S131 – Complicated Community-Acquired MRSA Sinusitis: A Case Series

Abstract

Objectives

Participants should 1) understand the similarities and differences between nosocomial methicillin-resistant Staphylococcus aureus (MRSA) and its community-acquired counterpart (CA-MRSA); 2) recognize MRSA as an evolving member of the bacterial pathogens responsible for acute bacterial rhinosinusitis (ABRS); and 3) raise suspicion of CAMRSA in the differential for cases of progressive sinusitis, with or without complications, despite conventional first-line antimicrobial therapies.

Methods

Following the retrospective review of patients presenting to an urban tertiary care institution, those patients presenting with complicated sinusitis were identified. Data collected from chart review included age, sex, presenting signs and symptoms, onset of illness, therapy initiated prior to emergent presentation, operative procedures performed and operative findings, culture organisms and sensitivities, postoperative course, and final outcomes.

Results

9 patients presented with periorbital complications following an antecedent sinusitis. All 9 patients developed infectious orbital complications including periorbital cellulitis, lid abscess, orbital abscess, and 1 case of ipsilateral blindness. Cultures identified CA-MRSA as the primary pathogen which was characteristically sensitive only to vancomycin, clindamycin, doxycycline, and trimethoprim/sulfamethoxazole. All patients were treated with vancomycin with subsequent transition to oral antibiotics. In addition, all patients required early surgical intervention to manage their disease.

Conclusions

While the vast majority of ABRS is easily treated using the guidelines established by the Sinus and Allergy Health Partnership, clinicians should consider CAMRSA sinusitis in those patients who fail to respond or who suffer disease progression. This presentation discusses the diagnosis and treatment of CA-MRSA sinusitis with emphasis on bacterial resistance and appropriate antibiotic selection.