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Faizal B, Nair L, Pavithran J, Moni M, Sheejamol VS. Role of surgery along with antimicrobials in refractory skull base osteomyelitis-A prospective observational study. Clin Otolaryngol 2024. [PMID: 38829037 DOI: 10.1111/coa.14188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/21/2024] [Accepted: 05/18/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Study aimed to ole of surgery along with antimicrobials to improve clinical outcomes in treating refractory cases of skull base osteomyelitis (SBO). METHODS A prospective observational study in a tertiary care centre with 70 SBO patients meeting eligibility criteria. The study population comprised 35 patients refractory to systemic antimicrobials of at least 4 weeks duration who later underwent surgery in addition to medication (surgical group). They were compared with a medical group that responded to medications alone. The outcome variables studied were the resolution of clinical features (pain, discharge, radiology, and inflammatory markers), culture yield, and total duration of treatment. RESULTS According to our study, relief of pain was faster in the surgical group (1.66 against 4.57 months) with statistical significance (p < 0.001). Relief of symptoms (p < 0.001), radiological improvement (p = 0.001), and normalising of inflammatory markers (p < 0.001) were better in the surgical group than in the medical group. The duration of treatment was an average of 9.2 months in the surgical group compared to 11.3 months in the medical group (p = 0.019). Microbial culture from deep tissue sampling was positive in 24 surgical patients (68.57%). CONCLUSIONS The treatment response in selected patients of refractory SBO who underwent surgery along with antimicrobials was better than the group who responded to antimicrobials alone. Surgery provided higher microbial yield resulting in culture-specific antimicrobials. The surgical group observed faster relief of symptoms, reduced hospital stay, and total treatment duration.
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Affiliation(s)
- Bini Faizal
- Department of ENT, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeedham University, Kochi, India
| | - Lakshmi Nair
- Department of ENT, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeedham University, Kochi, India
| | - Jayanthy Pavithran
- Department of ENT, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeedham University, Kochi, India
| | - Merlin Moni
- Division of Infectious Diseases, Department of General Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeedham University, Kochi, India
| | - V S Sheejamol
- Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeedham University, Kochi, India
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Wareham D, Melzer M. Clinical outcomes in OPAT patients treated with ceftriaxone 4 g and ceftazidime 6 g extended interval dosing regimens. JAC Antimicrob Resist 2024; 6:dlae079. [PMID: 38817948 PMCID: PMC11138961 DOI: 10.1093/jacamr/dlae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/05/2024] [Indexed: 06/01/2024] Open
Abstract
Background New dosing regimens for ceftriaxone 4 g/24 hours and ceftazidime 3 g/12 hours are convenient for patients receiving OPAT. To date, these have not been clinically validated. Aim To assess the tolerability, toxicity and effectiveness of once daily ceftriaxone (4 g) and 12 hourly ceftazidime regimens (3 g twice a day) in the OPAT setting. Patients and methods From April 2018 until March 2023; demographic, clinical, microbiological and outcome data were collected on all adult patients discharged to a community-based OPAT team in East London. Results There were 487 OPAT episodes. Fifty-three (10.9%) patients received ceftriaxone 4 g once a day and 20 (4.1%) ceftazidime 3 g twice a day. In the ceftriaxone group, the commonest conditions treated were orthopaedic, neurosurgical or diabetic foot infections. OPAT was used to expedite the discharge of 45 (84.9%) patients, the remainder were admission avoidance episodes. The commonest isolate causing infection was MSSA 23 (43.4%). There were no tolerability or toxicity episodes recorded. All patients were cured and bed days saved were 1266.In the smaller twice-daily ceftazidime cohort, seven (35%) patients were treated for necrotizing otitis externa, six (30%) for bronchiectasis and six (30%) for urinary tract infections. The commonest cause of infection was P. aeruginosa, 18 (90%). One case of nephrotoxicity was recorded. All patients were cured and bed days saved were 896. Conclusions Regimens of ceftriaxone 4 g once a day and ceftazidime 3 g twice a day were well tolerated and highly effective. If widely adopted, these regimens will save OPAT and nursing time and enable more patients to be treated.
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Affiliation(s)
- David Wareham
- Senior Clinical Lecturer in Microbiology, Queen Mary University London, Mile End Rd., London E1 4NS, UK
| | - Mark Melzer
- Consultant in Microbiology and Infectious Diseases, Whipps Cross University Hospitals, Whipps Cross Rd., London E11 1NR, UK
- Honorary Senior Lecturer in Microbiology, Queen Mary University London, Mile End Rd., London E1 4NS, UK
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Krawiec E, Brenet E, Truong F, Nguyen Y, Papthanassiou D, Labrousse M, Dubernard X. Epidemiology and risk factors for extension of necrotizing otitis externa. Eur Arch Otorhinolaryngol 2024; 281:2383-2394. [PMID: 38499694 DOI: 10.1007/s00405-024-08549-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/12/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Necrotizing otitis externa (OEN) is an aggressive and morbid infection of the external acoustic meatus. What are the risk factors for OEN extension? METHODS French monocentric retrospective study (2004-2021), including patients with OEN defined by the association of an inflamed EAM, a positive nuclear imaging, the presence of a bacteriological sample and the failure of a well-followed local and/or general antibiotic treatment. OEN was extensive if it was associated with vascular or neurological deficits, if nuclear imaging fixation and/or bone lysis extended beyond the tympanic bone. RESULTS Our population (n = 39) was male (74%), type 2 diabetic (72%), aged 75.2 years and pseudomonas aeruginosa was found in 88% of cases. Complications for 43% of patients were extensive fixation on nuclear imaging, for 21% of them the presence of extensive bone lysis, for 13% the appearance of facial palsy, for 5.3% the presence hypoglossal nerve palsy and for 2.5% the presence of thrombophlebitis or other nerves palsies. 59% of our population had extensive OEN. The diagnosis of the extensive OEN was made 22 days later (p = 0.04). The clinical presentation was falsely reassuring due to easier identification of the tympanic membrane (70% vs 46%, p = 0.17) but associated with periauricular oedema (42% vs 0%), bone exposure (16% vs 0%) and a temporomandibular joint pain (41% vs 12%). CONCLUSION Delayed treatment of OEN, identification of clinical bone lysis, especially when the tympanic membrane is easily visualized, and the presence of unbalanced diabetes are potential risk factors for extension of OEN.
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Affiliation(s)
- Elise Krawiec
- Departments of Oto-Rhino-Laryngology, University Hospital of Reims, Rue du Général Koenig, 51100, Reims, France
| | - Esteban Brenet
- Departments of Oto-Rhino-Laryngology, University Hospital of Reims, Rue du Général Koenig, 51100, Reims, France
| | - France Truong
- Departments of Oto-Rhino-Laryngology, University Hospital of Reims, Rue du Général Koenig, 51100, Reims, France
| | - Yohan Nguyen
- Department of Internal Medicine, Infectious Diseases and Clinical Immunology, University Hospital of Reims, Reims, France
| | | | - Marc Labrousse
- Departments of Oto-Rhino-Laryngology, University Hospital of Reims, Rue du Général Koenig, 51100, Reims, France
| | - Xavier Dubernard
- Departments of Oto-Rhino-Laryngology, University Hospital of Reims, Rue du Général Koenig, 51100, Reims, France.
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Lodhi S, Timms S, Stapleton E. A systematic review of antimicrobial treatment regimens and their outcomes in necrotising otitis externa. J Laryngol Otol 2024; 138:120-129. [PMID: 37767726 DOI: 10.1017/s0022215123001664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND Necrotising otitis externa is a serious infection with minimal evidence underpinning its management. This review aims to synthesise published evidence of antimicrobial therapies and their outcomes in necrotising otitis externa. METHODS The review was PROSPERO registered (CRD42022353244) and conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses ('PRISMA') guidelines. A robust search strategy filtered 28 manuscripts into the final review. Antimicrobial therapy and clinical outcome data were extracted and analysed. RESULTS Published studies are heterogeneous, with high risk of bias and low certainty. Reporting of outcomes is poor and extremely variable. First-line therapy is most commonly in-patient (95 per cent) empiric fluoroquinolone (68 per cent) delivered intravenously (82 per cent). The lack of granular data and poor outcome reporting mean it is impossible to correlate treatment strategies with clinical outcomes. CONCLUSION Robust, consistent outcome reporting with reference to treatments administered is mandatory, to inform clinical management and optimise future research. Optimal antimicrobial choices and treatment strategies require clarification through prospective clinical trials.
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Affiliation(s)
- Sirat Lodhi
- Department of Otolaryngology, Manchester Royal Infirmary, Oxford Road, Manchester, UK
| | - Sara Timms
- Department of Otolaryngology, Manchester Royal Infirmary, Oxford Road, Manchester, UK
| | - Emma Stapleton
- Department of Otolaryngology, Manchester Royal Infirmary, Oxford Road, Manchester, UK
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Vosbeek EGM, Straatman LV, Braat AJAT, de Keizer B, Thomeer HGXM, Smit AL. Management and Outcomes of Necrotizing Otitis Externa: A Retrospective Cohort Study in a Tertiary Referral Center. OTOLOGY & NEUROTOLOGY OPEN 2023; 3:e042. [PMID: 38516544 PMCID: PMC10950167 DOI: 10.1097/ono.0000000000000042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 10/09/2023] [Indexed: 03/23/2024]
Abstract
Objectives Necrotizing otitis externa (NOE) is a rare infection of the ear that causes osteomyelitis. We aimed to evaluate treatment outcomes and the role of imaging in diagnosing and monitoring disease resolution in a single-center study of patients with NOE. Methods In this retrospective cohort study, patients with NOE who were diagnosed and treated in a tertiary otology center in Utrecht, The Netherlands, between January 1, 2013 and August 1, 2022, were included. Data were retrieved from the medical records on demographics, symptoms, physical and diagnostic findings, type and duration of treatment, and course of disease. Results A total of 24 cases were included. Patients were often elderly (mean age = 75 years) and diabetic (88%). Pseudomonas aeruginosa was the most commonly found microorganism (63%). Twenty-two cases (92%) received intravenous antibiotic treatment, and 7 cases (29%) received additional systemic antifungal treatment. The mean duration of systemic treatment was 29 weeks. In 20 out of 22 cases (91%), imaging was used to determine the end point of treatment. None of the cases with a total resolution of disease activity (n = 5) on 18F-fluorodeoxyglucose-positron emission tomography-computed tomography imaging at the time of cessation of therapy showed clinical relapse, compared with 1 out of 4 cases on gallium single-photon emission computerized tomography. Conclusion Based on the experience from our center, we demonstrated that patients with NOE can successfully be treated with prolonged systemic treatment. Molecular imaging is reasonably successful for disease evaluation and decision-making on the eradication of disease.
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Affiliation(s)
- Eleonora G M Vosbeek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Centre Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Louise V Straatman
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Centre Utrecht, Heidelberglaan, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Centre Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Hans G X M Thomeer
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Centre Utrecht, Heidelberglaan, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Centre Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Adriana L Smit
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Centre Utrecht, Heidelberglaan, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Centre Utrecht, Heidelberglaan, Utrecht, The Netherlands
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Owen E, Abrar R, Stapleton E. Patients' experience of necrotising otitis externa: a qualitative study. J Laryngol Otol 2023; 137:356-362. [PMID: 35343410 DOI: 10.1017/s0022215122000858] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Necrotising otitis externa is a serious infective condition. Patients are typically frail, diagnostic delay is common and severe pain is a key feature. This study aimed to qualitatively analyse patient-centred data to identify key themes in the patient's experience. METHODS Open-ended questionnaires were sent to 28 patients. Responses were qualitatively analysed using a grounded theory approach. Iterative cycles were used to develop codes using a constant comparison technique. Emerging categories were refined to identify core themes. RESULTS Four main themes emerged: severe pain, mental health, quality of life and diagnostic delays. CONCLUSION This is the first study to explore patients' perspectives in necrotising otitis externa. It indicates a need to raise awareness of necrotising otitis externa, and to improve symptom management, pain control and quality of life. This valuable information can be used to identify research priorities, guide service improvements, improve clinical care and feed into the development of a Core Outcome Set for necrotising otitis externa.
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Affiliation(s)
- E Owen
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
| | - R Abrar
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
| | - E Stapleton
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
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Characteristics, management and outcome of a large necrotising otitis externa case series: need for standardised case definition. J Laryngol Otol 2022; 136:604-610. [PMID: 35042578 PMCID: PMC9257435 DOI: 10.1017/s002221512100462x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackgroundNecrotising otitis externa is a severe ear infection for which there are no established diagnostic or treatment guidelines.MethodThis study described clinical characteristics, management and outcomes for patients managed as necrotising otitis externa cases at a UK tertiary referral centre.ResultsA total of 58 (63 per cent) patients were classified as definite necrotising otitis externa cases, 31 (34 per cent) as probable cases and 3 (3 per cent) as possible cases. Median duration of intravenous and oral antimicrobial therapy was 6.0 weeks (0.49–44.9 weeks). Six per cent of patients relapsed a median of 16.4 weeks (interquartile range, 23–121) after stopping antimicrobials. Twenty-eight per cent of cases had complex disease. These patients were older (p = 0.042), had a longer duration of symptoms prior to imaging (p < 0.0001) and higher C-reactive protein at diagnosis (p = 0.005). Despite longer courses of intravenous antimicrobials (23 vs 14 days; p = 0.032), complex cases were more likely to relapse (p = 0.016).ConclusionA standardised case-definition of necrotising otitis externa is needed to optimise diagnosis, management and research.
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Danjou W, Chabert P, Perpoint T, Pradat P, Miailhes P, Boibieux A, Becker A, Fuchsmann C, Laurent F, Tringali S, Roux S, Triffault-Fillit C, Valour F, Ferry T. Necrotizing external otitis: analysis of relapse risk factors in 66 patients managed during a 12 year period. J Antimicrob Chemother 2022; 77:2532-2535. [PMID: 35696322 DOI: 10.1093/jac/dkac193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/16/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Necrotizing external otitis (NEO) is a severe infection of the skull base that occurs generally in the elderly and/or in diabetic recipients. There are few data in the literature about the therapeutic management of this complex bone infection. OBJECTIVES To analyse relapses after NEO treatment completion, and to describe the clinical features of NEO. METHODS We performed a retrospective cohort study in the Lyon regional reference centre for the management of complex bone and joint infections. Consecutive cases of NEO from 1 January 2006 to 31 December 2018 were included. The primary outcome was the relapse of NEO. Variables were analysed using Cox regression survival analysis with adjusted hazard ratio (aHR) and Kaplan-Meier curve. RESULTS Sixty-six patients were included. Median age was 75 (IQR 69-81) years and 46 (70%) patients were diabetic. Eleven patients (17%) had temporomandibular arthritis, 10 (15%) cranial nerve paralysis, 2 (3%) cerebral thrombophlebitis, and 2 (3%) contiguous abscess. Microbiological documentation was obtained in 56 patients and revealed Pseudomonas aeruginosa in 44/56 patients (79%). Nine (14%) cases had no microbiological documentation. Antibiotic therapy was dual for 63 (95%) patients. During a median follow-up of 27 (IQR 12-40) months, 16 out of 63 (25%) patients experienced a relapse. Fungal infection was significantly associated with relapse [aHR 4.1 (95% CI 1.1-15); P = 0.03]. CONCLUSIONS NEO is a severe bone infection, mainly (but not exclusively) caused by P. aeruginosa, which occurs in elderly and diabetic recipients. Fungal infections at baseline significantly impact the outcome.
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Affiliation(s)
- William Danjou
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France
| | - Paul Chabert
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France
| | - Thomas Perpoint
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France
| | - Pierre Pradat
- Hospices Civils de Lyon, Centre de recherche clinique, Groupement Hospitalier Nord, Lyon, France
| | - Patrick Miailhes
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France
| | - André Boibieux
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France
| | - Agathe Becker
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France
| | - Carine Fuchsmann
- Hospices Civils de Lyon, Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, Hôpital de la Croix Rousse, Lyon, France
| | - Frédéric Laurent
- Hospices Civils de Lyon, Laboratoires de bactériologie, Institut des Agents Infectieux, Hôpital de la Croix Rousse, Lyon, France
| | - Stephane Tringali
- Hospices Civils de Lyon, Chirurgie maxillo-faciale, stomatologie, chirurgie orale et chirurgie plastique de la face, Centre Hospitalier Lyon Sud, Pierre Bénite, France.,Université Claude-Bernard-Lyon 1, Lyon, France
| | - Sandrine Roux
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France
| | - Claire Triffault-Fillit
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France
| | - Florent Valour
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France.,Université Claude-Bernard-Lyon 1, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Tristan Ferry
- Hospices Civils de Lyon, Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, Auvergne-Rhône-Alpes, France.,Université Claude-Bernard-Lyon 1, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
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Emerging themes in necrotising otitis externa: a scoping review of the literature 2011-2020 and recommendations for future research. The Journal of Laryngology & Otology 2021; 136:575-581. [PMID: 34666847 DOI: 10.1017/s0022215121003030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Frost J, Samson AD. Standardised treatment protocol for necrotizing otitis externa: retrospective case series and systematic literature review. J Glob Antimicrob Resist 2021; 26:266-271. [PMID: 34273591 DOI: 10.1016/j.jgar.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/13/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES There is currently no consensus on the most effective treatment protocol for necrotizing otitis externa (NOE). This article aims to produce a NOE treatment protocol from the literature and clinical experience. METHODS A total of 26 case series from the literature were reviewed in combination with a retrospective case series of inpatients from Hull University Teaching Hospitals NHS Trust from 2013-2018. Over 5 years, 40 patients were identified, with only 29 being analysed due to unavailable or incomplete case notes. RESULTS In the literature review, the most common bacterial species causing NOE was Pseudomonas aeruginosa. Resistance to ciprofloxacin was prevalent, however multidrug resistance was rare. Ciprofloxacin and ceftazidime were the most widely used antibiotics. No ceftazidime resistance was reported in the literature or in our cohort. The average age of the patients in our cohort was 80 years. Moreover, 62% had either diabetes mellitus or were immunosuppressed. One patient died directly due to NOE-related sepsis. Intravenous ceftazidime monotherapy was mostly used. The duration of treatment was 6-7 weeks, with no relapses documented. CONCLUSION Ceftazidime monotherapy was an effective empirical treatment in our cohort, and a total duration of 6-7 weeks of antibiotics was sufficient. We have created a standardised treatment protocol based on our findings that will need to be validated in a larger cohort of patients.
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Affiliation(s)
- James Frost
- Hull York Medical School, John Hughlings Building, University Road, Heslington, York YO10 5DD, UK; Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, UK; Department of Infection, Hull University Teaching Hospitals, Castle Hill Hospital, Hull, East Yorkshire HU16 5JQ, UK.
| | - Anda D Samson
- Hull York Medical School, John Hughlings Building, University Road, Heslington, York YO10 5DD, UK; Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, UK; Department of Infection, Hull University Teaching Hospitals, Castle Hill Hospital, Hull, East Yorkshire HU16 5JQ, UK
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Horna G, Ruiz J. Type 3 secretion system of Pseudomonas aeruginosa. Microbiol Res 2021; 246:126719. [PMID: 33582609 DOI: 10.1016/j.micres.2021.126719] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 12/27/2022]
Abstract
Pseudomonas aeruginosa is an opportunistic pathogen, mainly affecting severe patients, such as those in intensive care units (ICUs). High levels of antibiotic resistance and a long battery of virulence factors characterise this pathogen. Among virulence factors, the T3SS (Type 3 Secretion Systems) are especially relevant, being one of the most important virulence factors in P. aeruginosa. T3SS are a complex "molecular syringe" able to inject different effectors in host cells, subverting cell machinery influencing immune responses, and increasing bacterial survival rates. While T3SS have been largely studied and the molecular structure and main effector functions have been established, a series of questions and further points remain to be clarified or established. The key role of T3SS in P. aeruginosa virulence has resulted in the search for T3SS-targeting molecules able to impair their functions and subsequently improve patient outcomes. This review aims to summarise the most relevant features of the P. aeruginosa T3SS.
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Affiliation(s)
- Gertrudis Horna
- Universidad Catolica Los Angeles de Chimbote, Instituto de Investigación, Chimbote, Peru.
| | - Joaquim Ruiz
- Laboratorio de Microbiología Molecular y Genómica Bacteriana, Universidad Científica del Sur, Panamericana Sur, Km 19, Lima, Peru.
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Olzowy B, Al-Nawas B, Havel M, Karbach J, Müller R. Calculated parenteral initial treatment of bacterial infections: Infections in the ear, nose, throat and mouth and jaw area. GMS INFECTIOUS DISEASES 2020; 8:Doc14. [PMID: 32373439 PMCID: PMC7186809 DOI: 10.3205/id000058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This is the sixth chapter of the guideline "Calculated initial parenteral treatment of bacterial infections in adults - update 2018" in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience. The chapter deals with the antibacterial treatment of more severe infections of the ear, the nose, the throat and the maxillofacial region, including odontogenic and salivary gland infections.
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Affiliation(s)
| | - Bilal Al-Nawas
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsmedizin Mainz, Germany
| | - Miriam Havel
- Klinik und Poliklinik für HNO-Heilkunde, Klinikum der Universität München, Munich, Germany
| | - Julia Karbach
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsmedizin Mainz, Germany
| | - Rainer Müller
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Carl Gustav Carus Dresden, Germany
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Malignant otitis externa, an increasing burden in the twenty-first century: review of cases in a UK teaching hospital, with a proposed algorithm for diagnosis and management. J Laryngol Otol 2019; 133:356-362. [DOI: 10.1017/s0022215119000604] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractBackgroundMalignant otitis externa is a potentially fatal infection of the skull base. With an ageing population and increasing prevalence of diabetes, the incidence of malignant otitis externa in the British population is rising. To date, there remain no accepted diagnostic criteria, few prognostic indicators and no consensus treatment pathways.MethodA prospective case series was conducted at a tertiary referral teaching hospital.ResultsA cohort of susceptible individuals predominates (elderly, male, with immunosuppression and diabetes), with 25 per cent reporting a preceding incident. Otorrhoea, otalgia and canal granulation were the commonest presenting features, alongside positive pseudomonas cultures. No clear markers for predicating disease severity were isolated; however, a high initial haemoglobin A1c level demonstrated a significant moderately positive correlation with length of treatment.ConclusionA treatment pathway designed to provide a standardised approach to investigation and treatment is proposed, which aims to increase earlier diagnosis, streamline care and facilitate the development of best practice.
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Chawdhary G, Pankhania M, Douglas S, Bottrill I. Current management of necrotising otitis externa in the UK: survey of 221 UK otolaryngologists. Acta Otolaryngol 2017; 137:818-822. [PMID: 28301961 DOI: 10.1080/00016489.2017.1295468] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Necrotising otitis externa (NOE) is a rare infection causing skull base osteomyelitis. The evidence regarding NOE consists mostly of case series. Hence, there is a limited evidence base to guide decision-making. This survey aims to report the experience of 221 otolaryngologists in this condition. MATERIALS AND METHODS Internet survey administered to the membership of the British Association of Otorhinolaryngology - Head and Neck Surgery (ENT UK). RESULTS Respondents' detailed replies on diagnosis, treatment and follow up are presented. One third of respondents reported increasing incidence of NOE. Over 80% diagnosed NOE based on pre-existing risk factors, severe pain, non-resolution of infection and CT scan. Most respondents managed NOE with intravenous antibiotics (90%) and blood sugar control (82%). There was less agreement in certain aspects of management including the role of surgery and the nature and duration of follow up. CONCLUSIONS Our survey provides a picture of NOE management in the UK. While there is consensus in some aspects of NOE management, other aspects attract widely differing answers. This may reflect the lack of strong evidence in the literature. Future work should aim to address this.
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Affiliation(s)
- Gaurav Chawdhary
- Department of Otolaryngology, Milton Keynes University Hospital, Milton Keynes, UK
| | - Miran Pankhania
- ENT Department, Rotherham District General Hospital, Rotherham, UK
| | - Susan Douglas
- ENT Department, Rotherham District General Hospital, Rotherham, UK
| | - Ian Bottrill
- Department of ENT, John Radcliffe Hospital, Oxford, UK
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