Rhinosinusitis in the Immunocompromised Cancer Population

Abstract

Objective: The microbiology of acute and chronic sinusitis in the general population is well documented, however, this is not well characterized in vulnerable subgroups. Our primary aim is to evaluate the paranasal sinus microbiology of immunocompromised patients at a tertiary cancer center. Method: Following institutional review board approval, records at Moffitt Cancer Center were retrospectively reviewed using ICD-9 codes for in-hospital treatment of sinusitis while undergoing concurrent oncologic therapy. All patients had nasal endoscopy with aerobic middle meatal culture. Demographics, type of malignancy, leukocyte count, glycemic status, and culture results were recorded. Results: Eighty patients were identified from June 2000 to April 2009. Malignancies included leukemia (63%), lymphoma (22%), multiple myeloma (5%), carcinoma (5%), and sarcoma (4%). One patient (1%) had common variable immunodeficiency. A total of 102 sinus cultures were collected. Of those, 59 (58%) were interpreted as no growth (n = 20) or usual respiratory flora (n = 39). Of the 46 positive cultures, 58 organisms were isolated. There were 16 fungi (28%), 12 coagulase-negative Staphylococcus (20%), 9 methicillin-sensitive Staphylococcus aureus (16%), 8 methicillin-resistant Staphylococcus aureus (14%), 6 Pseudomonas species (10%), 3 Moraxella catarrhalis (5%), and 4 other gram-negative bacilli (7%) isolated. Conclusion: Pathogens identified in this population differ from published data examining the general population. There is an increased percentage of negative cultures, fungi and coagulase negative staphylococcus. We found fewer streptococcus pneumonia species. We attribute this change in flora to frequent empiric treatment of this population with broad-spectrum antibiotics.