Møller Maria E, Alanin Mikkel C, Grønhøj Christian, Aanæs Kasper, Høiby Niels, von Buchwald Christian
Department of Otorhinolaryngology- Head and Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Am J Rhinol Allergy. 2017 Sep 1;31(5):293-298. doi: 10.2500/ajra.2017.31.4461.
A correlation exists between the microbial flora of the upper and lower airways in patients with cystic fibrosis (CF) or with primary ciliary dyskinesia (PCD). The sinuses can function as a bacterial reservoir where gram-negative bacteria adapt to the airways and repeatedly are aspirated to and colonize the lungs according to the theory of the united (unified) airways. Whereas the pattern of bacterial flora in the lower airways has been extensively studied, the upper airways have drawn limited attention.
Our aim was to review the literature that reported bacterial flora in the sinuses and nasal cavities of patients with CF or PCD.
A number of medical literature data bases were systematically searched between January 1960 and July 2016. We applied the following inclusion criteria: a minimum of one case of PCD (or Kartagener syndrome) or CF, and microbiology analyses from the nose or paranasal sinuses.
We included 46 studies (1823 patients) from 16 countries. Staphylococcus aureus was found in 30% of the noses and sinuses of patients with CF. Other common bacteria found included Pseudomonas aeruginosa, coagulase negative staphylococci, and Haemophilus influenzae. In PCD, H. influenzae was the most common bacteria (28%), followed by Streptococcus pneumoniae and P. aeruginosa. If studies that included nonsurgical swab and blowing samples were excluded, then P. aeruginosa was the most common bacterium in patients with CF (34%) and in patients with PCD (50%), followed by S. aureus and H. influenza.
S. aureus, P. aeruginosa, coagulase negative staphylococci, and H. influenzae dominated in the upper airways of patients with CF. In patients with PCD, H. influenzae, S. pneumoniae, and P. aeruginosa dominated. When studies that included swab and blowing samples were excluded, P. aeruginosa was the most common bacterium in both groups. Direct comparisons among the studies were restricted due to very heterogeneous methods, and a better standardization of procedures and outcomes is needed.
囊性纤维化（CF）患者或原发性纤毛运动障碍（PCD）患者的上、下呼吸道微生物群之间存在相关性。根据联合气道理论，鼻窦可作为细菌储存库，革兰氏阴性菌在此适应气道，并反复被吸入肺部并在肺部定植。虽然下呼吸道的细菌菌群模式已得到广泛研究，但上呼吸道受到的关注有限。
我们的目的是回顾报道CF或PCD患者鼻窦和鼻腔细菌菌群的文献。
在1960年1月至2016年7月期间系统检索了多个医学文献数据库。我们应用了以下纳入标准：至少1例PCD（或卡塔格内综合征）或CF病例，以及来自鼻子或鼻窦的微生物学分析。
我们纳入了来自16个国家的46项研究（1823例患者）。在CF患者的30%的鼻子和鼻窦中发现了金黄色葡萄球菌。发现的其他常见细菌包括铜绿假单胞菌、凝固酶阴性葡萄球菌和流感嗜血杆菌。在PCD中，流感嗜血杆菌是最常见的细菌（28%），其次是肺炎链球菌和铜绿假单胞菌。如果排除包括非手术拭子和吹气样本的研究，那么铜绿假单胞菌是CF患者（34%）和PCD患者（50%）中最常见的细菌，其次是金黄色葡萄球菌和流感嗜血杆菌。
金黄色葡萄球菌、铜绿假单胞菌、凝固酶阴性葡萄球菌和流感嗜血杆菌在CF患者的上呼吸道中占主导地位。在PCD患者中，流感嗜血杆菌、肺炎链球菌和铜绿假单胞菌占主导地位。当排除包括拭子和吹气样本的研究时，铜绿假单胞菌是两组中最常见的细菌。由于方法非常异质，研究之间的直接比较受到限制，需要更好地规范程序和结果。
