Are multiple sinus cultures necessary during sinus surgery for chronic rhinosinusitis?

Abstract

Background Multiple cultures are commonly obtained from different sinuses where purulence is encountered during endoscopic sinus surgery (ESS). This brings into question the utility and necessity of obtaining multiple cultures. The purpose of this study was to evaluate if multiple cultures obtained during a single case is informative in finding additional pathogens or if it is a redundant, cost-increasing practice. We hypothesized that multiple sinus cultures are necessary to identify the pathogens responsible for an individual’s sinus disease. We seek to add information on the utility of performing multiple sinus cultures from a patient care and a health economics standpoint. Methods This study was a retrospective review of a single rhinologist’s surgical database from 2008 to 2016. Patients that underwent ESS for chronic rhinosinusitis (CRS) and had multiple cultures obtained during surgery were included. Culture difference was recorded as a discrepancy of an infectious pathogen between cultures. Results We identified 231 patients with multiple sinus cultures. Of those, 39.4% had a difference of pathogens noted on culture between different sinuses. Only 5% of the cohort received clinically relevant benefit from the second culture obtained in regard to a change in antibiotics. Conclusion In this retrospective review we showed that, for the practitioner who obtains sinus cultures intraoperatively, limiting this practice to a single culture rather than multiple is cost-effective and sufficient for identifying the pathogen to be treated. This study, and the resultant change in practice, has the potential to reduce healthcare costs associated with the surgical care of the patient with CRS.

Comparison of outcomes following culture‐directed vs non–culture‐directed antibiotics in treatment of acute exacerbations of chronic rhinosinusitis

“…Studies have shown that a standard sinus culture may be a poor representation of the microbiota in chronic sinusitis . Miller and Davis demonstrated that when multiple cultures were obtained from the same patient intraoperatively, 39% of them grew different pathogens. Despite these different culture results, only 5% prompted a change in antibiotics based on sensitivities …”

The Microbiology of Acute Exacerbations in Chronic Rhinosinusitis - A Systematic Review

“…Thus, in vitro cultures may inadvertently bias growth to select for faster growing organisms, or those without niche or symbiotic growth needs. Additionally, standard cultures may not adequately represent the microbiome due to physical limitations in obtaining the culture; for example, Miller and Davis demonstrate significant variability in pathogens in cultures from the same patient when done via standard methods compared to those obtained intraoperatively ( Feazel et al., 2011 ; Hauser et al., 2015 ; Miller and Davis, 2018 ). Thus, it may beneficial to utilize alternative molecular methods of amplification, such as polymerase chain reaction, which can identify up to an order of magnitude more taxa that might be otherwise missed in between 25%-99% of cases.…”

European position paper on diagnostic tools in rhinology

“…Although the correlation of swabs between the middle meatus and maxillary sinus is well established, little research exists on how representative middle meatal swabs are of the remaining sinuses. Although not a direct comparative study, a recent retrospective study by Miller et al(124) demonstrated different pathogens in two or more…”