Abstract
Objective
To determine the pathogens causing complicated rhinosinusitis over 10 years at a tertiary pediatric hospital, with a focus on methicillin-resistent Staphylococcus aureus (MRSA).
Methods
Chart review for patients admitted for complicated rhinosinusitis from 1997–2007.
Results
179 patients were diagnosed with complicated rhinosinusitis. Of those, 67(37.4%) required surgical treatment in addition to antimicrobials. 51 surgical cultures (76.1%) were positive. Single organisms were isolated from 28 cultures (54.9%), while 23 of 51 were polymicrobial. The most frequently isolated pathogen was from the Streptococcus anginosus/milleri/constellatus group, comprising 29.4% of positive cultures. Anaerobes were identified in 23.5% of cultures and group A streptococcus in 19.6%. Organisms common to normal human oral flora accounted for 80.3% of isolates. Staphylococci were isolated from 17 cultures (33.3%). Three (5.8%) of 51 isolates were MRSA. No MRSA isolate was part of a polymicrobial infection. All occurrences of MRSA were within the last 2 years of the review.
Conclusions
At our institution, MRSA accounted for 5.8% of culture positive complicated rhinosinusitis cases in the last 10 years, but all presented within the last 2 years. This suggests a potential recent increase in MRSA prevalence in this clinical presentation. Therefore, MRSA should be considered as a potential pathogen in these children, although the overall 10-year frequency is low. Most pathogens were common oral commensal organisMS This suggests that host factors play an important role in the pathogenesis of complicated rhinosinusitis.
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