Necrotising Otitis Externa Antibiotic therapy complications: A retrospective cohort analysis

Introduction: Necrotising otitis externa (NOE) is a serious, progressive infection of the external ear canal. If untreated, it can invade into temporal bone, skull-base and surrounding tissue resulting in cranial nerve palsies, neurological infections and death. Patients present with unremitting, severe otalgia, otorrhoea and oedematous ear canals containing granulation. Surgery has a limited role; the mainstay of treatment involves a long course of intravenous antibiotics. Currently, there is no data on the complications of antibiotic treatment for NOE. This project aims to provide evidence on the nature/frequency of severe treatment-related complications requiring a change in antibiotic regime. Methods: A retrospective 5-year cohort analysis was performed on 64 patients who were treated for confirmed NOE with intravenous antibiotic therapy. Clinical notes, blood results and antibiotic prescriptions were documented and analysed. Results: Average duration of treatment was 11 weeks (range=38 weeks). There was an average of 2.1 antibiotic regimes per patient with 10 cases requiring inpatient admission due to treatment-related complications. 63% of treatment changes were directly related to adverse effects of intravenous antibiotics. Drug allergy/intolerance (n=18) and clinical deterioration i.e. Lack of symptomatic improvement and/or worsening inflammatory markers (n=18), were the most common reasons for antibiotic change. Neutropenia, deranged liver function tests and acute kidney injury were also recognised adverse effects of treatment. Conclusion: This study provides the first evidence on the notable frequency of antibiotic-related complications in NOE patients. Larger, multicentre studies are required in the future to validate our findings and will better inform both clinicians and patients of the risks of treatment.

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Resistance of Pseudomonas to ciprofloxacin: implications for the treatment of malignant otitis externa

The Journal of Laryngology & Otology ◽

10.1017/s0022215106002775 ◽

2006 ◽

Vol 121 (2) ◽

pp. 118-123 ◽

Cited By ~ 31

Author(s):

J M Bernstein ◽

N J Holland ◽

G C Porter ◽

A R Maw

Keyword(s):

Pseudomonas Aeruginosa ◽

Otitis Externa ◽

White Cell Count ◽

Antibiotic Sensitivity ◽

Response To Treatment ◽

Reactive Protein ◽

Intravenous Antibiotics ◽

Cranial Nerve Palsies ◽

Malignant Otitis Externa ◽

Oral Ciprofloxacin

For fifteen years oral ciprofloxacin has been the standard treatment for malignant otitis externa, a sometimes fatal osteomyelitis of the skull base usually caused by Pseudomonas aeruginosa. Resistance to ciprofloxacin is developing. Over a 16-month period, we saw five cases where malignant otitis externa progressed, with the development of cranial nerve palsies in four cases, despite oral ciprofloxacin. Prolonged intravenous antibiotic therapy became necessary. One case was managed largely as an out-patient, but four patients spent many weeks in hospital. Only two cases had diabetes and this was monitored and controlled. Pseudomonas aeruginosa was isolated in four of the five cases, but antibiotic sensitivity to ciprofloxacin was not determined. In one case a later isolate was tested and found to be ciprofloxacin resistant. Progress was monitored by serial C-reactive protein (CRP) and white cell count. For diagnosis and assessing response to treatment we considered serial magnetic resonance imaging or computed tomography more useful than isotope bone scan. There must be a readiness to use intravenous antibiotics, as a response to ciprofloxacin can no longer be assumed. Bacterial isolates must be tested for sensitivity to antibiotics including ciprofloxacin, and further biopsy and culture are essential if treatment fails.

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A case of malignant otitis externa following mastoidectomy

The Journal of Laryngology & Otology ◽

10.1017/s0022215100157986 ◽

1999 ◽

Vol 113 (12) ◽

pp. 1095-1097 ◽

Cited By ~ 9

Author(s):

S. K. Patel ◽

D. W. McPartlin ◽

J. M. Philpott ◽

S. Abramovich

Keyword(s):

Granulation Tissue ◽

Cranial Nerve ◽

Otitis Externa ◽

Cranial Nerves ◽

Complete Recovery ◽

Jugular Bulb ◽

Intravenous Antibiotics ◽

Cranial Nerve Palsies ◽

Malignant Otitis Externa ◽

Nerve Paresis

AbstractWe present a case of a 63-year-old diabetic male who developed malignant otitis externa following mastoidectomy. Extensive skull base osteomyelitis caused thrombosis of the jugular bulb and subsequent paralysis of cranial nerves VII, IX, X and XII. Hewas treated aggressively with intravenous antibiotics and debridement of granulation tissue in the mastoid bowl with full recovery of the cranial nerve palsies associated with recanalization of the jugular bulb. We believe this is the first reported case of malignant otitis externa to occur following mastoidectomy with complete recovery of the cranial nerve paresis.

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Renal and hepatic injury associated with COVID-19 infection; A prospective cohort analysis of renal and hepatic injury in patients infected with COVID-19

10.22541/au.162211344.48264187/v2 ◽

2021 ◽

Author(s):

Qutaiba Al Khames Aga ◽

Kawthar Nassir ◽

Hesham Al Mawla ◽

Hassan Abbas ◽

Jawad Rasheed ◽

...

Keyword(s):

Mortality Rate ◽

Hepatic Injury ◽

Cohort Analysis ◽

Kidney Injury ◽

Stage Iv ◽

Liver Function Tests ◽

Total Serum ◽

Liver Injuries ◽

Function Test ◽

Baseline Values

The current study evaluated the rate of progression of acute kidney and hepatic injury and its associated mortality rate in patients infected with COVID-19. For this study, a total of 397 COVID-19 positive adult patients were prospectively recruited. Routine medical examination, liver function tests (LFT) and renal function test (RFT) were performed at the time of hospitalization and this procedure was repeated for every two days until the hospital stay of the patient or till the death of the patient. The upper values (data obtained from the recovered patients or died patients during course of the disease) of LFT and RFT were compared to that of baseline values (recorded at the time of hospitalization) of recovered or died patients. The baseline values of both LFT and RFT values were not significantly varied between recovered 88.41% (n=351) and died patients 11.59% (n=46) at the time of hospitalization. However, the baseline values of total serum bilirubin were significantly (P = 0.001) higher in died patients at the time of hospitalization as compared to the recovered patients. Moreover, majority (52.17%) of the died patients progressed to stage III and stage IV acute kidney injury prior to death. Furthermore, both LFT and RFT were abnormally elevated as compared to their baseline values among the died patients. COVID-19 patients possess high risk for the development of acute kidney and liver injuries, which can substantially enhance the mortality rate.

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651. Comparative Analysis Between Bacterial And Fungal Malignant Otitis Externa

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.845 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S383-S384

Author(s):

Fatma Hammami ◽

Makram Koubaa ◽

Amal Chakroun ◽

Fatma Smaoui ◽

Khaoula Rekik ◽

...

Keyword(s):

Otitis Externa ◽

Clinical Presentation ◽

The Elderly ◽

Causative Organism ◽

Diabetic Patients ◽

Duration Of Treatment ◽

Evolutionary Features ◽

Significant Difference ◽

Malignant Otitis Externa ◽

History Of

Abstract Background Malignant otitis externa is a fatal infection of the external ear and temporal bone. Pseudomonas aeruginosa is the most common causative organism, while fungi are a rare cause of malignant otitis externa. We aimed to compare the clinical, therapeutic and evolutionary features between bacterial and fungal malignant otitis externa. Methods We conducted a retrospective study including all patients hospitalized for malignant otitis externa in the infectious diseases department between 2000 and 2018. Results Overall, we encountered 82 cases of malignant otitis externa, among which there were 54 cases (65.9%) of bacterial malignant otitis externa (BMO) and 28 cases (34.1%) of fungal malignant otitis externa (FMO). The males were predominant among BMO cases (57.4% vs 50%; p=0.5). Patients with FMO were significantly older (70±9 years vs 61±10 years; p< 0.001) and had medical history of diabetes mellitus more frequently (96.4% vs 77.8%; p=0.03). The use of topical corticosteroids was significantly more reported among FMO cases (28.6% vs 5.6%; p=0.006). Otalgia (96.4% vs 81.5%), otorrhea (75% vs 66.7%) and cephalalgia (46.4% vs 42.6%) were the revealing symptoms among FMO and BMO, respectively, with no significant difference. Tenderness to palpation of the mastoid bone (64.3% vs 38.9%; p=0.02) and stenosis of the external auditory canal (92.9% vs 72.2%; p=0.02) were significantly more frequent among FMO cases. Complications were significantly more frequent among FMO cases (42.9% vs 9.3%; p< 0.001). Treatment duration was significantly longer among FMO cases (70[40-90] days vs 45[34-75] days; p=0.03). Conclusion Our study showed that FMO affected more frequently the elderly and diabetic patients, when compared with BMO. Regardless of the causative agent, the clinical presentation was similar. However, the outcome was poor among FMO cases with the occurrence of complications, requiring a longer duration of treatment. Disclosures All Authors: No reported disclosures

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Adverse Effects of Systemic Immunosuppression in Keratolimbal Allograft

Journal of Ophthalmology ◽

10.1155/2012/576712 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 16

Author(s):

M. Krakauer ◽

J. D. Welder ◽

H. K. Pandya ◽

N. Nassiri ◽

A. R. Djalilian

Keyword(s):

Adverse Effects ◽

Calcineurin Inhibitor ◽

Liver Function Tests ◽

Case Review ◽

Retrospective Case ◽

Systemic Immunosuppression ◽

Keratolimbal Allograft ◽

Elevated Liver Function Tests ◽

Limbal Stem Cell ◽

Elevated Creatinine

Purpose. Keratolimbal allograft (KLAL) is a treatment for limbal stem cell deficiency. One disadvantage is systemic immunosuppression to avoid rejection. Our purpose was to examine the adverse effects of systemic immunosuppression in KLAL.Methods. A retrospective case review of 16 patients with KLAL who received systemic immunosuppression consisting of a corticosteroid, an antimetabolite, and/or a calcineurin inhibitor was performed. Patients were monitored for signs, symptoms, or laboratory evidence of toxicity.Results. Twelve of 16 patients (75%) experienced an adverse effect. The average age of those with adverse effects was 50.0 years (SD 17.8) and those without was 23.6 years (SD: 14.3), which was statistically significant (unpairedt-testP=0.022). Ten of 11 patients (91%) had resolution during mean followup of 16.4 months. No serious adverse effects occurred. The most common included anemia, hyperglycemia, elevated creatinine, and elevated liver function tests. Prednisone and tacrolimus were responsible for the most adverse effects. More patients with comorbidities experienced adverse effects (83%) than those without comorbidities (25%).Conclusions. KLAL requires prolonged systemic immunosuppression. Our data demonstrated that systemic immunosuppression did not result in serious adverse effects in our population and is relatively safe with monitoring for toxicity. In addition, we demonstrated that adverse effects occurred more frequently in older patients and those with comorbidities.

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Analysis of response of vitiligo to treatment with NBUVB

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20185105 ◽

2019 ◽

Vol 5 (1) ◽

pp. 37

Author(s):

J. Madhava Praveen ◽

Jatin Sidhwa

Keyword(s):

Adverse Effects ◽

Skin Disorder ◽

Environmental Risks ◽

Treatment Modalities ◽

Duration Of Treatment ◽

Autoimmune Attack ◽

Self Worth ◽

Good Treatment Response ◽

Dynamic Interplay

Background: Vitiligo is an acquired skin disorder characterised by white (depigmented) patches in the skin, due to the loss of functioning melanocytes. The disease can have devastating consequences on an individual’s relationships with others and internal feelings of self-worth. Vitiligo is caused by a dynamic interplay between genetic and environmental risks that initiates an autoimmune attack on melanocytes in the skin. Long term phototherapy has shown good response in the management of vitiligo. In this study we explore the efficacy of phototherapy in management of our vitiligo patients.Methods: 30 subjects were included in the study. Subjects were started on NBUVB at 300mj/cm2. Weekly 3 doses were given. Doses were increased after every 3rd sitting by 10%. In case of adverse effects treatment is withheld till resolution of symptoms following which NBUVB is given at 50% of the last dose and patient managed based on the response.Results: A majority of the subjects showed significant and persistent improvement within the first 3 months of initiation of treatment. The proportion of the patients showing improvement increased with duration of treatment.Conclusions: Our study has revealed the standard and significant role the phototherapy plays in the treatment of vitiligo as a monotherapy or as an adjuvant with other treatment modalities. With good treatment response and minimal side effect incidence, phototherapy is an important treatment modality in the management of vitiligo.

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A clinical study on nimesulide hepatotoxicity

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20184215 ◽

2018 ◽

Vol 6 (11) ◽

pp. 3523

Author(s):

Manju K. Nair ◽

Rema M. N. ◽

Shenoy K. T.

Keyword(s):

Liver Function ◽

Adverse Effects ◽

Serum Albumin ◽

Tertiary Care ◽

Liver Function Tests ◽

Tertiary Care Centre ◽

Function Tests ◽

Serum Aspartate Aminotransferase ◽

History Of Use ◽

Blood Routine

Background: Hepatic injury can occur with the use of nimesulide, a non steroidal anti-inflammatory drug. This study was done to evaluate the hepatic and renal functions in patients with rheumatological complaints receiving nimesulide for 2 weeks.Methods: Fifty patients with rheumatological complaints treated at orthopaedic outpatient clinic of a tertiary care centre with nimesulide 100mg twice daily were enrolled in this study. The sociodemographic details, details of comorbidities, history of use of alcohol or tobacco, indication for treatment with nimesulide etc. were recorded in a predesigned proforma. All patients were followed up for two weeks and reviewed at the end of each week for any gastrointestinal adverse effects, changes in blood routine, liver function tests and renal function tests. Data collected was entered in Microsoft Excel 2010, analysed and results were expressed as mean and standard deviation.Results: Out of the fifty patients analysed, mean age was 39 years. 66 % were males. Among liver function tests, only serum albumin and serum aspartate aminotransferase (SGPT) were altered after treatment with nimesulide. Blood urea nitrogen, serum creatinine and blood routine remained normal. No gastrointestinal adverse effects were noted.Conclusions: Nimesulide produced changes in serum albumin and SGPT levels without prominent gastrointestinal or renal adverse effects.

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Hydroxyethyl Starch 130/0.42 Effect’s on Renal Function in Patients After Cardiac Surgery: A Retrospective Cohort Analysis

10.21203/rs.3.rs-100124/v1 ◽

2020 ◽

Author(s):

Benedict Morath ◽

Andreas Meid ◽

Johannes Rickmann ◽

Jasmin Soethoff ◽

Markus Verch ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Cardiac Surgery ◽

Kidney Function ◽

Hydroxyethyl Starch ◽

Retrospective Cohort ◽

Cohort Analysis ◽

Kidney Injury ◽

Retrospective Cohort Analysis ◽

The Impact

Abstract Background: Fluid management is an everyday challenge in intensive care units worldwide. Data from recent trials suggest that the use of hydroxyethyl starch leads to a higher rate of acute kidney injury and mortality in septic patients. Evidence on the safety of hydroxyethyl starch used in postoperative cardiac surgery patients is lacking Methods: The aim was to determine the impact of postoperatively administered hydroxyethylstarch 130/0.42 on renal function and 90-day mortality compared to with or without balanced crystalloids in patients after elective cardiac surgery. A retrospective cohort analysis was performed including 2245 patients undergoing elective coronary artery bypass grafting or, aortic valve replacement, or a combination of both between 2015 - 2019. Acute kidney injury was defined according to the ‘kidney disease improving global outcomes’ criteria. Multivariate logistic regression yielded adjusted associations of postoperative hydroxyethyl starch administration with acute kidney injury during hospital stay and 90-day mortality. Linear mixed-effects models predicted trajectories of estimated glomerular filtration rates over the postoperative period to explore the impact of dosage and timing of hydroxyethyl starch administration.Results: A total of 1009 patients (45.0 %) suffered from acute kidney injury. Significantly less acute kidney injury of any stage occurred in patients receiving hydroxyethyl starch compared to patients receiving only crystalloids for fluid resuscitation (43.7 % vs. 51.2 % p=0.008). In multivariate analysis, the administration of hydroxyethyl starch showed a protective effect (OR 0.89 95% confidence interval (CI) (0.82-0.96)) which was less prominent in patients receiving only crystalloids (OR 0.98, 95% CI (0.95-1.00)). No association between hydroxyethyl starch and 90-day mortality (OR 1.05 95% CI (0.88-1.25)) was detected. Renal function trajectories were dose-dependent and biphasic and hydroxyethyl starch could even slow down the late postoperative decline of kidney function.Conclusion: This study showed no association between hydroxyethyl starch and the postoperative occurrence of acute kidney injury and may add evidence to the discussion about the use of hydroxyethyl starch in cardiac surgery patients. In addition, hydroxyethyl starch administered early after surgery in adequate low doses might even prevent the decline of the kidney function after cardiac surgery.

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Comprehensive management of malignant otitis externa with tuberculosis and cranial nerve paresis in geriatrics

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v50i1.355 ◽

2020 ◽

Vol 50 (1) ◽

pp. 77

Author(s):

Ratna Dwi Restuti

Keyword(s):

Diabetes Mellitus ◽

Temporal Bone ◽

Cranial Nerve ◽

Cranial Nerve Palsy ◽

Otitis Externa ◽

Nerve Palsy ◽

Geriatric Patients ◽

Cranial Nerve Palsies ◽

Malignant Otitis Externa ◽

Multiple Cranial Nerve

Background: Malignant otitis externa is an inflammatory condition of the external ear which has the propensity to spread to the skull base. It can be a difficult entity to treat as clinical presentation varies and response to treatment differs between patients. Purpose: Evaluating the management of malignant otitis externa with complications in geriatric patients who had multiple comorbidities. Case: A 71 years old female with a diagnosis of left malignant otitis externa with complications of multiple cranial nerve palsies (N.VII, IX, X) and comorbidity in the form of diabetes mellitus and chronic kidney disease. The patient underwent subtotal temporal bone resection and petrosectomy. Clinical Question: “Could surgical management of malignant otitis externa with cranial nerve palsies complication in geriatric patients with multiple comorbidities achieve better result than conservative treatment?” Review Method: Literature search using keywords ’malignant otitis externa’ OR ’temporal bone osteomyelitis’ AND ’geriatric’ OR ’elderly’ AND ’multiple cranial nerve palsy’ AND ’diabetes mellitus’ AND ’tuberculosis’ AND ’surgery’ OR ’surgical’ was conducted through Cochrane, Pubmed, and Google Scholar. Result: The search obtained 11 articles published in the last 10 years. Selection based on inclusion and exclusion criteria, 2 studies were found relevant with the topic. Conclusion: Management of malignant otitis externa with complications in geriatric patients with multiple comorbidities requires a multidisciplinary approach to determine the need for surgery intervention.Keywords: malignant otitis externa, cranial nerve palsy, subtotal temporal bone resection, geriatric, diabetes mellitus ABSTRAK Latar belakang: Otitis eksterna maligna adalah suatu kondisi peradangan pada telinga luar yang memiliki kecenderungan untuk meluas hingga ke dasar tengkorak. Penyakit ini menjadi sulit ditangani karena manifestasi klinis yang bervariasi dan respons terhadap pengobatan yang berbeda antara pasien. Tujuan: Mengevaluasi tatalaksana otitis eksterna maligna dengan komplikasi pada pasien geriatri yang memiliki komorbiditas multipel. Kasus: Pasien perempuan 71 tahun dengan diagnosis otitis eksterna maligna telinga kiri dengan komplikasi paresis saraf kranial multipel (n.VII, IX, X) dan penyakit penyerta berupa diabetes melitus dan gagal ginjal kronik. Pasien menjalani operasi reseksi tulang temporal subtotal dan petrosektomi. Pertanyaan klinis: “Apakah tatalaksana pembedahan memberikan hasil yang lebih baik dibandingkan terapi konservatif pada pasien geriatri dengan otitis eksterna maligna disertai paresis saraf kranialis dengan komorbiditas multipel.” Telaah Literatur: Dilakukan menggunakan kata kunci ’malignant otitis externa’ ATAU ’temporal bone osteomyelitis’ DAN ’geriatric’ ATAU ’elderly’ DAN ’multiple cranial nerve palsy’ DAN ’diabetes melitus’ DAN ’tuberculosis’ DAN ’surgery’ ATAU ’surgical’ pada beberapa sumber data seperti Cochrane, Pubmed, dan Google Scholar. Hasil: Didapatkan 11 artikel publikasi 10 tahun terakhir. Berdasarkan kriteria inklusi dan eksklusi diperoleh 2 artikel yang relevan dengan topik. Kesimpulan: Tatalaksana otitis eksterna maligna dengan komplikasi pada pasien geriatri dengan komorbiditas multipel, membutuhkan pendekatan multidisiplin terutama untuk menentukan perlunya dilakukan tindakan pembedahan.

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