The Role of Nasal Microbiota and Sensitivity in Patients With Chronic Rhinosinusitis at a Rural Tertiary Care...

Background and aim Etiopathogeneses of chronic rhinosinusitis are poorly understood. Recent research emphasizes culture-independent molecular sequencing to identify clusters of flora that may function as drivers of inflammation. Studies also indicate that macrolides are as effective as corticosteroids in controlling chronic rhinosinusitis. In this study, we aimed to isolate microbial cultures from the middle meatus of patients suffering from chronic rhinosinusitis and assess the isolates for similarities and antibiotic sensitivity. We also sought to identify the pathogenic species disrupting the nasal microbiome and provide appropriate antibiotics based on the least minimum inhibitory concentration (MIC) from the cultures. Disease progression and response to treatment were evaluated using the Sino-Nasal Outcome Test-22 (SNOT-22) and the Lund-Kennedy endoscopy scoring system. Specifically, diagnostic nasal endoscopy (DNE) was performed in patients with chronic rhinosinusitis without nasal polyps (CRSnNP), and the pre-treatment Lund-Kennedy score was recorded, along with subjective data collected from the SNOT-22 questionnaire. After isolating cultures from the middle meatus, antibiotic treatment was provided based on these findings. A repeat DNE was conducted to calculate the post-treatment Lund-Kennedy score and collect the post-treatment SNOT-22 score. Finally, the pre- and post-treatment scores were compared to assess any statistically significant differences. Methods The patients upon arrival to the hospital and diagnosed with chronic rhinosinusitis without nasal polyposis (CRSnNP) based on the joint EPOS 2020 Criterion for the same were enrolled in the study. The patients were administered an SNOT-22 Questionnaire for subjective evaluation. The patients underwent a diagnostic nasal endoscopy (DNE) to calculate the Lund-Kennedy score, take swabs from the middle meatus for culture and sensitivity, and provide objective evaluation by the assessing physicians. The scores were recorded at the first visit and on each visit till the two weeks of antibiotic treatment were completed. The patients were treated with antibiotics as per the cultured isolates. The Lund-Kennedy scores and SNOT-22 scores before and after treatment were compared to note the response to treatment. Results The mean average Lund-Kennedy score and SNOT-22 scores dropped following a course of antibiotics. The patients also experienced symptomatic relief. The most commonly isolated organism among the samples evaluated was Pseudomonas aeruginosa. The best response to antibiotics was noted with aminoglycosides. Total resistance (100%) to macrolides and amoxicillin was also observed, which contradicts the antibiotic guidelines of EPOS 2020, ICAR 2021, and JTFPP 2014. Conclusion This study found that the invasive species disrupting the local nasal microbiome of the participants consisted of various pathogenic microorganisms. It indicated that a culture-based treatment of CRSnNP will yield better results compared to empirical antibiotics. The present study also suggests revising guidelines for antibiotic use and developing personalized antibiograms for treating chronic rhinosinusitis.