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Chen CH, Wang CY, Cheng MY, Hsih WH, Tien N, Chou CH, Lin PC, Chi CY, Ho MW, Lu MC. Definite therapy of mixed infection alleviates refractory dilemma of adult chronic suppurative otitis media. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:1283-1292. [PMID: 36117089 DOI: 10.1016/j.jmii.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/22/2022] [Accepted: 07/30/2022] [Indexed: 12/27/2022]
Abstract
The characteristics, risk factors, microbial distributions and effective treatment regimens for Chronic suppurative otitis media (CSOM) patients intractable to empirical therapy were analyzed. Adult CSOM patients of China Medical University Hospital from 2018 to 2020 were included. Subjects of refractory and non-refractory groups were investigated for characteristics of age, sex, nation, comorbidities, otomycosis, and associated complications. Risk factors, microbiology distributions, and treatment regimens were analyzed. Twenty-six refractory patients (55.0 ± 17.7 years) and 66 non-refractory patients (54.1 ± 13.7 years) were studied. A significantly higher rate of otomycosis and CSOM complications was observed in refractory group than in non-refractory one (73.1% vs. 36.4%; p = 0.002; 57.7% vs. 10.6%, p < 0.001, respectively). Multivariate analysis revealed atopic diathesis (p = 0.048), otomycosis (p = 0.003) and CSOM complications (p < 0.001) were risk factors of refractory CSOM. Coagulase-negative staphylococci (CoNS) and methicillin-resistant Staphylococcus aureus (MRSA) were the prevailing pathogens. Patients of refractory group tented to have higher rates of mixed infection (42.9%% vs. 23.7%) and significantly more included fungal pathogen (19.0% vs. 2.6%; p = 0.049) than those of non-refractory cohort. Topical treatment of fungus significantly improved outcome of refractory CSOM. Atopic diathesis, otomycosis, and CSOM-associated complications were risk factors of refractory CSOM. Systemic and local treatment to possible drug-resistant pathogens, likely CoNS and fungus, possible improves recalcitrant CSOM. Correspondingly, early identification of CSOM complications, routine culture and susceptibility testing and treatment of resistant bacteria and fungus are key elements to the successful management of adult CSOM.
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Affiliation(s)
- Chih-Hao Chen
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
| | - Ching-Yuan Wang
- Department of Otolaryngology, Head and neck surgery, China Medical University Hospital, Taichung, Taiwan.
| | - Meng-Yu Cheng
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Hsin Hsih
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ni Tien
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Huei Chou
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Po-Chang Lin
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Yu Chi
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Mao-Wang Ho
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Internal Medicine, School of Medicine, China Medical University, Taichung, Taiwan.
| | - Min-Chi Lu
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, Taiwan.
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Wu S, Cheng Y, Lin S, Liu H. A Comparison of Antifungal Drugs and Traditional Antiseptic Medication for Otomycosis Treatment: A Systematic Review and Meta-Analysis. Front Surg 2022; 8:739360. [PMID: 35004834 PMCID: PMC8728675 DOI: 10.3389/fsurg.2021.739360] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives/Hypothesis: To perform a systematic review and meta-analysis to compare the efficacy of and complications associated with antifungal drugs and traditional antiseptic medication for the treatment of otomycosis. Data Sources: The PubMed, EMBASE, GeenMedical, Cochrane Library, CBM, CNKI, VIP and other databases were searched from January 1991 to January 2021. Methods: The systematic literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials (RCTs) and non-randomized studies (case-control, cohort, and case series) were included to assess the topical use of antifungal drugs and traditional antiseptic medication in patients with otomycosis. The research subjects were patients who were clinically diagnosed with otomycosis and whose external auditory canal secretions were positive for fungi. Funnel plots were used to detect bias, and the Q test was used to assess heterogeneity. The random-effects model was used for meta-analysis. The t-test was used to assess significance. Results: Of the 324 non-duplicate studies screened, 16 studies met the criteria for full-text review, and 7 were included in the meta-analysis. Four studies reported recovery conditions (P = 0.01). Six common complications after medication use were compared, and there were no significant differences. The authors further conducted subgroup analysis according to complications. The differences in the rates of ear distension (P = 0.007), earache (P = 0.03) and tinnitus (P = 0.003) were statistically significant. Conclusion: The results of this meta-analysis and literature review showed that antifungal drugs and traditional antiseptic medication were effective in relieving symptoms in patients with otomycosis, and the two treatments were associated with different complications. Otolaryngologists have the option to use one medication or a combination of two drugs on the basis of the condition. Future research in this area should include RCTs with long-term follow-up to guide the development of otomycosis guidelines to overcome some of the weaknesses found in the literature. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/#myprospero.
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Affiliation(s)
- Shunyu Wu
- Department of Otolaryngological, Shanghai Changzheng Hospital, Shanghai, China
| | - Yin Cheng
- Department of Otolaryngological, Shanghai Changzheng Hospital, Shanghai, China
| | - Shunzhang Lin
- Department of Otolaryngological, Shanghai Changzheng Hospital, Shanghai, China
| | - Huanhai Liu
- Department of Otolaryngological, Shanghai Changzheng Hospital, Shanghai, China
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Jamir L, Tripathi M, Shankar S, Kakkar R, Ayyanar R, Aravindakshan R. Determinants of Outcome Among Critically Ill Police Personnel With COVID-19: A Retrospective Observational Study From Andhra Pradesh, India. Cureus 2021; 13:e20394. [PMID: 35036224 PMCID: PMC8754352 DOI: 10.7759/cureus.20394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 12/02/2022] Open
Abstract
Background and Aims: Police personnel have been key frontline workers throughout the coronavirus disease 2019 (COVID-19) pandemic. This study was conducted to assess the correlates and outcomes of critically ill police personnel. Methods: This retrospective observational study analyzed key parameters of hospitalized police personnel who were critically ill with COVID-19 in Andhra Pradesh, India, between June and October 2020. Survival was analyzed for correlation with body mass index, ABO/Rh blood group, co-morbidities, treatment (oxygen therapy, prone positioning, mechanical ventilation, remdesivir, Ivermectin, oral and nasal topical povidone-iodine). We also performed Cox proportional hazard analysis with relevant function plots. Results: The majority of the 266 patients were male (n = 259; 97.4%) and obese (75.2%). The overall mortality of patients was 38% (n = 101). COVID-19 mortality increased significantly with age (p = 0.019) and BMI (p = 0.030) in the bivariate analysis. There was no significant difference between blood group (p = 0.297), co-morbidity (p = 0.582) and COVID-19 outcome. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of the risk factors for COVID-19 mortality were males (HR 4.89, 95% CI: 1.020-23.430) and ventilator therapy (HR 7.5, 95% CI: 4.527-12.296). The protective factors were symptom onset to reverse transcription polymerase chain reaction (RT-PCR) report interval (HR 0.36, 95% CI: 0.158-0.814), prone positioning (HR 0.43, 95% CI: 0.197-0.915), and use of povidone iodine (HR 0.43; 95% CI: 0.273-0.692). Conclusion: COVID-19 mortality among critically ill hospitalized police personnel was reduced by time to diagnostic test result, prone positioning, and povidone-iodine use and increased with male gender and mechanical ventilation.
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Role of Clotrimazole in Prevention of Recurrent Otomycosis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5269535. [PMID: 31950041 PMCID: PMC6944967 DOI: 10.1155/2019/5269535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 12/03/2019] [Indexed: 11/28/2022]
Abstract
Otomycosis is one of the relatively common diseases in the world which is caused by different fungi especially saprophytes. Concerning the relapse of this disease in a number of individuals, the present study was performed to evaluate the inhibitory effect of clotrimazole drop in the relapse of otomycosis. Clinical samples were taken by an ENT specialist from patients suspicious of having otomycosis. A part of these samples were stained, and others were cultured. The diagnosis of otomycosis was made on the basis of the recognizable and characteristic appearance of fungal hyphae or mycelium and fruiting bodies and/or conidiophores under microscopic examination. Patients with suspected otomycosis are not at risk of recurrence after treatment with clotrimazole drops. Out of the 161 individuals in whom definite diagnosis of otomycosis was made, the most affected individuals were, in the age range of 40–49 years, women, urban citizens, and housewives. Pruritus and diminished hearing were the main complaints of the patients. Aspergillus niger and A. flavus as well as Candida albicans were the main causes of the disease. The relapse of disease was observed in only five patients (3.1%), where A. niger was the main fungus. Most relapses were observed in women and in those with diminished hearing, manipulating the ears, ulcers in the canal, and tympanum. Our results suggested that usage of clotrimazole can be effective in reducing the relapse of otomycosis, and concerning the high cost of treating otomycosis while the low cost of using clotrimazole, usage of this drop is recommended to reduce the relapse of otomycosis.
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