Methicillin-resistant Staphylococcus aureus infections in acute rhinosinusitis.

OBJECTIVE/HYPOTHESIS: Methicillin-resistant Staphylococcus aureus (MRSA) has recently become a serious problem in various fields of medicine. However, it has rarely been studied in acute rhinosinusitis. The aim of this study was to identify the clinical manifestations and treatment outcome of community-acquired methicillin-resistant S. aureus in acute rhinosinusitis. STUDY DESIGN: This was a prospectively collected case series. METHODS: Since 2000, we have launched a prospective long-term study for bacteriology, drug susceptibility, and their changing trend in acute rhinosinusitis. Patients with the diagnosis of acute rhinosinusitis were enrolled from October 2000 through March 2003. Their middle meatus discharge was taken for aerobic culture. Antibiotic sensitivity test was performed for each isolate. RESULTS: A total of 601 patients with the diagnosis of acute rhinosinusitis were included in this study. MRSA was isolated in 16 specimens. Its prevalence rate in acute rhinosinusitis was 2.7% (16 of 601). Multiple pathogens were more frequently found in children with MRSA infection. Five of seven adults had previous nasal procedures. Eight of nine children had a history of antibiotic use. Except for two patients without follow up, the remaining 14 patients resolved after receiving oral antibiotics according to culture results. CONCLUSIONS: The incidence of MRSA infection in acute rhinosinusitis was 2.7% in our study. The most important risk factor was nasal surgeries in adults and previous antibiotic use in children. The treatment outcome of community-acquired MRSA was excellent with oral antibiotics.

Middle meatus bacteriology of acute rhinosinusitis in patients after irradiation of nasopharynx.

BACKGROUND: Patients who undergo radiotherapy for nasopharyngeal carcinoma (NPC) tend to suffer from rhinosinusitis because irradiation causes damage to sinonasal tissue; however, their bacteriology is lacking in the literature. The aim of this study was to determine the bacteriology and antibiotic resistance in acute rhinosinusitis (ARS) of these patients. METHODS: We collected nasal purulent discharge for bacteriology and antibiotic susceptibility tests in irradiated NPC patients with ARS. Middle meatus discharge was aspirated for culture with endoscopic assistance. RESULTS: A total of 33 episodes of ARS were documented in 25 patients. Staphylococcus aureus comprised 42% of all aerobes. Thirty-six percents of aerobic isolates were Gram-negative bacilli. Peptostreptococcus micros and Veillonella spp were the most frequently isolated anaerobes. CONCLUSION: The bacteriology in irradiated NPC patients with ARS was distinctive in the following: first, the most common pathogen was S. aureus; second, frequently isolated Gram-negative bacilli and anaerobes; and third, polymicrobial infections. The beta-lactamase-producing pathogens were highly prevalent.

Inflammatory pseudotumor of the nasal cavity.

Inflammatory pseudotumor is usually found in the orbits and lungs, but rarely in the sinonasal area. We present a 59-year-old woman with a right nasal mass. This lesion caused nasal bleeding and blockage. Image study showed that the solid mass eroded the bony structure and pushed the nasal septum toward the left side. Wide excision was done via lateral rhinotomy. Although its clinical picture mimicked a malignant tumor, histological examination showed an inflammatory process composed of a mixture of lymphoplasmacytic infiltrate, histiocytic cells, and spindled fibroblastic/myofibroblastic cells. Both culture and pathology identified no microorganism. No evidence of recurrence was found after follow-up for more than 2.5 years. The clinical behavior of inflammatory pseudotumor was confusing and tended to be mistaken as malignancy. Its diagnosis and management could be a great challenge for clinicians.

High prevalence of antibiotic resistance in isolates from the middle meatus of children and adults with acute rhinosinusitis.

BACKGROUND: The pathogens in acute rhinosinusitis are similar worldwide. An increase in antibiotic resistance has been shown in a large number of studies in recent years. The prevalence of resistance varies greatly in different countries. This study was performed to determine the endemic prevalence of antibiotic resistance in pathogens of acute rhinosinusitis in Taiwan. METHODS: Middle meatus discharge was taken for aerobic culture in 133 outpatients with the diagnosis of acute rhinosinusitis. RESULTS: One hundred two isolates of pathogens were found, including three major bacteria: Haemophilus influenzae (37.3%), Streptococcus pneumoniae (28.4%), and Moraxella catarrhalis (11.8%). Polymicrobial infections and positive cultures occurred more frequently in pediatric patients, as did recovery of M. catarrhalis infection. An extremely high percentage of resistance to first-line antibiotics was noted, viz., penicillin-nonsusceptible S. pneumoniae (PNSSP) (72.4%), ampicillin-resistant H. influenzae (60.5%), and M. catarrhalis (58.3%). CONCLUSION: The high prevalence of drug resistance is a great threat to public health. Antibiotic use should be more prudent, especially in pediatric patients, who were found to be more susceptible to bacterial rhinosinusitis and multiple pathogenic infection.