Rhinosinusitis with MRSA Infection

Abstract

Background: Methicillin-resistant Staphylococcus (MRSA) is a highly virulent bacterium which is difficult to eradicate. It has become a common nosocomail pathogen. However, it is relatively less emphasized in outpatient settings. Moreover, although Staphylococcus aureus is a common pathogen of the head and neck, MRSA infection in the sinonasal area rarely reported. Methods: Charts were reviewed to find MRSA rhinosinusitis patients who were diagnosed in the Outpatient Clinic of the Department of Otolaryngology, Taichung Veterans General Hospital. When rhinosinusitis patients were not responsive to empiric antibiotic treatment in the Outpatient Clinic, specimens were taken from the middle meatus with cotton-tipped sticks. The specimens were sent for aerobic and anaerobic cultures to determine the appropriate antibiotics to be used for treatment. After MRSA was cultured, several treatments, including antibiotics and nasal irrigation, were used for these patients. Results: Twenty-eight patients with MRSA rhinosinusitis were identified in our Outpatient Clinic between July 1995 and August 1997. Among them, 16 patients were male, and 12 were female. Their ages ranged from 7 to 71 years old. The mean age was 36.1 years. Six of these MRSA-infected patients were chronic sinusitis patients without any history of prior sinonasal surgery. Three were chronic hypertrophic rhinitis patients who had undergone a partial turbinectomy. The remaining 19 patients had undergone functional endoscopic sinus surgery (FESS). The indication for FESS chronic sinusitis in 17 patients, noninvasive fungal sinusitis in another, and atrophic rhinitis in the last. Mucopurulent nasal discharge and nasal crusting were the most common clinical manifestations. No responsible predisposing factor was found in these MRSA-infected patients. After treatment, 21 patients improved. Conclusions: MRSA infection may constitute a new problem in the management of rhinosinusitis patients.