Middle meatus aspirates from patients with chronic rhinosinusitis were analyzed by bacterial culture, denaturing gradient gel electrophoresis (DGGE), and antibiotic sensitivity techniques. DGGE detected a greater bacterial diversity than culture methods. Although resistance to antibiotics was low, there was evidence of changes in the composition of the bacterial microbiota over time, and the presence of noncultured bacteria was demonstrated.
CASE REPORTUsing a glass canula, aspirates were taken from the middle meatus of six patients who had previously undergone surgery for chronic rhinosinusitis. These patients had continued infection after surgery despite ongoing nasal toilet and antibiotic treatment. The antibiotics prescribed to the patients within the 2 months prior to the aspirates being taken are listed in Table 1. Four of the patients had a second aspirate taken 2 to 3 months after the first sample. The aspirates were first suspended in 2 ml phosphate-buffered saline and then thoroughly homogenized by being vortexed before being divided into two equal volumes for use in culture-based and DNA-based analyses. For the isolation of staphylococci, mannitol salt agar (Difco, Sparks, MD) was incubated at 37°C aerobically. Total bacterial populations were isolated on chocolate agar (Columbia agar base [Difco] with 5% heat-lysed defibrinated sheep blood [New Zealand Venous Supplies, Tuakau, New Zealand]) by incubation at 37°C either aerobically, in air supplemented with 5% CO 2 , or in an anaerobic atmosphere (85% N 2 , 10% H 2 , 5% CO 2 ). For the isolation of Streptococcus pneumoniae, sheep blood agar (Columbia agar base containing 5% defibrinated sheep blood) with 5 g/ml gentamicin (Sigma, St. Louis, MO) was used with anaerobic incubation at 37°C. Representative bacterial isolates were then identified by