PDF(Pubmed)
Abstract：
OBJECTIVE: Achromobacter xylosoxidans is an emerging pathogen mainly associated with resistant nosocomial infections. This bacteria had been isolated in the ear together with other pathogens in cultures from patients with chronic otitis media, but it had never been reported as a cause of osteomyelitis of the external auditory canal.
METHODS: We present a unique case of a healthy 81-year-old woman who presented with left chronic otorrhea refractory to topical and oral antibiotic treatment. Otomicroscopy revealed an erythematous and exudative external auditory canal (EAC) with scant otorrhea. The tympanic membrane was intact, but an area of bone remodeling with a small cavity anterior and inferior to the bony tympanic frame was observed. Otic culture isolated multi-drug-resistant A. xylosoxidans, only sensitive to meropenem and cotrimoxazole. Temporal bone computed tomography showed an excavation of the floor of the EAC compatible with osteomyelitis. Targeted antibiotherapy for 12 weeks was conducted, with subsequent resolution of symptoms and no progression of the bone erosion.
CONCLUSIONS: Atypical pathogens such as A. xylosoxidans can be the cause of chronic otitis externa. Early diagnosis and specific antibiotherapy can prevent the development of further complications, such as osteomyelitis. In these cases, otic cultures play an essential role to identify the causal germ. This is the first case of EAC osteomyelitis due to A. xylosoxidans reported to date.
METHODS: We present a unique case of a healthy 81-year-old woman who presented with left chronic otorrhea refractory to topical and oral antibiotic treatment. Otomicroscopy revealed an erythematous and exudative external auditory canal (EAC) with scant otorrhea. The tympanic membrane was intact, but an area of bone remodeling with a small cavity anterior and inferior to the bony tympanic frame was observed. Otic culture isolated multi-drug-resistant A. xylosoxidans, only sensitive to meropenem and cotrimoxazole. Temporal bone computed tomography showed an excavation of the floor of the EAC compatible with osteomyelitis. Targeted antibiotherapy for 12 weeks was conducted, with subsequent resolution of symptoms and no progression of the bone erosion.
CONCLUSIONS: Atypical pathogens such as A. xylosoxidans can be the cause of chronic otitis externa. Early diagnosis and specific antibiotherapy can prevent the development of further complications, such as osteomyelitis. In these cases, otic cultures play an essential role to identify the causal germ. This is the first case of EAC osteomyelitis due to A. xylosoxidans reported to date.
摘要：
目的：木氧化嗜铬杆菌是一种新出现的病原菌，主要与耐药医院感染有关。这种细菌与慢性中耳炎患者培养物中的其他病原体一起在耳中分离出，但它从未被报道为外耳道骨髓炎的原因。
方法：我们介绍了一例81岁健康女性的独特病例，该女性表现为局部和口服抗生素治疗难以治疗的左侧慢性耳漏。耳镜检查显示红斑和渗出性外耳道（EAC）伴有耳漏。鼓膜完好无损,但是观察到骨重建区域，在骨性鼓室框架的前部和下部有一个小腔。Otic培养分离的多药耐药木聚糖，仅对美罗培南和复方新诺明敏感。颞骨计算机断层扫描显示EAC地板的开挖与骨髓炎相容。进行了为期12周的靶向抗生素治疗，随后症状消退，骨侵蚀没有进展。
结论：非典型病原体如A.xylosoxidans可能是慢性外耳炎的原因。早期诊断和特定的抗生素治疗可以防止进一步的并发症的发展，比如骨髓炎。在这些情况下,耳道文化在识别因果细菌中起着至关重要的作用。这是迄今为止报道的由于A.xylosoxidans引起的EAC骨髓炎的第一例。
方法：我们介绍了一例81岁健康女性的独特病例，该女性表现为局部和口服抗生素治疗难以治疗的左侧慢性耳漏。耳镜检查显示红斑和渗出性外耳道（EAC）伴有耳漏。鼓膜完好无损,但是观察到骨重建区域，在骨性鼓室框架的前部和下部有一个小腔。Otic培养分离的多药耐药木聚糖，仅对美罗培南和复方新诺明敏感。颞骨计算机断层扫描显示EAC地板的开挖与骨髓炎相容。进行了为期12周的靶向抗生素治疗，随后症状消退，骨侵蚀没有进展。
结论：非典型病原体如A.xylosoxidans可能是慢性外耳炎的原因。早期诊断和特定的抗生素治疗可以防止进一步的并发症的发展，比如骨髓炎。在这些情况下,耳道文化在识别因果细菌中起着至关重要的作用。这是迄今为止报道的由于A.xylosoxidans引起的EAC骨髓炎的第一例。
