Comparative characteristics and outcomes of bacterial and fungal skull base osteomyelitis: a retrospective analysis of 127 cases.

OBJECTIVES

The aim of this study was to compare the clinical features, microbiological diagnosis, and management of bacterial and fungal skull base osteomyelitis (SBO).

METHODS

A single-center retrospective study was conducted between January 2012 and August 2022 at Lariboisière Hospital in Paris, including patients treated for SBO, defined by the presence of compatible symptoms and bone involvement on computed tomography or magnetic resonance imaging.

RESULTS

One hundred and twenty-seven patients were included: 97 with bacterial SBO and 27 with fungal SBO. The median age was 72.3 (65.6-81.2) years, and 106 (83%) patients had diabetes. Patients with fungal SBOs had more headache (44% vs 8%, P < 0.001), facial paralysis, and cranial nerve palsy (48% vs 24%, P = 0.013, and 30% vs 9%, P = 0.012) than those with bacterial SBOs. In cases of fungal SBOs, the imaging diagnosis of central venous thrombosis (33% vs 11%, P = 0.014), nerve infiltration (44% vs 11%, P < 0.001), or collection (48% vs 23%, P = 0.009) was more frequent. There was no significant difference in overall 1-year mortality between the two groups (10% vs 15%, P = 0.52), but the fungal nature of SBO was associated with intensive care unit admission or disease-specific mortality in a multivariate logistic analysis (odds ratio 3.56 [1.04-12.60], P = 0.043).

CONCLUSIONS

This study highlights the clinical severity and morbidity associated with fungal SBOs.