Risk factors for the emergence of multidrug-resistant bacteria in patients with head and neck infections: a retrospective analysis

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Background: The emergence and spread of multidrug-resistant (MDR) pathogens have been linked to excessive antibiotic use, as well as patient-related factors such as hospitalization. This study investigated the clinical determinants of antimicrobial resistance (AMR) and the occurrence of MDR bacteria. Methods: We evaluated 4,492 bacterial isolates from 1,719 patients and analyzed the association between resistance levels and various patient-related factors, including age, primary diagnosis, comorbidities, oral hygiene, smoking, alcohol use, and prior antibiotic therapy. AMR rate was graded from 0 to 3, and a mixed-effect continuation ratio was used for the analysis. Results: Patients with oral cancer (OR 1.38, 95% CI 1.06-1.80), a history of smoking (OR 1.19, 95% CI 1.01-1.41), immunosuppressive therapy (OR 1.36, 95% CI 1.06-1.75), insulin-treated diabetes (OR 1.57, 95% CI 1.05-2.35), or cardiovascular disease (OR 1.28, 95% CI 1.02-1.61) had significantly higher risk of infection with MDR bacteria. Prior antibiotic use (OR 1.44, 95% CI 1.24-1.68), older age (OR 1.01, 95% CI 1.00-1.01), and female sex (OR 1.28, 95% CI 1.09-1.49) were also significantly associated with progression to multidrug resistance. Conclusions: These findings suggest that, beyond selective pressure from antibiotics, individual patient characteristics may also contribute to the development of MDR bacteria in head and neck infections and. Clinicians should consider these factors during hospitalization, particularly regarding infection prevention and the responsible selection of antibiotics.

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