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 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.     

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.     

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.     

The microbiology of mucopyocele.

OBJECTIVE: To evaluate the aerobic and anaerobic microbiology of mucopyocele. STUDY DESIGN: Retrospective review of clinical and microbiologic records of patients with mucopyocele between June 1982 and September 1997. METHODS: Aspirates of 36 mucopyocele were processed for aerobic and anaerobic bacteria. RESULTS: One hundred six bacterial isolates, 42 aerobic and facultatives and 64 anaerobic, were recovered. The predominant aerobic isolates were Staphylococcus aureus (6 isolates), alpha-hemolytic streptococci (6), Hemophilus spp. (5), and Gram-negative bacilli (6). The predominant anaerobes were Peptostreptococcus sp. (22), Prevotella sp. (15), Fusobacterium sp. (5), and Propionibacterium acnes(5). Thirty-three beta-lactamase-producing bacteria were isolated from 23 patients. CONCLUSIONS: These findings illustrate the polymicrobial aerobic and anaerobic bacteriology of mucopyocele.     

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.     

Bacteriology of antrum in adults with chronic maxillary sinusitis

Swabs of 126 chronically inflamed maxillary sinuses were processed for aerobic and anaerobic bacteria during endoscopy. Bacterial growth was present in 113 of 126 specimens (90%). Anaerobic bacteria were isolated in 100 of 113 culture-positive specimens (88%). Anaerobes only were recovered in 59 cases (52%) and, in 41 (36%), they were mixed with aerobic or facultative bacteria. Aerobic or facultative bacteria were present in 13 cases (12%). A total of 323 isolates (2.8 per specimen), 228 (2.3 per specimen) anaerobes and 95 (1.7 per specimen) aerobes or facultatives, were isolated. The predominant anaerobic organisms were anaerobic cocci and Bacteroides species; the predominant aerobes or facultative bacteria were Streptococcus species and Staphylococcus aureus. These findings indicate the major role of anaerobic organisms in chronic sinusitis.     

Bacteriology of chronic tonsillitis in young adults

Tonsils were obtained from 22 young adults (mean age, 23 years) suffering from chronic tonsillitis. Mixed aerobic and anaerobic flora was obtained from core tonsillar cultures in all patients, yielding an average of 9.0 isolates (5.3 anaerobes and 3.7 aerobes) per specimen. The predominant anaerobic isolates were Bacteroides sp, Fusobacterium sp, and gram-positive cocci. The predominant aerobic isolates were alpha-hemolytic streptococci, Staphylococcus aureus, Branhamella catarrhalis, beta-hemolytic streptococci, and hemophilus sp. beta-Lactamase-production was noted in 32 isolates recovered from 18 tonsils (82%). These included all eight isolates of S aureus and five B fragilis, and 11 of 24 B melaninogenicus group (46%). Our findings indicate the polymicrobial nature of deep tonsillar flora in young adults with chronic tonsillitis, and demonstrate the presence of beta-lactamase-producing organisms in most of the patients.     

Bacteriology of adenoids and tonsils in children with recurrent adenotonsillitis

Adenoids and tonsils electively removed from 25 children with a history of recurrent group A beta-hemolytic streptococci (GABHS) adenotonsillitis were cultured for aerobic and anaerobic bacteria. Two hundred twenty-four organisms (112 aerobes and facultatives, 110 anaerobes, and 2 Candida albicans) were isolated from the tonsils, and 229 (111 aerobes and facultatives and 118 anaerobes) were isolated from the adenoids. Mixed infection was present in all instances, with an average of 9.1 isolates per specimen. The predominant aerobes were Streptococcus sp, Haemophilus influenzae, and GABHS, and the prevalent anaerobes were Peptostreptococcus, Prevotella, and Fusobacterium spp. Beta-lactamase-producing bacteria were detected in 72 isolates recovered from 22 tonsils (88%) and in 74 isolates recovered from 21 adenoids (84%). Discrepancies in the organisms recovered were found between the tonsils and adenoids. Of the aerobic isolates, 20% were isolated only in tonsils and 18% only in adenoids. Of the anaerobes, 20% were found only in tonsils and 26% only in adenoids. This study demonstrates a polymicrobial aerobic-anaerobic flora in both adenoids and tonsils, and discrepancies in recovery of pathogens such as GABHS. The adenoids may serve as a potential source of tonsillitis caused by GABHS.     

Correlation between microbiology and previous sinus surgery in patients with chronic maxillary sinusitis

Aspirates of 108 chronically inflamed maxillary sinuses were processed for aerobic and anaerobic bacteria. There were 295 bacterial isolates: 109 aerobic and facultative, and 186 anaerobic. The predominant aerobic isolates were Staphylococcus aureus (17 isolates), alpha-hemolytic streptococci (14), Pseudomonas aeruginosa (12), Moraxella catarrhalis (10), and Haemophilus spp (8). The predominant anaerobes were Peptostreptococcus spp (61), Prevotella spp (45), Fusobacterium spp (15), and Propionibacterium acnes (14). Analysis of the medical histories revealed a correlation only between the microbial results and previous sinus surgery. Pseudomonas aeruginosa and gram-negative aerobic bacilli (GNAB) were more often isolated in patients who had surgery (9 of 33 patients had P aeruginosa and 17 had GNAB) than in patients who did not have surgery (3 of 75 had P aeruginosa and 7 had GNAB; p < .001). Anaerobes were isolated more often in patients who did not have surgery (69 of 75 patients) than in those who had previous surgery (21 of 33 patients; p < .001). These findings illustrate the unique microbiological features of chronic maxillary sinusitis that persist after sinus surgery.     

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.     

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.     

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.     

Aerobic and anaerobic bacteriology of cholesteatoma

Cholesteatoma specimens were obtained from 28 patients undergoing surgery for chronic otitis media and cholesteatoma. All specimens were cultured for aerobic and anaerobic organisms. Bacterial growth was present in specimens of 24 of the 28 patients. A total of 74 bacterial isolates were present (40 aerobes and 34 anaerobes). Aerobes alone were isolated from 8 (33.3%) of culture positive patients, 4 patients (26.7%) yielded only anaerobes, and 12 (50%) had both aerobic and anaerobic bacteria. Fifty isolates (27 aerobes and 23 anaerobes) were present in a concentration > 10⁰ CFU/gm. The most commonly isolated aerobic organisms were P. aeruginosa (9), Proteus sp. (7), K. pneumoniae (5), S. aureus (5), and E. coli (4). The anaerobic bacteria most commonly isolated were gram-positive anaerobic cocci (12), Bacteroides sp. (12, including 5 B. fragilis group), Clostridium sp. (3), and Bifidobacterium sp. (3). The above findings indicate the polymicrobial aerobic and anaerobic bacteriology of cholesteatoma.     

Bacteriology of chronic sinusitis: the bulla ethmoidalis content

OBJECTIVE: To study the microbiology of the bulla ethmoidalis of patients who suffered from chronic sinusitis. DESIGN: A prospective study performed at the Saint-Luc universitary clinic (University of Louvain) from June 1999 to December 2000. MATERIAL AND METHODS: Seventy seven patients underwent functional endoscopic endonasal surgery during this period for chronic sinusitis refractory to standard medical treatment. All the patients presented symptoms for more than 3 months. After Povidone-Iodine disinfection, samples were taken into the bulla ethmoidalis after its opening with an endoscopic endonasal control. Samples were transferred to the microbiology laboratory using a thioglycolate medium for aerobic and anaerobic cultures. RESULTS: One hundred forty eight samples were studied. Culture rate was 73.6%. Thirty nine samples remained sterile. In the 109 culture positive specimens, 135 bacterial isolates were recovered. The main results are: Staphylococcus coagulase negative: 31, Staphylococcus aureus: 22, Streptococcus sp: 20, other Gram positive Cocci: 5, Haemophilus influenzae: 4, non-fermentative Gram negative bacilli: 6, Enterobacteriaceae: 45, anaerobic bacteria: 2. CONCLUSION: Enterobacteriaceae or enteric gram negative bacilli were frequently encountered in the bulla ethmoidalis of patients suffering from chronic sinusitis. This report suggests that endoscopically guided culture obtained from the ethmoid sinus may accurate our understanding of the microbiology of chronic ethmoidal sinusitis and underline the importance of Enterobacteriaceae in this disease.     

Bacteriology of chronic maxillary sinusitis]

132 patients with chronic maxillary sinusitis were included in this bacteriological study of the intrasinus exudate obtained by a radical antrostomy or antral puncture. We found 78.3% aerobes, 21.7% anaerobes, 51.5% gram positive and 48.5% gram negative micro-organisms, but no fungi in 120 cultures. The commonest aerobic species was Haemophylus (20%), whereas Peptococcus and Bacteroides were the commonest anaerobes (10%).     

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.     

The importance of the anaerobic bacteria in paranasal sinusitis.

The anaerobic examination of the material, obtained by 100 antral punctures, in 66 patients with paranasal sinusitis, showed the importance of the anaerobic bacteria. In 33% we found anaerobes: 12% of the cultures were pure anaerobic, 21% were mixed aerobic-anaerobic. The most frequent anaerobe is the Peptostreptococcus. Anaerobic cultures are more frequently found in the unilateral cases of paranasal sinusitis. The presence of anaerobes does not seem to be dependent on the patient's age, the duration of the sinusitis and the previous administration of antibiotics during the last 3 days. In 76% the anaerobes disappeared after the initial antral puncture and washing.