HSC Section 8_April 2017

Otolaryngology–Head and Neck Surgery 151(1)

Table 2. Culture Methods and Prior Therapy.

Patient

Therapy Prior to Culture

Culture Method

Pseudomonas 1

None

Canal swab Canal swab Canal swab Canal swab Unknown Canal swab Unknown

2 3 4 5 6 7 8 9

Oral amoxicillin-clavulanic acid and topical ciprofloxacin-dexamethasone

Unknown Unknown

Oral ciprofloxacin and topical ciprofloxacin-dexamethasone Oral ciprofloxacin and topical ciprofloxacin-dexamethasone

Oral antibiotic Topical antibiotic

Canal swab (tissue negative)

Oral ciprofloxacin and topical ciprofloxacin-dexamethasone

Canal swab

MRSA 10

Oral trimethoprim-sulfamethoxazole Topical ciprofloxacin-dexamethasone Topical ciprofloxacin-dexamethasone

Canal swab Canal swab Canal tissue

11 12

Other 13

Oral amoxicillin-clavulanic acid and topical ciprofloxacin-dexamethasone

Canal swab Canal swab

14 15 16 17

Oral moxifloxacin and topical ciprofloxacin-dexamethasone

Topical ciprofloxacin-dexamethasone

Canal swab and tissue

Unknown

Canal swab

Oral ciprofloxacin and topical ciprofloxacin-dexamethasone

Canal swab and tissue

Negative 18

Oral and topical antibiotics

Canal tissue Canal swab Canal swab

19 20

Oral/IV ciprofloxacin and topical ciprofloxacin-dexamethasone

Topical antibiotic

Abbreviations: IV, intravenous; MRSA, methicillin-resistant Staphylococcus aureus .

the MRSA-infected patients and 18% of all non- Pseudomonas -infected patients. These differences were not statistically significant ( P = .51 and P = .62). No other cra- nial neuropathies were documented ( Table 1 ). Comorbidities Fifteen patients (75%) had diabetes mellitus. All 9 patients infected with Pseudomonas had diabetes mellitus, compared with 33% of MRSA-infected patients and 55% of all non- Pseudomonas infected patients. These differences were statisti- cally significant ( P = .046 and P = .04, respectively). One patient (non- Pseudomonas , non-MRSA) had acute myeloid leu- kemia and received chemotherapy at around the time of his infection; this patient also had diabetes. One patient (non- Pseudomonas , non-MRSA) had rheumatoid arthritis and was taking immunosuppressive medications at the onset of infection. Another patient (non- Pseudomonas , non-MRSA) had systemic lupus erythematous but was not receiving immunosuppressive therapy. Overall, 63% of the non- Pseudomonas -infected patients either had diabetes or were immunosuppressed, compared with 100% of the Pseudomonas -infected patients ( P = .09). Treatment Summary At the time of this study, 1 patient had an ongoing infection, 3 patients were lost to follow-up, and 1 patient (MRSA, panresis- tant Acinetobacter ) died from a central catheter infection while

undergoing ongoing therapy for MOE. The remaining 15 patients (75%) had documented resolution of their infections. Two patients had recurrences of their infections and were treated with a second course of antibiotics. Of the 15 patients with documented resolution of their infections, the mean defini- tive antibiotic course was 7.8 6 3.9 weeks, and the mean total antibiotic course was 9.2 6 4.2 weeks. The most frequent treat- ment duration, including treatment of recurrences, was 6 weeks. Three patients underwent mastoidectomy during their treatment for MOE: 2 mastoidectomies were performed for patients who, while receiving intravenous antibiotic therapy, had sequestered bone in the mastoid seen on CT scans; 1 patient underwent mastoidectomy to evaluate for malignancy, as that patient exhib- ited radiographic evidence of progressive bony erosion and a soft tissue lesion despite treatment. One of the Pseudomonas -infected patients was lost to follow-up. The remaining 8 had resolution of their infec- tions with an average of 6.1 6 2.1 weeks of definitive anti- biotic therapy and 7.9 6 3.4 total weeks of antibiotic therapy. Five of those 8 patients were treated with oral qui- nolone antibiotics, 3 in combination with an intravenous anti- Pseudomonal cephalosporin. One patient was treated with intravenous moxifloxacin. The 2 patients who were not treated with quinolone antibiotics were treated with an intra- venous anti- Pseudomonal penicillin. One patient, who did not follow up, underwent a canal wall up mastoidectomy.

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