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Antimicrobial therapy in complicated rhinosinusitis
Simion-Antonie Catrinel Beatrice1,2, Bejenaru Paula Luiza1,2, Popescu Bogdan1,2
1Department of ENT, Head and Neck Surgery, Colţea Clinical Hospital, Bucharest, Romania.
Introduction:
Complicated rhinosinusitis is a rare but life-threatening pathology that requires both medical and surgical treatment as soon as possible. The spread of the infection from the paranasal sinuses affects, most often, the orbit, patients presenting diplopia, preseptal cellulitis, orbital cellulitis, or even blindness alongside exteriorization of puss from the middle meatus and nasal obstruction.
Materials And Methods:
We carried out a retrospective review of 32 patients that were diagnosed in our clinic with complicated rhinosinusitis from 2015 to 2022. All the patients received at least one intravenous antibiotic, and some also received antifungal drugs. All patients underwent surgery, either endoscopically or combined approach. Nasal washout or nasal swabs during surgery were sent for laboratory examination in all patients, and we studied the microbial etiology in these extensive infections. A database with all the information regarding demographic and medical data was established.
Results:
78% of the patients were male, with a mean age of 50.55. A wide range of antibiotics were used, while some patients, diagnosed with mucormycosis also received antifungal drugs. The mean hospitalization period was 12 days. We correlated the type of antibiotic with the hospitalization period and the outcome but also the degree of involvement of the orbit and the microbial strains identified.
Discussion:
The management of patients with complicated rhinosinusitis is complex and dynamic and it must be tailored to every patient, after an interdisciplinary meeting with the infectious disease specialist, ophthalmologist, and rhinologist. The microbial strains that produce such important infections are sometimes multi-resistant or combined, patients usually already had followed a course of antibiotics at home, and choosing the right treatment is sometimes challenging.
Insights
Complicated rhinosinusitis, a serious sinus infection, often spreads to the eye, requiring prompt medical and surgical care. This study analyzed 32 cases, detailing microbial causes and treatment outcomes for better patient management.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Ophthalmology
Background:
- Complicated rhinosinusitis is a rare but severe condition with potential for orbital invasion and vision loss.
- Early medical and surgical intervention is critical for managing this life-threatening pathology.
- Orbital complications include diplopia, preseptal and orbital cellulitis, and blindness.
Purpose of the Study:
- To review a cohort of patients with complicated rhinosinusitis.
- To identify the microbial etiology of these extensive sinus infections.
- To analyze treatment strategies and outcomes, including antibiotic use and hospitalization duration.
Main Methods:
- Retrospective review of 32 patients diagnosed with complicated rhinosinusitis between 2015 and 2022.
- Analysis of demographic and medical data, including intravenous antibiotic and antifungal treatments.
- Microbial examination of nasal washouts or swabs obtained during endoscopic or combined approach surgery.
Main Results:
- The patient cohort was predominantly male (78%) with a mean age of 50.55 years.
- A variety of antibiotics were administered; antifungal drugs were used for mucormycosis cases.
- Mean hospitalization was 12 days, with correlations drawn between antibiotic type, orbital involvement, microbial strains, and outcomes.
Conclusions:
- Management of complicated rhinosinusitis is complex, requiring a multidisciplinary approach involving infectious disease specialists, ophthalmologists, and rhinologists.
- Identifying and treating multi-resistant or combined microbial strains presents significant challenges.
- Tailored, individualized treatment plans are essential for optimal patient outcomes.
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