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

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.

Abducens Nerve Neuropraxia due to Acute Bacterial Rhinosinusitis: Case Report and Literature Review

“…This infection activates the host inflammatory pathway and promotes the classical manifestations of AECRS [ 1 ]. In addition, the microbiological profile for AECRS is different from that of classical ABRS, and culture-guided therapy is recommended [ 17 ]. However, only around 50% of patients suspected of having ABRS yield a positive culture [ 4 ].…”

Maxillary sinus aeration analysis using computational fluid dynamics

“…Despite the development of microbiological, histological, and radiological diagnostics, the cause of sinusitis remains difficult to define. The combination of topical medications and surgical procedures remains the gold standard of therapy 1 – 3 . The development of micro-invasive endoscopic techniques has led to a change in the therapeutic approach to nasal diseases.…”