Microbiology of the middle meatus compared to sputum in young patients with cystic fibrosis from Bahia – Brazil

Abstract

Lower airway infection is a major cause of morbidity and mortality in patients with cystic fibrosis. It is currently unknown if the infection of the upper airway can cause exacerbation of lower respiratory tract infection. This study aimed to determine the microbiological profile of the anterior paranasal sinuses outflow tract (middle meatus) of cystic fibrosis outpatients. The microbiological profile was defined using endoscopically directed middle meatal cultures. Paired middle meatal and sputum specimens were collected from 56 outpatients for aerobic cultures. A semi-quantitative leukocyte count of the middle meatal samples was performed. The median age of patients was nine years (3-20 years). Staphylococcus aureus (37%), Staphylococcus coagulase-negative (25%), Neisseriac (14%), Pseudomonas aeruginosa (11%), and Streptococcus pneumoniae (7%) were the most prevalent microorganisms in the middle meatal cultures. Using the middle meatal leukocyte count, 16 out of 54 patients (29.6%) presented sinus infection. The most frequently identified pathogens in patients with sinus infections were Staphylococcus aureus (10 patients), Pseudomonas aeruginosa (4 patients), and Streptococcus pneumoniae (3 patients). Agreement of paired middle meatal and sputum cultures was significantly higher among patients with infection in middle meatal (69%). The most common middle meatal pathogens were the typical cystic fibrosis spectrum. This suggests the potential for participating in post-nasal lower airway seeding.

Sinus Bacteriology in Patients with Cystic Fibrosis or Primary Ciliary Dyskinesia: A Systematic Review

“…The origins of the studies are noted in the Online Supplemental Material. 5,6,10,11,13,14,16,17,19–56 The most common bacteria isolated in the upper airways in CF were S. aureus (including methicillin resistant S. aureus , methicillin sensitive S. aureus , and glycopeptide intermediate S. aureus ), which were identified in 513 patients (30%). The second most common bacterium was P. aeruginosa , which was isolated in 437 patients (25%).…”

“…Data presented were cumulative, which meant that samples could be obtained from more than one anatomic location per study. Forty-one percent of the studies 13,17,20–22,24,26,27,29,30,38–42,45,50,52,53 provided information about the use of antibiotics before or during the sampling procedure. In four studies, 14,16,25,33 it was unclear whether the patients received antibiotics before or during sampling.…”

“…When excluding studies that used only swabs and blowing samples, nine studies 13,19,20,24,27–31 were excluded, which left a total of 37 studies 5,6,10,11,14,16,17,21–23,25,26,32–56 with 1139 patients. In CF, seven articles 13,24,27–31 were excluded, which left 1131 patients with CF, and two PCD articles 19,20 were excluded, which left eight patients with PCD in the study.…”

“…In four studies, 14,16,25,33 it was unclear whether the patients received antibiotics before or during sampling. Fifty percent of the studies 10,11,13,14,17,[22][23][24][26][27][28][29][30][31][32][33]36,38,39,42,45,47,49 provided information about culture methods. Most studies 10,11,14,17,[22][23][24][27][28][29][30][31][32]38,39,42,45,47,49 used conventional culture methods (41%).…”