Role of surgery along with antimicrobials in refractory skull base osteomyelitis—A prospective observational study

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY Clinical Otolaryngology Pub Date : 2024-06-03 DOI:10.1111/coa.14188

Bini Faizal, Lakshmi Nair, Jayanthy Pavithran, Merlin Moni, V. S. Sheejamol

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Abstract

Introduction

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.

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手术与抗菌药在难治性颅底骨髓炎中的作用--一项前瞻性观察研究。

导言研究旨在通过手术和抗菌药物治疗难治性颅底骨髓炎（SBO）病例，改善临床疗效：在一家三级医疗中心进行的前瞻性观察研究，共有 70 名 SBO 患者符合资格标准。研究对象包括35名全身抗菌药物治疗至少4周的难治性患者，这些患者后来在药物治疗的基础上接受了手术治疗（手术组）。他们与仅接受药物治疗的内科组进行了比较。研究的结果变量包括临床症状（疼痛、出院、放射学检查和炎症指标）的缓解情况、培养结果和总治疗时间：根据我们的研究，手术组患者的疼痛缓解更快（1.66 个月对 4.57 个月），且有统计学意义（P 结论：手术组患者的疼痛缓解更快（1.66 个月对 4.57 个月）：在选定的难治性 SBO 患者中，接受手术治疗并同时使用抗菌药物的患者的治疗反应优于仅使用抗菌药物的患者。手术提供了更高的微生物产量，从而产生了培养特异性抗菌药物。手术组患者的症状缓解更快，住院时间更短，总治疗时间也更短。

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来源期刊

Clinical Otolaryngology 医学-耳鼻喉科学

CiteScore

4.00

自引率

4.80%

发文量

106

审稿时长

>12 weeks

期刊介绍： Clinical Otolaryngology is a bimonthly journal devoted to clinically-oriented research papers of the highest scientific standards dealing with: current otorhinolaryngological practice audiology, otology, balance, rhinology, larynx, voice and paediatric ORL head and neck oncology head and neck plastic and reconstructive surgery continuing medical education and ORL training The emphasis is on high quality new work in the clinical field and on fresh, original research. Each issue begins with an editorial expressing the personal opinions of an individual with a particular knowledge of a chosen subject. The main body of each issue is then devoted to original papers carrying important results for those working in the field. In addition, topical review articles are published discussing a particular subject in depth, including not only the opinions of the author but also any controversies surrounding the subject. • Negative/null results In order for research to advance, negative results, which often make a valuable contribution to the field, should be published. However, articles containing negative or null results are frequently not considered for publication or rejected by journals. We welcome papers of this kind, where appropriate and valid power calculations are included that give confidence that a negative result can be relied upon.