Bacteriologic findings from the nose, ethmoid, and bloodstream during endoscopic surgery for chronic rhinosinusitis: Implications for antibiotic therapy

This study addresses the bacterial flora of chronic rhinosinusitis at the time of endoscopic sinus surgery. We risen the consensus definition of chronic rhinosinusitis as the presence of paranasal sinus inflammation present Sor greater than IZ weeks. In our patient study group, all cases of chronic rhinosinusitis had failed to respond to antibiotic therapy and had not been treated previously with surgery. By microscopic examination, chronic inflammatory changes were confirmed ill the resected sinus lining of all study patients. Intraoperative cultures,were obtained from the nasal vestibule, the middle meatus,, ethmoid lining, and peripheral blood during mid after the endoscopic procedure. We found approximately 30% of the patients with sterile sinuses, 50% with coagulase-negative staphylococci, and the remainder with a mixed group of "nonpathogenic" organisms. Anaerobes were conspicuously rare. The blood cultures were positive in 7% of cases and were consistent with ail organism of the operative site. This is the first time bacteremia. has been reported in association with endoscopic skills surgery. The results suggest that chronic rhinosinusitis is not a bacterial disease, but rather the result. of chronic inflammation produced bg a previous acute inflammation. The incidence of positive blood cultures,,while relatively lon and cleared quickly, should alert the physician for the possible need for prophylactic antibiotics in patients with car diac, prosthetic, or systemic conditions that could lead to metastatic infection.