Abstract：
BACKGROUND: Study aimed to ole of surgery along with antimicrobials to improve clinical outcomes in treating refractory cases of skull base osteomyelitis (SBO).
METHODS: A prospective observational study in a tertiary care centre with 70 SBO patients meeting eligibility criteria. The study population comprised 35 patients refractory to systemic antimicrobials of at least 4 weeks duration who later underwent surgery in addition to medication (surgical group). They were compared with a medical group that responded to medications alone. The outcome variables studied were the resolution of clinical features (pain, discharge, radiology, and inflammatory markers), culture yield, and total duration of treatment.
RESULTS: According to our study, relief of pain was faster in the surgical group (1.66 against 4.57 months) with statistical significance (p < 0.001). Relief of symptoms (p < 0.001), radiological improvement (p = 0.001), and normalising of inflammatory markers (p < 0.001) were better in the surgical group than in the medical group. The duration of treatment was an average of 9.2 months in the surgical group compared to 11.3 months in the medical group (p = 0.019). Microbial culture from deep tissue sampling was positive in 24 surgical patients (68.57%).
CONCLUSIONS: The treatment response in selected patients of refractory SBO who underwent surgery along with antimicrobials was better than the group who responded to antimicrobials alone. Surgery provided higher microbial yield resulting in culture-specific antimicrobials. The surgical group observed faster relief of symptoms, reduced hospital stay, and total treatment duration.
METHODS: A prospective observational study in a tertiary care centre with 70 SBO patients meeting eligibility criteria. The study population comprised 35 patients refractory to systemic antimicrobials of at least 4 weeks duration who later underwent surgery in addition to medication (surgical group). They were compared with a medical group that responded to medications alone. The outcome variables studied were the resolution of clinical features (pain, discharge, radiology, and inflammatory markers), culture yield, and total duration of treatment.
RESULTS: According to our study, relief of pain was faster in the surgical group (1.66 against 4.57 months) with statistical significance (p < 0.001). Relief of symptoms (p < 0.001), radiological improvement (p = 0.001), and normalising of inflammatory markers (p < 0.001) were better in the surgical group than in the medical group. The duration of treatment was an average of 9.2 months in the surgical group compared to 11.3 months in the medical group (p = 0.019). Microbial culture from deep tissue sampling was positive in 24 surgical patients (68.57%).
CONCLUSIONS: The treatment response in selected patients of refractory SBO who underwent surgery along with antimicrobials was better than the group who responded to antimicrobials alone. Surgery provided higher microbial yield resulting in culture-specific antimicrobials. The surgical group observed faster relief of symptoms, reduced hospital stay, and total treatment duration.
摘要：
背景：研究的目的是在治疗难治性颅底骨髓炎（SBO）的过程中，通过手术和抗菌药物来改善临床效果。
方法：一项在三级护理中心进行的前瞻性观察性研究，有70名符合资格标准的SBO患者。研究人群包括35名患者，这些患者对至少4周的全身抗菌药物治疗无效，后来除了药物治疗外还接受了手术（手术组）。他们与仅对药物有反应的医疗小组进行了比较。研究的结果变量是临床特征的分辨率(疼痛，放电,放射学,和炎症标记物)，培养产量，和治疗的总持续时间。
结果：根据我们的研究，手术组疼痛缓解更快(1.66对4.57个月),差异有统计学意义(p<0.001).缓解症状（p<0.001），放射学改善（p=0.001），与药物组相比，手术组的炎症标志物正常化（p<0.001）更好。手术组的治疗时间平均为9.2个月，而药物组为11.3个月（p=0.019）。24例手术患者（68.57％）的深部组织采样微生物培养阳性。
结论：接受手术联合抗菌药物治疗的难治性SBO患者的治疗反应优于仅接受抗菌药物治疗的患者。手术提供了更高的微生物产量，导致培养特异性抗微生物剂。手术组观察到症状缓解更快，减少住院时间,和总治疗持续时间。
方法：一项在三级护理中心进行的前瞻性观察性研究，有70名符合资格标准的SBO患者。研究人群包括35名患者，这些患者对至少4周的全身抗菌药物治疗无效，后来除了药物治疗外还接受了手术（手术组）。他们与仅对药物有反应的医疗小组进行了比较。研究的结果变量是临床特征的分辨率(疼痛，放电,放射学,和炎症标记物)，培养产量，和治疗的总持续时间。
结果：根据我们的研究，手术组疼痛缓解更快(1.66对4.57个月),差异有统计学意义(p<0.001).缓解症状（p<0.001），放射学改善（p=0.001），与药物组相比，手术组的炎症标志物正常化（p<0.001）更好。手术组的治疗时间平均为9.2个月，而药物组为11.3个月（p=0.019）。24例手术患者（68.57％）的深部组织采样微生物培养阳性。
结论：接受手术联合抗菌药物治疗的难治性SBO患者的治疗反应优于仅接受抗菌药物治疗的患者。手术提供了更高的微生物产量，导致培养特异性抗微生物剂。手术组观察到症状缓解更快，减少住院时间,和总治疗持续时间。
