Definite therapy of mixed infection alleviates refractory dilemma of adult chronic suppurative otitis media.

Autor:	Chen CH; Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan. Electronic address: D24772@mail.cmuh.org.tw., Wang CY; Department of Otolaryngology, Head and neck surgery, China Medical University Hospital, Taichung, Taiwan. Electronic address: D11466@mail.cmuh.org.tw., Cheng MY; Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan., Hsih WH; Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan., Tien N; Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan., Chou CH; Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan., Lin PC; Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan., Chi CY; Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan., Ho MW; Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Internal Medicine, School of Medicine, China Medical University, Taichung, Taiwan. Electronic address: D7905@mail.cmuh.org.tw., Lu MC; Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, Taiwan. Electronic address: D6197@mail.cmuh.org.tw.
Jazyk:	angličtina
Zdroj:	Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi [J Microbiol Immunol Infect] 2022 Dec; Vol. 55 (6 Pt 2), pp. 1283-1292. Date of Electronic Publication: 2022 Aug 21.
DOI:	10.1016/j.jmii.2022.07.014
Abstrakt:	The characteristics, risk factors, microbial distributions and effective treatment regimens for Chronic suppurative otitis media (CSOM) patients intractable to empirical therapy were analyzed. Adult CSOM patients of China Medical University Hospital from 2018 to 2020 were included. Subjects of refractory and non-refractory groups were investigated for characteristics of age, sex, nation, comorbidities, otomycosis, and associated complications. Risk factors, microbiology distributions, and treatment regimens were analyzed. Twenty-six refractory patients (55.0 ± 17.7 years) and 66 non-refractory patients (54.1 ± 13.7 years) were studied. A significantly higher rate of otomycosis and CSOM complications was observed in refractory group than in non-refractory one (73.1% vs. 36.4%; p = 0.002; 57.7% vs. 10.6%, p < 0.001, respectively). Multivariate analysis revealed atopic diathesis (p = 0.048), otomycosis (p = 0.003) and CSOM complications (p < 0.001) were risk factors of refractory CSOM. Coagulase-negative staphylococci (CoNS) and methicillin-resistant Staphylococcus aureus (MRSA) were the prevailing pathogens. Patients of refractory group tented to have higher rates of mixed infection (42.9%% vs. 23.7%) and significantly more included fungal pathogen (19.0% vs. 2.6%; p = 0.049) than those of non-refractory cohort. Topical treatment of fungus significantly improved outcome of refractory CSOM. Atopic diathesis, otomycosis, and CSOM-associated complications were risk factors of refractory CSOM. Systemic and local treatment to possible drug-resistant pathogens, likely CoNS and fungus, possible improves recalcitrant CSOM. Correspondingly, early identification of CSOM complications, routine culture and susceptibility testing and treatment of resistant bacteria and fungus are key elements to the successful management of adult CSOM. (Copyright © 2022. Published by Elsevier B.V.)
Databáze:	MEDLINE
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