Department of Otolaryngology, Faculty of Medicine, Jagiellonian University Medical College, Jakubowskiego 2, 30-688, Kraków, Poland.
Jerzy Haber Institute of Catalysis and Surface Chemistry Polish Academy of Sciences, Niezapominajek 8, 30-239, Krakow, Poland.
Eur Arch Otorhinolaryngol. 2021 Dec;278(12):4795-4803. doi: 10.1007/s00405-021-06747-z. Epub 2021 Mar 27.
Chronic rhinosinusitis (CRS) is a highly prevalent multifactorial disorder. Culture-directed antibiotics are frequently prescribed to patients with CRS and the middle nasal meatus (MM) is traditionally believed to be a representative sampling site of the sinuses as a whole. The purpose of our study was to reevaluate the reliability of the MM as a sampling site in patients with CRS who suffer from impaired drainage from the sinuses to the MM.
Swabs and tissue biopsies were collected from the MM, maxillary sinus and frontal sinus from 50 patients with CRS. The results of bacterial culture were compared between sampling methods and sites in relation to the patency of the sinus ostia.
782 bacterial isolates were cultured from the samples. Concordant results between the MM and the sinus cavity were noted in 80% of patients for the maxillary sinus, but only 66% for the frontal sinus and 76% for the sinuses a whole. The differences were similarly prevalent in patients with open and occluded sinus ostia. Notably, swabs from all three sites provided representative information in 92% of patients and tissue biopsies did not provide additional information compared to multiple swabs.
The traditional method of sampling from the middle meatus provides inadequate information in 24% of patients with CRS, which may result in inadequate antibiotic therapy and contribute to increasing antibiotic resistance. Additional sampling from the sinuses should be recommended whenever possible, while invasive sampling is not necessary.
慢性鼻-鼻窦炎（CRS）是一种高发的多因素疾病。经常向患有 CRS 的患者开具针对特定病原体的抗生素，而中鼻道（MM）传统上被认为是整个鼻窦的代表性采样部位。我们的研究旨在重新评估 MM 作为 CRS 患者鼻窦引流功能受损时的采样部位的可靠性。
从 50 例 CRS 患者的 MM、上颌窦和额窦采集拭子和组织活检。比较了不同采样方法和部位的细菌培养结果与窦口通畅性的关系。
从样本中培养出 782 株细菌。上颌窦 80%的患者 MM 和窦腔的结果一致，但额窦仅为 66%，整个鼻窦为 76%。在窦口通畅和阻塞的患者中，差异同样普遍。值得注意的是，所有三个部位的拭子在 92%的患者中提供了具有代表性的信息，而组织活检与多次拭子相比并没有提供更多信息。
在 24%的 CRS 患者中，传统的 MM 采样方法提供的信息不足，这可能导致抗生素治疗不足，并导致抗生素耐药性增加。应尽可能推荐额外从鼻窦取样，而无需进行有创性取样。
