Studies in Adults

The presence of anaerobic bacteria in chronic sinusitis in adults is clinically significant. Finegold et al. (25) in a study of chronic maxillary sinusitis, found recurrence of signs and symptoms twice as frequent when cultures showed anaerobic bacterial counts above 103 colony-forming units per milliliter.

Anaerobes were identified in chronic sinusitis in adults whenever techniques for their cultivation were employed (24,33). The predominant isolates were pigmented Prevotella, Fusobacterium, and Peptostreptococcus spp. The predominant aerobic bacteria were S. aureus, M. catarrhalis, and Haemophilus spp.

A summary of 13 studies of chronic sinusitis done since 1974, including 1758 patients (133 were children) is shown in Table 2 (7,25,32,34-42). Anaerobes were recovered in 12% to 93%. The variability in recovery may result from differences in the methodologies used for transportation and cultivation, patient population, geography, and previous antimicrobial therapy.

Brook and Frazier (43) who correlated the microbiology with the history of sinus surgery in 108 patients with chronic maxillary sinusitis found a higher rate of isolation of P. aeruginosa and other aerobic gram-negative bacilli in patients with previous sinus surgery. Anaerobes were, however, isolated significantly more frequently in patients who had not had prior surgery.

TABLE 2 Anaerobes in Chronic Sinusitis

Anaerobes

TABLE 2 Anaerobes in Chronic Sinusitis

Anaerobes

References

No. of patients

Percentage points

Percentage organisms

Frederick & Braude (34)

U.S.A.

83

75

52

Van Cauwenberge et al. (42)

Belgium

66

39

39

Karma et al. (35)

Finland

40 (adult)

19

Brook (7)

U.S.A.

40

100

80

Berg et al. (36)

Sweden

54 (adult)

> 33

42

Tabaqchali (37)

U.K.

35

70

39

Brook (8)

U.S.A.

72

88

71

Fiscella & Chow (38)

U.S.A.

15 (adult)

38

48

Erkan et al. (39)

Turkey

126 (adult)

88

71

Erkan et al. (32)

Turkey

93 (ped.)

93

74

Ito et al. (40)

Japan

10

60

82

Klosseket al. (41)

France

394

26

25

Finegold et al. (25)

U.S.A.

150 (adult)

56

48

Brook et al. evaluated the microbiology of 13 chronically infected frontal (9), seven sphenoid (10), and 17 ethmoid sinuses (11). Anaerobic bacteria were recovered in over 2/3 of the patients. The predominant anaerobes included Prevotella, Peptostreptococcus, and Fusobacterium spp. The main aerobic organisms were gram-negative bacilli (H. influenzae, K. pneumoniae, E. coli, and P. aeruginosa).

Nadel et al. (22) also recovered aerobic and facultative gram-negative rods more commonly in patients who had previous surgery or those who had sinus irrigation. P. aeruginosa was also more common in patients who received systemic steroids. Other studies have also noted this shift toward aerobic and facultative gram-negative organisms in patients who have been extensively and repeatedly treated (21,44). The bacterial flora includes Pseudomonas spp., Enterobacter spp., methicillin-resistant S. aureus, H. influenzae, and M. catarrhalis.

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