October 8, 2025Open Access

Delayed Clinical Response of Deep Facial Infections Due to Prior Unregulated Antibiotics Use Assessed By CRP Levels In A Tertiary Care Hospital

NRNuzhat RahilLady Reading Hospital SWSana WazirLady Reading Hospital AIA. F. Md. Hassan IftekharLady Reading Hospital

Key Points

Delayed resolution of infections leads to longer hospital stays and increased costs, impacting healthcare efficiency.
Assessing CRP levels revealed that 54.3% of patients had poor responses to initial treatments due to prior unregulated antibiotic use.
Initial CRP levels averaged 15.46 mg/dl on admission, decreasing to 3.2 mg/dl post-adjustment of antibiotics, indicating treatment effectiveness.
65.7% of patients reported previous unregulated antibiotic use, highlighting a significant public health concern regarding antibiotic resistance.

Abstract

OBJECTIVES This study aimed to assess the efficacy of serum CRP levels as monitoring tools for patients with fascial space infections who had a delayed clinical response to initial treatment, as per guidelines, due to prior unregulated antibiotics. METHODOLOGY This case series study was conducted at Lady Reading Hospital’s Department of Oral and Maxillofacial Surgery and Ophthalmology from January 2024 to March 2025, with ethics approval and informed consent obtained from 35 participants with fascial space infections requiring hospitalization and prior antibiotic use. Those with recurrent infections, trauma, or chronic conditions were excluded. Diagnosis involved a comprehensive history, clinical examination, and imaging studies (OPG for odontogenic infections and CT for non-odontogenic infections). Infection severity was tracked through C-reactive protein (CRP) levels measured at admission, day three, and discharge. Initial treatment followed clinical guidelines, utilizing first-line antibiotics and incision and drainage. If CRP levels did not decrease, the antibiotic regimen was adjusted, leading to improved outcomes. Data were analyzed using SPSS. RESULTSThe most commonly involved space was the submandibular space (31%), followed by unilateral and bilateral submandibular, sublingual, and submental spaces (20%). Orbital cellulitis was observed in 17% of patients. When asked about the prior unregulated use of antibiotics, 65.7% of patients admitted to having used them. The Mean CRP on the day of admission was 15.46 mg/dl with a SD of 6.42. The follow-up means CRP on the 3rd day of admission was 15.17mg/dl with SD 9.77, showing a poor response to initial treatment in 54.3% of the patients. The mean CRP on the day of discharge and after the change of antibiotic was markedly reduced, with a mean of 3.2mg/dl and SD of 3.7, showing resolution of infection. CONCLUSION Delays in infection resolution lead to longer hospital stays and increased antibiotic resistance. Urgent action is needed to establish national antibiotic programs, implement public awareness campaigns, and enforce stricter regulations on antibiotic use to improve outcomes and reduce antibiotic resistance.

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