Kao Richard, Wannemuehler Todd, Yates Charles W, Nelson Rick F
Department of Otolaryngology-Head and Neck Surgery Indiana University School of Medicine Indianapolis Indiana U.S.A.
Laryngoscope Investig Otolaryngol. 2017 Oct 31;2(6):351-357. doi: 10.1002/lio2.116. eCollection 2017 Dec.
The postoperative wound infection rate for canal wall reconstruction (CWR) tympanomastoidectomy with mastoid obliteration in the treatment of chronic otitis media with cholesteatoma has been reported to be 3.6%. Postoperative administration of 24-48 hours of intravenous antibiotics has been recommended. We aim to determine the infection rate of CWR with postoperative outpatient oral antibiotics.
Institutional review board-approved retrospective case review.
Tertiary referral center. : Retrospective review of consecutive patients who underwent CWR tympanomastoidectomy with mastoid obliteration at a single institution from 2014 to 2016. : Patient characteristics (age, sex) were calculated. Rate of postoperative complications and infections within 1 month of surgery were calculated. Comparison to previous published infection rates with postoperative intravenous antibiotics.
51 patients underwent CWR followed by outpatient oral antibiotics with a mean age of 25.9 years (16 patients were less than 10 years old). There were no postoperative wound infections. Outpatient antibiotics showed non-inferiority to IV antibiotic historic controls (0% vs. 3.6%; 95% confidence interval [CI], 0-6.09%; = 0.03). One patient had small postoperative wound dehiscence with CSF leak that was managed conservatively. One patient developed colitis on postoperative day 2.
The infection rate after CWR tympanomastoidectomy with use of outpatient antibiotics is low and is non-inferior to a historic cohort treated with inpatient intravenous antibiotics. A larger randomized controlled trial is warranted.
据报道，在胆脂瘤型慢性中耳炎治疗中，采用乳突腔封闭的外耳道后壁重建（CWR）鼓室乳突切除术的术后伤口感染率为3.6%。推荐术后静脉使用抗生素24 - 48小时。我们旨在确定采用术后门诊口服抗生素的CWR手术的感染率。
经机构审查委员会批准的回顾性病例审查。
三级转诊中心。对2014年至2016年在单一机构接受CWR鼓室乳突切除术并进行乳突腔封闭的连续患者进行回顾性研究。计算患者特征（年龄、性别）。计算术后1个月内的并发症和感染发生率。与先前发表的术后静脉使用抗生素的感染率进行比较。
51例患者接受CWR手术，随后使用门诊口服抗生素，平均年龄25.9岁（16例患者年龄小于10岁）。无术后伤口感染。门诊抗生素治疗与静脉抗生素治疗的历史对照相比无劣势（0%对3.6%；95%置信区间[CI]，0 - 6.09%；P = 0.03）。1例患者术后伤口有小的裂开并伴有脑脊液漏，经保守治疗。1例患者在术后第2天发生结肠炎。
采用门诊抗生素的CWR鼓室乳突切除术后感染率低，且不劣于接受住院静脉抗生素治疗的历史队列。有必要进行更大规模的随机对照试验。
4级
