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

Yan, Carol H.; Tangbumrungtham, Navarat; Maul, Ximena; Ma, Yifei; Nayak, Jayakar V.; Hwang, Peter H.; Patel, Zara M.

doi:10.1002/alr.22147

Cited by 14 publications

(15 citation statements)

References 25 publications

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“…Culture‐directed therapy for AECRS showed an improvement in Lund‐Kennedy endoscopy scores long term, but not in the short term. Furthermore, culture directed antibiotics does not improve short or long‐term QoL in CRS 1761 . This is in contrast to an earlier study that showed a decreased short‐term QoL improvement in the post ESS patients treated with culture inappropriate antibiotics, which is defined as at least 1 cultured organism resistant to or not covered by the prescribed post‐operative antibiotics.…”

Section: Acute Exaccerbation Of Chronic Rhinosinusitis (Aecrs)contrasting

confidence: 88%

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Orlandi

Kingdom

Smith

et al. 2021

Int Forum Allergy Rhinol

Self Cite

530

479

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I. Executive Summary Background The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS.

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Section: Acute Exaccerbation Of Chronic Rhinosinusitis (Aecrs)contrasting

confidence: 88%

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Orlandi

Kingdom

Smith

et al. 2021

Int Forum Allergy Rhinol

Self Cite

530

479

View full text Add to dashboard Cite

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“…Other authors who investigated populations similar to our study group (mainly post-ESS patients with correctly diagnosed AECRS) reported comparable findings [34][35][36][37][38]. The most commonly isolated pathogens were always S. aureus (25%-70%) and P. aeruginosa (9%-24%), while the "acute pathogens" S. pneumoniae, H. influenzae, and M. catarrhalis constituted only 10%-22% of all isolates.…”

Section: Microbiology and Antibiotic Resistance In Aecrssupporting

confidence: 84%

“…Other authors who investigated populations similar to our study group (mainly post-ESS patients with correctly diagnosed AECRS) reported comparable findings [34][35][36][37][38]. The most As explained above, due to uneven distribution of the bacteria among patients, the prevalence of phage-sensitive bacteria in the study group needs to be presented separately from the analysis of phage sensitivity in the bacterial isolates.…”

Section: Microbiology and Antibiotic Resistance In Aecrssupporting

confidence: 64%

Exacerbations of Chronic Rhinosinusitis—Microbiology and Perspectives of Phage Therapy

Szaleniec

Gibała

Pobiega³

et al. 2019

Antibiotics

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The chronically inflamed mucosa in patients with chronic rhinosinusitis (CRS) can additionally be infected by bacteria, which results in an acute exacerbation of the disease (AECRS). Currently, AECRS is universally treated with antibiotics following the guidelines for acute bacterial rhinosinusitis (ABRS), as our understanding of its microbiology is insufficient to establish specific treatment recommendations. Unfortunately, antibiotics frequently fail to control the symptoms of AECRS due to biofilm formation, disruption of the natural microbiota, and arising antibiotic resistance. These issues can potentially be addressed by phage therapy. In this study, the endoscopically-guided cultures were postoperatively obtained from 50 patients in order to explore the microbiology of AECRS, evaluate options for antibiotic treatment, and, most importantly, assess a possibility of efficient phage therapy. Staphylococcus aureus and coagulase-negative staphylococci were the most frequently isolated bacteria, followed by Haemophilus influenzae, Pseudomonas aeruginosa, and Enterobacteriaceae. Alarmingly, mechanisms of antibiotic resistance were detected in the isolates from 46% of the patients. Bacteria not sensitive to amoxicillin were carried by 28% of the patients. The lowest rates of resistance were noted for fluoroquinolones and aminoglycosides. Fortunately, 60% of the patients carried bacterial strains that were sensitive to bacteriophages from the Biophage Pharma collection and 81% of the antibiotic-resistant strains turned out to be sensitive to bacteriophages. The results showed that microbiology of AECRS is distinct from ABRS and amoxicillin should not be the antibiotic of first choice. Currently available bacteriophages could be used instead of antibiotics or as an adjunct to antibiotics in the majority of patients with AECRS.

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“…In the study by Yan et al ., 21 empiric and culture-directed antibiotic therapy for acute exacerbation of chronic rhinosinusitis were analysed, and the authors pointed out that primary targeted treatment improved long-term endoscopy scores compared with empiric treatment. Nevertheless, in that study, the short- and long-term quality of life and short-term endoscopy scores were comparable.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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

Cited by 14 publications

References 25 publications

International consensus statement on allergy and rhinology: rhinosinusitis 2021

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Exacerbations of Chronic Rhinosinusitis—Microbiology and Perspectives of Phage Therapy

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

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