Abstract
IntroductionChronic sinusitis caused by anaerobes is a particular concern clinically, because many of the complications are associated with infections caused by these organisms. The aim of this study was to evaluate the incidence of anaerobic bacteria in chronic sinusitis in adults as a part of a prospective microbiological study.Materials and methodsOver a one-year period, aspirations of maxillary sinus secretions and/or ethmoid cavities were derived in n = 79 adult patients with chronic sinusitis by endoscopy in a tertiary-care teaching hospital in Hungary. The qualitative and quantitative compositions of the total cultivable aerobic and anaerobic bacterial and fungal flora cultured on the samples were compared. Correct anaerobic species level identifications were carried out according to standard methods.ResultsBacteria were recovered for all of the 79 aspirates and the numbers of the significant cultured isolates (with colony forming units ≥103) were between 1 and 10. A total of 206 isolates, 106 anaerobic and 100 aerobic or facultative-anaerobic strains were isolated. The most common aerobic bacteria were Streptococcus pneumoniae (n = 40), Haemophilus influenzae (n = 29), Moraxella catarrhalis (n = 6), Staphylococcus aureus (n = 7) and Streptococcus pyogenes (n = 6). The anaerobic bacteria included black-pigmented Prevotella spp. and Porphyromonas spp. (n = 27), Actinomyces spp. (n = 13), Gram-positive anaerobic cocci (n = 16), Fusobacterium spp. (n = 19) and Cutibacterium acnes (n = 8).ConclusionsThis study illustrates the microbial dynamics in which anaerobic and aerobic bacteria prevail and highlights the importance of obtaining cultures from patients with chronic sinusitis for guidance in selection of proper antimicrobial therapy.
Highlights
Chronic sinusitis caused by anaerobes is a particular concern clinically, because many of the complications are associated with infections caused by these organisms
Because of the special techniques required for the collection, transport and culture of anaerobes, the availability of reliable data on anaerobic bacteria associated with chronic rhinosinusitis (CRS), especially in adult patients is limited; based on various reports, anaerobic pathogens were recovered in 8–93% of cases [12,13,14]
Aerobic or facultative anaerobic bacteria were cultured from n 5 41 samples (51.9%), aerobic and anaerobic mixed flora was cultured in n 5 36 cases (45.6%) and only two patients had anaerobic bacterial flora exclusively (2.5%)
Summary
Chronic sinusitis caused by anaerobes is a particular concern clinically, because many of the complications are associated with infections caused by these organisms. CRS begins with an inflammation of the mucous membranes in the sinuses, the air-filled passages around the nose and throat, leading to mucous stagnation in the sinus, which forms a rich medium for the growth of various pathogens [1,2,3] This early stage of sinusitis is often caused by a viral infection, generally lasting up to 10 days, completely resolving in 99% of cases; a small number of patients may develop a secondary acute bacterial infection, which is generally caused by aerobic bacteria [1, 2]. Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Corynebacterium spp., Staphylococcus epidermidis and members of the Enterobacterales order have been noted as the predominant aerobic pathogens recovered from patients with sinusitis; with the exception of Staphylococcus aureus, the association between any single species and CRS is tenuous [10] Many of these bacteria can interfere with the overgrowth of potential other pathogens and may play a role in preventing the development of infections. The variability in their recovery rate may be due to differences in the methodologies used for sample preparation, transportation, laboratory possibilities of culturing and identification, patient population, different geography and previous surgical and/or antimicrobial therapy
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