ANTIMICROBIAL RESISTANCE IN BACTERIAL CHRONIC SINUSITIS

Recent reports describe the emergence of antimicrobial resistant bacte ria in acute sinusitis and an increased incidence of enteric gram nega tive bacilli in chronic sinusitis. The objective of this cross section al study is to identify the emergent resistance patterns in bacterial chronic sinusitis. Specifically, this article seeks to characterize th e bacteriology of outpatient chronic sinusitis, then to compare the an timicrobial susceptibilities of the bacterial isolates with standard c ulture data from a tertiary care center. Between March and August, 199 4, 113 new outpatients presented with chronic sinusitis at a major tea ching institution. Of these patients 34 underwent endoscopically guide d aerobic culture of the paranasal sinuses and nasal cavities. Of the 48 total cultures, there were 43 positive cultures yielding 72 isolate s. Thirty-eight cultures had two or fewer isolates; four cultures had three plus isolates, and one culture grew out normal flora. The most f requently isolated organisms were coagulase negative Staphylococcus (S CN), 20 (28%); Pseudomonas aeruginosa, 12 (17%); and Staphylococcus au reus, 9 (13%). Within the limited sample size for each isolate, Staphy lococcus coagulase negative, Pseudomonas, and Pneumococcus demonstrate d higher antimicrobial resistance compared to the medical center's cor responding nonurinary isolates. Additionally, three of six patients wi th Pseudomonal aeruginosa (50%) had a quinolone resistant strain. Thes e preliminary data suggest that both an increased incidence of antimic robial resistance and of enteric gram negative bacilli may exist in th ese outpatient tertiary care center patients with chronic bacterial si nusitis.