Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Department of Otolaryngology, Sawanpracharak Hospital, Nakhonsawan, Thailand.
Rhinology. 2018 Sep 1;56(3):241-244. doi: 10.4193/Rhin17.261.
Acute bacterial rhinosinusitis (ABRS) is a subtype of acute rhinosinusitis (ARS). To prevent excessive antibiotic prescribing, clinical criteria for diagnosing ABRS are presented in two major international guidelines from European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS2012) and the Infectious Diseases Society of America (IDSA2012). This study aims to assess accuracy of these criteria.
Patients with ARS were recruited. Clinical features were collected including discolored nasal discharge, facial pain, fever, double sickening, symptoms persisting longer than 10 days, and elevated serum C reactive protein (CRP) and erythrocyte sedimentation rate (ERS). Using middle meatal bacterial culture as a reference, accuracy of EPOS2012 and IDSA2012 criteria were analyzed.
Eighty-eight patients (age 43.2+/-14.5 years, 67% female) with ARS were recruited. Using the two criteria for diagnosing ABRS, EPOS2012 and IDSA2012 have sensitivity of 50% (95%CI: 38%-62%) versus 69% (95%CI: 57%-79%), specificity of 63% (95%CI: 43%-79%) versus 46% (95%CI: 28%-65%), and accuracy of 53% versus 63%, respectively.
Both EPOS2012 and IDSA2012 had modest accuracy. EPOS2012 had less sensitivity but a better specificity compared to IDSA2012. This suggests that IDSA2012 diagnostic criteria may contribute to inappropriate use of antibiotics due to poorer specificity.
急性细菌性鼻-鼻窦炎（ABRS）是急性鼻-鼻窦炎（ARS）的一个亚型。为了防止过度使用抗生素，两个主要的国际指南，即欧洲鼻-鼻窦炎和鼻息肉诊疗指南（EPOS2012）和美国传染病学会（IDSA2012），都提出了用于诊断 ABRS 的临床标准。本研究旨在评估这些标准的准确性。
招募了患有 ARS 的患者。收集了临床特征，包括颜色异常的鼻涕、面部疼痛、发热、双侧发病、症状持续超过 10 天以及血清 C 反应蛋白（CRP）和红细胞沉降率（ESR）升高。以中鼻甲细菌培养作为参考，分析 EPOS2012 和 IDSA2012 标准的准确性。
共招募了 88 例 ARS 患者（年龄 43.2+/-14.5 岁，67%为女性）。使用诊断 ABRS 的两个标准，EPOS2012 和 IDSA2012 的灵敏度分别为 50%（95%CI：38%-62%）和 69%（95%CI：57%-79%），特异性分别为 63%（95%CI：43%-79%）和 46%（95%CI：28%-65%），准确性分别为 53%和 63%。
EPOS2012 和 IDSA2012 的准确性均一般。EPOS2012 的灵敏度较低，但特异性优于 IDSA2012。这表明，由于特异性较差，IDSA2012 的诊断标准可能导致抗生素的不合理使用。
