Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, WA.
Int Forum Allergy Rhinol. 2018 Apr;8(4):504-508. doi: 10.1002/alr.22068. Epub 2018 Jan 5.
Multiple cultures are commonly obtained from different sinuses where purulence is encountered during endoscopic sinus surgery (ESS). This brings into question the utility and necessity of obtaining multiple cultures. The purpose of this study was to evaluate if multiple cultures obtained during a single case is informative in finding additional pathogens or if it is a redundant, cost-increasing practice. We hypothesized that multiple sinus cultures are necessary to identify the pathogens responsible for an individual's sinus disease. We seek to add information on the utility of performing multiple sinus cultures from a patient care and a health economics standpoint.
This study was a retrospective review of a single rhinologist's surgical database from 2008 to 2016. Patients that underwent ESS for chronic rhinosinusitis (CRS) and had multiple cultures obtained during surgery were included. Culture difference was recorded as a discrepancy of an infectious pathogen between cultures.
We identified 231 patients with multiple sinus cultures. Of those, 39.4% had a difference of pathogens noted on culture between different sinuses. Only 5% of the cohort received clinically relevant benefit from the second culture obtained in regard to a change in antibiotics.
In this retrospective review we showed that, for the practitioner who obtains sinus cultures intraoperatively, limiting this practice to a single culture rather than multiple is cost-effective and sufficient for identifying the pathogen to be treated. This study, and the resultant change in practice, has the potential to reduce healthcare costs associated with the surgical care of the patient with CRS.
在鼻窦内窥镜手术（ESS）过程中遇到脓液时，通常会从不同的鼻窦中获得多种培养物。这就引发了一个问题，即获得多种培养物是否有用且有必要。本研究的目的是评估在单个病例中获得的多种培养物是否有助于发现其他病原体，或者这是否是一种多余且增加成本的做法。我们假设，获得多个鼻窦培养物对于确定导致个体鼻窦疾病的病原体是必要的。我们旨在从患者护理和健康经济学的角度来增加关于进行多次鼻窦培养物的效用的信息。
本研究是对 2008 年至 2016 年期间一位单鼻科医生手术数据库的回顾性研究。纳入接受 ESS 治疗慢性鼻-鼻窦炎（CRS）且术中获得多个鼻窦培养物的患者。将培养物差异记录为不同窦腔之间感染病原体的差异。
我们确定了 231 例具有多个鼻窦培养物的患者。其中，39.4%的患者在不同鼻窦的培养物之间存在病原体差异。只有 5%的患者从第二次培养物中获得了临床相关的益处，即抗生素的改变。
在这项回顾性研究中，我们表明，对于术中获取鼻窦培养物的医生来说，将这种做法限制为单次培养而非多次培养既具有成本效益，又足以确定要治疗的病原体。这项研究以及由此产生的实践改变，有可能降低与 CRS 患者手术护理相关的医疗保健成本。
