Brook I, Frazier E H, Foote P A
Department of Pediatrics, Georgetown University, Alachua General Hospital, Gainesville, FL, USA.
J Med Microbiol. 1996 Nov;45(5):372-5. doi: 10.1099/00222615-45-5-372.
Repeated aspirations of sinus secretions by endoscopy was performed in five patients over a period of 34-50 days and, ultimately, surgical drainage was done in three who presented with acute maxillary sinusitis that did not respond to antimicrobial therapy and became chronic. The aspirates were cultured for aerobic and anaerobic bacteria. Most of the bacteria isolated from the first culture were aerobic or facultative bacteria: Streptococcus pneumoniae (three isolates), Haemophilus influenzae non-type-b (two) and Moraxella catarrhalis (one). Three of these cultures yielded bacteria that were resistant to the antimicrobial agents prescribed for treatment. Failure to respond to therapy was associated with the emergence of resistant aerobic and anaerobic bacteria in subsequent aspirates. These organisms included Fusobacterium nucleatum, pigmented Prevotella and Porphyromonas spp. and Peptostreptococcus spp. Eradication of the infection was achieved in all instances following the administration of antimicrobial agents effective against these bacteria, and in three instances by surgical drainage. This study illustrates the microbial dynamics of maxillary sinusitis that did not respond to antimicrobial therapy.
对5例患者在内镜下反复抽取鼻窦分泌物，持续34 - 50天，最终，3例对抗菌治疗无反应且转为慢性的急性上颌窦炎患者接受了手术引流。对抽取物进行需氧菌和厌氧菌培养。首次培养分离出的大多数细菌为需氧菌或兼性菌：肺炎链球菌（3株）、非b型流感嗜血杆菌（2株）和卡他莫拉菌（1株）。其中3份培养物分离出的细菌对规定的治疗用抗菌药物耐药。治疗无反应与随后抽取物中出现耐药需氧菌和厌氧菌有关。这些微生物包括具核梭杆菌、产色素普雷沃菌和卟啉单胞菌属以及消化链球菌属。在使用对这些细菌有效的抗菌药物后，所有病例的感染均得到根除，3例通过手术引流治愈。本研究阐明了对抗菌治疗无反应的上颌窦炎的微生物动态变化。
