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Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
Published on: February 10, 2011
Antibiotic-resistant bacteria in pediatric chronic sinusitis
C L Slack1, K A Dahn, M J Abzug
1Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, The Children's Hospital, Denver, USA.
Insights
Antibiotic resistance is a significant concern in pediatric chronic sinusitis, with common pathogens like Streptococcus pneumoniae showing high rates of nonsusceptibility to standard antibiotics. This highlights the need for updated treatment guidelines for this condition.
Area of Science:
- Pediatric Otolaryngology
- Microbiology
- Infectious Diseases
Background:
- Limited data exists on bacterial resistance patterns in pediatric chronic sinusitis.
- Chronic sinusitis affects children, necessitating understanding of causative pathogens and their antibiotic susceptibility.
Purpose of the Study:
- To investigate the aerobic microbiology and antibiotic resistance patterns of pediatric chronic sinusitis.
- To identify common bacterial isolates and their susceptibility profiles in children with chronic maxillary sinusitis.
Main Methods:
- Retrospective review of aerobic cultures from pediatric patients with chronic maxillary sinusitis (1995-1998).
- Analysis of 119 children with sinusitis duration >8 weeks, excluding immunodeficiency or cystic fibrosis.
- Identification of bacterial isolates and assessment of antibiotic susceptibility.
Main Results:
- 67% of cultures were positive, yielding 274 isolates, with 88% polymicrobial.
- Most frequent isolates: nontypable Haemophilus influenzae (24%), Streptococcus pneumoniae (19%), Moraxella catarrhalis (17%).
- High nonsusceptibility rates observed: S. pneumoniae (64% penicillin, 40% cefotaxime), H. influenzae (44% ampicillin). All M. catarrhalis were beta-lactamase positive.
Conclusions:
- Pediatric chronic sinusitis involves typical acute sinusitis pathogens and organisms characteristic of chronic disease.
- Antibiotic-resistant bacteria, including multidrug-resistant S. pneumoniae, play a significant role in pediatric chronic sinusitis.
- Findings underscore the need for awareness of antibiotic resistance in managing pediatric chronic sinusitis.
Background:
Limited information exists on emerging bacterial resistance patterns in pediatric chronic sinusitis.
Methods:
A retrospective review (1995 to 1998) of the aerobic microbiology of chronic sinusitis in children at a tertiary care children's hospital was conducted. One hundred nineteen children (mean age, 4.9 years) with maxillary sinusitis of >8 weeks duration and no known immunodeficiency or cystic fibrosis who underwent antral irrigation were included.
Results:
One hundred sixty-one of 240 (67%) aerobic cultures were positive, yielding 274 isolates. Eighty-eight positive cultures were polymicrobial. The most frequent isolates were nontypable Haemophilus influenzae (24%), Streptococcus pneumoniae (19%), Moraxella catarrhalis (17%), coagulase-negative Staphylococcus (6%), alpha-streptococci (6%), diphtheroids (5%), Staphylococcus aureus (3%) and Neisseria spp. (3%). Rates of nonsusceptibility of Streptococcus pneumoniae were 64% for penicillin (24% high grade resistance), 40% for cefotaxime, 18% for clindamycin and 0% for vancomycin. Rates of nonsusceptibility of S. pneumoniae did not change significantly during the study period. Thirty-nine percent of H. influenzae isolates were beta-lactamase-positive and 44% were nonsusceptible to ampicillin (41% high grade resistance). Beta-lactamase positivity of H. influenzae decreased during the study period (P = 0.06). All M. catarrhalis isolates tested were beta-lactamase-positive.
Conclusion:
This study indicates that the aerobic pathogens in pediatric chronic sinusitis include bacteria typical of acute sinusitis as well as organisms more characteristic of chronic disease. Moreover it highlights the significant role of antibiotic-resistant aerobes, including multiply resistant S. pneumoniae, in pediatric chronic sinusitis.
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Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
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