Microbiology of Acute and Chronic Maxillary Sinusitis in Smokers and Nonsmokers

Abstract

We evaluated the microbiology of sinus aspirates of smokers and nonsmokers with acute and chronic maxillary sinusitis. Cultures were obtained from 458 patients, 244 (87 smokers and 157 nonsmokers) of whom had acute maxillary sinusitis and 214 (84 smokers and 130 nonsmokers) of whom had chronic maxillary sinusitis, between 2001 and 2007. A greater number of Staphylococcus aureus, methicillin-resistant S aureus (MRSA), and beta-lactamase-producing bacteria (BLPB) were found in the 87 smokers with acute sinusitis than in the nonsmokers with acute sinusitis (p < 0.005, p < 0.025, and p < 0.05, respectively). A greater number of these organisms were found in the 84 smokers with chronic sinusitis than in the nonsmokers (p < 0.01, p < 0.025, and p < 0.001, respectively). Eighty-five BLPB isolates were recovered from 73 patients (30%) with acute sinusitis. These included Moraxella catarrhalis, S aureus, Haemophilus influenzae, Prevotella spp, and Fusobacterium spp; 40 BLPB isolates were found in smokers, and 45 in nonsmokers (p < 0.05). One hundred twenty-five BLPB isolates were recovered from 91 patients (43%) with chronic sinusitis, including M catarrhalis, Bacteroides fragilis group, S aureus, H influenzae, Prevotella spp, and Fusobacterium spp; 69 BLPB isolates were found in smokers, and 56 in nonsmokers (p < 0.001). Antimicrobial therapy had been administered in the past month to 130 patients (28%; 60 smokers and 70 nonsmokers; p <0.025). Both MRSA and BLPB were isolated more often from these individuals (p < 0.025). However, the higher isolation rates of MRSA and BLPB in smokers were independent of previous antimicrobial therapy. These data illustrate a greater frequency of isolation of S aureus, MRSA, and BLPB in patients with acute and chronic sinusitis who smoke.