71 Pseudomonas aeruginosa in paranasal sinuses and in lower airways in cystic fibrosis patients

Abstract

Objective The paranasal sinuses could be a site of P. aeruginosa (PA) infection and/or reservoir for episodes of pulmonary re-infection in CF patients. The aim of this research was to clarify the role of the paranasal sinuses in the PA pulmonary infection. Methods Paired nasal lavage and lower airways samples were taken from 65 CF patients (median age 22.7 range 1.8–53.2 years) during 2014. Patients were classified in four group according to Leeds definition: 3 (4%) patients never infected, 18 (28%) PA-free, 24 (37%) intermittently infected, 9 (14%) chronically infected plus 11 (17%) lung transplanted patients. PA isolates from upper airways and lower airways were genotyped using BOX-PCR analysis. Results We found that 21 (32.3%) out of 65 patients had a positive PA culture from the nasal lavage. The mucoid PA phenotype was isolated in 9 (42.8%) out 21 positive samples. In the 3 never-infected patients all samples were PA-negative. Only 1 (5.5%) out of 18 patients had positive nasal lavage in the PA-free group. In the intermittent PA infection group 4 (16.6%) out of 24 patients had a positive upper respiratory tract. In the chronically infected patients all 9 (100%) nasal lavage samples were positive for PA. Seven (63.6%) out of 11 nasal lavage were positive for PA in patients who had been transplanted. The PA strains from the upper and lower respiratory tract cultures had the same genotype in 19 (90.5%) out of 21 patients except in 1 patient with chronic PA and in 1 transplanted patient. Conclusion Identical PA genotype and phenotype isolated from the upper and lower respiratory samples suggest that the paranasal sinuses may be a reservoir for pulmonary infection.