Bacteriology of chronic sinusitis and acute exacerbation of chronic sinusitis

OBJECTIVE: To establish the microbiological characteristics of acute exacerbation of chronic sinusitis (AECS). SETTING: Academic medical center. PATIENTS: Thirty-two patients with chronic sinusitis and 30 patients with AECS. MAIN OUTCOME MEASURE: The aerobic and anaerobic microbiology of maxillary AECS and chronic maxillary sinusitis. RESULTS: A total of 81 isolates (33 aerobic and 48 anaerobic) were recovered from the 32 cases (2.5 per specimen) with chronic sinusitis. Aerobes alone were recovered in 8 specimens (25%), anaerobes only were isolated in 11 (34%), and mixed aerobes and anaerobes were recovered in 13 (41%). The predominant aerobic and facultative bacteria were Enterobacteriaceae and Staphylococcus aureus. The predominant anaerobic bacteria were Peptostreptococcus subspecies, Fusobacterium subspecies, anaerobic gram-negative bacilli, and Propionibacterium acnes. Twenty-one beta-lactamase-producing bacteria were recovered from 17 specimens (53%). A total of 89 isolates (40 aerobic and facultatives, and 49 anaerobic) were recovered from the 30 patients (3.0 per specimen) with AECS. Aerobes were recovered in 8 instances (27%), anaerobes only in 11 (37%), and mixed aerobes and anaerobes were recovered in 11 (37%). The predominant aerobes were Streptococcus pneumoniae, Enterobacteriaceae, and S aureus. The predominant anaerobes were Peptostreptococcus subspecies, Fusobacterium subspecies, anaerobic gram-negative bacilli, and P acnes. Thirty-six beta-lactamase-producing bacteria were recovered from 28 specimens (53%). CONCLUSIONS: This study demonstrates that the organisms isolated from patients with AECS were predominantly anaerobic and were similar to those generally recovered in patients with chronic sinusitis. However, aerobic bacteria that are usually found in acute infections (eg, S pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis) can also emerge in some of the episodes of AECS.     

Bacteriology of acute and chronic frontal sinusitis

Aspirates of 15 acutely and 13 chronically infected frontal sinuses were processed for aerobic and anaerobic bacteria. A total of 20 isolates (1.3 per specimen) were recovered from the 15 cases of acute frontal sinusitis, 16 aerobic and facultative isolates (1.1 per specimen) and 4 anaerobic isolates (0.3 per specimen). Aerobic and facultative organisms alone were recovered in 13 specimens (87%), and mixed aerobic and anaerobic bacteria were recovered in 2 (13%). The predominant aerobic and facultative organisms were Haemophilus influenzae (6), Streptococcus pneumoniae (5), and Moraxella catarrhalis (3). A total of 32 isolates were recovered from the 13 cases (2.5 per patient) of chronic frontal sinusitis, 12 aerobic and facultative isolates (0.9 per specimen) and 20 anaerobic isolates (1.5 per specimen). Aerobic and facultative organisms only were recovered in 3 instances (23%), anaerobes only in 7 instances (54%), and mixed aerobic and anaerobic bacteria in 3 instances (23%). The predominant aerobic bacteria were gram-negative bacilli (H influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa). The predominant anaerobes included Prevotella species (8), Peptostreptococcus species (6), and Fusobacterium species (4). These findings illustrate the microbiologic features of acute and chronic frontal sinusitis.     

Microbiology of acute and chronic maxillary sinusitis associated with an odontogenic origin

OBJECTIVES:: To study the microbiology of sinusitis associated with odontogenic origin. METHODS:: Aspirates of 20 acutely and 28 chronically infected maxillary sinuses that were associated with odontogenic infection were processed for aerobic and anaerobic bacteria. RESULTS:: A total of 66 isolates were recovered from the 20 cases of acute sinusitis (3.3/specimen), 16 aerobic and facultatives, and 50 anaerobic. Aerobes alone were recovered in 2 (10%) specimens, anaerobes only in 10 (50%), and mixed aerobic and anaerobic bacteria in 8 (40%). The predominant aerobic were alpha-hemolytic streptococci (5), microaerophilic streptococci (4), and Staphylococcus aureus (2). The predominant anaerobes were anaerobic Gram-negative bacilli (22), Peptostreptococcus (12), and Fusobacterium spp. (9). A total of 98 isolates were recovered from the 28 cases of chronic sinusitis (3.5/patient): 21 aerobic and facultatives and 77 anaerobic. Aerobes were recovered in 3 (11%) instances, anaerobes only in 11 (39%), and mixed aerobic and anaerobic bacteria in 14 (50%). The predominant aerobes were alpha-hemolytic streptococci (7), microaerophilic streptococci (4), and S. aureus (5). The predominant anaerobes were Gram-negative bacilli (41), Peptostreptococcus (16), and Fusobacterium spp. (12). Thirteen beta-lactamase-producing bacteria (BLPB) were recovered from 10 (50%) patients with acute sinusitis and 25 BLPB from 21 (75%) patients with chronic sinusitis. No correlation was found between the predisposing odontogenic conditions and the microbiological findings. CONCLUSIONS:: These data illustrate the similar microbiology of acute and chronic maxillary sinusitis associated with odontogenic infection where anaerobic bacteria predominate in both types of infections.     

Bacteriology of acute and chronic sphenoid sinusitis

Aspirates of 16 acutely infected and 7 chronically infected sphenoid sinuses were processed for aerobic and anaerobic bacteria. A total of 29 isolates were recovered from the 16 cases of acute sphenoid sinusitis (1.8 per specimen): 22 aerobic and facultative (1.4 per specimen), and 7 anaerobic (0.4 per specimen). Aerobic and facultative organisms alone were recovered in 10 specimens (62%), anaerobes alone were isolated in 3 (19%), and mixed aerobic and anaerobic bacteria were recovered in 3 (19%). The predominant aerobic and facultative species were Staphylococcus aureus (9 isolates), Streptococcus spp (9), and Haemophilus influenzae (2). A total of 28 isolates were recovered from the 7 cases of chronic sphenoid sinusitis (4.0 per specimen): 11 aerobic and facultative (1.6 per specimen) and 17 anaerobic (2.4 per specimen). Aerobic and facultative organisms alone were recovered in I instance (14%), anaerobes alone in 3 instances (43%), and mixed aerobes and anaerobes in 3 instances (43%). The predominant aerobic bacteria were gram-negative bacilli (Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa; 1 each). The predominant anaerobes included Peptostreptococcus spp (4 isolates), Prevotella spp (5), and Fusobacterium spp (4). These findings illustrate the unique microbiology of acute and chronic sphenoid sinusitis.     

Microbiology of acute sinusitis of odontogenic origin presenting with periorbital cellulitis in children

OBJECTIVES: This study was undertaken to evaluate the aerobic and anaerobic microbiology of acute maxillary sinusitis of odontogenic origin presenting with periodontal infection in children. METHODS: Aspirates of 18 acutely infected maxillary sinuses that were associated with odontogenic infection in children who presented with periorbital cellulitis were processed for aerobic and anaerobic bacteria. RESULTS: A total of 54 isolates were recovered (3.0 per specimen): 13 aerobic and facultative (0.7 per specimen) and 41 anaerobic (2.3 per specimen). The number of isolates per specimen varied from 1 to 4. Aerobic and facultative organisms alone were recovered in 2 specimens (11%), anaerobes only in 7 (39%), and mixed aerobic and anaerobic bacteria in 9 (50%). The predominant aerobic and facultative organisms were alpha-hemolytic streptococci (4), microaerophilic streptococci (3), and Streptococcus pyogenes and Staphylococcus aureus (2 each). The predominant anaerobic bacteria were anaerobic gram-negative bacilli (17), Peptostreptococcus spp (11), Fusobacterium spp (8), and Propionibacterium acnes (2). Twelve beta-lactamase-producing bacteria were recovered from 9 specimens (50%). CONCLUSIONS: This study demonstrates the unique aerobic and anaerobic microbiological features of acute maxillary sinusitis of odontogenic origin presenting with periorbital cellulitis in children.     

Microbiology of acute exacerbation chronic sinusitis in adults

The bacterial flora taken by sinus puncture from 115 patients with uni and bilateral acute exacerbation of chronic maxillary sinusitis was analyzed. Germ-free culture was obtained in 49 cases (40%) and in 69 cases (60%) bacteria were isolated from all sinus aspirates. Microbiological evaluation shows, that in majority of cases (90%) of acute exacerbation of chronic sinusitis there were pathogenic bacteria namely aerobic and anaerobic. The most frequent pathogens isolated from the aspirates were; Staphylococcus aureus, Haemophilus influenzae, Escherichia coli, Streptococcus pneumoniae, Staphylococcus hominis, Propionibacterium acnes i Candida albicans. The culture analysis proves that one or more pathogens can be the etiological factor. In the majority of cases (64%) the sinusitis is caused by monoculture.     

Bacteriology of chronic maxillary sinusitis and normal maxillary sinuses: using culture and multiplex polymerase chain reaction

BACKGROUND: Although many investigations have been performed on bacteriology of chronic sinusitis and normal sinuses, there still is much discussion. Also a new bacterial agent, Alloiococcus otitidis determined in the nasopharynx and middle ear specimens can be thought as a causative agent of sinusitis. METHODS: The bacteriology of chronic maxillary sinusitis and maxillary sinuses with normal radiogram and endoscopic findings were studied by culture methods for aerobic and anaerobic bacteria. Multiplex polymerase chain reaction (PCR) was used to investigate four bacteria in study and control groups. There were 27 specimens in the study group and 28 specimens in the control group. RESULTS: In the study group, the bacteria commonly isolated were Staphylococcus aureus (11.1%), alpha-hemolytic streptococci (11.1%), Streptococcus pneumoniae (11.1%), Haemophilus influenzae (7.4%), coagulase-negative staphylococci (7.4%), and anaerobes (33.3%). Coagulase-negative staphylococci (14.3%), alpha-hemolytic streptococci (10.7%), and anaerobes (35.7%) were isolated also in the control group. PCR was used to investigate S. pneumoniae, H. influenzae, Moraxella catarrhalis, and A. otitidis in the study and control groups. None of these bacteria was determined in the control group whereas detection rates of these bacteria in the study group were 11.1, 11.1, 3.7, and 7.4%, respectively. It should be considered that PCR yielded faint amplification band for A. otitidis. CONCLUSION: Using multiplex PCR can help to increase detection rates of bacterial etiology. Healthy sinuses are not sterile. A. otitidis may be one of the pathogens causing sinusitis.     

Comparative evaluation of cefuroxime axetil and cefaclor for treatment of acute bacterial maxillary sinusitis

Cefuroxime axetil, a new beta-lactamase-stable cephalosporin, was compared with cefaclor for the treatment of acute bacterial maxillary sinusitis in 106 adult patients. Direct sinus aspirations for quantitative bacterial culture were done for all patients before treatment; aspiration was repeated for most patients after treatment. Pretreatment sinus aspirates were positive for 63 of 134 sampled sinuses. Of specimens yielding at least 10(4) CFU/mL, Haemophilus influenzae (38%) and Streptococcus pneumoniae (37%) were the most common pathogens. Ten (42%) of 24 strains of H influenzae, 2 (40%) of 5 Haemophilus parainfluenzae, and all 3 isolates (60%) of Branhamella catarrhalis produced beta-lactamase. Cefuroxime axetil, 250 mg twice a day, was compared with cefaclor, 500 mg three times a day. Among culture-positive sinuses, bacteriologic cure was achieved in 36 (95%) of 38 sinuses and 15 (71%) of 21 sinuses treated with cefuroxime axetil and cefaclor, respectively. The overall frequencies of adverse events were similar between drugs, although cefuroxime axetil was associated with more frequent diarrhea. Cefuroxime axetil was an effective therapy for the treatment of acute bacterial maxillary sinusitis in adults.     

Bacteriologic findings in patients with chronic sinusitis

We studied the bacteriology of maxillary sinus aspirates obtained from patients diagnosed with chronic sinusitis. We recovered 659 strains from 510 aspirates; of these, 572 (86.8%) were aerobes and 87 (13.2%) were anaerobes. Aerobes only were recovered from 310 of the 510 specimens (60.8%) and anaerobes only from 31 (6.1%). Among the 572 aerobic bacteria, the most prevalent organisms were Streptococcus viridans (158 strains [27.6%]), Streptococcus pneumoniae (67 [11.7%]), Corynebacterium species (66 [11.5%]), Staphylococcus aureus (54 [9.4%]), Moraxella catarrhalis (38 [6.6%]), Hemophilus parainfluenzae (33 [5.8%]), and group C beta-hemolytic streptococci (26 [4.5%]). Among the 87 recovered anaerobes were species of Peptostreptococcus (32 strains [36.8%]), Prevotella (22 [25.3%]), Actinomyces (13 [14.9%]), Propionibacterium (11 [12.6%]), Fusobacterium (8 [9.2%]), and Veillonella (1 [1.1%]). Beta-lactamase production was detected in 115 of the 572 aerobic strains (20.1%) and in 10 of the 87 anaerobic strains (11.5%). We found that the prevalence and type of organisms we identified in chronic sinusitis did not differ substantially from those reported in previous studies. Our study is one of the more extensive reports on the type and prevalence of pathogens in chronic sinusitis that has been published to date.     

Microbiology of serous otitis media in children: correlation with age and length of effusion

The purpose of this study was to correlate the microbiology of serous otitis media in children with the duration of the condition and the patient's age. Aspirates of serous ear fluids from 114 children were examined for aerobic and anaerobic bacteria. Bacterial growth was noted in 47 patients (41%). Aerobic organisms only were recovered in 27 aspirates (57% of the culture-positive aspirates); anaerobic bacteria only in 7 (15%); and mixed aerobic and anaerobic bacteria in 13 (28%). A total of 83 bacterial isolates were recovered, accounting for 1.8 isolates per specimen (1.2 aerobes and 0.6 anaerobe). There were a total of 57 aerobic isolates, including Haemophilus influenzae (15 isolates), Streptococcus pneumoniae (13), and Staphylococcus sp (12). Twenty-six anaerobes were recovered, including anaerobic gram-positive cocci (10), Prevotella spp (8), and Propionibacterium acnes (4). The rate of positive cultures (20 of 36; 56%) was higher in patients younger than 2 years of age than in those older than 2 years of age (27 of 78; 35%). Streptococcus pneumoniae and H influenzae were more often isolated in children younger than 2 years of age and those with effusion for 3 to 5 months, whereas anaerobes were recovered more often in those older than 2 years of age and those with effusion for 6 to 13 months. These data illustrate the effects of the length of effusion and age on the recovery of aerobic and anaerobic bacteria in serous otitis media.     

Bacteriological study in chronic maxillary sinusitis.

The bacterial findings of 73 maxillary sinuses in 48 patients with chronic maxillary sinusitis, together with 7 non-inflamed sinuses, are reported. Employing an intraoperative technique and simultaneous collection of 3 different types of specimens in the present investigation made possible comparison of their bacterial characteristics. The results indicated that intraoperative culture of antral mucosa seems to provide the most reliable finding of bacterial flora in chronic maxillary sinusitis. The anaerobic bacteria were never found in the mucosal culture of non-inflamed sinus. The anaerobes appeared to invade the sinus cavity following the sealing of the ostium through the lymphatic or venous system and maintain the inflammatory process. Microbiological analysis of the results between the infected and non-inflamed sinuses established anerobic bacteria as the most important pathogen in chronic maxillary sinusitis. The predominant anaerobes recovered in descending order of frequency were Veillonella sp., Peptococcus sp., Propionibacterium acne and anaerobic nonspore-forming GPB. Statistical analysis of the results of mucosal culture of inflamed and control materials demonstrated that those aerobic and faculatative bacteria recovered in the inflamed sinus appeared to be the normal inhabitants of non-inflamed sinus mucosa. The presence of normal flora in the normal healthy sinus mucosa may explain the chain of events that follows the occlusion of the ostium. These aerobic bacteria may become pathogenic and play a role in the pathogenesis of sinusitis.     

Differential diagnosis of purulent and non-purulent acute maxillary sinusitis in young adults

In acute maxillary sinusitis, purulence could best be assessed from sinus washings, but evaluation based on aspirates was also reliable, provided that the amount of secretion was adequate. Injection-aspirates were of negligible diagnostic value in this respect. Sinus washings and aspirates which were clinically defined as purulent were almost invariably indicative of bacterial infection. The bacterial etiology was most accurately obtained by sinus aspiration. Only 14.5% of cultured specimens were negative for pathogenic bacteria. In maxillary sinusitis, judged to be non-purulent, 52.5% of cultures grew a pathogen. The most common pathogen was Haemophilus influenzae, which accounted for 90% of these isolations. There was a clear correlation between occurrence of many PMNs and pathogen positive culture in non-purulent cases. Thus, antimicrobial therapy which is effective against Haemophilus influenzae seems indicated in most cases of non-purulent maxillary sinusitis.     

Bacterial examination of sinusitis using antral puncture and irrigation

Aerobic bacterial examination for sinusitis was conducted using specimens from maxillary sinuses collected by antral puncture in 540 patients--284 men and 256 women aged 6-89 years--between May 1999 and April 2000. We obtained 528 strains of bacteria. Our results were as follows: 1. We obtained 303 pathogens from 540 patients. In acute sinusitis, the most frequently found was Streptococcus pneumoniae (30.4%), followed by Hemophilus influenzae (27.7%). In chronic cases, the most frequently found was Streptococcus pneumoniae (16.0%), followed by Hemophilus influenzae (15.1%) and Staphylococcus epidermidis (12.6%). 2. We found an increase in bacteria resistant to multiple drugs, with 11.1% of the Staphylococcus aureus isolates methicillin-resistant in acute sinusitis and 40% methicillin-resistant in chronic sinusitis, and that 30.6% of Streptococcus pneumoniae isolates were penicillin-resistant. 3. Ciclacillin was effective against 64.7% of all pathogens isolated in this study, cefpodoxime proxetil effective against 6.5%, and cefixime effective against 2.4%. 4. In considering pathogens, we therefore choose antibiotics and make a maxillary aspiration puncture.     

Bacteriology of chronic maxillary sinusitis in adults

Aspirates of 72 chronically inflamed maxillary sinuses were processed for aerobic and anaerobic bacteria. Bacterial growth was present in 66 of the 72 specimens (92%). Anaerobic bacteria were isolated in 58 of the 66 culture-positive specimens (88%). Anaerobes only were recovered in 37 cases (56%) and in 21 (32%) they were mixed with aerobic or facultative bacteria. Aerobic or facultative bacteria were present in eight cases (12%). A total of 185 isolates (2.8 per specimen)--131 (2.0 per specimen) anaerobes and 54 (0.8 per specimen) aerobes or facultatives--were isolated. The predominant anaerobic organisms were anaerobic cocci and Bacteroides sp, and the predominant aerobes or facultatives were Streptococcus sp and Staphylococcus aureus. Twelve of the 27 Bacteroides sp that were tested for beta-lactamase (44%) produced the enzyme. These findings indicate the major role of anaerobic organisms in chronic sinusitis.     

Microbiology of intracranial abscesses and their associated sinusitis

OBJECTIVE: To evaluate the organisms recovered from infected sinuses and associated intracranial abscesses (IAs). DESIGN: Retrospective review of findings from aspirate of pus from 10 infected sinuses and their corresponding IAs. SETTING: Academic medical center. PATIENTS: Ten patients diagnosed as having sinusitis (age range, 7-58 years). MAIN OUTCOME MEASURE: Aerobic and anaerobic bacteria findings from infected sinuses and IAs. RESULTS: Polymicrobial flora was found in 9 sinuses and 8 IAs. Anaerobes were isolated from all sinuses and 9 IAs. A total of 26 isolates (2.6 isolates per specimen) were recovered from the sinuses: 19 anaerobic, 6 aerobic or facultative, and 1 microaerophilic; 17 isolates were found in the IAs (1.7 isolates per site): 13 anaerobic, 2 aerobic or facultative, and 2 microaerophilic. The predominant anaerobes were Fusobacterium species (in 5 corresponding sinuses and abscesses, 1 in a sinus only, and 1 in an IA only), Prevotella species (in 3 corresponding sinuses and abscesses), Peptostreptococcus species (in 2 corresponding sinuses and abscesses, and 4 in a sinus only), Staphylococcus aureus, Haemophilus influenzae type b, microaerophilic streptococci, and Bacteroides ureolyticus (in 1 corresponding sinus and abscess each). Streptococcus pneumoniae was recovered 2 times, only from a sinus. Alpha-hemolytic streptococci and beta-hemolytic streptococci group F were each isolated once from the sinus. Concordance in the microbiological findings between the sinus and the IA was found in all instances. However, certain organisms were present at only one or the other site. CONCLUSION: These data illustrate the concordance in the recovery of organisms from infected sinuses and their associated IA and confirm the importance of anaerobic bacteria in sinusitis and IA.     

Aerobic and anaerobic bacteriology of concurrent chronic otitis media with effusion and chronic sinusitis in children

OBJECTIVE: To correlate the aerobic and anaerobic microbiologic findings of concurrent chronic otitis media with effusion and chronic maxillary sinusitis. METHODS: Cultures were obtained from 32 children with concurrent chronic otitis media with effusion and maxillary sinusitis who underwent tympanostomy tube placement. RESULTS: A total of 42 isolates, 24 aerobic and 18 anaerobic, were recovered from 30 patients; 27 were isolated from both sites, 4 from the ear only, and 11 from the sinus only. The most common isolates were Haemophilus influenzae (9 isolates), Streptococcus pneumoniae (n = 7), Prevotella species (n = 8), and Peptostreptococcus species (n = 6). Microbiological concordance between the ear and sinus was found in 22 (69%) of culture-positive patients. CONCLUSION: The concordance in recovery of organisms in more than two thirds of the patients illustrates the common bacterial etiology between chronic otitis media with effusion and chronic sinusitis in children.     

Bacteriological findings and antimicrobial susceptibility in chronic sinusitis with nasal polyp

CONCLUSIONS: We recommend amoxacillin/clavulanate, cephalosporins and macrolides rather than penicillin as the first-line drug in chronic sinusitis with nasal polyps. In cases where there is no improvement of symptoms, cultures should be taken from the middle meatus, followed by appropriate selection of second-line antibiotics according to the sensitivity test results. OBJECTIVE: To investigate the causative bacteria and the antimicrobial susceptibility in patients with chronic sinusitis and nasal polyps in Korea. MATERIALS AND METHODS: The bacteriology and antimicrobial susceptibility of maxillary sinus aspirates from 81 patients were evaluated. RESULTS: Aerobes were isolated from 58.0% of the cultures from the middle meatus and from 48.1% of those from the maxillary sinus. Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae were the most prevalent aerobic pathogens. Anaerobes were isolated from 8.6% of the cultures from the middle meatus and from 18.5% of the cultures from the maxillary sinus. The predominant anaerobic organisms were Prevotella and Peptostreptococcus in adults but none of them were cultured in children. A high rate of concordance of the middle meatus and maxillary sinus was noted. Monomicrobial infection was most commonly observed. Ampicillin-resistant H. influenzae isolates were cultured in 46% of the cases. Penicillin resistance rates were 93% for Staph. aureus; 25% of Strep. pneumoniae were intermediate and 25% were resistant.     

Microbial flora of nose and paranasal sinuses in chronic maxillary sinusitis

Nasal secretions, maxillary sinus aspirates and specimens of the maxillary sinus mucosa were collected in 44 patients aged between 25 and 60 affected by mono- or bilateral chronic maxillary sinusitis, in order to establish the best sampling technique for microbiological purposes, the most frequently involved bacteria and the physiopathological mechanism underlying chronic maxillary disease. The sinusal mucosa resulted to be the most reliable sample as it reduces contamination and microbial variability. Anaerobic bacteria were isolated in nasal swab (15.6%), in maxillary sinus aspirates (30.4%) and in maxillary sinus mucosa (36.4%) of maxillary sinusitis patients. In controls anaerobic bacteria were isolated only in one nasal swab (2.3%), while they could not be isolated in maxillary sinus aspirates and in maxillary sinus mucosa. The presence of anaerobic bacteria in chronic maxillary sinusitis patients and their absence in controls seem to confirm that anaerobic microorganisms represent the main pathogenetic agents of chronic maxillary sinusitis. The possible physiopathological mechanisms underlying chronic maxillary sinus disease are finally discussed.     

Microbiology of acute exacerbation of chronic sinusitis

OBJECTIVES: We undertook to evaluate the microbiology of acute exacerbation of chronic sinusitis (AECS). METHODS: Repeated aspirations of maxillary sinus secretions by endoscopy were performed in 7 patients over a period of 125 to 242 days. RESULTS: Bacteria were recovered for all 22 aspirates, and the number of isolates was between 2 and 4. A total of 54 isolates were isolated: 16 aerobic and facultative bacteria and 38 anaerobic bacteria. The aerobic bacteria were Haemophilus influenzae (7 isolates), Streptococcus pneumoniae (3), Moraxella catarrhalis (3), Staphylococcus aureus (2), and Klebsiella pneumoniae (1). The anaerobic bacteria included pigmented Prevotella and Porphyromonas spp (19), Peptostreptococcus spp (9), Fusobacterium spp (8), and Propionibacterium acnes (2). 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 recovered. An increase in antimicrobial resistance was noted in 6 instances. CONCLUSIONS: This study illustrates the microbial dynamics of AECS in which anaerobic and aerobic bacteria prevail, and highlights the importance of obtaining cultures from patients with AECS for guidance in selection of proper antimicrobial therapy.     

The microbiology of ethmoid and maxillary sinuses in patients with chronic sinusitis

PURPOSE: To investigate aerob-anaerob microorganisms growth in maxillary and ethmoid sinuses by evaluating aspiration materials from patients with chronic sinusitis. Patients and Methods: The study was performed prospectively, and there were 31 patients (23 men, 8 women; mean age, 31.4+/-14.15, between 18-65 years) who had endoscopic sinus surgery because of chronic sinusitis. During the operation, when the maxillary sinus ostium and ethmoid sinus were opened, readily aspirated materials from sinuses were evaluated regarding aerob and anaerob bacteria. Nose and throat swap samples were collected preoperatively to determine the upper respiratory tract flora and also to understand the relationship between the flora and the microorganisms aspirated from sinuses. RESULTS: Total aerob bacteria count, which was isolated from preoperative nasal swab cultures, was 36, and aerob-anaerob bacteria count that included cultures taken from maxillary and ethmoid sinuses during the functional endoscopic sinus surgery was 42. For each 2 samples, the most common isolated aerob bacteria were coagulase (-) staphylococci. Microorganisms were isolated in 87.0% of 27 patients, in which cultures taken from maxillary and ethmoid sinuses during the functional endoscopic sinus surgery were included. It is determined that the isolated aerob bacteria rate was 90.4%, and the isolated anaerob bacteria rate was 14.2%. All of the 6 samples in which anaerob bacteria isolated were all maxillary sinus aspiration materials. Microorganisms that isolated from the nose and the sinuses were similar with the rate of 25.8%, and microorganisms that isolated from the throat cultures and sinuses were similar with the rate of 22.5%. CONCLUSIONS: This study reveals the aerob and anaerob microbiology of the maxillary and ethmoid sinuses so the treatment of chronic sinusitis will be easier.