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Retrospective analysis of outcomes of outpatient parenteral antimicrobial therapy (OPAT) for necrotising otitis externa

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Abstract

Necrotising otitis externa (NOE) is an uncommon but life-threatening infection that requires prolonged systemic antimicrobial therapy. This study aims to identify factors associated with treatment response and outcome in patients with NOE treated through outpatient parenteral antimicrobial therapy (OPAT). We performed a retrospective analysis of patients with NOE treated over a 4-year period (January 2018–January 2022) at a tertiary referral hospital in Derbyshire, UK. We defined OPAT failure as unplanned readmission within 30 days of discontinuation of OPAT. Prolonged duration of therapy was defined as length of parenteral antimicrobial treatment of more than 8 weeks. A total of 46 cases of NOE were reviewed. OPAT failure and prolonged therapy were recorded in 9 (19.6%) and 23 (50.0%) episodes respectively. Facial nerve involvement (odds ratio [OR], 14.54; 95% confidence interval [CI], 2.76–76.60; p = 0.002), dementia (OR, 7.65; 95% CI, 1.23–47.46; p = 0.029), Charlson comorbidity score (OR, 1.41 per unit increase; 95% CI, 1.00–2.00; p = 0.049) and peak CRP level (OR, 1.03 per unit increase; 95% CI, 1.00–1.06; p = 0.027) were associated with increased risk of treatment failure. Facial nerve involvement (OR, 16.30; 95% CI, 2.60–102.31; p = 0.003) and peak CRP level (OR, 1.04; 95% CI, 1.01–1.07; p = 0.016) were also associated with an increased need for prolonged antimicrobial therapy. In addition, extent of disease (based on imaging findings) was linked to prolonged therapy (OR, 22.89; 95% CI, 3.62–144.76; p = 0.001). NOE could be effectively managed as outpatient via OPAT. However, vigorous antimicrobial treatment and close monitoring of patients with pre-existing comorbidities, facial nerve paralysis, extensive disease and markedly elevated inflammatory markers are essential to optimise clinical outcomes.

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Change history

  • 22 May 2022

    The name of the 1st and 3rd authors were incorrectly tagged. The given name and last name taggings were corrected.

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Acknowledgements

The authors wish to thank all the clinical staff working in the Derby OPAT service.

Author information

Authors and Affiliations

  1. Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK

    Oyewole Chris Durojaiye

  2. Department of Microbiology, Royal Derby Hospital, Derby, DE22 3NE, UK

    Oyewole Chris Durojaiye

  3. Department of Pharmacist, Royal Derby Hospital, Derby, DE22 3NE, UK

    Augustinas Slucka

  4. Present Address: NHS Sheffield Clinical Commissioning Group, Sheffield, S9 4EU, UK

    Augustinas Slucka

  5. Laboratory of Biostatistics, School of Medicine, University of Crete, 71003, Heraklion, Greece

    Evangelos I Kritsotakis

  6. School of Health and Related Research, Faculty of Medicine, Dentistry and Health, University of Sheffield, S1 4DA, Sheffield, UK

    Evangelos I Kritsotakis

Authors
  1. Oyewole Chris Durojaiye
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  2. Augustinas Slucka
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  3. Evangelos I Kritsotakis
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Contributions

OCD conceived the study, collected and analysed data, and wrote the manuscript. AS collected data and revised the manuscript. EIK analysed data and revised the manuscript.

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Correspondence to Oyewole Chris Durojaiye.

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This study was approved by the local clinical audit/effectiveness unit as part of ongoing commitment to service development and clinical governance.

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The authors declare no competing interests.

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Durojaiye, O.C., Slucka, A. & Kritsotakis, E.I. Retrospective analysis of outcomes of outpatient parenteral antimicrobial therapy (OPAT) for necrotising otitis externa. Eur J Clin Microbiol Infect Dis 41, 941–949 (2022). https://doi.org/10.1007/s10096-022-04455-y

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  • DOI: https://doi.org/10.1007/s10096-022-04455-y

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