MICROBIOLOGY OF THE MAXILLARY SINUS IN ADULTS WITH CHRONIC SINUS DISEASE

Antimicrobial therapy is a part of the care of patients with chronic s inus disease (CSD), but the etiologic role of microorganisms in this c ondition is unclear. Twenty patients with CSD undergoing functional en doscopic sinus surgery who had been off antibiotics for at least 1 wee k before surgery had a maxillary sinus aspirate for quantitative cultu re for aerobic bacteria and fungi and a semiquantitative culture from the antrostomy of the same maxillary sinus during endoscopic surgery. Six (30%) of the patients had infection of the maxillary sinus diagnos ed by the presence of greater than or equal to 10(3) cfu/mL of organis ms in the sinus aspirate (Haemophilus influenzae in two patients and o ne patient each with Moraxella catarrhalis, alpha-streptococcus, mixed oropharyngeal flora, or Alternaria sp.). All antrostomy specimens obt ained by nasal endoscopy during surgery were positive, but the antrost omy cultures did not correlate with the sinus aspirate cultures from t he same sinus. Staphylococcus aureus and/or Gram negative rods in eigh t antrostomy cultures did not predict the presence of these pathogens in any of the maxillary sinus aspirates. Conversely, the bacteria dete cted with the quantitative aspirate culture in five of the six infecte d sinuses were not found in the antrostomy specimen; only the fungal s inus infection correlated with the antrostomy culture. Infection of th e maxillary sinuses occurred in patients with both limited and severe disease by CT imaging. About one third of patients with CSD necessitat ing surgery had microbial infection of the maxillary sinus, but antros tomy cultures obtained via endoscopy did not predict the organisms inf ecting the sinus.