Skull base osteomyelitis: Incidence of resistance, morbidity, and treatment strategy. (10th June 2014)

• Record Type: Journal Article
• Authors: Clerc, Nicolas Le; Verillaud, Benjamin; Duet, Michele; Guichard, Jean‐Pierre; Herman, Philippe; Kania, Romain
• Is Part Of: Laryngoscope. Volume 124:Number 9(2014:Sep.)
• Page Start: 2013
• Page End: 2016
• Publication Date: 2014-06-10
• Subjects: Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.24726
• Languages: English
• ISSNs: 0023-852X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="lary24726-sec-0001" sec-type="section"> <title>Objectives/Hypothesis</title> <p>The pathogeny of osteomyelitis of the skull base has evolved over time with the emergence of ciprofloxacin‐resistant <italic>Pseudomonas</italic> strains and significant fungal infections, both of which seem to bring a higher morbidity. The aims of this study were 1) to document the incidence of ciprofloxacin‐resistant <italic>Pseudomonas aeruginosa</italic> over the past 7 years; 2) to assess morbidity by a radiologic score, the occurrence of cranial nerve palsies, and the duration of the hospital stay, according to the pathogenesis; and 3) to propose a treatment strategy.</p> </sec> <sec id="lary24726-sec-0002" sec-type="section"> <title>Study Design</title> <p>Retrospective chart review of necrotizing external otitis cases from 2004 to 2011. The setting was the Department of ENT Surgery, Lariboisière Hospital, Paris.</p> </sec> <sec id="lary24726-sec-0003" sec-type="section"> <title>Methods</title> <p>Thirty‐one patients were included. Radiological scores were assessed based on the initial computed tomography scans or magnetic resonance imaging, which specified the anatomical territory involved. Nerve palsies, the duration of hospitalization, and the radiological scores were analyzed with regard to the pathogen.</p> </sec> <sec id="lary24726-sec-0004" sec-type="section"> <title>Results</title> <p>Twenty‐eight patients had a bacterial disease. Of the 20 strains of <italic>P. aeruginosa</italic> identified, five (25%) were ciprofloxacin‐resistant <italic>P. aeruginosa</italic>. Three patients (10%) had a fungal infection due to <italic>Aspergillus flavus</italic>. Nerve palsies, radiological scores, and hospitalization durations were significantly higher for patients with resistant strains and <italic>A. flavus</italic>.</p> </sec> <sec id="lary24726-sec-0005" sec-type="section"> <title>Conclusions</title> <p>In our series, the prevalence of ciprofloxacin‐resistant <italic>Pseudomonas</italic> strains increased over time. Along with fungal infections, they formed a group with a higher morbidity than that of ciprofloxacin‐sensitive <italic>Pseudomonas</italic> infections that furthermore did not respond to oral outpatient treatment. This is why pathogen identification using biopsies is sometimes required to start a prolonged treatment.</p> </sec> <sec id="lary24726-sec-0006" sec-type="section"> <title>Level of Evidence</title> <p>4 <italic>Laryngoscope</italic>, 124:2013–2016, 2014</p> </sec> </abstract>