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Pseudomonas Biofilm Formation after Haemophilus Infection
P118
Otolaryngology-Head and Neck Surgery, Vol 143, No 2S2, August 2010
Predictors of Surgery in Pediatric Orbital Cellulitis Aditya Mahalingam-Dhingra (presenter); Rahul Shah, MD, FAAP; Diego Preciado, MD, PhD; Jonathan Taylormoore, MD; Lina Lander, ScD OBJECTIVE: To identify predictors of surgery in pediatric orbital cellulitis. METHOD: Analysis of the Kids Inpatient Database 2006 for patients admitted with a diagnosis of orbital cellulitis; univariate and multivariate analysis was performed. RESULTS: Of 5440 admissions, 672 (12%) underwent surgical intervention. Patients that had surgery were older with a mean age of 10.15 years (SE 0.29), compared to 6.07 years (SE 0.10) for non-surgical patients (p⬍0.001). Mean length of stay (LOS) for all sampled patients was 3.8 days, and 90.4% were routinely discharged. For surgical patients, cost of care (mean $41,009) and LOS (mean 7.11 days) were higher compared to non-surgical patients (mean cost $16,401; mean LOS 3.39 days). Mean age and LOS differed significantly between the surgical and non-surgical groups (p⬍0.001). Predictors of surgery include male gender, admission source, type of admission, and hospital location. With the exception of gender, these variables remained significant in a multivariate model. Clinical predictors of surgical intervention include diplopia, ethmoidal sinusitis (odds ratio 4.8) or maxillary sinusitis (odds ratio 3.7). CONCLUSION: This study is the first to report on the national resource utilization in the surgical and medical treatment of pediatric orbital cellulitis. Predictors of surgical intervention include older age, presentation with diplopia, involvement of ethmoid and maxillary sinuses, and admissions via the emergency department. These results can enable critical analysis of resource utilization for pediatric orbital cellulitis and can be used to optimally triage patients, reducing costs and lengths of stay. Pseudomonas Biofilm Formation after Haemophilus Infection Carolyn Ojano-Dirain, PhD (presenter); Gregory Schultz, PhD; Patrick Antonelli, MD OBJECTIVE: Tympanostomy tube (TT) biofilm formation may lead to refractory otorrhea and occlusion. Biofilms are typically composed of multiple microbial species. The presence of one species may promote or inhibit biofilm formation by other species. The aim of this study was to determine if Haemophilus influenzae (HI) biofilm promotes the development of Pseudomonas aeruginosa (PA) biofilm on TTs. METHOD: Fluoroplastic TTs were exposed to plasma, allowed to dry, then cultured with HI for seven days. TTs were either gas-sterilized or treated for 24h with ten mcg/ml or three mg/ml of ciprofloxacin. Half of the TTs from each treatment group underwent bacterial counts or scanning electron microscopy. The remainder, as well as TTs not exposed to HI, were
cultured with PA for four days and treated with gentamicin to kill planktonic PA. Biofilm formation was assessed with bacterial counts. RESULTS: TTs treated with ciprofloxacin three mg/ml had lower HI counts than TTs treated with ten mcg/ml (p ⬍ 0.001), but viable HI persisted. PA biofilm formation on TTs with prior HI biofilm and treated with ciprofloxacin ten mcg/ml or gas sterilization was not different than TTs without HI. Less PA biofilm formed on TTs with HI treated with three mg/mL ciprofloxacin (p ⫽ 0.002). CONCLUSION: HI biofilm does not promote PA biofilm formation on TTs. Use of high dose ciprofloxacin to clear HI infection may reduce subsequent PA biofilm formation. The clinical significance of this finding warrants examination. QOL and Voice Outcome after Laryngotracheal Reconstruction Neil Chadha, MBChB, MPH, FRCS (presenter); Jennifer Allegro, MSc; Vito Forte, MD; Paolo Campisi, MD OBJECTIVE: 1) To asses long-term impact of thyroid alar cartilage laryngotracheal reconstruction (LTR) on health-related quality of life (QOL) in infants using three validated instruments: Health Utility Version 3 (HUI3), Pediatric VoiceRelated Quality of Life Instrument (PVRQOL), and Impact on Family questionnaire; 2) To perform acoustic and perceptual voice assessments to evaluate long-term voice quality outcome. METHOD: Eligible children had all undergone an anterior thyroid alar cartilage graft LTR before the age of 24 months, between 1995 and 2007. Recruitment occurred over a 6-month period using validated QOL instruments and acoustic and perceptual voice analyses. RESULTS: Thirteen patients (eight male, five female, median 10 years) were enrolled. The mean age at LTR was five months (range 0-20) and the mean study follow-up period was 9 years (range 2-14). The average speech HUI3, PVRQOL and Impact on Family scores were 0.84 (SD-0.31), 0.83 (SD-0.22) and 0.67 (SD-0.28), respectively. The acoustic scores were either within the normal range or mildly abnormal for the variables: jitter, shimmer, noise-to-harmonic ratio, peak amplitude variation and fundamental frequency variation. The CAPE-V overall severity perceptual score was in the mildly abnormal range for 8 of 10 patients. CONCLUSION: This is the first study to explore and quantify long-term QOL and voice function in children following LTR with thyroid alar graft at a very young age. The vast majority of patients had a very good functional voice outcome as evidenced by the HUI3 and PVRQOL scores. This was corroborated by acoustic and perceptual voice assessments.
Otolaryngology-Head and Neck Surgery, Vol 143, No 2S2, August 2010
Predictors of Surgery in Pediatric Orbital Cellulitis Aditya Mahalingam-Dhingra (presenter); Rahul Shah, MD, FAAP; Diego Preciado, MD, PhD; Jonathan Taylormoore, MD; Lina Lander, ScD OBJECTIVE: To identify predictors of surgery in pediatric orbital cellulitis. METHOD: Analysis of the Kids Inpatient Database 2006 for patients admitted with a diagnosis of orbital cellulitis; univariate and multivariate analysis was performed. RESULTS: Of 5440 admissions, 672 (12%) underwent surgical intervention. Patients that had surgery were older with a mean age of 10.15 years (SE 0.29), compared to 6.07 years (SE 0.10) for non-surgical patients (p⬍0.001). Mean length of stay (LOS) for all sampled patients was 3.8 days, and 90.4% were routinely discharged. For surgical patients, cost of care (mean $41,009) and LOS (mean 7.11 days) were higher compared to non-surgical patients (mean cost $16,401; mean LOS 3.39 days). Mean age and LOS differed significantly between the surgical and non-surgical groups (p⬍0.001). Predictors of surgery include male gender, admission source, type of admission, and hospital location. With the exception of gender, these variables remained significant in a multivariate model. Clinical predictors of surgical intervention include diplopia, ethmoidal sinusitis (odds ratio 4.8) or maxillary sinusitis (odds ratio 3.7). CONCLUSION: This study is the first to report on the national resource utilization in the surgical and medical treatment of pediatric orbital cellulitis. Predictors of surgical intervention include older age, presentation with diplopia, involvement of ethmoid and maxillary sinuses, and admissions via the emergency department. These results can enable critical analysis of resource utilization for pediatric orbital cellulitis and can be used to optimally triage patients, reducing costs and lengths of stay. Pseudomonas Biofilm Formation after Haemophilus Infection Carolyn Ojano-Dirain, PhD (presenter); Gregory Schultz, PhD; Patrick Antonelli, MD OBJECTIVE: Tympanostomy tube (TT) biofilm formation may lead to refractory otorrhea and occlusion. Biofilms are typically composed of multiple microbial species. The presence of one species may promote or inhibit biofilm formation by other species. The aim of this study was to determine if Haemophilus influenzae (HI) biofilm promotes the development of Pseudomonas aeruginosa (PA) biofilm on TTs. METHOD: Fluoroplastic TTs were exposed to plasma, allowed to dry, then cultured with HI for seven days. TTs were either gas-sterilized or treated for 24h with ten mcg/ml or three mg/ml of ciprofloxacin. Half of the TTs from each treatment group underwent bacterial counts or scanning electron microscopy. The remainder, as well as TTs not exposed to HI, were
cultured with PA for four days and treated with gentamicin to kill planktonic PA. Biofilm formation was assessed with bacterial counts. RESULTS: TTs treated with ciprofloxacin three mg/ml had lower HI counts than TTs treated with ten mcg/ml (p ⬍ 0.001), but viable HI persisted. PA biofilm formation on TTs with prior HI biofilm and treated with ciprofloxacin ten mcg/ml or gas sterilization was not different than TTs without HI. Less PA biofilm formed on TTs with HI treated with three mg/mL ciprofloxacin (p ⫽ 0.002). CONCLUSION: HI biofilm does not promote PA biofilm formation on TTs. Use of high dose ciprofloxacin to clear HI infection may reduce subsequent PA biofilm formation. The clinical significance of this finding warrants examination. QOL and Voice Outcome after Laryngotracheal Reconstruction Neil Chadha, MBChB, MPH, FRCS (presenter); Jennifer Allegro, MSc; Vito Forte, MD; Paolo Campisi, MD OBJECTIVE: 1) To asses long-term impact of thyroid alar cartilage laryngotracheal reconstruction (LTR) on health-related quality of life (QOL) in infants using three validated instruments: Health Utility Version 3 (HUI3), Pediatric VoiceRelated Quality of Life Instrument (PVRQOL), and Impact on Family questionnaire; 2) To perform acoustic and perceptual voice assessments to evaluate long-term voice quality outcome. METHOD: Eligible children had all undergone an anterior thyroid alar cartilage graft LTR before the age of 24 months, between 1995 and 2007. Recruitment occurred over a 6-month period using validated QOL instruments and acoustic and perceptual voice analyses. RESULTS: Thirteen patients (eight male, five female, median 10 years) were enrolled. The mean age at LTR was five months (range 0-20) and the mean study follow-up period was 9 years (range 2-14). The average speech HUI3, PVRQOL and Impact on Family scores were 0.84 (SD-0.31), 0.83 (SD-0.22) and 0.67 (SD-0.28), respectively. The acoustic scores were either within the normal range or mildly abnormal for the variables: jitter, shimmer, noise-to-harmonic ratio, peak amplitude variation and fundamental frequency variation. The CAPE-V overall severity perceptual score was in the mildly abnormal range for 8 of 10 patients. CONCLUSION: This is the first study to explore and quantify long-term QOL and voice function in children following LTR with thyroid alar graft at a very young age. The vast majority of patients had a very good functional voice outcome as evidenced by the HUI3 and PVRQOL scores. This was corroborated by acoustic and perceptual voice assessments.