Impaired Mucosal Healing and Infection Associated with <i>Staphylococcus Aureus</i> After Endoscopic Sinus Surgery

Jervis-Bardy, Joshua; Foreman, Andrew; Field, John; Wormald, Peter John

doi:10.2500/ajra.2009.23.3366

Cited by 67 publications

(72 citation statements)

References 16 publications

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“…When the microbial density was compared for these three organisms between CRS and control patients, S. aureus was present at approximately 10 times higher genomes per sample in CRS patients, whereas S. epidermidis and P. acnes were found in similar abundance between both patient groups. The increased bioburden of S. aureus in the disease group is of particular interest, as it is emerging as a prominent disease modifying organism in CRS and it’s presence in patients has important clinical implications [14,15]. The capacity of S. aureus to exist within dense mucosal biofilms has been documented [11,16], which may explain the variable detection from clinical specimens using traditional culture techniques.…”

Section: Discussionmentioning

confidence: 99%

The microbiome of chronic rhinosinusitis: culture, molecular diagnostics and biofilm detection

et al. 2013

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BackgroundBacteria and fungi are believed to influence mucosal inflammation in chronic rhinosinusitis (CRS). However their presence and relationship to disease is debated. This study used multiple detection methods to compare microbial diversity and microbial abundance in healthy and diseased sinonasal mucosa. The utility of contemporary detection methods is also examined.MethodsSinonasal mucosa was analyzed from 38 CRS and 6 controls. Bacterial and fungal analysis was performed using conventional culture, molecular diagnostics (polymerase chain reaction coupled with electrospray ionization time-of-flight mass spectrometry) and fluorescence in situ hybridization.ResultsMicrobes were detected in all samples, including controls, and were often polymicrobial. 33 different bacterial species were detected in CRS, 5 in control patients, with frequent recovery of anaerobes. Staphylococcus aureus and Propionibacterium acnes were the most common organisms in CRS and controls, respectively. Using a model organism, FISH had a sensitivity of 78%, and a specificity of 93%. Many species were detected in both CRS and controls however, microbial abundance was associated with disease manifestation.ConclusionsThis study highlights some cornerstones of microbial variations in healthy and diseased paranasal sinuses. Whilst the healthy sinus is clearly not sterile, it appears prevalence and abundance of organisms is critical in determining disease. Evidence from high-sensitivity techniques, limits the role of fungi in CRS to a small group of patients. Comparison with molecular analysis suggests that the detection threshold of FISH and culture is related to organism abundance and, furthermore, culture tends to select for rapidly growing organisms.

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Section: Discussionmentioning

confidence: 99%

The microbiome of chronic rhinosinusitis: culture, molecular diagnostics and biofilm detection

et al. 2013

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“…In particular, the isolation of S. aureus biofilms in the sinuses of patients with chronic rhinosinusitis (CRS) has been linked to poorer clinical outcomes and disease prognosis[10]–[12], further defining the importance of this microorganism in disease severity. Although antibiotics initially improve patients’ signs and symptoms, recurrence after treatment cessation is often the case, demonstrating the limitations of the use of antimicrobial compounds.…”

Section: Introductionmentioning

confidence: 99%

Liposome-Encapsulated ISMN: A Novel Nitric Oxide-Based Therapeutic Agent against Staphylococcus aureus Biofilms

et al. 2014

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Background Staphylococcus aureus in its biofilm form has been associated with recalcitrant chronic rhinosinusitis with significant resistance to conventional therapies. This study aims to determine if liposomal-encapsulation of a precursor of the naturally occurring antimicrobial nitric oxide (NO) enhances its desired anti-biofilm effects against S. aureus, in the hope that improving its efficacy can provide an effective topical agent for future clinical use.Methodology S. aureus ATCC 25923 biofilms were grown in-vitro using the Minimum Biofilm Eradication Concentration (MBEC) device and exposed to 3 and 60 mg/mL of the NO donor isosorbide mononitrate (ISMN) encapsulated into different anionic liposomal formulations based on particle size (unilamellar ULV, multilamellar MLV) and lipid content (5 and 25 mM) at 24 h and 5 min exposure times. Biofilms were viewed using Live-Dead Baclight stain and confocal scanning laser microscopy and quantified using the software COMSTAT2.ResultsAt 3 and 60 mg/mL, ISMN-ULV liposomes had comparable and significant anti-biofilm effects compared to untreated control at 24 h exposure (p = 0.012 and 0.02 respectively). ULV blanks also had significant anti-biofilm effects at both 24 h and 5 min exposure (p = 0.02 and 0.047 respectively). At 5 min exposure, 60 mg/mL ISMN-MLV liposomes appeared to have greater anti-biofilm effects compared to pure ISMN or ULV particles. Increasing liposomal lipid content improved the anti-biofilm efficacy of both MLV and ULVs at 5 min exposure.ConclusionLiposome-encapsulated “nitric oxide” is highly effective in eradicating S. aureus biofilms in-vitro, giving great promise for use in the clinical setting to treat this burdensome infection. Further studies however are needed to assess its safety and efficacy in-vivo before clinical translation is attempted.

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“…Although in this study we did not examine postoperative outcomes, other studies have looked at the course of patients with persistent bacterial infections postsurgery. Jervis-Bardy et al 6 have shown that the intraoperative presence of S. aureus with failure to clear the bacteria postoperatively leads to persistent mucosal disease at the 90-day postoperative visit. This study suggests that the presence of S. aureus at the time of ESS and the lack of clearance of the bacteria during surgery may be a predictor for surgical failure.…”

Section: Discussionmentioning

confidence: 99%

The impact of intraoperative saline irrigations on bacterial load within the maxillary sinus

Seiberling

McHugh

Aruni

et al. 2011

Int Forum Allergy Rhinol

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Background Saline irrigations are routinely employed during endoscopic sinus surgery to remove mucous and debris from the sinus cavities. What is unknown is whether this results in a quantitative reduction in pathologic bacteria within the sinus mucosa. The objectives of this study were to quantify the amount of 5 different bacteria (Staphylococcus aureus, Haemophilus influenzae, Pseudomonas aeruginosa, coagulase-negative Staphylococcus (CNS), and Streptococcus pneumoniae) within the maxillary sinus and to determine the impact of saline irrigations on bacterial counts. Methods Twenty patients with chronic rhinosinusitis were prospectively enrolled. After bilateral maxillary antrostomies, biopsies were taken of the maxillary sinus mucosa prior to any irrigation. In each patient, the left maxillary sinus was then irrigated with 250 cc of normal saline (NS) with a pressurized pulse-irrigation device and the right side was irrigated with 250 cc of NS using a 30-cc syringe attached to a curved suction tip. Repeat maxillary sinus mucosal biopsies were then taken from each side. Each biopsy was analyzed using quantitative polymerase chain reaction to determine the presence and amount of each of the bacteria. Results Saline irrigations were found to significantly reduce the amount of S. aureus, P. aeruginosa, and S. pneumoniae found within the maxillary sinus mucosa. No difference was found for H. influenzae or CNS. No difference in bacterial load reduction was able to be shown between the pressurized saline flushes and manual saline rinse methods. Conclusion Intraoperative saline irrigations are able to significantly reduce the amount of potentially pathogenic bacteria within the diseased sinus mucosa.

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Impaired Mucosal Healing and Infection Associated with Staphylococcus Aureus After Endoscopic Sinus Surgery

Cited by 67 publications

References 16 publications

The microbiome of chronic rhinosinusitis: culture, molecular diagnostics and biofilm detection

The microbiome of chronic rhinosinusitis: culture, molecular diagnostics and biofilm detection

Liposome-Encapsulated ISMN: A Novel Nitric Oxide-Based Therapeutic Agent against Staphylococcus aureus Biofilms

The impact of intraoperative saline irrigations on bacterial load within the maxillary sinus

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