Microbiology of Acute Exacerbation of Chronic Sinusitis

Abstract

Objectives:

We undertook to evaluate the microbiology of acute exacerbation of chronic sinusitis (AECS).

Methods:

Repeated aspirations of maxillary sinus secretions by endoscopy were performed in 7 patients over a period of 125 to 242 days.

Results:

Bacteria were recovered for all 22 aspirates, and the number of isolates was between 2 and 4. A total of 54 isolates were isolated: 16 aerobic and facultative bacteria and 38 anaerobic bacteria. The aerobic bacteria were Haemophilus influenzae (7 isolates), Streptococcus pneumoniae (3), Moraxella catarrhalis (3), Staphylococcus aureus (2), and Klebsiella pneumoniae (1). The anaerobic bacteria included pigmented Prevotella and Porphyromonas spp (19), Peptostreptococcus spp (9), Fusobacterium spp (8), and Propionibacterium acnes (2). A change in the types of isolates was noted in all consecutive cultures obtained from the same patients as different organisms emerged and previously isolated bacteria were no longer recovered. An increase in antimicrobial resistance was noted in 6 instances.

Conclusions:

This study illustrates the microbial dynamics of AECS in which anaerobic and aerobic bacteria prevail, and highlights the importance of obtaining cultures from patients with AECS for guidance in selection of proper antimicrobial therapy.

Keywords

anaerobic bacteria antimicrobial resistance chronic sinusitis exacerbation

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References

Clement

Bluestone

Gordts

. Management of rhinosinusitis in children: Consensus meeting, Brussels, Belgium, September 13, 1996. Arch Otolaryngol Head Neck Surg 1998; 124: 31–4.

Jousimies-Somer

Savolainen

Ylikoski

. Bacteriological findings of acute maxillary sinusitis in young adults. J Clin Microbiol 1988; 26: 1919–25.

Brook

. Bacteriologic features of chronic sinusitis in children. JAMA 1981; 246: 967–9.

Nord

. The role of anaerobic bacteria in recurrent episodes of sinusitis and tonsillitis. Clin Infect Dis 1995; 20: 1512–24.

Brook

Frazier

. Microbial dynamics of persistent purulent otitis media in children. J Pediatr 1996; 128: 237–40.

National Committee for Clinical Laboratory Standards. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. 4th ed. M7–A4. Villanova, Pa: National Committee for Clinical Laboratory Standards, 1995.

O'Callaghan

Morris

Kirby

Shingler

. Novel method for detection of beta-lactamases by using a chromogenic cephalosporin substrate. Antimicrob Agents Chemother 1972; 1: 283–8.

Brook

Gober

. Bacterial interference in the nasopharynx and nasal cavity of sinusitis prone and non-sinusitis prone children. Acta Otolaryngol (Stockh) 1999; 119: 832–6.

Brook

Gober

. Resistance to antimicrobials used for therapy of otitis media and sinusitis: Effect of previous antimicrobial therapy and smoking. Ann Otol Rhinol Laryngol 1999; 108: 645–7.

10.

Ednie

Spangler

Jacobs

Appelbaum

. Susceptibilities of 228 penicillin- and erythromycin-susceptible and -resistant pneumococci to RU 64004, a new ketolide, compared with susceptibilities to 16 other agents. Antimicrob Agents Chemother 1997; 41: 1033–6.

11.

Brook

Gober

. Emergence of beta-lactamase—producing aerobic and anaerobic bacteria in the oropharynx of children following penicillin chemotherapy. Clin Pediatr (Phila) 1984; 23: 338–41.

12.

Finegold

. In vitro efficacy of beta-lactam/beta-lactamase inhibitor combinations against bacteria involved in mixed infections. Int J Antimicrob Agents 1999; 12 (suppl 1):S9–S14, S26–S27.

13.

Brook

Gober

. Prophylaxis with amoxicillin or sulfisoxazole for otitis media: Effect on the recovery of penicillin-resistant bacteria from children. Clin Infect Dis 1996; 22: 143–5.