Symptoms and clinical and radiological signs predicting the presence of pathogenic bacteria in acute sinusitis

A minority of patients with common cold and upper respiratory tract infecti ons have a bacterial infection and may benefit from antibiotic therapy. The present analysis set out to determine whether there were clinical symptoms or signs which could help the clinician to identify a subset of patients w ith moderate forms of acute rhinosinusitis who are infected with pathogenic bacteria. Detailed clinical history and medical examination were obtained from 265 pa tients (mean age 35 years, 138 females and 127 males) presenting symptoms o f upper respiratory tract infections but no fever above 38 degreesC. The pr esence of three pathogenic bacteria (S. pneumoniae, H. influenzae or M. cat arrhalis) was determined in all patients by culture of nasopharyngeal secre tions. Aggravating factors for severity of rhinosinusitis, such as severe nasal ob struction, inferior and/or middle turbinate hypertrophy, oedema of the midd le meatus mucosa and septal defects, were not associated with the presence of bacteria. Pathogenic bacteria were found in 77 patients (29%). The clinical signs and symptoms which were significantly associated in a multivariate model with the presence of bacteria included facial pain (p < 0.003), coloured nasal d ischarge (p < 0.003) and radiological maxillary sinusitis (complete opacity , air-fluid level or mucosal thickening greater than 10 mm) (p < 0.002). Th is, the best predictive model, had a sensitivity of 69% and a specificity o f 64% and therefore could not be used either as a screening tool or as a di agnostic criterion for bacterial rhinosinusitis. We conclude that signs and symptoms of acute rhinosinusitis in patients wit h a mild to moderate clinical presentation are poor predictors of the prese nce of bacteria. In agreement with previous studies, culture of nasopharyng eal secretions may identify patients who would benefit from antibiotic trea tment. Thus, antibiotic therapy should not be prescribed in the absence of bacteriological evidence.