Burkholderia cepacia complex nasal isolation in immunocompetent patients with sinonasal polyposis not associated with cystic fibrosis

Abstract

The Burkholderia cepacia complex (Bcc) is a group of phenotypically similar, genetically distinct, motile, freeliving, glucose-non-fermentative, gram-negative bacilli that can be found in soil or water, and it has emerged as an important lung pathogen for patients with cystic fibrosis [1]. Many strains of Bcc are transmissible. Although it is capable of occasionally contaminating hospital environments [1], Bcc rarely causes community-acquired infections in immunocompetent patients. The prospective study described here investigated the nasal microbiology of 48 patients with sinonasal polyposis and 24 patients with chronic sinusitis who consecutively underwent functional endoscopic sinus surgery (FESS). The nasal microbiology of a control group of ten patients without rhinologic abnormalities was also considered. The significant rate of Bcc isolation in our sinonasal polyposis group is discussed. The records of 72 consecutive patients with chronic sinonasal disease treated with FESS at the Section of Otolaryngology of Padova University, a tertiary referral academic hospital, were reviewed. None of the patients had immunosuppression or cystic fibrosis in their medical history, but one had diabetes mellitus. All patients considered for inclusion in the study were admitted on the day of surgical intervention. Nasal swabs were obtained in the operating room before the administration of local nasal anesthesia; a second nasal swab was performed on an outpatient basis 1 month after FESS, during follow-up nasal endoscopy. One nasal middle meatal bacterial swab was taken from each patient under rigid endoscope control. Postoperatively, intravenous antibiotic treatment (ampicillin/sulbactam 1.5 g four times a day in 50 patients; cefazolin 1 g three times a day in 14 patients) was administered for 2–3 days in 64 patients, and oral antibiotic treatment (levofloxacin 500 mg once a day) was administered in eight patients. After discharge, the patients received a 7-day course of antibiotic treatment, consisting of oral amoxicillin-clavulanate (1 g three times per day) in 58 cases, levofloxacin (500 mg once a day) in seven cases, or ceftibuten (400 mg twice a day) in seven cases. Nasal irrigation with either sulphurous-arsenical-ferruginous thermal water (Levico Terme, Trento, Italy) (40 cases) or isotonic sodium chloride solution (32 cases) was performed for at least 1 month after surgery. Histological evaluation of surgical specimens confirmed the diagnosis of sinonasal polyposis in 48 of 72 patients. In the clinical history of these patients, allergy was present in 15 cases, asthma in eight and acetylsalicylic acid intolerance in five. A control group of ten patients without rhinologic abnormalities ruled out by rigid nasal endoscopy also underwent nasal swabbing. Nasal swabs were plated onto sheep blood agar (COS; bioMerieux, Marcy l’Etoile, France) and chocolate agar with PolyVitex (bioMerieux). Plates were incubated for 24 and 48 h. Gram staining was performed. The isolates were Eur J Clin Microbiol Infect Dis (2007) 26:73–75 DOI 10.1007/s10096-006-0233-9