Bacteriology of chronic purulent secretions in chronic rhinosinusitis

The aim of this work was to study the bacterial flora of purulent secretion s during chronic rhinosinusitis. We studied a total of 533 patients divided into two groups. The control population consisted of 139 adults (>16 years ) of both sexes seen in the community or hospitalized for less than 72 hour s for nonrhinological conditions. The rhinosinusitis group consisted of 394 patients referred to the ENT clinic with chronic rhinosinusitis. All the p atients with rhinosinusitis had had a post-nasal discharge for at least thr ee months, associated with purulent or mucopurulent secretions originating from the involved sinus cavity. Ail samples were obtained endonasally under endoscopic guidance from the sinus ostium or from the sinus cavity during surgery. Cultures were positive in 81.3 per cent of the control subjects an d 83.1 per cent of the patients with rhinosinusitis. Corynebacteria, coagulase-negative staphylococci, propionibacteria and pept ostreptococci were the main commensal organisms, while Haemophilus influenz ae, streptococci, Streptococcus pneumoniae, Prevotella spp and Fusobacteriu m spp were probable causative pathogens. Anaerobes were isolated from appro ximately 25 per cent of the patients in the rhinosinusitis group. Betalacta mase producers represented 27.5 per cent of H. influenzae and 28 per cent o f Prevotella spp isolates. Diminished susceptibility to penicillin was foun d in 13 per cent of S. pneumoniae isolates. The amoxycillin-clavulanate com bination was the most active oral antibiotic tested against the pathogenic species in vitro.