Bacteriology of Acute Exacerbation of Chronic Sinusitis

Brook et al. evaluated the microbiology of maxillary AECS by performing repeated endoscopic aspirations in seven patients over a period of 125 to 242 days (45). Bacteria were recovered from all aspirates and the number of isolates varied between two and four. The aerobes isolated were H. influenzae, S. pneumoniae, M. catarrhalis, S. aureus, and K. pneumoniae. The anaerobes included pigmented Prevotella and Porphyromonas, Peptostreptococcus, Fusobacterium spp., and Propionibacterium acnes. A change in the types of isolates was noted in all consecutive cultures obtained from the same patients, as different organisms emerged, and previously isolated bacteria were no longer found. An increase in antimicrobial resistance was noted in six instances. These findings illustrate the microbial dynamics of AECS where anaerobic and aerobic bacteria prevail, and highlight the importance of obtaining cultures from patients with this infection for guidance in the selection of proper antimicrobial therapy.

Brook et al. (46) also compared the microbiology of maxillary AECS in 30 patients with the microbiology of chronic maxillary sinusitis in 32 individuals. The study illustrated the predominance of anaerobic bacteria and polymicrobial nature of both conditions (2.5-3 isolates/sinus). However, aerobic bacteria that are usually found in acute infections (e.g., S. pneumoniae, H. influenzae, and M. catarrhalis) emerged in some of the episodes of AECS.

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