Department of Otolaryngology, University of Arizona, Tucson.
Division of Allergy/Immunology, National Jewish Health, Denver, Colorado.
JAMA Otolaryngol Head Neck Surg. 2016 Feb;142(2):138-42. doi: 10.1001/jamaoto.2015.3059.
Topical mupirocin therapy is used to treat symptomatic chronic sinusitis (CRS). However, the potential adverse impact of this therapy on the sinus microbiota has not been well quantified.
To determine changes in microbiologic culture results before and after topical mupirocin therapy in patients with CRS with medically and surgically refractory disease.
DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective medical chart review for 22 consecutive adults evaluated and treated between January 1, 2012, and January 1, 2014, at an otolaryngology-rhinology clinic at a regional academic medical center. The patients were 14 men and 8 women, who had undergone functional endoscopic sinus surgery for CRS, and in whom sinus aspirate cultures were performed before and after topical mupirocin therapy for symptomatic disease. Analyses were performed in April 2014.
Patients underwent treatment with saline sinus rinse, with the addition of mupirocin, for at least 1 week.
Bacterial isolates from sinus aspirate culture.
The patients included 14 men and 8 women, 18 to 75 years old, who underwent a mean of 1.9 functional endoscopic sinus surgical procedures. The mean (range) duration of mupirocin therapy was 6 (2-12) weeks. Before mupirocin therapy, cultures from symptomatic patients (14 men and 8 women, ages 18-75 years) revealed common bacteria implicated in CRS, which are characteristically gram-positive. After mupirocin therapy, cultures from symptomatic patients shifted significantly: 19 were gram-positive vs 3 gram-negative before treatment; 9 were gram-positive vs 13 gram-negative after treatment (P = .004), with increased growth of pathogenic gram-negative bacteria and Corynebacterium.
These data present evidence supporting the distinct abrogation of culturable sinus bacteria after mupirocin rinses, identifying a shift toward increased pathogenic bacteria. Consideration of healthy host microbiome and immune dysfunction should guide future treatment considerations.
局部莫匹罗星治疗用于治疗有症状的慢性鼻窦炎（CRS）。然而，这种治疗方法对鼻窦微生物群的潜在不良影响尚未得到很好的量化。
确定在患有医学和手术难治性疾病的 CRS 患者中，局部莫匹罗星治疗前后微生物培养结果的变化。
设计、地点和参与者：我们对 2012 年 1 月 1 日至 2014 年 1 月 1 日期间在一家地区学术医疗中心的耳鼻喉科-鼻科诊所接受评估和治疗的 22 例连续成人进行了回顾性病历审查。这些患者包括 14 名男性和 8 名女性，他们因 CRS 接受了功能性内窥镜鼻窦手术，并且在有症状疾病的情况下进行了局部莫匹罗星治疗之前和之后进行了鼻窦抽吸培养。分析于 2014 年 4 月进行。
患者接受盐水鼻窦冲洗治疗，并添加莫匹罗星，至少治疗 1 周。
鼻窦抽吸培养的细菌分离株。
患者包括 14 名男性和 8 名女性，年龄 18-75 岁，平均（范围）接受 1.9 次功能性内窥镜鼻窦手术。莫匹罗星治疗的平均（范围）持续时间为 6（2-12）周。在局部莫匹罗星治疗之前，来自有症状患者（14 名男性和 8 名女性，年龄 18-75 岁）的培养物显示出与 CRS 相关的常见细菌，这些细菌通常为革兰氏阳性。在局部莫匹罗星治疗后，来自有症状患者的培养物明显变化：19 个为革兰氏阳性，治疗前为 3 个革兰氏阴性；9 个为革兰氏阳性，治疗后为 13 个革兰氏阴性（P = .004），致病性革兰氏阴性菌和棒状杆菌的生长增加。
这些数据提供了支持莫匹罗星冲洗后可培养鼻窦细菌明显减少的证据，确定了向致病性细菌增加的转变。应考虑健康宿主微生物组和免疫功能障碍，以指导未来的治疗考虑。
