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General antibiotic exposure is associated with increased risk of developing chronic rhinosinusitis
Alice Z Maxfield1, Hakan Korkmaz2, Luciano L Gregorio1
1Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.
Objective:
Antibiotic use and chronic rhinosinusitis (CRS) have been independently associated with microbiome diversity depletion and opportunistic infections. This study was undertaken to investigate whether antibiotic use may be an unrecognized risk factor for developing CRS.
Study Design:
Case-control study of 1,162 patients referred to a tertiary sinus center for a range of sinonasal disorders.
Methods:
Patients diagnosed with CRS according to established consensus criteria (n = 410) were assigned to the case group (273 without nasal polyps [CRSsNP], 137 with nasal polyps [CRSwNP]). Patients with all other diagnoses (n = 752) were assigned to the control group. Chronic rhinosinusitis disease severity was determined using a validated quality of life (QOL) instrument. The class, diagnosis, and timing of previous nonsinusitis-related antibiotic exposures were recorded. Results were validated using a randomized administrative data review of 452 (38.9%) of patient charts. The odds ratio of developing CRS following antibiotic exposure were calculated, as well as the impact of antibiotic use on the subsequent QOL.
Results:
Antibiotic use significantly increased the odds of developing CRSsNP (odds ratio: 2.21, 95% confidence interval, 1.66-2.93, P < 0.0001) as compared to nonusers. Antibiotic exposure was significantly associated with worse CRS QOL scores (P = 0.0009) over at least the subsequent 2 years. These findings were confirmed by the administrative data review.
Conclusion:
Use of antibiotics more than doubles the odds of developing CRSsNP and is associated with a worse QOL for at least 2 years following exposure. These findings expose an unrecognized and concerning consequence of general antibiotic use.
Level Of Evidence:
3b. Laryngoscope, 2016 127:296-302, 2017.
Insights
Antibiotic use more than doubles the risk of developing chronic rhinosinusitis without nasal polyps (CRSsNP) and leads to worse quality of life for years. This study highlights a significant, previously unrecognized consequence of antibiotic exposure.
Area of Science:
- Otolaryngology
- Microbiology
- Pharmacology
Background:
- Antibiotic use and chronic rhinosinusitis (CRS) are linked to reduced microbiome diversity and increased opportunistic infections.
- The potential role of antibiotic use as a risk factor for CRS development remains largely unexplored.
Purpose of the Study:
- To investigate whether prior antibiotic use is an unrecognized risk factor for developing chronic rhinosinusitis (CRS).
- To assess the impact of antibiotic exposure on the quality of life (QOL) in patients with CRS.
Main Methods:
- A case-control study involving 1,162 patients with sinonasal disorders.
- Patients were categorized into CRS (n=410) and control (n=752) groups.
- Antibiotic exposure history, CRS diagnosis, and QOL were assessed, with results validated via chart review.
Main Results:
- Antibiotic use significantly increased the odds of developing CRS without nasal polyps (CRSsNP) by 2.21 times (P < 0.0001).
- Antibiotic exposure was associated with significantly worse CRS QOL scores for at least two years post-exposure (P = 0.0009).
- Findings were confirmed by an administrative data review.
Conclusions:
- Antibiotic use more than doubles the risk of developing CRSsNP.
- Antibiotic exposure negatively impacts CRS-related quality of life for a minimum of two years.
- This study identifies a concerning, unrecognized consequence of general antibiotic use.
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