Microbiological studies of the core of tonsils removed from children with recurrent tonsillitis due to group A beta-hemolytic streptococci were conducted during three periods, with 50 patients in each period: 1977-1978 (period 1), 1984-1985 (period 2), and 1992-1993 (period 3). Mixed flora were present in all tonsils, with 8.1 organisms per tonsil (3.8 aerobes and 4.3 anaerobes). The predominant isolates in each period were Staphylococcus aureus, Moraxella catarrhalis, Peptostreptococcus species, pigmented Prevotella species, Porphyromonas species, and Fusobacterium species. The rate of recovery of Haemophilus influenzae type b increased from 24% in period 1 to 76% in period 2 (P < .001); a decline to 12% in period 3 correlated with a concomitant increase in the frequency of recovery of non-type b strains of H. influenzae from 4% and 10% in periods 1 and 2, respectively, to 64% in period 3 (P < .001). Both the rate of recovery of beta-lactamase-producing bacteria and the number of these organisms per tonsil increased over time. Specifically, beta-lactamase-producing strains were detected in 37 tonsils (74%) during period 1, in 46 tonsils (92%) during period 2, and in 47 tonsils (94%) during period 3, and the number of such strains per tonsil increased from 1.1 in period 1 to 2.9 and 3.3 in periods 2 and 3, respectively.

Repeated aspirations of sinus secretions by endoscopy was performed in five patients over a period of 34-50 days and, ultimately, surgical drainage was done in three who presented with acute maxillary sinusitis that did not respond to antimicrobial therapy and became chronic. The aspirates were cultured for aerobic and anaerobic bacteria. Most of the bacteria isolated from the first culture were aerobic or facultative bacteria: Streptococcus pn eum oniae (three isolates), Haemop hilus injluenzae non-t ype-b (two) and Moraxella catarrhalis (one). Three of these cultures yielded bacteria that were resistant to the antimicrobial agents prescribed for treatment. Failure to respond to therapy was associated with the emergence of resistant aerobic and anaerobic bacteria in subsequent aspirates. These organisms included Fusobacterium nucleatum, pigmented Prevotella and Porphyromonas spp. and Peptostreptococcus spp. Eradication of the infection was achieved in all instances following the administration of antimicrobial agents effective against these bacteria, and in three instances by surgical drainage. This study illustrates the microbial dynamics of maxillary sinusitis that did not respond to antimicrobial therapy.

The objective of the study was to compare the proportions of the recovery of pathogens of acute maxillary sinusitis in adults in the 4-year period prior to the 5-year period that followed the introduction of vaccination of children with the 7-valent pneumococcal vaccine (PCV7). Cultures were obtained through endoscopy from 385 adults with acute maxillary sinusitis, 156 between 1997 and 2000, and 229 between 2001 and 2005. One hundred and seventeen potentially pathogenic organisms were isolated from the cultures obtained between 1997 and 2000. The predominant organisms were Streptococcus pneumoniae (54 or 46 % of all isolates), Haemophilus influenzae non-type b (42 or 36 %), Moraxella catarrhalis (7 or 6 %), Streptococcus pyogenes (8 or 7 %) and Staphylococcus aureus (6 or 5 %). One hundred and sixty-seven potentially pathogenic organisms were isolated from the cultures obtained between 2001 and 2005. The most predominant organisms were H. influenzae non-type b (71 or 43 % of all isolates), Strep. pneumoniae (58 or 35 %), M. catarrhalis (13 or 8 %), Strep. pyogenes (12 or 7 %) and Staph. aureus (13 or 8 %). Significant statistical differences were noted in the rates of recovery of H. influenzae non-type b (P<0?05) and Strep. pneumoniae (P<0?05). A decrease occurred in the recovery of Strep. pneumoniae resistant to penicillin from 41 to 29 %, and an increase was noted in the isolation of beta-lactamase-producing H. influenzae from 33 to 39 %; however, neither change was statistically significant. These data illustrate that a significant shift occurred in the causative pathogens of acute maxillary sinusitis in adults in the 5 years after the introduction of vaccination of children with the PCV7 compared to the previous 4 years.

The aerobic and anaerobic microbiology of sinus aspirates obtained during surgery was compared with culture of samples obtained by endoscopy. Six patients with chronic maxillary sinusitis were evaluated. Polymicrobial flora was found in all specimens (twoto-five isolates/sample). A total of 24 isolates (18 anaerobic, five aerobic and one microaerophilic) was obtained from sinus aspirates, and 25 isolates (16 anaerobic and nine aerobic) were found in endoscopic specimens. The predominant organisms were Prevotella spp., Fusobacterium nucleatum, Peptostreptococcus spp. and Staphylococcus spp. Concordance in the type and concentration of organisms was found in all cases. Sixteen of the 18 anaerobes isolated from sinus aspirates were also found in the concomitant endoscopic sample. Five aerobic isolates were found in both sinus aspirates and endoscopic samples and their concentration was similar. However, four aerobic gram-positive bacteria (< lo4 cfu/sarnple) were found only in endoscopy samples. This pilot study demonstrates the usefulness of endoscopic aspiration in the isolation of bacteria from chronically infected maxillary sinuses.