Bacterial colonization or infection in chronic sinusitis

Abstract

The aim of this study was the determination of bacteria present in maxillary and ethmoid cavities in patients with chronic sinusitis and to correlate these findings with bacteria simultaneously present in their nasopharynx. The purpose of this correlation was to establish the role of bacteria found in chronically inflamed sinuses and to evaluate if the bacteria present colonized or infected sinus mucosa. Nasopharyngeal and sinus swabs of 65 patients that underwent functional endoscopic sinus surgery were cultivated and at the same time the presence of leukocytes were determined in each swab. The most frequently found bacteria in nasopharynx were Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus spp., Streptococcus viridans and Streptococcus pneumoniae. Maxillary or ethmoidal sinus swabs yielded bacterial growth in 47 (72.31%) patients. The most frequently found bacteria in sinuses were Staphylococcus epidermidis, Staphylococcus aureus, Klebsiella spp. and Streptococci (pneumoniae, viridans and spp.). The insignificant number of leukocytes was present in each sinus and nasopharyngeal swab. Every published microbiology study of chronic sinusitis proved that sinus mucosa were colonized with bacteria and not infected, yet antibiotic therapy was discussed making no difference between infection and colonization. Chronic sinusitis should be considered a chronic inflammatory condition rather than bacterial infection, so routine antibiotic therapy should be avoided. Empiric antibiotic therapy should be prescribed only in cases when the acute exacerbation of chronic sinusitis occurs and the antibiotics prescribed should aim the usual bacteria causing acute sinusitis. In case of therapy failure, antibiotics should be changed having in mind that under certain circumstances any bacteria colonizing sinus mucosa can cause acute exacerbation of chronic sinusitis.

Staphylococcus epidermidis and biofilm‐associated neutrophils in chronic rhinosinusitis. A pilot study

“…Such opinion was supported by a non-effective antibiotic therapy in a majority of cases of CRS in contrast to ARS (Fokkens et al 2012). Moreover, it has been postulated that bacteria found in chronically inflamed sinuses are associated with colonization but not infection of a sinus mucosa (Pandak et al 2011). Our understanding of the role of bacteria in CRS has changed over the last decade when a number of papers demonstrated the presence of bacterial biofilm in mucosa specimens taken from patients with both CRSsNP and CRSwNP.…”

“…However, in the majority of CRS, the aetiology, the pathogenesis and the role of bacterial infections in the development of the disease are unclear (Pandak et al . ). In addition, the association of neutrophil infiltration in CRS with and without nasal polyps is not well documented (Hirotsu et al .…”

“…; Pandak et al . ). Moreover, coagulase‐negative staphylococci ( S. epidermidis ) were the most common bacteria found within ethmoid and maxillary sinuses (31–51% of isolates) (Fokkens et al .…”

“…It is commonly accepted that the presence of S. aureus biofilm is associated with a poor prognosis of illness and with an unfavourable clinical outcome such as persistent sinusitis symptoms with ongoing mucosal inflammation and high risk of recurrent infections (Głowacki et al 2008;G€ unther et al 2009;Thurlow et al 2011). In contrast, the pathologic role of S. epidermidis in CRS has been documented by some investigators in spite of the emergence of the coagulase-negative staphylococci (S. epidermidis) as major nosocomial pathogens associated with infections of implanted medical devices (Sachse et al 2008;Pandak et al 2011). Moreover, coagulase-negative staphylococci (S. epidermidis) were the most common bacteria found within ethmoid and maxillary sinuses (31-51% of isolates) (Fokkens et al 2012).…”

Chronic rhinosinusitis and emerging treatment options

“…Pandak et al77 attempted to prove this controversial issue. The presence of an insignificant number of leukocytes in each sinus and nasopharyngeal swab shown by this study indicated bacterial colonization of sinonasal mucosa, not infection.…”