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Chronic rhinosinusitis: microbiology and treatment of acute exacerbations in patients after endoscopic surgery

Published online by Cambridge University Press:  06 October 2021

A Woźniak ,
K Nowak ,
J Wnuk ,
J Kaczmarczyk ,
P Król ,
P Stręk ,
J Składzień  and
J Szaleniec
A Woźniak
Affiliation:
Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
K Nowak
Affiliation:
Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
J Wnuk
Affiliation:
Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
J Kaczmarczyk
Affiliation:
Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
P Król
Affiliation:
Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
P Stręk
Affiliation:
Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
J Składzień
Affiliation:
Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
J Szaleniec*
Affiliation:
Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
*
Author for correspondence: Dr J Szaleniec, Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Jakubowskiego 2, Krakow30-688, Poland E-mail: joanna.szaleniec@uj.edu.pl
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Abstract

Objective

Antibiotics are the mainstay of therapy for acute exacerbation of chronic rhinosinusitis. However, no treatment guidelines exist. Most clinicians follow the recommendations for acute bacterial rhinosinusitis, usually caused by Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhalis, and treat with amoxicillin or amoxicillin-clavulanate.

Method

Medical data of 810 patients who had undergone endoscopic sinus surgery were analysed retrospectively. The results of bacterial cultures and treatment course were assessed in 152 patients who presented with acute exacerbation of chronic rhinosinusitis within 6 months of endoscopic sinus surgery.

Results

The most common bacterial species present were Staphylococcus aureus (36 per cent), Pseudomonas aeruginosa (13 per cent) and Escherichia coli (11 per cent). Most of the isolates showed resistance or intermediate sensitivity to amoxicillin-clavulanate. Targeted antibiotic therapy was significantly more effective than empiric therapy (71 per cent versus 42 per cent). The most effective antibiotics were fluoroquinolones.

Conclusion

Acute exacerbation of chronic rhinosinusitis shows different microbiology than acute bacterial rhinosinusitis and requires a different therapeutic approach. It is optimally treated with culture-directed antibiotic therapy.

Keywords

SinusitisBacteriaMicrobiotaAnti-Bacterial Agents
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 12 , December 2021 , pp. 1088 - 1093
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Dr J Szaleniec takes responsibility for the integrity of the content of the paper

†

Deceased

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