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Endoscopically guided cultures in chronic sinusitis

D M Nadel1, D C Lanza, D W Kennedy

  • 1Department of Otorhinolaryngology: Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA.

American Journal of Rhinology
|September 19, 1998
PubMed
Summary
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In chronic sinusitis, bacterial cultures reveal common pathogens. Prior sinus surgery and irrigations increase Gram-negative rods, while systemic steroids correlate with Pseudomonas aeruginosa.

Area of Science:

  • Otolaryngology
  • Microbiology
  • Immunology

Background:

  • Culture-directed antibiotics are standard for chronic sinusitis, but the role of specific bacteria like Gram-negative rods (GNRs) and Staphylococcus species remains debated.
  • Understanding host factors influencing bacterial culture results is crucial for effective treatment strategies.

Purpose of the Study:

  • To identify host factors associated with specific bacterial isolates in chronic sinusitis patients.
  • To compare bacterial prevalence in chronic sinusitis patients with healthy controls.

Main Methods:

  • Analysis of 507 endoscopically-guided cultures from 265 chronic sinusitis patients.
  • Comparison of host factors (asthma, allergic rhinitis, prior surgery, medication use) using chi-squared tests.
  • Comparison with 50 cultures from healthy volunteers.

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Main Results:

  • Coagulase-negative Staphylococci (SCN), Staphylococcus aureus, Pseudomonas aeruginosa, and Streptococcus were most common.
  • Gram-negative rods (GNRs) were found in 27% of cultures, more frequent with prior sinus surgery or irrigation use.
  • Pseudomonas aeruginosa prevalence increased with systemic steroid use; SCN was more common intraoperatively and with systemic steroids.
  • No host factor linked to S. aureus, though heavier growth was observed in patients versus controls.
  • Topical nasal steroids showed no significant impact on bacterial cultures.

Conclusions:

  • Prior sinus surgery and irrigations are linked to Gram-negative rods in chronic sinusitis.
  • Systemic steroid use is associated with Pseudomonas aeruginosa and SCN, while topical steroids have minimal impact.
  • Findings enhance understanding of chronic sinusitis microbiology and may inform treatment decisions.