MICROBIOLOGY OF RHINOSINUSITIS

Culture specimens obtained directly from the sinuses are more accurate than specimens obtained from the nose, nasopharynx, and oropharynx. Numerous investigators have shown that there usually is little correlation between culture results with specimens obtained randomly from the nose or nasopharynx and those obtained by means of sinus aspiration. Culture material can be obtained directly from the sinus by means of sinus puncture and lavage or during surgical exploration. Because intranasal culture does not adequately reflect the bacterial organism in the sinuses, antibiotic management of acute sinusitis usually is empiric and based on the results of previous studies. There may be more accurate correlation between culture results with specimens obtained by means of endoscopy of the middle meatus and bacteria in the maxillary sinus (3).

The usual organisms that cause acute suppurative sinus-itis are similar in both adults and children (Table 30.4). Most infections appear to be caused by Streptococcus pneumo-niae, Haemophilus influenzae, Moraxella (formerly Branhamella) catarrhalis, and other streptococcal species. Anaerobic bacteria sometimes are isolated from the maxillary sinus during acute infection. Chronically infected sinuses in both adults and children usually grow anaerobic bacteria with much greater frequency than do acutely infected sinuses. a-Hemolytic streptococci, Staphylococcus aureus, and H. influenzae also are common pathogens. The type of organisms retrieved from chronically infected sinuses probably depends on the type of antimicrobial therapy before culture. Chronic suppurative sinusitis rarely if ever resolves with antibiotic management.

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