Optimizing pathogen detection in skull base osteomyelitis: a comparative analysis of swab versus biopsy sampling

Area of Science:

• Ophthalmology
• Microbiology
• Infectious Diseases

Background:

• Severe bacterial eye infections (SBO) are serious conditions requiring prompt and accurate diagnosis.
• Effective treatment relies on identifying the causative pathogen for targeted antibiotic therapy.
• Current diagnostic methods involve tissue sampling, with varying techniques available.

Purpose of the Study:

• To compare the efficacy of biopsy versus swab techniques in pathogen identification for SBO.
• To evaluate the impact of different specimen collection methods on the initiation and adequacy of antibiotic treatment.
• To determine the optimal approach for microbiological sampling in SBO management.

Main Methods:

• Retrospective analysis of 56 adult patients diagnosed with SBO between 2008 and 2025.
• Comparison of intraoperative swab and biopsy specimens against non-intraoperative swab specimens.
• Assessment of pathogen detection rates and subsequent antibiotic therapy adjustments.

Main Results:

• Pseudomonas aeruginosa was the most common pathogen in typical SBO, identified in 28.0% of external auditory canal swabs and 23.7% of biopsy samples.
• In atypical SBO cases, pathogen identification reached 78.6%.
• A significant proportion of patients (16.1%) had no microbiological pathogen isolated despite comprehensive sampling.

Conclusions:

• Pathogen-specific antibiotic therapy, guided by tissue sampling, is fundamental for successful SBO treatment.
• The choice of specimen collection method is critical for selecting appropriate and effective antibiotic regimens.
• Optimizing diagnostic sampling techniques can improve treatment outcomes for SBO.