Role of surgery and antimicrobials in refractory skull base
osteomyelitis- a prospective study.
Abstract
Abstract Objective: To analyse the role of surgery along with
antimicrobials to improve clinical outcomes in treating refractory cases
of skull base osteomyelitis (SBO). Study design and setting: A
prospective comparative study in a tertiary care centre with 70 SBO
patients meeting eligibility criteria. Participants: The study
population comprised 35 patients refractory to systemic antimicrobials
of at least four weeks duration who later underwent surgery in addition
to medication (surgical group). They were compared with a medical group
that responded to medications alone. Main outcome measures: The outcome
variables studied were the resolution of clinical features (pain,
discharge, radiology, and inflammatory markers), culture yield, and
total duration of treatment. Results: According to our study, relief of
pain was faster in the surgical group(1.66 against 4.57 months) with
statistical significance (p< 0. 001). Relief of symptoms
(p< 0.001), radiological improvement (p= 0.001), and
normalizing of inflammatory markers (p<0.001) were better in
the surgical group than in the medical group. The duration of treatment
was an average of 9. 2 months in the surgical group compared to 11.3
months in the medical group (p= 0.019). Microbial culture from deep
tissue sampling was positive in 24 surgical patients (68.57%).
Conclusion: The treatment response to surgery and antimicrobials in
treating refractory cases of SBO was better than the group who responded
to antimicrobials alone. Surgery provided higher microbial yield
resulting in culture-specific antimicrobials. The surgical group
observed faster relief of symptoms, reduced hospital stay, and total
treatment duration.