热带北昆士兰坏死性外耳道炎的发病率、临床预测因素和治疗结局：识别区域和偏远地区风险

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中文摘要

目的： 评估澳大利亚热带北昆士兰坏死性外耳道炎（NOE）的发病率、临床表现、微生物学及结局预测因素。
研究设计： 回顾性队列研究。
地点： 汤斯维尔大学医院。
患者： 46例NOE患者（2017年1月至2025年3月）。
干预： 回顾人口学、临床和微生物学数据。按地理区域（本地<50 km vs. 区域/偏远>50至>400 km）和原住民身份对结局进行分层，并识别预后因素。
主要结局指标： 根据2024年坏死性外耳道炎核心结局集（COSNOE）指南，评估发病率、复发、治疗失败、疾病特异性生存率和总生存率。
结果： 2017年1月至2025年3月期间共诊断46例NOE患者。在8年研究期间，NOE发病率呈上升趋势，峰值达1.21/10万。患者多为老年人（78岁）、男性（82.6%）和糖尿病患者（71.7%）。铜绿假单胞菌（82.2%）占主导，同时真菌（64.4%）和多种微生物（71.1%）感染率高。高龄、颅神经病变和晚期疾病预测不良结局（P < 0.05）。培养阴性晚期颅底疾病相关（P = 0.045）。原住民患者（19.5%）显著更年轻（P < 0.001），但合并症负担相当（P = 0.719）。总体复发率为21.7%。C反应蛋白<15 mg/L对复发的阴性预测值为91.3%（P = 0.026）。区域/偏远地区居住是复发的独立预测因素（风险比：10.47，P = 0.027），与本地患者相比，无复发生存率更低（61.1% vs 88.5%；P = 0.044）。12个月治疗成功率为80.4%，1年疾病特异性死亡率为11.1%，总体疾病特异性生存率为84.7%。
结论： 北昆士兰NOE发病率正在上升，由高风险人群中独特的热带和社会决定因素驱动。随着发病率增加和高复发率，需要进一步研究以改善高风险社区的结局。

英文摘要

OBJECTIVE: To evaluate incidence, presentation, microbiology, and predictors of necrotizing otitis externa (NOE) outcomes in tropical North Queensland, Australia.
STUDY DESIGN: Retrospective cohort study.
SETTING: Townsville University Hospital.
PATIENTS: Forty-six NOE patients (January 2017-March 2025).
INTERVENTIONS: Review of demographic, clinical, and microbiology data. Outcomes stratified by geography (local <50 km vs. regional/remote >50 to >400 km) and indigenous status, with identification of prognostic factors.
MAIN OUTCOME MEASURES: Incidence, relapse, treatment failure, disease-specific survival, and overall survival per 2024 core outcome set necrotizing otitis externa (COSNOE) guidelines.
RESULTS: A total of 46 patients with NOE were diagnosed between January 2017 and March 2025. Over the 8-year study period, NOE incidence trended higher, peaking at 1.21 per 100,000. Patients were elderly (78 years), male (82.6%), and diabetic (71.7%). Pseudomonas aeruginosa (82.2%) dominated alongside high fungal (64.4%) and polymicrobial (71.1%) infections. Advanced age, cranial neuropathy, and advanced disease predicted adverse outcomes (P < 0.05). Culture-negativity correlated with advanced skull base disease (P = 0.045). Indigenous patients (19.5%) were significantly younger (P < 0.001) with equivalent comorbidity burden (P = 0.719). Overall relapse was 21.7%. C-reactive protein <15 mg/L yielded a 91.3% negative predictive value for recurrence (P = 0.026). Regional/remote residence was an independent predictor of relapse (hazard ratio: 10.47, P = 0.027), yielding a lower relapse-free survival compared with local patients (61.1% vs 88.5%; P = 0.044). Twelve-month treatment success was 80.4%, with 1-year disease-specific mortality 11.1% and overall disease-specific survival 84.7%.
CONCLUSION: NOE incidence is rising in North Queensland, driven by distinct tropical and social determinants in a high-risk population. With increasing incidence and high relapse rates, further research is required to improve outcomes for high-risk communities.