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Clinical utility of a polymerase chain reaction assay in culture-negative necrotizing otitis externa
Maayan Gruber1, Ariel Roitman, Ilana Doweck
1*Department of Otolaryngology-Head and Neck Surgery, and †Bacteriology Laboratory, Lady Davis Carmel Medical Center, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Objective:
This study describes a subset of necrotizing otitis externa (NOE) patients with a refractory disease and negative cultures. In these cases, we decided to use a polymerase chain reaction (PCR) assay from surgically obtained tissue under sterile conditions to improve pathogen detection sensitivity.
Study Design:
Retrospective case review.
Setting:
Academic medical center.
Patients:
Nineteen consecutive patients diagnosed with NOE between January 2008 and January 2014 inclusive. Three patients of this cohort presented a culture-negative disease.
Interventions:
Diagnostic.
Main Outcome Measures:
Positive detection of pathogens using a PCR assay in cases with a complicated course of NOE and clinical resolution of the disease after targeted therapy according to PCR results.
Results:
Surgical samples were obtained under sterile conditions from three patients with negative cultures and a refractory disease course of NOE. PCR assays were performed using pan-bacteria and pan-fungi protocols. In all three samples, a positive result for a fungal pathogen was recorded and followed by successful empirical targeted therapy.
Conclusion:
Patients who present with a refractory culture-negative NOE should be suspected as suffering from a fungal disease. The PCR assay may be an important laboratory adjunct in detecting pathogens responsible for NOE and can aid to promote therapy and disease resolution.
