Frost James, Samson Anda D
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.
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.
J Glob Antimicrob Resist. 2021 Sep;26:266-271. doi: 10.1016/j.jgar.2021.06.015. Epub 2021 Jul 14.
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.
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.
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.
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.
目前对于坏死性外耳道炎（NOE）最有效的治疗方案尚无共识。本文旨在根据文献和临床经验制定一份NOE治疗方案。
回顾了文献中的26个病例系列，并结合了赫尔大学教学医院国民保健服务信托基金2013 - 2018年住院患者的回顾性病例系列。在5年多的时间里，共确定了40例患者，由于病例记录不可用或不完整，仅对29例进行了分析。
在文献综述中，引起NOE最常见的细菌种类是铜绿假单胞菌。对环丙沙星的耐药性普遍存在，但多重耐药很少见。环丙沙星和头孢他啶是使用最广泛的抗生素。文献或我们的队列中均未报告对头孢他啶的耐药性。我们队列中患者的平均年龄为80岁。此外，62%的患者患有糖尿病或免疫功能低下。1例患者直接死于与NOE相关的败血症。大多采用静脉注射头孢他啶单药治疗。治疗持续时间为6 - 7周，无复发记录。
头孢他啶单药治疗在我们的队列中是一种有效的经验性治疗方法，抗生素总疗程6 - 7周就足够了。我们根据研究结果制定了一份标准化治疗方案，该方案需要在更大的患者队列中进行验证。
