Endoscopic-guided cultures in pediatric recurrent acute rhinosinusitis

Rhinosinusitis is a highly prevalent disease among children. Many pathogens cause acute bacterial rhinosinusitis; however, literature is scarce when it comes to identifying bacteria responsible for pediatric recurrent acute rhinosinusitis (PRARS). This study aims to identify the most common organisms causing PRARS along with antimicrobial susceptibility, ideally with an endoscopic-guided culture from the middle meatus.

Retrospective data were collected between 2017 and 2023 for all PRARS patients who attended a pediatric ENT clinic at a tertiary hospital. Demographic characteristics and clinical data of 109 children were gathered. Samples were obtained through endoscopic-guided middle meatal cultures under general anesthesia.

Cultures were positive in 56 patients (51.4 %) consisting of either one or more organisms. The incidence of positive bacterial cultures was higher in the post-Covid19 era (74 versus 35). The predominant solo organism isolated was Moraxella species, accounting for 31.8 % of the total positive cultures. The second most common organism was Haemophilus influenzae (21.2 %). Staphylococcus aureus (18.2 %) was the third most isolated organism. Almost all Moraxella isolates were sensitive to amoxicillin-clavulanic acid, macrolides, and cefuroxime (100 %, 100 %, and 95 %, respectively). All Haemophilus isolates were 100 % sensitive to ceftriaxone and levofloxacin. All Streptococcus pneumoniae isolates were 100 % sensitive to penicillin and levofloxacin.

In PRARS, endoscopic-guided middle meatal cultures provided an accurate identification of the causative organism. A culture directed antibiotic choice will lead to a more favorable medical outcome.