title: Skull base osteomyelitis: current microbiology and management.
abstract: BACKGROUND
  Skull base osteomyelitis typically presents in an immunocompromised patient with severe otalgia and otorrhoea. Pseudomonas aeruginosa is the commonest pathogenic micro-organism, and reports of resistance to fluoroquinolones are now emerging, complicating management. We reviewed our experience of this condition, and of the local pathogenic organisms.
  
  
  METHODS
  A retrospective review from 2004 to 2011 was performed. Patients were identified by their admission diagnostic code, and computerised records examined.
  
  
  RESULTS
  Twenty patients were identified. A facial palsy was present in 12 patients (60 per cent). Blood cultures were uniformly negative, and culture of ear canal granulations was non-diagnostic in 71 per cent of cases. Pseudomonas aeruginosa was isolated in only 10 (50 per cent) cases; one strain was resistant to ciprofloxacin but all were sensitive to ceftazidime. Two cases of fungal skull base osteomyelitis were identified. The mortality rate was 15 per cent. The patients' treatment algorithm is presented.
  
  
  CONCLUSIONS
  Our treatment algorithm reflects the need for multidisciplinary input, early microbial culture of specimens, appropriate imaging, and prolonged and systemic antimicrobial treatment. Resolution of infection must be confirmed by close follow up and imaging.
authors.affiliation: Department of Otolaryngology, Greenlane Hospital and Auckland City Hospital, Auckland, New Zealand. patrickspielmann@nhs.net
authors.forename: P M
authors.initials: PM
authors.lastname: Spielmann
authors.forename: R
authors.initials: R
authors.lastname: Yu
authors.forename: M
authors.initials: M
authors.lastname: Neeff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy; D002442:Ceftazidime / Q000008:administration & dosage / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000627:therapeutic use; D019299:Decompression, Surgical; D004352:Drug Resistance, Microbial; D004424:Ear Canal / Q000382:microbiology; D004433:Earache / Q000209:etiology; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D005710:Gallium Radioisotopes; D006801:Humans; D016867:Immunocompromised Host; D008279:Magnetic Resonance Imaging; D008297:Male; D008416:Mastoid / Q000601:surgery; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy; D010019:Osteomyelitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D012189:Retrospective Studies; D019291:Skull Base; D014057:Tomography, X-Ray Computed
chemical_list: D000890:Anti-Infective Agents; D005710:Gallium Radioisotopes; D002939:Ciprofloxacin; D002442:Ceftazidime