A prospective multicentric study of microbiological profile, treatment protocols and clinical indicators of cure in skull base osteomyelitis.

OBJECTIVES

To find the microbial profile, effective treatment protocols and indicators of cure in skull base osteomyelitis(SBO).

METHODS

This prospective multicentric observational study involved 235 diagnosed SBO cases who satisfied the inclusion criteria from12 tertiary care centres. Minimum follow up(FU) was 6 months and maximum, 24 months. Osteomyelitis following trauma, radiotherapy and malignancy were excluded. Culture directed or empirical antipseudomonal intravenous antibiotics(IVAB) from a predetermined pool, were administered for 4 to 6 weeks, then switched to oral therapy for 4 weeks with improvement in pain, discharge, and or canal wall edema with declining inflammatory markers. Antifungals were administered when there was no response to IVABs and deep biopsy, not possible. Outcome measures were defined as cured, relieved, symptomatic or expired.

RESULTS

Bacterial culture- Positive in 60.4% with Pseudomonas Aeruginosa (PA) (57.75%), Staphylococcus aureus (SA) (26.06%) and fungus (10.4%). MRSA was 62.2%. Pseudomonal sensitivity to Piperacillin, Ciprofloxacin, Ceftazidime, Levofloxacin and Cefoperazone was 67.1%, 56.10%, 54.90%, 40.20%, and 36.60% respectively and resistance was 11%, 31.7%, 14.6%, 20.7%, and 13.4%. Average total duration of AB was 8 weeks. At the end of the study, 43.4% were cured, 15.7% were relieved, 5.1% were symptomatic and 16.2% expired. A normal ESR and CRP at 3rd and 6th month, indicated cure (p- < 0.001).

CONCLUSIONS

Microbial profile in our study was PA in 57.75% of positive cultures. The most effective treatment protocols were Piperacillin- Levofloxacin and Piperacillin. Normal inflammatory markers at the end of the 3rd and 6th month indicated a cure.