Concordance of Middle Meatal Swab and Maxillary Sinus Aspirate in Acute and Chronic Sinusitis: A Meta-Analysis

Dubin, Marc G.; Ebert, Charles S.; Coffey, Charles S.; Melroy, Christopher T.; Sonnenburg, Robert E.; Senior, Brent A.

doi:10.1177/194589240501900508

Cited by 37 publications

(39 citation statements)

References 14 publications

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“…Th e bacteria species identifi ed in every microbiology study of chronic sinusitis are rarely associated with acute sinusitis or the acute exacerbation of chronic sinusitis, so the presence of bacteria on sinus mucosa should be interpreted as colonization rather than the infection [9]. Staphylococcus epidermidis is the bacteria that colonizes human body, including the oral cavity, so the majority of the authors of chronic sinusitis bacteriology studies assume this bacteria the contaminant and its presence in culture is usually discounted [10,11]. Comparing rates and species of bacteria found in chronic paranasal sinusitis with those found in normal maxillary sinuses, it is evident that there is no signifi cant diff erence between these two, suggesting that the same fl ora exists on the normal and chronically infl amed sinus mucosa [12].…”

Section: Discussionmentioning

confidence: 97%

Bacterial colonization or infection in chronic sinusitis

Pandak¹,

Pajić-Penavić²,

Sekelj³

et al. 2011

Wien Klin Wochenschr

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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.

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Section: Discussionmentioning

confidence: 97%

Bacterial colonization or infection in chronic sinusitis

Pandak¹,

Pajić-Penavić²,

Sekelj³

et al. 2011

Wien Klin Wochenschr

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“…Finally, the microbes present in the middle meatus may not be entirely representative of the underlying sinuses. When compared to the “gold standard” of maxillary sinus puncture and aspirate, prior culture-based studies of middle meatus sampling in acute rhinosinusitis have demonstrated an accuracy in the 80-90% range [41-45], leading to the clinical practice recommendation for culture-directed antibiotics in the specialty care of CRS [46]. However, in the era of more sensitive culture-independent microbiologic techniques [5], and with the understanding that subtle alterations in the microenvironment may result in alterations in the local microbial communities, this acceptance must be critically re-examined.…”

Section: Discussionmentioning

confidence: 99%

The Microbiome of the Middle Meatus in Healthy Adults

Ramakrishnan¹,

Feazel

Gitomer³

et al. 2013

PLoS ONE

175

182

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Rhinitis and rhinosinusitis are multifactorial disease processes in which bacteria may play a role either in infection or stimulation of the inflammatory process. Rhinosinusitis has been historically studied with culture-based techniques, which have implicated several common pathogens in disease states. More recently, the NIH Human Microbiome Project has examined the microbiome at a number of accessible body sites, and demonstrated differences among healthy and diseased patients. Recent DNA-based sinus studies have suggested that healthy sinuses are not sterile, as was previously believed, but the normal sinonasal microbiome has yet to be thoroughly examined. Middle meatus swab specimens were collected from 28 consecutive patients presenting with no signs or symptoms of rhinosinusitis. Bacterial colonization was assessed in these specimens using quantitative PCR and 16S rRNA pyrosequencing. All subjects were positive for bacterial colonization of the middle meatus. Staphylococcus aureus, Staphylococcus epidermidis and Propionibacterium acnes were the most prevalent and abundant microorganisms detected. Rich and diverse bacterial assemblages are present in the sinonasal cavity in the normal state, including opportunistic pathogens typically found in the nasopharynx. This work helps establish a baseline for understanding how the sinonasal microbiome may impact diseases of the upper airways.

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“…Prior culture-based study has demonstrated that the middle meatus is about 80-90% representative of underlying sinuses in detection of colonizing bacteria [11-13]. Although not perfect, these results imply that microbial similarities exist between the middle meatus and underlying ethmoid and maxillary sinuses.…”

Section: Introductionmentioning

confidence: 93%

Investigation of sinonasal microbiome spatial organization in chronic rhinosinusitis

Ramakrishnan

Gitomer

Kofonow

et al. 2016

Int Forum Allergy Rhinol

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Background Chronic rhinosinusitis (CRS) is a multifactorial inflammatory airway disorder in which bacteria are implicated in the initiation and/or sustenance of disease in some patients. The sinuses are colonized by bacteria even in health, and the potential for sinus-specific niches harboring unique microbial consortia raises questions for clinical and research investigation. Objective To determine the degree to which resident upper airways microbiota differ between individuals and anatomic sites, in order to determine the optimal site of microbial sampling for study in CRS. Methods 8 CRS patients undergoing primary surgery were sampled bilaterally at the anterior nares, middle meatus, nasopharynx, maxillary, frontal, and sphenoid sinuses, for investigation using broad-range bacterial 16S rRNA sequencing. Results Between-subject variability in bacterial microbiota was substantially greater than within-subject variability. The middle meatus was fairly representative of the underlying sinuses, although corynebacteria were detected at higher abundances in the middle meatus, relative to the maxillary (P<0.1), frontal (P<0.05), or sphenoid (P<0.1) sinuses. Conclusion Interpersonal variation of the upper airway microbiome greatly outweighs niche-specific differences. The middle meatus is a fair representation of the underlying sinuses and may be considered for use as a simple single site for sampling in longitudinal studies or in subjects who have not undergone sinus surgery.

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Concordance of Middle Meatal Swab and Maxillary Sinus Aspirate in Acute and Chronic Sinusitis: A Meta-Analysis

Abstract: Endoscopic middle meatal cultures have a high concordance with MSAs.

Cited by 37 publications

References 14 publications

Bacterial colonization or infection in chronic sinusitis

Bacterial colonization or infection in chronic sinusitis

The Microbiome of the Middle Meatus in Healthy Adults

Investigation of sinonasal microbiome spatial organization in chronic rhinosinusitis

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