2021). Prevalence, morbidity, and mortality of deep neck abscess in a tertiary hospital from Northwestern Mexico. Romanian Journal of Rhinology, 11(41), 41–46. https://doi.org/10.2478/rjr-2021-0008?urlappend=%3Futm_source%3Dresearchgate.net%26utm_medium%3Darticle
Ars, E., Bernis, C., Fraga, G., Furlano, M., Martínez, V., Martins, J., Ortiz, A., Pérez-gómez, M. V., Rodríguez-pérez, J. C., Sans, L., & Torra, R. (2021). Special article Consensus document on autosomal dominant polycystic kindey disease from the Spanish Working Group on Inherited Kindey Diseases . Review 2020. 2(4), 367–389. https://doi.org/10.1016/j.nefroe.2022.11.011
Buckley, J., Harris, A., & Addams-Williams, J. (2019). Ten years of deep neck space abscesses. The Journal of Laryngology & Otology, 133(4), 324–328. https://doi.org/10.1017/s0022215119000458
French, K., Brown, E., Collin, J., & Bell, C. (2017). Extra-oral drainage of submandibular abscess under local anaesthetic: Review of the literature and case series. Oral Surgery, 10(1), 32–37. https://doi.org/10.1111/ors.12212
Haleem, A. H., Shahidi, S., Hilton, J. M., Pringle, M., Biggs, T. C., & Buckland, J. (2025). American Journal of Otolaryngology – Head and Neck Medicine and Surgery Refining necrotising otitis externa management : A follow-up study on a departmental algorithm and the role of nuclear medicine imaging. American Journal of Otolaryngology--Head and Neck Medicine and Surgery, 46(4), 104659. https://doi.org/10.1016/j.amjoto.2025.104659
Hensel, M., Grädel, L., Kutz, A., Haubitz, S., Huber, A., Mueller, B., & Schuetz, P. (2017). Peripheral monocytosis as a predictive factor for adverse outcome in the emergency department: Survey based on a register study. Medicine (Baltimore), 96(28), e7404. https://doi.org/10.1097/md.0000000000007404
Huang, S., Wen, J., Zhang, Y., Bai, X., & Cui, Z. (2023). Choosing the right animal model for osteomyelitis research : Considerations and challenges. Journal of Orthopaedic Translation, 43(October), 47–65. https://doi.org/10.1016/j.jot.2023.10.001
June, F., Carteaux, G., Stephan, E., Frat, P., Cassibba, J., Chevalier, M., Pin, I., & Fauroux, B. (2021). Proceedings of Reanimation 2021 , the French Intensive Care Society International Congress (Vol. 11, Issue Suppl 1). https://doi.org/10.1186/s13613-021-00862-0
Leng, T., Ali, A., & Ct, F. P. E. T. (2025). Spinal epidural abscess in infants : Case report and review of the literature. Medical Reports, 13(June), 100303. https://doi.org/10.1016/j.hmedic.2025.100303
Leon, P., Macedo, D. G., Taborda, M., Falc, V., Satie, A., Kono, G., Frutuoso, L. L., Wagner, D., Lima, D. C., Altruda, F., Costa, D. M., Bridi, F., Andr, M. L., Vidal, E., Francis, D., Freitas, S., Garnica, M., Zancop, R. M., Jesus, M., . . . Magri, C. (2025). Brazilian task force for the management of mucormycosis. The Brazilian Journal of Infectious Diseases, 29(4), 104572. https://doi.org/10.1016/j.bjid.2025.104579
Malavika, G., Sri, S., Ravi, S., Maheswary, D., Leela, K. V., Lathakumari, R. H., & S, L. P. K. (2025). Cancer Pathogenesis and Therapy Role of Candida albicans in chronic in fl ammation and the development of oral squamous cell carcinoma. Cancer Pathogenesis and Therapy, 3(5), 402–410. https://doi.org/10.1016/j.cpt.2025.03.002
Motahari, S. J., Poormoosa, R., Nikkhah, M., Bahari, M., Shirazy, S. M. H., & Khavarinejad, F. (2015). Treatment and prognosis of deep neck infections. Indian Journal of Otolaryngology and Head & Neck Surgery, 67(1), 134–137. https://doi.org/10.1007/s12070-014-0802-7
Mouliou, D. S. (2023). C-reactive protein: Pathophysiology, diagnosis, false test results and a novel diagnostic algorithm for clinicians. Diseases, 11(4), 132. https://doi.org/10.3390/diseases11040132
Rautaporras, N., Uittamo, J., Furuholm, J., & Snäll, J. (2023). Deep odontogenic infections computed tomography imaging-based spreading routes and risk for airway obstruction. Journal of Stomatology, Oral and Maxillofacial Surgery, 124(4), 101424. https://doi.org/10.1016/j.jormas.2023.101424
Ricardo, P., Fachini, R., Criado, J., Ianhez, M., & Amante, H. (2025). Dermatologia Chronic pruritus : a narrative review ଝ. Anais Brasileiros de Dermatologia, 100(3), 487–519. https://doi.org/10.1016/j.abd.2024.09.008
Ricci, F., Anselmo-lima, W. T., Macoto, E., Sakano, E., Cardoso, F., Valera, P., Lessa, M., Roithmann, R., Pignatari, S., Wady, A., Felippu, D., Degen, C., Sol, D., Sim, E., Pinna, F. D. R., Serpa, F. S., Ricci, G., Luz, L., Subtil, G., … Eust, R. (2025). Rhinosinusitis: Evidence and experience – 2024. Brazilian Journal of Otorhinolaryngology, 91(3), 101542. https://doi.org/10.1016/j.bjorl.2025.101595
Rijal, S., & Romdhoni, A. C. (2018). Bacteria pattern, results of antibiotic sensitivity test, and complications of deep neck abscess patients in Dr. Soetomo General Hospital. Biomolecular and Health Science Journal, 1(2), 124–131. https://doi.org/10.20473/bhsj.v1i2.9832
Savran, H. M., & Savran, F. (2025). American Journal of Otolaryngology – Head and Neck Medicine and Surgery Predictive factors for drainage in pediatric cervical lymphadenitis : A study of clinical indicators and recovery outcomes. 46(November 2024), 0–5. https://doi.org/10.1016/j.amjoto.2024.104586
Setiawan, P. D., & Putra, I. D. A. E. (2020). Karakteristik penderita abses submandibula di Departemen THT-KL RSUP Sanglah Denpasar. Medicina, 51(2), 153–158. https://doi.org/10.15562/medicina.v51i2.762
Ullal, A., & Ajith, A. P. (2021). Deep neck abscesses-a diagnostic and therapeutic challenge. International Journal of Otorhinolaryngology and Head and Neck Surgery, 7(11), 1788–1793. https://doi.org/10.18203/issn.2454-5929.ijohns20214232
Yueh, C., Chi, H., & Chiu, N. (2022). ScienceDirect Etiology , clinical features , management , and outcomes of skin and soft tissue infections in hospitalized children : A 10-year review. Journal of Microbiology, Immunology and Infection, 55(4), 728–739. https://doi.org/10.1016/j.jmii.2022.01.007
Zheng, N., Zhu, D., & Han, Y. (2020). Procalcitonin and C-reactive protein perform better than the neutrophil/lymphocyte count ratio in evaluating hospital-acquired pneumonia. BMC Pulmonary Medicine, 20(1), 1–10. https://doi.org/10.1186/s12890-020-01207-6
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Mohammad Dwijo Murdiyo, I Made Indra Wijaya (Author)
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
