A 5-year review of the microbiology of acute complicated bacterial sinusitis at the University of the Witwatersrand

Olwoch, Ian Paul
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SUMMARY This study retrospectively analysed the bacteriology of 226 patients who were admitted, with acute complicated sinusitis, to the University of the Witwatersrand’s ENT complex over a 5-year period, between the 1st January 2002 and 31st December 2006. There were 159 male and 67 females (ratio 2.4:1) aged between 1 and 74 (mean 16.5 ± 0.7) years. 116 (51.3%) patients were 15 years and younger and 110 (48.7%) were above the age of 15 years. All 226 patients had one or more of an orbital, soft tissue or bony complication and underwent open sinus surgery by way of an external frontoethmoidectomy approach (or ethmoidectomy) with maxillary sinus puncture and sinus washout. Intracranial complications were present in 37 (16.4%) patients of whom 12 required drainage of a subdural empyema and, one required drainage of a brain abscess. 233 microorganisms were isolated for analysis from positive cultures obtained from 163 (72.1%) patients (1.4 isolates per specimen) and 63 (27.9%) cultures were negative. Aerobic and facultative anaerobes accounted for 199 (85.4%) of the isolates whilst anaerobes accounted for 31 (13.3%) and fungi for 3 (1.3%). 107 (65.4%) of the positive culture specimens were monomicrobial whilst 56 (34.6%) contained 2 to 4 different species of microorganism. The proportion of anaerobes was notably higher (p<0.05) polymicrobial specimen than in monomicrobial specimen.The most commonly isolated aerobic microorganisms were Streptococcus milleri (18.5%), Staphylococcus aureus (12.4%), β-haemolytic streptococci groups A, C, F, and G (10.3%), coagulase negative staphylococcus (8.6%) and Haemophilus influenzae (8.6%). In contrast, Streptococcus pneumoniae (2.6%) and Moraxella catarrhalis (0.4%) were not major pathogens. Peptostreptococcus (6.4%) and Prevotella (4.7%) species were the most common anaerobes. The profile of isolates was not influenced by gender or by the presence of intracranial complications. However, age and location did have a significant (p<0.05) impact. Haemophilus influenzae was more significant (p<0.05) in patients aged 15 years and younger. Streptococcus milleri was the most common isolate (28.3%) at the Chris Hani Baragwanath Hospital but ranked 5th (2.3%) at the Johannesburg Hospital. β-haemolytic streptococci and coagulase negative staphylococcus ranked 1st (20.8%) and 2nd (14.8%) respectively at the Johannesburg Hospital but only 4th (4.8%) and 5th (2.8%) respectively at the Chris Hani Baragwanath Hospital. Penicillin, ampicillin and erythromycin were effective against Streptococcus milleri, β-haemolytic streptococci, Streptococcus pneumoniae and streptococcal species. Cloxacillin was effective against Staphylococcus aureus and coagulase negative staphylococci. Methicillin-resistant Staphylococcus aureus was isolated in 3 patients (1.3%). Haemophilus influenzae was resistant to ampicillin in 22.2% cases in which it was the sole pathogen.
bacterial sinusitis, microbiology