Preliminary evidence supporting use of UK consensus definitions for necrotising otitis externa

Q3 Medicine
Junko Takata , Victoria J. Sinclair , Holly Hendron , Robert Wilson , Laura Wilkins , Charlotte Miles , Jessica Larwood , Alanna Wall , Oliver Bannister , Monique I. Andersson , Susanne H. Hodgson
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Abstract

Background

Infections of the external ear canal (EAC) exist as a spectrum of disease from severe otitis externa (SOE) to necrotising otitis externa (NOE), but distinguishing between these is challenging. The UK consensus case definition (UKCCD) was established in 2022, but had not yet been assessed in clinical practice.

Methods

All consecutive adult patients undergoing CT to investigate a diagnosis of possible NOE between November 2018 and October 2019 were prospectively included in the cohort. Clinical diagnosis at baseline and the end of 12 months follow-up were compared to the diagnosis defined by UKCCD.

Results

55 patients were included in the analysis. 27 % (15/55) had an initial clinical diagnosis of NOE, of which 47 % (7/15) did not have changes on CT consistent with NOE. Only 9 % (5/55) patients had an MRI scan performed within 7 days of the baseline CT. At the end of 12 months, 9 % (5/55) patients had a change in diagnosis to or from NOE. All cases diagnosed as NOE by UKCCD had a clinical diagnosis of ‘NOE’ at baseline, while no cases clinically diagnosed as NOE were mislabelled by UKCCD as ‘not NOE’. All cases that had a change of diagnosis in the 12-month period or had an initial CT with no changes consistent with NOE, were captured by the UKCCD category of ‘possible NOE’. Median duration of antibiotics of clinically defined NOE cases were 14 days of intravenous (IQR: 7.3–23.8), 28 days of oral (IQR: 21.0–40.3), and 49.5 days combined (IQR: 29.8–67.3).

Conclusion

UKCCD has excellent clinical concordance with clinical diagnosis. Further work is warranted to assess its utility for risk stratification of patients presenting with severe infections of the EAC in a larger cohort.

支持使用英国一致同意的坏死性外耳道炎定义的初步证据
背景外耳道(EAC)感染存在从重症外耳道炎(SOE)到坏死性外耳道炎(NOE)的疾病谱,但区分这些疾病具有挑战性。英国共识病例定义(UKCCD)于2022年确立,但尚未在临床实践中进行评估。方法将2018年11月至2019年10月期间所有接受CT检查以诊断可能患有NOE的连续成年患者前瞻性地纳入队列。将基线和 12 个月随访结束时的临床诊断与 UKCCD 所定义的诊断进行比较。27%(15/55)的患者初步临床诊断为 NOE,其中 47%(7/15)的患者 CT 检查未发现与 NOE 一致的变化。只有 9% 的患者(5/55)在基线 CT 检查后 7 天内进行了 MRI 扫描。在 12 个月后,9% 的患者(5/55)的诊断结果由 NOE 转为 NOE。所有被 UKCCD 诊断为 NOE 的病例在基线时的临床诊断均为 "NOE",而没有临床诊断为 NOE 的病例被 UKCCD 误诊为 "非 NOE"。所有在 12 个月内诊断发生变化的病例,或最初 CT 无变化且与 NOE 一致的病例,均被 UKCCD 归入 "可能 NOE "类别。临床定义为 NOE 病例的抗生素中位持续时间分别为静脉注射 14 天(IQR:7.3-23.8)、口服 28 天(IQR:21.0-40.3)和 49.5 天(IQR:29.8-67.3)。需要进一步开展工作,在更大的群体中评估其对 EAC 严重感染患者进行风险分层的实用性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical Infection in Practice
Clinical Infection in Practice Medicine-Infectious Diseases
CiteScore
2.10
自引率
0.00%
发文量
95
审稿时长
82 days
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