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Current and emerging treatment modalities for bacterial rhinosinusitis in adults: A comprehensive review. Expert Opin Pharmacother 2022; 23:2013-2022. [DOI: 10.1080/14656566.2022.2147825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maria Gabriella Matera
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Barbara Rinaldi
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Vito de Novellis
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Paola Rogliani
- Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Mario Cazzola
- Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
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Biofilm and Planktonic Antibiotic Resistance in Patients With Acute Exacerbation of Chronic Rhinosinusitis. Front Cell Infect Microbiol 2022; 11:813076. [PMID: 35111699 PMCID: PMC8801706 DOI: 10.3389/fcimb.2021.813076] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The recalcitrant nature of patients with acute exacerbation of chronic rhinosinusitis (AECRS) potentially involves persisting colonization of the sinonasal mucosa by bacterial biofilms. Biofilms are known to be highly resistant to antibiotics, which may trigger or maintain chronic inflammation in the sinonasal mucosa. However, little is known about the relationship between the minimum inhibitory concentration (MIC) and antibiofilm concentrations of bacteria obtained from AECRS patients. MATERIAL AND METHODS Thirty bacterial strains from 25 patients with AECRS were identified and underwent MIC determination (VITEK® 2). The planktonic isolates were submitted to an in vitro formation of biofilms (Modified Calgary Biofilm Device) and determination of minimum biofilm inhibitory concentration (MBIC) and minimum biofilm eradication concentration (MBEC) for amoxicillin, amoxicillin/clavulanic acid, clarithromycin, and levofloxacin. MIC of the planktonic forms was compared with MBIC and MBEC levels, according to the breakpoints established by the Clinical Laboratory Standards Institute guidelines. RESULTS The main bacteria retrieved was S. aureus (60%), followed by other Gram-positive and Gram-negative bacteria in lower frequencies. 76.7% of strains formed biofilm in vitro (n=23/30). The planktonic isolates presented high rates of resistance for amoxicillin (82.6%) and clarithromycin (39.1%), and lower rates for amoxicillin/clavulanic acid (17.4%). The biofilm-forming bacteria counterparts presented higher levels of MBIC and MBEC compared to the MIC levels for amoxicillin, amoxicillin/clavulanic acid, and clarithromycin. Levofloxacin was highly effective against both planktonic and biofilm forms. Planktonic resistant forms were associated with levels of antibiofilm concentrations (MBIC and MBEC). CONCLUSIONS Biofilm-forming bacteria from AECRS patients are prevalent, and biofilm forms are highly resistant to antibiotics compared to their planktonic counterparts. Antibiotic resistance observed in planktonic forms is a good indicator of biofilm resistance, although near 20% of susceptible planktonic bacteria can produce antibiotic tolerant biofilms.
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Affiliation(s)
- Henrique Augusto Cantareira Sabino
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Division of Otorhinolaryngology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Fabiana Cardoso Pereira Valera
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Division of Otorhinolaryngology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Denise Vieira Santos
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Division of Otorhinolaryngology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marina Zilio Fantucci
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Division of Otorhinolaryngology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Carolina Carneiro Titoneli
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Division of Otorhinolaryngology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Roberto Martinez
- Department of Internal Medicine, Division of Infectious Diseases, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Wilma T Anselmo-Lima
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Division of Otorhinolaryngology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Edwin Tamashiro
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Division of Otorhinolaryngology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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The Microbiology of Acute Exacerbations in Chronic Rhinosinusitis - A Systematic Review. Front Cell Infect Microbiol 2022; 12:858196. [PMID: 35402317 PMCID: PMC8988222 DOI: 10.3389/fcimb.2022.858196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Acute exacerbations (AE) in chronic rhinosinusitis (CRS) are a common and important clinical issue. However, relatively little is known regarding the underlying microbiology that drives exacerbations or how it relates to the microbiome of CRS. The purpose of this study is to examine the literature to characterize the microbiome associated with acute exacerbations in a chronic rhinosinusitis setting. Understanding this disease process may facilitate targeted antibiotic therapy, reduced antibiotic resistance, and offer more effective disease control and treatment efficacy. Objective To characterize the microbiome associated with acute exacerbations of chronic rhinosinusitis (AECRS). Methods We conducted a systematic review of the literature on Medline, Embase, and Web of Science databases from January 1990-June 2021 to identify studies related to AE in CRS. Exclusion criteria include non-English, non-human studies, and case reports. Studies without culture or PCR data were also excluded. Results Fourteen studies were identified which provided detailed data regarding sinus microbiome in AECRS patients. In these patients, a total of 1252 individual isolates were identified. While common acute pathogens were identified in high frequencies in the sinonasal cultures (Staphylococcus pneumonia, Haemophilus influenza), the predominant bacteria were Staphylococcus aureus (including methicillin-sensitive Staphylococcus aureus) and Pseudomonas aeruginosa. Patient characteristics that may represent higher risk phenotypes were not consistently collected in the studies. Discussion of antimicrobial sensitivities and/or resistance were included in 7/14 studies. Conclusions This systematic review identifies the predominant microbiology species that may contribute to AECRS. Further studies are needed to understand the pathogenic role of bacteria and viruses in AECRS and to identify associated comorbidities and patient phenotypes that may predispose to AE. The optimal treatment regimen for AECRS remains unclear.
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Affiliation(s)
- Oghenefejiro Okifo
- Department of Otolaryngology – Head & Neck Surgery, Henry Ford Health System, Detroit, MI, United States
| | - Amrita Ray
- Department of Otolaryngology – Head & Neck Surgery, Henry Ford Health System, Detroit, MI, United States
- *Correspondence: Amrita Ray,
| | - David A. Gudis
- Department of Otolaryngology Head and Neck Surgery, Columbia University, New York City, NY, United States
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Patient-reported chronic rhinosinusitis disease control is a valid measure of disease burden. Rhinology 2021; 59:545-551. [PMID: 34762075 DOI: 10.4193/rhin21.282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Disease control is an important treatment goal for chronic uncurable conditions such as chronic rhinosinusitis (CRS). The objective of this study was to determine whether patient-reported CRS disease control is a valid reflection of disease burden. METHODS Prospective longitudinal study of 300 CRS patients (35% CRS with nasal polyps, 65% CRS without nasal polyps). At enrollment and at a subsequent follow-up timepoint, all participants were asked to rate their CRS disease control as "not at all," "a little," "somewhat," "very," or "completely", as well as to complete a 22-item Sinonasal Outcome Test (SNOT-22) and the 5-dimension EuroQol general health questionnaire from which the visual analogue scale (EQ-5D VAS) was used. RESULTS At enrollment and follow-up timepoints, patient-reported CRS disease control was significantly correlated with SNOT-22 and EQ-5D VAS scores. The change in patient-reported CRS disease control was significantly correlated with change in SNOT-22 and change in EQ-5D VAS scores. There was significant cross-sectional and longitudinal correlation between patient-reported control and all SNOT-22 subdomain scores. A SNOT-22 score of ≤ 25 points or lower, or an EQ-5D VAS score of ≥77 was predictive of having well - (i.e. "very" or "completely") controlled CRS. CONCLUSIONS Patient-reported CRS disease control is a valid measure of CRS disease burden and general QOL. A patient-reported assessment of CRS disease control could be considered as a component of a more comprehensive measure of CRS disease control.
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Affiliation(s)
- K M Phillips
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - F A Houssein
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - K Singerman
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - L M Boeckermann
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - A R Sedaghat
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Ciliary function and sinonasal mucosal cytology in pediatric patients with chronic rhinosinusitis during a year after functional endoscopic sinus surgery. Rhinology 2021; 59:319-327. [PMID: 33904535 DOI: 10.4193/rhin20.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The objective of the study is evaluation of ciliary function and mucosal cytology after endoscopic sinus surgery in children with chronic rhinosinusitis (CRS). METHODOLOGY A total of 132 children with CRS who underwent endoscopic sinus surgery, as well as 15 healthy controls were involved in the study. In this follow-up study patients were examined preoperatively, as well as 3, 6, 9, and 12 months after endoscopic sinus surgery. Assessment of ciliary function and sinonasal mucosal cytology was performed using high-speed videomicroscopy. Lund-Kennedy, Lund-Mackay, and sinonasal outcome test 20 (SNOT20) scores were also evaluated. RESULTS Total SNOT-20, Lund-Mackay, and Lund-Kennedy values significantly decreased after sinus surgery. In contrast, ciliary function and mucosal cytology only tended to improve after 6 months. 9 months after surgery the number of ciliated cells, ciliary beat frequency, cell viability, and ciliary length were significantly higher than preoperatively. The most significant improvement of ciliary function and cell height was observed 12 months after operation, whereas epithelial dystrophy and neutrophil infiltration were significantly reduced. CONCLUSIONS Substantial improvement was observed only in a year after surgery, whereas 0 to 3 months after the surgery ciliary function was severely impaired thus predisposing to recurrent sinusitis or other complications.
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Affiliation(s)
- S Alekseenko
- Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia; I.I. Mechnikov North-Western State Medical University, St. Petersburg, Russia; K.A. Raukhfus Childrens City Multidisciplinary Clinical Center for High Medical Technologies, St. Petersburg, Russia
| | - S Karpischenko
- Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia; K.A. Raukhfus Childrens City Multidisciplinary Clinical Center for High Medical Technologies, St. Petersburg, Russia; First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
| | - S Artyushkin
- I.I. Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - S Barashkova
- K.A. Raukhfus Childrens City Multidisciplinary Clinical Center for High Medical Technologies, St. Petersburg, Russia; National Center of morphological diagnostic, St. Petersburg, Russia
| | - I Anikin
- Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia; K.A. Raukhfus Childrens City Multidisciplinary Clinical Center for High Medical Technologies, St. Petersburg, Russia
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Olfactory Dysfunction is not a Determinant Of Patient-Reported Chronic Rhinosinusitis Disease Control. Laryngoscope 2020; 131:E2116-E2120. [PMID: 33300623 DOI: 10.1002/lary.29280] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/25/2020] [Accepted: 11/10/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES/HYPOTHESIS As a cardinal symptom of chronic rhinosinusitis (CRS), hyposmia has been recommended to be assessed as a component of CRS disease control. Herein we determine the significance of hyposmia in CRS in the context of nasal obstruction and drainage symptoms. STUDY DESIGN Prospective, cross-sectional METHODS: Cross-sectional study of 308 CRS patients (102 CRSwNP, 206 CRSsNP) without prior endoscopic sinus surgery. The burden of nasal obstruction and hyposmia were assessed using the corresponding item scores on the 22-item Sinonasal Outcome Test (SNOT-22). Burden of nasal discharge was assessed using the mean of "thick nasal discharge" and "thick post-nasal discharge" SNOT-22 item scores. Patients were all asked to rate their CRS symptom control as "not at all," "a little," "somewhat," "very," or "completely." RESULTS In CRSwNP, only 4.9% had a hyposmia score > 1 with nasal obstruction and drainage scores less than or equal to 1. In CRSsNP, only 1.9% had a hyposmia score > 1 with nasal obstruction and drainage scores less than or equal to 1. On univariate association, CRS symptom control was significantly associated with nasal obstruction, hyposmia, and drainage in both CRSwNP and CRSsNP (P < .05 in all cases). Using multivariable regression to account for all nasal symptoms, only nasal obstruction and nasal discharge scores (but not hyposmia) were significantly associated with CRS symptom control. CONCLUSIONS Hyposmia rarely occurs without nasal obstruction or nasal drainage, and may therefore be redundant to assess for CRS disease control. Moreover, hyposmia was not associated with patient-reported CRS symptom control when accounting for the burden of nasal obstruction and drainage. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2116-E2120, 2021.
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Affiliation(s)
- Adam C McCann
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Michal Trope
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Victoria L Walker
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Tazheh A Kavoosi
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Marlene M Speth
- Klinik für Hals-, Nasen-, Ohren- Krankheiten, Hals-und Gesichtschirurgie, Kantonsspital Aarau, Aarau, Switzerland
| | - Isabelle Gengler
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
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