Microbiology of the Maxillary Sinus in Adults with Chronic Sinus Disease

Abstract

Antimicrobial therapy is a part of the care of patients with chronic sinus disease (CSD), but the etiologic role of microorganisms in this condition is unclear. Twenty patients with CSD undergoing functional endoscopic sinus surgery who had been off antibiotics for at least 1 week before surgery had a maxillary sinus aspirate for quantitative culture for aerobic bacteria and fungi and a semiquantitative culture from the antrostomy of the same maxillary sinus during endoscopic surgery. Six (30%) of the patients had infection of the maxillary sinus diagnosed by the presence of ≥ 103 cfu/mL of organisms in the sinus aspirate (Haemophilus influenzae in two patients and one patient each with Moraxella catarrhalis, α-streptococcus, mixed oropharyngeal flora, or Alternaria sp.). All antrostomy specimens obtained by nasal endoscopy during surgery were positive, but the antrostomy cultures did not correlate with the sinus aspirate cultures from the same sinus. Staphylococcus aureus and/or Gram negative rods in eight antrostomy cultures did not predict the presence of these pathogens in any of the maxillary sinus aspirates. Conversely, the bacteria detected with the quantitative aspirate culture in five of the six infected sinuses were not found in the antrostomy specimen; only the fungal sinus infection correlated with the antrostomy culture. Infection of the maxillary sinuses occurred in patients with both limited and severe disease by CT imaging. About one third of patients with CSD necessitating surgery had microbial infection of the maxillary sinus, but antrostomy cultures obtained via endoscopy did not predict the organisms infecting the sinus.

Microbiology of Chronic Frontal Sinusitis

“…Studies using sinus punctures have implicated anaerobic bacteria, S aureus, and H influenzae as potential pathogens. 1–5 Several recent studies using cultures of maxillary and ethmoid sinus mucosa biopsy specimens have not found a significant role for anaerobes. These more recent studies have predominantly cultured coagulase‐negative Staphylococcus.…”

“…Studies using sinus punctures implicated Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, and anaerobes as the primary pathogens. 1–5 More recent studies, using samples obtained by swab or tissue fragments taken primarily from the nasal cavity, OMC, or maxillary or ethmoid sinuses by way of antrostomy or other surgical opening, have raised the question of Gram‐negative organisms, coagulase‐negative Staphylococcus, and even fungi as crucial pathogens. 6–10 …”

Rhinosinusitis: Establishing definitions for clinical research and patient care

“…Several studies in adults have shown a good correlation between cultures of the middle meatus and the sinus aspirate in patients with acute sinusitis, especially when purulence is seen in the middle meatus 164,264,270 ; however, other studies have not. 271,272 CNS is usually interpreted as a nonpathogen in acute sinusitis. Talbot et al 264 correlated the results of endoscopically obtained cultures and cultures obtained from maxillary sinus aspirates.…”

Comparação entre diferentes métodos de coleta para avaliação microbiológica de pacientes com rinossinusite crônica

“…In order to identify these microorganisms, many studies have been published in order to establish numerous variables, such as the ideal site to collect the material for culture, the best collection method, the type of material to be sent to the lab (mucosa or secretion), or the specific way to identify the microorganisms (culture or Polymerase Chain Reaction -PCR) 1,[8][9][10][11][12][13] . In recent years, many studies have tried to validate the culture done from samples collected by means of middle meatus endoscopy, and the middle meatus aspiration was investigated and established by Jiang et al (1993) 14 .…”