背景:坏死性外耳炎是一种侵袭性感染,影响老年患者,具有显著的相关发病率。尽管如此,没有针对管理的随机对照试验,因此,治疗方法可能差异很大。我们描述了在5年内使用多学科治疗途径治疗坏死性外耳炎的37例患者的治疗和结果。该途径基于静脉内头孢他啶加口服环丙沙星3周的标准化抗生素方案,然后再服用3周环丙沙星。
方法:这是自2016年引入我们的途径以来所有诊断为坏死性外耳道炎的患者的回顾性回顾。我们包括患者人口统计数据,合并症,微生物学,逗留时间,和抗菌治疗的长度。结果数据,包括死亡率,复发和治疗失败,以及治疗的不良影响,被呈现。
结果:我们患者的中位年龄为82岁。大约54%的患者患有糖尿病或其他免疫功能低下的原因。铜绿假单胞菌的分离率为68%。住院时间中位数为9天,中位治疗时间为6周。37名患者中,32例治愈(86%),剩下的5个病人,有2例与坏死性外耳道炎无关的死亡率和3例因解剖异常而反复感染的患者.
结论:我们注意到,当使用标准化的多学科途径和6周疗程的抗生素治疗时,治疗效果良好。
BACKGROUND: Necrotizing otitis externa is an invasive infection, affecting older patients, with significant associated morbidity. Despite this, there are no randomized controlled trials that address management, and therefore, treatment approaches may vary considerably. We describe the management and outcomes of 37 patients managed using a multidisciplinary treatment pathway for necrotizing otitis externa over a 5-year period. The pathway is based on a standardized antibiotic regime of 3 weeks of intravenous ceftazidime plus oral ciprofloxacin, followed by a further 3 weeks of ciprofloxacin.
METHODS: This is a retrospective
review of all patients diagnosed with necrotizing otitis externa since the introduction of our pathway in 2016. We include data on patient demographics, comorbidities, microbiology, length of stay, and length of antimicrobial treatment. Outcome data, including mortality, relapse and treatment failure, and adverse effects of treatment, are presented.
RESULTS: The median age of our patients was 82 years. About 54% of patients had diabetes mellitus or another cause of immunocompromise. Pseudomonas aeruginosa was isolated in 68%. The median duration of inpatient stay was 9 days, and median treatment duration was 6 weeks. Of 37 patients, 32 were cured (86%), and of the remaining 5 patients, there were 2 mortalities unrelated to necrotizing otitis externa and 3 patients with recurrent infections due to anatomical abnormalities.
CONCLUSIONS: We note favorable treatment outcomes when using a standardized multidisciplinary pathway and a 6-week course of antibiotic therapy.