SINUSITIS IN NEUROLOGICALLY IMPAIRED CHILDREN

The microbiologic features of infected sinus aspirates in nine childre n with neurologic impairment were studied. Anaerobic bacteria, always mixed with aerobic and facultative bacteria, were isolated in 6 (67%) aspirates and aerobic bacteria only in 3 (33%). There were 24 bacteria l isolates, 12 aerobic or facultative and 12 anaerobic. The predominan t aerobic isolates were Klebsiella pneumoniae, Escherichia coli, and S taphylococcus aureus (2 each) and Proteus mirabilis, Pseudomonas aerug inosa, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcu s pneumoniae (1 each). The predominant anaerobes were Prevotella sp. ( 5), Peptostreptococcus sp. (4), Fusobacterium nucleatum (2), and Bacte roides fragilis (1). beta-Lactamase-producing bacteria were isolated f rom 8 (89%) patients. Organisms similar to those recovered from the si nuses were also isolated from tracheostomy site and gastrostomy wound aspirates in five of seven instances. This study demonstrates the uniq ueness of the microbiologic features of sinusitis in neurologically im paired children, in which, in addition to the organisms known to cause infection in children without neurologic impairment, facultative and anaerobic gram-negative organisms that can colonize other body sites a re predominant.