Chris Durojaiye, O., Slucka, A. and I Kritsotakis, E. (2022) Retrospective analysis of outcomes of outpatient parenteral antimicrobial therapy (OPAT) for necrotising otitis externa. European Journal of Clinical Microbiology and Infectious Diseases, 41. pp. 941-949. ISSN 0934-9723
Abstract
Necrotising otitis externa (NOE) is an uncommon but life-threatening infection that requires prolonged systemic antimicrobial therapy. This study aims to identify factors associated with treatment response and outcome in patients with NOE treated through outpatient parenteral antimicrobial therapy (OPAT). We performed a retrospective analysis of patients with NOE treated over a 4-year period (January 2018–January 2022) at a tertiary referral hospital in Derbyshire, UK. We defined OPAT failure as unplanned readmission within 30 days of discontinuation of OPAT. Prolonged duration of therapy was defined as length of parenteral antimicrobial treatment of more than 8 weeks. A total of 46 cases of NOE were reviewed. OPAT failure and prolonged therapy were recorded in 9 (19.6%) and 23 (50.0%) episodes respectively. Facial nerve involvement (odds ratio [OR], 14.54; 95% confidence interval [CI], 2.76–76.60; p = 0.002), dementia (OR, 7.65; 95% CI, 1.23–47.46; p = 0.029), Charlson comorbidity score (OR, 1.41 per unit increase; 95% CI, 1.00–2.00; p = 0.049) and peak CRP level (OR, 1.03 per unit increase; 95% CI, 1.00–1.06; p = 0.027) were associated with increased risk of treatment failure. Facial nerve involvement (OR, 16.30; 95% CI, 2.60–102.31; p = 0.003) and peak CRP level (OR, 1.04; 95% CI, 1.01–1.07; p = 0.016) were also associated with an increased need for prolonged antimicrobial therapy. In addition, extent of disease (based on imaging findings) was linked to prolonged therapy (OR, 22.89; 95% CI, 3.62–144.76; p = 0.001). NOE could be effectively managed as outpatient via OPAT. However, vigorous antimicrobial treatment and close monitoring of patients with pre-existing comorbidities, facial nerve paralysis, extensive disease and markedly elevated inflammatory markers are essential to optimise clinical outcomes.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2022. This is an author-produced version of a paper subsequently published in European Journal of Clinical Microbiology and Infectious Diseases. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Malignant otitis externa; Necrotising otitis externa; Outcomes; Outpatient parenteral antimicrobial therapy; Risk factors; Treatment failure |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 13 May 2022 13:46 |
Last Modified: | 13 May 2023 00:13 |
Status: | Published |
Publisher: | Springer Verlag |
Refereed: | Yes |
Identification Number: | 10.1007/s10096-022-04455-y |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:186822 |