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.     

Arachidonic acid metabolites in antrochoanal polyp and nasal polyp associated with chronic paranasal sinusitis

The aim of this study was to investigate the role of arachidonic acid metabolites (AAMs) in the pathogenesis of antrochoanal polyp (ACP). Using high-performance liquid chromatography (HPLC), we assayed the tissue concentrations of 6-keto-PGF1alpha, leukotrienes (LTs) and hydroxyeicosatetraenoic acids (HETE). Concentrations of AAMs in ACP were compared with the level in the control turbinate tissues and nasal polyps associated with chronic paranasal sinusitis (NPS). The concentrations of 6-keto-PGF1alpha were not significantly different in the control turbinate, ACP and NPS groups. In ACP, concentrations of LTC4, 15-HETE and 12-HETE were significantly lower than in the control turbinate. The striking differences in the profile of AAMs between ACP and NPS included a lack of production of LTD4 and LTE4 in ACP, also detectable in NPS, and markedly lower concentrations of 15-HETE and 12-HETE in ACP. The results of this study indicate that decreased lipoxygenase pathway products in arachidonic acid metabolism may be involved in the pathogenesis of ACP. However, in the pathogenesis of NPS, increased production of LTD4 and LTE4 may have an important role. Taken together, our results demonstrate a difference in pathogenesis between ACP and NPS, particularly in terms of arachidonic acid metabolism.     

奥玛株单抗在慢性鼻窦炎伴鼻息肉患者治疗中的应用

慢性鼻窦炎伴鼻息肉(CRSwNP)的炎症机制复杂,现有治疗方式对其病情控制欠佳。奥玛株单抗可通过与IgE受体结合降低患者的免疫级联反应,已有研究证明其对缓解CRSwNP合并哮喘患者的鼻部症状有良好的效果,但针对伴嗜酸性粒细胞增多、IgE水平高的难治性复发性CRSwNP治疗效果的探索还需要更多、更大规模的随机对照实验来证明。本文结合该背景对奥玛株单抗的作用机制以及在CRSwNP中的应用进行阐述,为CRSwNP的治疗提供参考。     

慢性鼻窦炎鼻息肉鼻内镜术后的康复治疗

目的:分析鼻息肉、慢性鼻窦炎经鼻内镜手术后影响疗效的因素,并探讨其预防措施。 方法:对因鼻息肉、慢性鼻窦炎接受鼻内镜手术、随访3年以上的226例患者从职业、个人生活习 惯、术后是否坚持系统的康复治疗及持续时间、临床转归等方面进行回顾性分析。结果:从事接触 刺激性物质或粉尘的职业(化工、纺织、建筑、装饰、锅炉和厨师等)、具有不良生活习惯(喜食辛辣 食物、嗜烟酒)、术后(尤其是出院后)根本不曾或不能坚持进行系统康复治疗(包括局部用药、全 身用药、鼻腔冲洗、定期鼻内镜下清理术腔等)的患者与不具有前述"特质"的患者鼻息肉、鼻窦炎 复发的可能性明显居高、复发时间亦明显提前;具备前述"特质"类别愈多,复发愈快、愈剧。其中 尤以系统康复治疗对术后转归影响最显著。结论:术后定期、足够疗程的系统康复治疗是提高鼻 息肉、慢性鼻窦炎经鼻内镜手术疗效的有力措施,良好的职业保护和戒除不良生活习惯能有效地 预防和减缓鼻息肉、慢性鼻窦炎经鼻内镜手术后的复发。     

慢性鼻窦炎的细菌学研究

目的研究慢性鼻窦炎的细菌分布及其耐药性特征。方法术中收集76例慢性鼻窦炎患者上颌窦和后组筛窦的分泌物,分别进行需氧菌、厌氧菌与真菌的培养、药物敏感试验以及产β内酰胺酶菌株(βLPB)检测,同时以10名健康受试者作对照。结果实验组共培养出20种细菌,主要为表皮葡萄球菌、大肠埃希菌、金黄色葡萄球菌、甲型链球菌和肺炎链球菌等;细菌培养阳性率为81.8%,其中需氧菌占83.4%,厌氧菌占16.6%;革兰阳性菌为56.3%,革兰阴性菌43.7%;真菌培养阳性率仅1.4%。药物敏感试验显示对需氧菌抗菌活性较高的广谱抗生素是亚胺培南、头孢噻肟和阿莫西林克拉维酸;对厌氧菌抗菌活性较高的是甲硝唑、亚胺培南和氯霉素。βLPB检出率为37.7%,以表皮葡萄球菌、金黄色葡萄球菌、流感嗜血杆菌和卡他布兰汉菌的比例较高。对照组检测出表皮葡萄球菌和大肠埃希菌等5种细菌,与实验组同种细菌分布的差异无统计学意义(χ2=0.446,P>0.05)。结论慢性鼻窦炎以需氧菌感染为主,菌株耐药现象严重。细菌感染在本病中的作用并非关键,不宜过分强调抗生素的使用。应用抗生素治疗宜先进行细菌培养与药物敏感试验;如情况不允许,可选择广谱耐β内酰胺酶类抗生素,如头孢噻肟、阿莫西林克拉维酸等。     

Expression and clinical significance of PLUNC protein in nasal polyp and chronic sinusitis tissue

We conducted a study to validate the expression of PLUNC (palate, lung, and nasal epithelial clone) protein in nasal polyp and chronic sinusitis tissue by immunohistochemistry. We also explored the relationship between the intensity of positive immunohistochemical staining for PLUNC protein and postoperative therapeutic efficacy. Our study population consisted of 34 patients with nasal polyps and 30 with chronic sinusitis who had undergone surgical treatment, along with 18 healthy controls who did not undergo surgery. All samples were stained according to the streptavidin-peroxidase immunohistochemical method to examine PLUNC protein expression. The surgical patients were evaluated for clinical therapeutic efficacy 6 months postoperatively. The association between efficacy and the intensity of PLUNC protein positivity was examined by the Spearman rank correlation analysis. Intensity was rated as either +++(>50% positive cells), ++ (26 to 50% positive cells),+ (≤25% positive cells), or -(no positive cells). We found that the most common levels of PLUNC positivity were + in the patients with nasal polyps, +++ in the patients with chronic sinusitis, and ++ in the controls (p< 0.01). Analysis of the Spearman rank correlation indicated that the intensity of PLUNC protein expression was significantly correlated with postoperative therapeutic efficacy (p< 0.001). We conclude that PLUNC protein is an essential factor in the innate defense mechanism of the nasal mucosa. The immunohistochemical staining of PLUNC protein could have clinical benefit in terms of predicting therapeutic efficacy and outcomes in patients with nasal polyps or chronic sinusitis.     

Intractable pediatric chronic sinusitis with antrochoanal polyp

It has been reported that pediatric chronic sinusitis with antrochoanal polyp is difficult to cure because it tends to recur easily even with surgery. Therefore, in order to improve its cure rate, aggressive treatment combining polypectomy, intra-maxillary intubation through the inferior meatus, macrolide administration, etc., was attempted. Thirty-seven sides of pediatric chronic sinusitis with antrochoanal polyp and 44 sides of chronic sinusitis without polyp were evaluated after the same treatments. The mean age of patients was 9.7 years, and the mean intubation period was 20 months. Since subjective improvements in children are questionable, the efficacy was evaluated strictly on the basis of X-ray alone focusing on the maxillary sinus. Twenty-four percent of the group with antrochoanal polyp showed 'excellent' effect, i.e. almost complete resolution of the sinus findings, while 45% of the group without polyp showed 'excellent' effect, with a mean follow-up period of 3 years and 6 months. This difference was significant (P<0. 01, chi(2)-test). These results further document the intractableness of chronic sinusitis with choanal polyp in children.     

干酪性上颌窦炎伴鼻息肉一例

患者男，36岁，因左侧鼻塞、流涕、头痛1年就诊。间断左侧眼眶疼，曾有左眼视力下降，于某院就诊，诊断为“角膜炎”，给予对症治疗，已治愈。就诊时已在外院作鼻窦CT检查，示左侧鼻腔与左侧上颌窦已融为一个大腔，鼻腔外侧壁、上颌窦内侧壁已破坏，左侧鼻腔、上颌窦、筛窦、额窦均可见低密底影（图1）。     

成人慢性上颌窦炎的细菌学研究及药敏观察

为研究成人慢性上颌窦炎的细菌分布及分离菌株对常用抗生素的敏感性，对４２例成人慢性上颌窦炎患者的单侧病窦粘膜进行细菌培养，药敏试验及产β－内酰胺酶细菌（βＬＰＢ）鉴定，结果发现８５．７１％标本有细菌生长，９例（２１．４３％）分离出厌氧菌，３３例（７８．５７％）分离出需氧菌。βＬＰＢ阳性率高达４０％，和细菌的耐药性有关。分离细菌对含β－内酰胺酶抑制剂的抗生素、三代头孢菌素类药物及三代喹诺酮类药物有较高     

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.     

单发性鼻窦炎细菌学检测及药敏试验结果分析

目的：了解单发性鼻窦炎细菌分布及对常用抗生素敏感情况。方法：对９４例上颌窦炎和４１例筛窦炎,蝶窦炎患者行功能性鼻窦内窥镜手术,将取出的窦腔分泌舶和粘膜进行细菌培养分离和常用抗生素的药敏试验。结果：１３５份标本中,有菌生长１１９份（８８．１５％）,共分离细菌１９２株,混合细菌生长６２份,厌氧菌７５株,分离菌株对青霉素的总敏感度为５３．１２％。头孢唑啉钠总敏感度为８７．５０％〉厌氧菌对甲硝唑的总敏感度     

慢性鼻窦炎鼻息肉围手术前期处理对术中出血影响的观察

目的　探讨减少慢性鼻窦炎、鼻息肉内镜鼻窦手术中出血的方法。方法　通过对慢性鼻窦炎、鼻息肉患者进行围手术期术前处理 68例 ,并与未经围手术前期处理的同类手术 (30例 )进行比较。结果　术前处理组的手术有效率为 91 2 % ,术前未处理组的手术有效率为 80 % ,两者经统计学处理差异有显著性 (F =8 61 7,P =0 0 2 6) ;术前处理组术中出血量为 (53 2± 41 8)ml,术前未处理组为 (97 2± 59 0 )ml,两者经统计学处理差异有显著性 (F =2 7 946 ,P =0 0 0 2 )。结论　术前用药物控制慢性鼻窦炎、鼻息肉的炎症是减少内镜鼻窦手术出血的重要环节 ,而良好和足够时间的术中中鼻道血管收缩剂的应用、控制性低血压的应用、控制出血高危因素和减少术中损伤等对减少术中出血也非常有效     

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.     

超氧化物歧化酶和PLUNC蛋白在慢性鼻窦炎和鼻息肉组织中的表达及意义

目的:采用免疫组织化学实验并扩大标本量来进一步验证超氧化物歧化酶(Cu/ZnSOD)和PLUNC蛋白在鼻息肉、慢性鼻窦炎和正常鼻黏膜组织之间的差异表达及意义。方法:采用免疫组织化学SP法分别检测34例鼻息肉、30例慢性鼻窦炎和18例正常鼻黏膜组织中Cu/ZnSOD和PLUNC蛋白的表达情况。结果:①Cu/ZnSOD和PLUNC蛋白在同一个组织标本中的定位和表达强度一致,均表达于鼻黏膜上皮、腺上皮和杯状细胞中;②鼻息肉、慢性鼻窦炎和正常鼻黏膜组织之间Cu/ZnSOD和PLUNC蛋白阳性强度构成比的差异有统计学意义(χ2=30.689,P<0.01)。鼻息肉组织的阳性强度以" "为主,慢性鼻窦炎组织的阳性强度以" "为主,正常鼻黏膜组织的阳性强度以" "为主。结论:Cu/ZnSOD和PLUNC蛋白是鼻黏膜局部免疫防御系统的重要组成部分。当鼻黏膜受病原体侵袭或理化因素刺激引起炎症反应时,鼻黏膜上皮、腺上皮和杯状细胞反应性增生明显,它们产生和分泌Cu/ZnSOD、PLUNC蛋白等抗炎物质增多来产生炎症防御作用。     

慢性鼻窦炎鼻息肉围手术前期处理对术中出血影响的观察

OBJECTIVE: To explore the method of reducing bleeding during endoscopic sinus surgery for chronic sinusitis and nasal polyp. METHODS: Bleeding during surgery and the effective rate of two groups patients with chronic sinusitis and nasal polyp were compared (68 cases in group A with preoperative treatment, 30 cases in group B without preoperative treatment). RESULTS: The effective rate between group A(91.2%) and group B (80%) is of significant difference (F = 8.617, P = 0.026); The volume of bleeding during surgery between group A that is (53.2 +/- 41.8) ml and group B that is (97.2 +/- 59.0) ml is of significant difference (F = 27.946, P = 0.002). CONCLUSIONS: Controlling the inflammatory reaction of chronic sinusitis and nasal polyp by preoperative treatment is the most important factor to reduce bleeding while undergoing endoscopic sinus surgery. However, the followings are also important factors to reduce bleeding in endoscopic sinus surgery, such as adequate use of vasoconstrictor in the middle nasal meatus during surgery, the use of deliberate hypotension during surgery, controlling the high risk factors by preoperative treatment and reducing trauma during surgery, etc.