Adelman Avraham E, Tangutur Akshay, Archilla Alfredo S, Vengerovich Gennadiy
Department of Surgery, Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA.
ENT Specialists, Boynton Beach, Florida, USA.
Otolaryngol Head Neck Surg. 2025 Apr;172(4):1442-1449. doi: 10.1002/ohn.1122. Epub 2025 Jan 5.
Identify common pathogens and antibiotic resistances in chronic rhinosinusitis patients post-endoscopic sinus surgery presenting with an active sinus infection.
Retrospective chart review.
Single-institution rhinology private practice in Southeast Florida.
Recorded postoperative endoscopically-guided sinus cultures from symptomatic patients with purulent drainage on endoscopy from August 2020 to December 2023. When available, pre- or intraoperatively cultured organisms were collected.
Of 125 patients, 50.4% were female with a mean age of 51.0. In 34.4% of patients that underwent revision surgery, 76% had nasal polyps and 26.4% had asthma. Of 301 cultures, 264 (87.7%) were positive, 53 (17.6%) were polymicrobial, and 37 (12.3%) were negative. Of 351 total isolates, 165 (47%) were Gram-negative, 125 (35.6%) Gram-positive, 14 (4%) fungi, and 10 (2.8%) anaerobic. 46.9% of postoperative organisms were not cultured preoperatively. Gram-negative bacteria included Enterobacteriaceae (17.7%), Pseudomonas spp. (10.5%), Serratia spp. (5.1%). Gram-positive bacteria included Methicillin-sensitive Staphylococcus aureus (MSSA, 17.1%) and Methicillin-resistant S. aureus (MRSA, 8%). Antibiotic resistances included MSSA to penicillins (52.8%) and clindamycin (32.8%), and MRSA resistance to quinolones (53.6%) and clindamycin (35.7%). Enterobacteriaceae were 42% resistant to amoxicillin-clavulanate and 37.1% to penicillins, while Pseudomonas aeruginosa was 17.7% resistant to quinolones.
A cohort of chronic rhinosinusitis patients post-sinus surgery grew a large proportion of Gram-negative organisms and significant Staphylococcal penicillin and Gram-negative amoxicillin-clavulanate resistance. Our findings indicate the benefit of culturing patients with this patient presentation. If cultures cannot be obtained, we suggest broad-spectrum antibiotics that consider wide Gram-negative coverage and local antibiotic resistance patterns.
