Necrotising (malignant) otitis externa in the UK: a growing problem. Review of five cases and analysis of national Hospital Episode Statistics trends
Necrotising (malignant) otitis externa in the UK: a growing problem. Review of five cases and analysis of national Hospital Episode Statistics trends
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DOI：
10.1017/s002221511500105x
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发表时间：
2015-06-01
影响因子：
1.7
通讯作者：
Whiteside, O.
中科院分区：
文献类型：
--
作者：
Chawdhary, G.;Liow, N.;Whiteside, O.
背景：坏死性（恶性）外耳炎是一种导致颞骨骨髓炎的严重感染。尽管罕见，但我们的经验（本文报告）显示 2013 年局部病例翻倍。英格兰 14 年来的医院发病统计数据也表明全国发病率有所增加。还讨论了管理中的具体学习点。方法：对 2013 年英国斯劳 Wexham Park 医院（辖区人口 45 万）收治的患者进行回顾性评估。此外，还查阅了英国政府医院的发病统计数据。结果：2013年有5例坏死性（恶性）外耳炎病例，局部较往年增加了一倍。患者的平均年龄为82岁。所有培养物均生长有铜绿假单胞菌；没有分离株对抗生素产生耐药性。所有患者的临床、生化和放射学参数均对全身抗假单胞菌药物有反应。医院发作统计数据显示，从 1999 年 (n = 67) 到 2013 年 (n = 421)，病例数增加了六倍。结论：我们的经验表明坏死性（恶性）外耳炎发病率不断增加，医院发作统计数据的回顾性分析支持了这一观察结果。正如我们的病例所示，坏死性（恶性）外耳炎给治疗带来了挑战，需要高度怀疑和早期积极治疗才能治愈。
Background: Necrotising (malignant) otitis externa is a severe infection causing temporal bone osteomyelitis. Although rare, our experience (reported herein) shows local doubling of cases in 2013. Hospital Episodes Statistics data for England over 14 years also indicate increased incidence nationally. Specific learning points in management are also discussed.Methods: A retrospective review was conducted of patients admitted in 2013 to Wexham Park Hospital, Slough, UK (catchment population, 450 000). In addition, the UK Government Hospital Episodes Statistics data were interrogated.Results: There were five cases of necrotising (malignant) otitis externa in 2013, representing a local doubling on previous years. The mean age of patients was 82 years. All cultures grew Pseudomonas aeruginosa; no isolates were antibiotic resistant. All patients responded to systemic anti-pseudomonals on clinical, biochemical and radiological parameters. Hospital Episodes Statistics data showed a six-fold increase in the number of cases from 1999 (n = 67) to 2013 (n = 421).Conclusion: Our experience suggests increasing necrotising (malignant) otitis externa incidence, and retrospective analysis of Hospital Episodes Statistics data supports this observation. Necrotising (malignant) otitis externa poses challenges in management, as exemplified in our cases, requiring a high index of suspicion and early aggressive treatment to achieve cure.