RESUMO
IMPORTANCE: Malignant external otitis (MEO) is an aggressive infection occurring in immunocompromised hosts. Increasing antimicrobial resistance is making the disease more difficult to treat. OBJECTIVE: Determine if there has been a shift in the microbiology and outcomes of MEO. DESIGN: A retrospective case series at a tertiary care institution. SETTING: Inpatient and outpatient tertiary care hospital. PARTICIPANTS: 12 cases of recent MEO were reviewed. MAIN OUTCOMES AND MEASURES: The primary outcome was progression of disease. Secondary outcomes were drug resistance and complications of MEO. RESULTS: Only 4 patients were cured of MEO. Four patients expired during the study period and at least one of these deaths was a direct result of the MEO. 7 patients developed Cranial nerve palsies, and 3 patients developed abscesses. CONCLUSIONS: Select cases of MEO now require multi-drug and long-term parenteral antibiotic therapy with extended hospital stays.
Assuntos
Antibacterianos/administração & dosagem , Farmacorresistência Bacteriana , Otite Externa/tratamento farmacológico , Infecções por Pseudomonas/tratamento farmacológico , Idoso , Estudos de Coortes , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/tratamento farmacológico , Progressão da Doença , Feminino , Seguimentos , Humanos , Infusões Intravenosas , Pacientes Internados/estatística & dados numéricos , Imageamento por Ressonância Magnética/métodos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Otite Externa/diagnóstico por imagem , Otite Externa/microbiologia , Otite Externa/patologia , Pacientes Ambulatoriais/estatística & dados numéricos , Infecções por Pseudomonas/diagnóstico por imagem , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
A flavanoid fraction (FF) from Drynaria fortunei, was investigated to see if it has the protective and ameliorative effects against gentamicin (GM) ototoxicity in guinea pigs (n = 36). Eleven (GM-group) animals received GM 100 mg/kg/day. Eleven (GMFF-group) animals received the same dose of GM but 2 days prior were dosed with FF (10 mg/kg/day) for 2 weeks. Seven (S-group) animals received saline and seven (FF-group) animals received the same dose of FF as the GMFF-group. The thresholds of tone-burst auditory evoked response (ABR) at 2 k, 8 k, and 32 k Hz were determined to be as follows: GM-group: 90 dB, 92 dB and 72 dB, GMFF-group: 30 dB, 37 dB and 38 dB, FF-group: 28 dB, 25 dB and 29 dB, S-group: 30 dB, 28 dB and 39 dB. The GM-group had a significantly higher hearing threshold than the other groups (p < 0.05). The GMFF- and FF-groups had hearing thresholds similar to the S-groups (p > 0.1). Repair of damaged hair cells was observed histologically. The percentage of the damaged outer hair cells (OHC) and inner hair cells (IHC) were determined to be as follows: GM-group: 43% and 20%, GMFF-group: 20% and 2%, FF-group: 9% and 2% and S-group: 4% and 1%. The GMFF-group showed less damage to the OHC (p > 0.05) and significantly less damage to the IHC (p < 0.05) than the GM-group. FF did not change the antimicrobial activity of GM and it did not show any intrinsic antibacterial effect. FF did not affect the kinetics of GM during the course of the experiment.