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Necrotizing external otitis: analysis of relapse risk factors in 66 patients managed during a 12 year period

2022; Oxford University Press; Volume: 77; Issue: 9 Linguagem: Inglês

10.1093/jac/dkac193

1460-2091

William Danjou, Brahim Harbaoui, Thomas Perpoint, Pierre Pradat, Patrick Miailhes, A. Boibieux, Agathe Becker, Carine Fuchsmann, Frédéric Laurent, S. Tringali, Sandrine Roux, Claire Triffault-Fillit, Florent Valour, Tristan Ferry, Tristan Ferry, Tristan Ferry, Florent Valour, Thomas Perpoint, Florence Ader, Sandrine Roux, Agathe Becker, Claire Triffault-Fillit, Marie Simon, Anne Conrad, Cécile Pouderoux, Pierre Chauvelot, Brahim Harbaoui, Johanna Lippman, E. Braun, Sébastien Lustig, Elvire Servıen, Cécile Batailler, Stanislas Gunst, Axel Schmidt, Elliot Sappey‐Marinier, Quentin Ode, Michel-Henry Fessy, Anthony Viste, Jean‐Luc Besse, Philippe Chaudier, Lucie Louboutin, Adrien Van Haecke, Marcelle Mercier, Vincent Belgaïd, Aram Gazarian, Arnaud Walch, Antoine Bertani, Frédéric Rongièras, Sébastien Martres, Franck Trouillet, Cédric Barrey, Ali Mojallal, Sophie Brosset, Camille Hanriat, Mathilde Lherm, Hélène Person, Philippe Céruse, Carine Fuchsmann, A. Gleizal, Frédéric Aubrun, Mikhail Dziadzko, Caroline Macabéo, Dana Patrascu, Frédéric Laurent, Laetitia Béraud, Tiphaine Roussel-Gaillard, Céline Dupieux, Camille Kolenda, Jérôme Josse, Fabien Craighero, Loïc Boussel, Jean‐Baptiste Pialat, Isabelle Morelec, Michel Tod, Marie‐Claude Gagnieu, Sylvain Goutelle, Catherine Piron, Eugénie Mabrut,

Streptococcal Infections and Treatments

Abstract Background Necrotizing external otitis (NEO) is a severe infection of the skull base that occurs generally in the elderly and/or in diabetic recipients. There are few data in the literature about the therapeutic management of this complex bone infection. Objectives To analyse relapses after NEO treatment completion, and to describe the clinical features of NEO. Methods We performed a retrospective cohort study in the Lyon regional reference centre for the management of complex bone and joint infections. Consecutive cases of NEO from 1 January 2006 to 31 December 2018 were included. The primary outcome was the relapse of NEO. Variables were analysed using Cox regression survival analysis with adjusted hazard ratio (aHR) and Kaplan–Meier curve. Results Sixty-six patients were included. Median age was 75 (IQR 69–81) years and 46 (70%) patients were diabetic. Eleven patients (17%) had temporomandibular arthritis, 10 (15%) cranial nerve paralysis, 2 (3%) cerebral thrombophlebitis, and 2 (3%) contiguous abscess. Microbiological documentation was obtained in 56 patients and revealed Pseudomonas aeruginosa in 44/56 patients (79%). Nine (14%) cases had no microbiological documentation. Antibiotic therapy was dual for 63 (95%) patients. During a median follow-up of 27 (IQR 12–40) months, 16 out of 63 (25%) patients experienced a relapse. Fungal infection was significantly associated with relapse [aHR 4.1 (95% CI 1.1–15); P = 0.03]. Conclusions NEO is a severe bone infection, mainly (but not exclusively) caused by P. aeruginosa, which occurs in elderly and diabetic recipients. Fungal infections at baseline significantly impact the outcome.