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Skull base osteomyelitis: current microbiology and management
1Department of Otolaryngology, Greenlane Hospital and Auckland City Hospital, Auckland, New Zealand. patrickspielmann@nhs.net
Introduction:
Skull base osteomyelitis typically presents in an immunocompromised patient with severe otalgia and otorrhoea. Pseudomonas aeruginosa is the commonest pathogenic micro-organism, and reports of resistance to fluoroquinolones are now emerging, complicating management. We reviewed our experience of this condition, and of the local pathogenic organisms.
Methods:
A retrospective review from 2004 to 2011 was performed. Patients were identified by their admission diagnostic code, and computerised records examined.
Results:
Twenty patients were identified. A facial palsy was present in 12 patients (60 per cent). Blood cultures were uniformly negative, and culture of ear canal granulations was non-diagnostic in 71 per cent of cases. Pseudomonas aeruginosa was isolated in only 10 (50 per cent) cases; one strain was resistant to ciprofloxacin but all were sensitive to ceftazidime. Two cases of fungal skull base osteomyelitis were identified. The mortality rate was 15 per cent. The patients' treatment algorithm is presented.
Conclusion:
Our treatment algorithm reflects the need for multidisciplinary input, early microbial culture of specimens, appropriate imaging, and prolonged and systemic antimicrobial treatment. Resolution of infection must be confirmed by close follow up and imaging.
Insights
Skull base osteomyelitis management is complex due to emerging Pseudomonas aeruginosa resistance. This review highlights the need for early diagnosis, multidisciplinary care, and targeted antimicrobial treatment for better patient outcomes.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Medical Microbiology
Background:
- Skull base osteomyelitis (SB0) is a severe infection.
- Often seen in immunocompromised patients with otalgia and otorrhoea.
- Pseudomonas aeruginosa is a common pathogen, with increasing fluoroquinolone resistance.
Purpose of the Study:
- To review experience with skull base osteomyelitis.
- To identify local pathogenic organisms.
- To evaluate treatment strategies and outcomes.
Main Methods:
- Retrospective review of patients from 2004 to 2011.
- Identification via admission diagnostic codes.
- Examination of computerized patient records.
Main Results:
- Twenty patients identified; 60% had facial palsy.
- Blood cultures were negative; ear granulation cultures often non-diagnostic.
- Pseudomonas aeruginosa found in 50% of cases; one resistant to ciprofloxacin, all sensitive to ceftazidime. Two fungal cases identified. Mortality rate was 15%.
Conclusions:
- Treatment requires multidisciplinary input, early microbial culture, and imaging.
- Prolonged, systemic antimicrobial therapy is crucial.
- Infection resolution must be confirmed by follow-up and imaging.
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