AlSharhan Salma S, Alwazzeh Marwan J, ALRammah Mona K, ALMarzouq Wasan F, AlGhuneem Aishah A, Alshrefy Afnan J, Albahrani Nada A, Telmesani Lena S, AlGhamdi Amal A, Telmesani Laila M
Department of Otorhinolaryngology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Infectious Disease Division, Department of Internal Medicine, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Dammam & King Fahad Hospital of the University, Al Khobar, Saudi Arabia.
Infez Med. 2024 Sep 1;32(3):340-351. doi: 10.53854/liim-3203-8. eCollection 2024.
The study aimed to explore the spectrum and trend of causative microbial agents and to identify management challenges and the risk factors for poor outcomes in patients with confirmed otogenic skull base osteomyelitis.
A retrospective observational study was conducted at a tertiary-care academic center from 1999 through 2019 and included 28 adult patients with confirmed otogenic skull base osteomyelitis. Relevant data was extracted from electronic and hard patient medical files. The microbial spectrum of involved microbes was identified and correlated to management options. Deterioration risk factors were investigated using suitable statistical analysis tests.
Twenty-eight patients with confirmed skull base osteomyelitis were included; most were males (78.6%) and Saudis (78.6%). All patients were ≥50 years of age (mean ± SD is 69.0±10.2.4). Of 41 identified microbial isolates, 56% were bacterial, 44% were fungal. 32.1% of patients had polymicrobial infections, most patients (92.8%) had received ≥2 systemic antibiotics, 57.1% received systemic antibiotic combinations, and 32.1% underwent surgical interventions. The mean antibiotic and antifungal therapy duration was 58.3 and 45.8 days, respectively. The identified risk factors of deterioration were advanced age and concomitant cardiac failure, with P-values of .006 and .034, respectively.
The study findings highlight the microbiological spectrum and trend of otogenic skull base osteomyelitis-causative microbes over two decades, present the management challenges, identify deterioration risk factors, and suggest tissue biopsy as the golden standard for accurately identifying causative microbes.
本研究旨在探讨致病性微生物病原体的种类和趋势，确定确诊为耳源性颅底骨髓炎患者的治疗挑战及预后不良的危险因素。
1999年至2019年在一家三级医疗学术中心进行了一项回顾性观察研究，纳入28例确诊为耳源性颅底骨髓炎的成年患者。从电子和纸质患者医疗档案中提取相关数据。确定受累微生物的微生物谱，并与治疗方案相关联。使用适当的统计分析测试研究恶化危险因素。
纳入28例确诊为颅底骨髓炎的患者；大多数为男性（78.6%）和沙特人（78.6%）。所有患者年龄均≥50岁（平均±标准差为69.0±10.24）。在41株鉴定出的微生物分离株中，56%为细菌，44%为真菌。32.1%的患者有混合感染，大多数患者（92.8%）接受了≥2种全身抗生素治疗，57.1%接受了全身抗生素联合治疗，32.1%接受了手术干预。抗生素和抗真菌治疗的平均持续时间分别为58.3天和45.8天。确定的病情恶化危险因素为高龄和并发心力衰竭，P值分别为0.006和0.034。
研究结果突出了二十年来耳源性颅底骨髓炎致病性微生物的微生物谱和趋势，呈现了治疗挑战，确定了病情恶化危险因素，并建议组织活检作为准确鉴定致病性微生物的金标准。
