We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
<italic>Staphylococcus aureus</italic> on Sinus Culture Is Associated With Recurrence of Chronic Rhinosinusitis After Endoscopic Sinus Surgery.
- Authors
Maniakas, Anastasios; Asmar, Marc-Henri; Renteria Flores, Axel E.; Nayan, Smriti; Alromaih, Saud; Mfuna Endam, Leandra; Desrosiers, Martin Y.
- Abstract
<bold>Objectives:</bold> Identify whether identification of <italic>S. aureus</italic> on conventional culture is a predictor of success or failure after ESS followed by budesonide nasal irrigations (BUD) in chronic rhinosinusitis (CRS) patients at high risk of recurrence. <bold>Methodology:</bold> Prospective clinical trial including 116 patients from a tertiary care center at high-risk of disease recurrence following ESS+BUD. Blood samples, microbial swabs, and SNSS/SNOT-22 were taken on the day of surgery (Visit-1) and 4 months postoperatively (Visit-2). Outcomes were evaluated using symptoms and mucosal status as assessed by the Lund-Kennedy endoscopic score. <bold>Results:</bold> Seventy-five patients (69.4%) attained SNOT-22 MCID or higher. (Mean = 33.4, range 9–75). Objective documentation of recurrence of disease, as defined by combined endoscopic/symptomatic criteria, was noted in 58/116 patients (50%). Revision surgery was associated with a significantly higher rate of disease recurrence (60.0 vs. 28.0%; <italic>p</italic> < 0.001). Culture for <italic>Staphylococcus aureus</italic> was associated with disease recurrence, preoperatively and at 4 months post-surgery (<italic>p</italic> = 0.020; <italic>p</italic> < 0.001). This was restricted to post-operative cultures in the revision group (10.0 vs. 48.8%; <italic>p</italic> < 0.001). Other factors associated with poor outcome included intolerance to non-steroidal anti-inflammatory drugs (NSAID) (<italic>p</italic> = 0.036). Significantly higher Lund-Kennedy scores in the recurrence groups despite similar symptom intensity, emphasizing the importance of considering objective outcome in addition to patient-reported ones. <bold>Conclusion:</bold> Patients undergoing revision ESS are at high risk of disease recurrence, even when budesonide irrigations are used post operatively. Presence of <italic>S. aureus</italic> on culture pre-operatively or at 4 months post-ESS is associated with a negative outcome. This suggests that <italic>S. aureus</italic> negatively influences outcome, possibly via a number of mechanisms, including interactions with the (i) immune system, (ii) regeneration and repair of the sinus epithelium, or (iii) via interference with the sinus microbiome. This suggests that <italic>S. aureus</italic> may be a simple and inexpensive biomarker for disease severity and indicates a clear need to better appreciate <italic>S. aureus</italic> on how it contributes mechanistically to disease development and persistence in order to develop targeted therapeutic strategies.
- Subjects
STAPHYLOCOCCUS aureus; SINUSITIS; PARANASAL sinus surgery; REOPERATION; BUDESONIDE; ENDOSCOPY
- Publication
Frontiers in Cellular & Infection Microbiology, 2018, Vol 8, pN.PAG
- ISSN
2235-2988
- Publication type
Article
- DOI
10.3389/fcimb.2018.00150