106 / 264
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.
Table 2.
Culture Methods and Prior Therapy.
Patient
Therapy Prior to Culture
Culture Method
Pseudomonas
1
None
Canal swab
2
Oral amoxicillin-clavulanic acid and topical ciprofloxacin-dexamethasone
Canal swab
3
Unknown
Canal swab
4
Unknown
Canal swab
5
Oral ciprofloxacin and topical ciprofloxacin-dexamethasone
Unknown
6
Oral ciprofloxacin and topical ciprofloxacin-dexamethasone
Canal swab
7
Oral antibiotic
Unknown
8
Topical antibiotic
Canal swab (tissue negative)
9
Oral ciprofloxacin and topical ciprofloxacin-dexamethasone
Canal swab
MRSA
10
Oral trimethoprim-sulfamethoxazole
Canal swab
11
Topical ciprofloxacin-dexamethasone
Canal swab
12
Topical ciprofloxacin-dexamethasone
Canal tissue
Other
13
Oral amoxicillin-clavulanic acid and topical ciprofloxacin-dexamethasone
Canal swab
14
Oral moxifloxacin and topical ciprofloxacin-dexamethasone
Canal swab
15
Topical ciprofloxacin-dexamethasone
Canal swab and tissue
16
Unknown
Canal swab
17
Oral ciprofloxacin and topical ciprofloxacin-dexamethasone
Canal swab and tissue
Negative
18
Oral and topical antibiotics
Canal tissue
19
Oral/IV ciprofloxacin and topical ciprofloxacin-dexamethasone
Canal swab
20
Topical antibiotic
Canal swab
Abbreviations: IV, intravenous; MRSA, methicillin-resistant
Staphylococcus aureus
.
Otolaryngology–Head and Neck Surgery 151(1)
85