Abstract

Objective: Skull base osteomyelitis (SBO) is a rare, life-threatening infection and frequently followed and treated by otolaryngologists previously. In this study, we analyzed the diagnosis, treatment and long-term outcomes of SBO from the perspective of infectious diseases and clinical microbiology (IDCM).

Methods: Hospitalized patients with SBO between 2012-2019 were evaluated retrospectively. Epidemiological, clinical, laboratory data of the patients were recorded. The patients who recovered with and without sequelae were compared.

Results: The mean age of 16 SBO cases was 66 years, 75% of them were male and 87.5% had diabetes mellitus (DM). Cranial nerve and vascular/dural involvement were present in 75% and 56.3% of them, respectively. The most common isolated microorganism were P. aeruginosa, staphylococci and Candida spp. 81.2%, 43.7%, and 56% of the patients received anti-pseudomonal antibiotics, additional glycopeptide and additional antifungal drugs, respectively. The sequelae rate was 46.7% in a 24-month follow-up. Hypertension (p=0.041), duration of complaints (p=0.003), bilateral involvement of skull base (p=0.001), vascular thrombosis/inflammation or dural involvement (p=0.007), previous surgical intervention (p=0.041) and elevated ESR at the end of treatment (p=0.014) were defined as risk factors for permanent sequelae. There was no in-hospital mortality. 

Conclusions: SBO mainly affects older male patients with DM and causes significant sequelae in half of them. In the cases unresponsive to anti-pseudomonal agents, the addition of antifungal therapy empirically may provide a clinical response. Permanent sequelae are more common in cases with delayed diagnosis/treatment, bilateral, vascular or dural involvement, and elevated ESR at the end of treatment.  ESR can be used to determine the treatment response and duration. The follow-up and treatment of SBO cases by IDCM with the support of experienced surgeons may contribute to the positive clinical results.