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Chronic rhinosinusitis: microbiology and treatment of acute exacerbations in patients after endoscopic surgery

Published online by Cambridge University Press:  06 October 2021

A Woźniak ,
K Nowak ,
J Wnuk ,
J Kaczmarczyk ,
P Król ,
P Stręk ,
J Składzień  and
J Szaleniec
A Woźniak
Affiliation:
Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
K Nowak
Affiliation:
Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
J Wnuk
Affiliation:
Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
J Kaczmarczyk
Affiliation:
Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
P Król
Affiliation:
Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
P Stręk
Affiliation:
Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
J Składzień
Affiliation:
Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
J Szaleniec*
Affiliation:
Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
*
Author for correspondence: Dr J Szaleniec, Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Jakubowskiego 2, Krakow30-688, Poland E-mail: [email protected]
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Abstract

Objective

Antibiotics are the mainstay of therapy for acute exacerbation of chronic rhinosinusitis. However, no treatment guidelines exist. Most clinicians follow the recommendations for acute bacterial rhinosinusitis, usually caused by Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhalis, and treat with amoxicillin or amoxicillin-clavulanate.

Method

Medical data of 810 patients who had undergone endoscopic sinus surgery were analysed retrospectively. The results of bacterial cultures and treatment course were assessed in 152 patients who presented with acute exacerbation of chronic rhinosinusitis within 6 months of endoscopic sinus surgery.

Results

The most common bacterial species present were Staphylococcus aureus (36 per cent), Pseudomonas aeruginosa (13 per cent) and Escherichia coli (11 per cent). Most of the isolates showed resistance or intermediate sensitivity to amoxicillin-clavulanate. Targeted antibiotic therapy was significantly more effective than empiric therapy (71 per cent versus 42 per cent). The most effective antibiotics were fluoroquinolones.

Conclusion

Acute exacerbation of chronic rhinosinusitis shows different microbiology than acute bacterial rhinosinusitis and requires a different therapeutic approach. It is optimally treated with culture-directed antibiotic therapy.

Keywords

SinusitisBacteriaMicrobiotaAnti-Bacterial Agents
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 12 , December 2021 , pp. 1088 - 1093
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Dr J Szaleniec takes responsibility for the integrity of the content of the paper

†

Deceased

References

Fokkens, WJ, Lund, VJ, Hopkins, C, Hellings, PW, Kern, R, Reitsma, S et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology 2020;58:1–464CrossRefGoogle ScholarPubMed
Hastan, D, Fokkens, WJ, Bachert, C, Newson, RB, Bislimovska, J, Bockelbrink, A et al. Chronic rhinosinusitis in Europe--an underestimated disease. A GA2LEN study. Allergy 2011;66:1216–23CrossRefGoogle Scholar
Shashy, RG, Moore, EJ, Weaver, A. Prevalence of the chronic sinusitis diagnosis in Olmsted County, Minnesota. Arch Otolaryngol Head Neck Surg 2004;130:320–3CrossRefGoogle ScholarPubMed
Speth, MM, Hoehle, LP, Phillips, KM, Caradonna, DS, Gray, ST, Sedaghat, AR. Changes in chronic rhinosinusitis symptoms differentially associate with improvement in general health-related quality of life. Ann Allergy Asthma Immunol 2018;121:195–9CrossRefGoogle ScholarPubMed
Rudmik, L. Economics of Chronic Rhinosinusitis. Curr Allergy Asthma Rep 2017;17:20CrossRefGoogle ScholarPubMed
DeConde, AS, Soler, ZM. Chronic rhinosinusitis: epidemiology and burden of disease. Am J Rhinol Allergy 2016;30:134–9CrossRefGoogle ScholarPubMed
Orlandi, RR, Kingdom, TT, Hwang, PH. International consensus statement on allergy and rhinology: rhinosinusitis executive summary. Int Forum Allergy Rhinol 2016;6:S3–21Google Scholar
Tan, KS, Yan, Y, Ong, HH, Chow, VTK, Shi, L, Wang, DY. Impact of respiratory virus infections in exacerbation of acute and chronic rhinosinusitis. Curr Allergy Asthma Rep 2017;17:24CrossRefGoogle ScholarPubMed
Lam, K, Schleimer, R, Kern, RC. The etiology and pathogenesis of chronic rhinosinusitis: a review of current hypotheses. Curr Allergy Asthma Rep 2015;15:41CrossRefGoogle ScholarPubMed
Brook, I. Microbiology of chronic rhinosinusitis. Eur J Clin Microbiol Infect Dis 2016;35:1059–68CrossRefGoogle ScholarPubMed
Kaper, NM, Aarts, MCJ, van Benthem, PPG, van der Heijden, GJMG. Otolaryngologists adhere to evidence-based guidelines for chronic rhinosinusitis. Eur Arch Otorhinolaryngol 2019;276:1101–8CrossRefGoogle ScholarPubMed
Fokkens, WJ, Lund, VJ, Mullol, J, Bachert, C, Alobid, I, Baroody, F et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology 2012;50:1–12CrossRefGoogle ScholarPubMed
Jiang, ZY, Kou, YF, Batra, PS. Endoscopic culture-directed antibiotic therapy: impact on patient symptoms in chronic rhinosinusitis. Am J Otolaryngol 2015;36:642–6CrossRefGoogle ScholarPubMed
Szaleniec, J, Gibala, A, Pobiega, M, Parasion, S, Skladzien, J, Strek, P et al. Exacerbations of chronic rhinosinusitis - microbiology and perspectives of phage therapy. Antibiotics (Basel) 2019;8:175CrossRefGoogle ScholarPubMed
Brook, I, Frazier, EH. Microbiology of recurrent acute rhinosinusitis. Laryngoscope 2004;114:129–31CrossRefGoogle ScholarPubMed
Merkley, MA, Bice, TC, Grier, A, Strohl, AM, Man, LX, Gill, SR. The effect of antibiotics on the microbiome in acute exacerbations of chronic rhinosinusitis. Int Forum Allergy Rhinol 2015;5:884–93CrossRefGoogle ScholarPubMed
Liu, CM, Soldanova, K, Nordstrom, L, Dwan, MG, Moss, OL, Contente-Cuomo, TL et al. Medical therapy reduces microbiota diversity and evenness in surgically recalcitrant chronic rhinosinusitis. Int Forum Allergy Rhinol 2013;3:775–81CrossRefGoogle ScholarPubMed
World Health Organization. Antimicrobial resistance: global report on surveillance, 2014. Geneva, Switzerland: World Health Organization, 2014Google Scholar
Namyslowski, G, Misiolek, M, Czecior, E, Malafiej, E, Orecka, B, Namyslowski, P et al. Comparison of the efficacy and tolerability of amoxycillin/clavulanic acid 875 mg b.i.d. with cefuroxime 500 mg b.i.d. in the treatment of chronic and acute exacerbation of chronic sinusitis in adults. J Chemother 2002;14:508–17CrossRefGoogle ScholarPubMed
Sabino, HA, Valera, FC, Aragon, DC, Fantucci, MZ, Titoneli, CC, Martinez, R et al. Amoxicillin-clavulanate for patients with acute exacerbation of chronic rhinosinusitis: a prospective, double-blinded, placebo-controlled trial. Int Forum Allergy Rhinol 2017;7:135–42CrossRefGoogle ScholarPubMed
Yan, CH, Tangbumrungtham, N, Maul, XA, Ma, Y, Nayak, JV, Hwang, PH et al. Comparison of outcomes following culture-directed vs non-culture-directed antibiotics in treatment of acute exacerbations of chronic rhinosinusitis. Int Forum Allergy Rhinol 2018;8:1028–33CrossRefGoogle ScholarPubMed
Cincik, H, Ferguson, BJ. The impact of endoscopic cultures on care in rhinosinusitis. Laryngoscope 2006;116:1562–8CrossRefGoogle ScholarPubMed