Guss Joel, Abuzeid W M, Doghramji Laurel, Edelstein Paul H, Chiu Alexander G
Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA.
ORL J Otorhinolaryngol Relat Spec. 2009;71(5):263-7. doi: 10.1159/000242428. Epub 2009 Sep 30.
Pseudomonas aeruginosa is cultured in nearly 1 of 5 patients with chronic rhinosinusitis and a history of sinus surgery. Fluoroquinolones are the only enterally administered antibiotics with efficacy against P. aeruginosa, but their frequent empiric use in the community raises concern for a rise in resistance.
It was the aim of this study to determine the prevalence of fluoroquinolone-resistant P. aeruginosa in a tertiary rhinology practice.
All bacterial sinus culture results from the outpatient otolaryngology clinic that yielded P. aeruginosa over a 5-year period (2002-2007) were reviewed along with the medical records of a randomly selected subset of patients.
In total, 689 culture results of 324 patients were examined. Nearly all patients had a history of endoscopic sinus surgery. Of all P. aeruginosa cultured, 13% were resistant to levofloxacin and 5% were intermediately sensitive, while 5% were resistant to ciprofloxacin and 7% intermediately sensitive. Of the 324 patients in the study, 19 and 15% had a history of a P. aeruginosa culture resistant to levofloxacin or ciprofloxacin, respectively. Mucoid strains of P. aeruginosa were significantly more likely to be fluoroquinolone resistant. No patient comorbidities were associated with a higher rate of resistance. The prevalence of resistant cultures remained stable over the 5-year study period.
P. aeruginosa is cultured primarily in patients with previous sinus surgery. Nearly 20% of isolates are resistant to fluoroquinolones. Resistance to levofloxacin is more common than resistance to ciprofloxacin. This study supports the use of culture-directed therapy in the management of the postfunctional endoscopic sinus surgery patient and the avoidance of empiric use of fluoroquinolones.
在近五分之一有慢性鼻窦炎病史且接受过鼻窦手术的患者中培养出铜绿假单胞菌。氟喹诺酮类药物是唯一经肠道给药且对铜绿假单胞菌有效的抗生素，但其在社区的频繁经验性使用引发了对耐药性增加的担忧。
本研究旨在确定在一家三级鼻科学诊所中耐氟喹诺酮铜绿假单胞菌的患病率。
回顾了门诊耳鼻喉科诊所5年期间（2002 - 2007年）所有培养出铜绿假单胞菌的细菌鼻窦培养结果，并查阅了随机选择的部分患者的病历。
共检查了324例患者的689份培养结果。几乎所有患者都有内窥镜鼻窦手术史。在所有培养出的铜绿假单胞菌中，13%对左氧氟沙星耐药，5%为中介敏感，而5%对环丙沙星耐药，7%为中介敏感。在该研究的324例患者中，分别有19%和15%有对左氧氟沙星或环丙沙星耐药的铜绿假单胞菌培养史。铜绿假单胞菌的黏液样菌株更有可能对氟喹诺酮耐药。患者的合并症与更高的耐药率无关。在5年的研究期间，耐药培养物的患病率保持稳定。
铜绿假单胞菌主要在既往有鼻窦手术的患者中培养出。近20%的分离株对氟喹诺酮耐药。对左氧氟沙星的耐药比对环丙沙星的耐药更常见。本研究支持在功能性内窥镜鼻窦手术后患者的管理中使用培养指导的治疗方法，并避免经验性使用氟喹诺酮类药物。
