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The adequacy of antibiotic therapy in chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is a symptomatic inflammation of the mucosa of the nose and paranasal sinuses lasting for at least 12 weeks. The aetiology and pathogenesis of CRS are still the matter of numerous investigations. Some authors support the role of bacterial or fungal infection as the cause of CRS while others consider the disease to be the result of immune response. Empiric antimicrobial therapy is an accepted method of treatment for CRS supported by the current guidelines. The purpose of this study was to determine bacteria present in sinus cavities of CRS patients and to establish if these bacteria cause an infection or just colonize sinuses. 62 consecutive patients with CRS who underwent the functional endoscopic sinus surgery (FESS) were included in the study. During the FESS sinus was irrigated with sterile 0.9% NaCl solution and this lavages were used to detect bacteria and fungi. Excised sinus mucosa was sent to the pathologist for the histopahology analysis. Bacteria and fungi were detected in 45 % of sinus lavage samples. The most commonly isolated bacteria were Staphylococcus epidermidis and Staphylococcus aureus. Chronic inflammation was detected in each mucosa sample. Half of patients had the inflammation with lymphocytic predominance while others had eosinophilic granulocyte predominance. Results of this study show that bacteria detected colonize sinus mucosa and don't cause the infection. According to this CRS should be considered a chronic inflammatory condition rather than bacterial infection so routine antibiotic therapy should be avoided as frequent and prolonged antibiotic therapy could induce bacterial resistance.

Chronic rhinosinusitis; antibiotic therapy

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