Use of nasopharyngeal culture to determine appropriateness of antibiotic therapy in acute bacterial rhinosinusitis. Issue 4 (25th October 2012)

• Record Type: Journal Article
• Authors: Lee, Stella; Woodbury, Kristin; Ferguson, Berrylin J.
• Is Part Of: International forum of allergy & rhinology. Volume 3:Issue 4(2013:Apr.)
• Page Start: 272
• Page End: 275
• Publication Date: 2012-10-25
• Subjects: 617.51005
• DOI: 10.1002/alr.21102
• Languages: English
• ISSNs: 2042-6976

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="alr21102-sec-0010" sec-type="section"> <title>Background</title> <p>Rhinosinusitis is one of the top 5 diagnoses for which an antibiotic is prescribed, often without a clear bacterial etiology. This study evaluated whether nasopharyngeal culture and gram stain could serve as a surrogate for endoscopically obtained middle meatal cultures in directing appropriate therapy for acute bacterial rhinosinusitis (ABRS). This study also investigated the utility of a rapid sinus test screen in differentiating bacterial from nonbacterial rhinosinusitis.</p> </sec> <sec id="alr21102-sec-0020" sec-type="section"> <title>Methods</title> <p>Thirty‐one adult patients met inclusion criteria for ABRS. Samples were obtained from both the middle meatus and nasopharynx for Gram stain and culture. Nasal mucous samples were tested with a rapid sinus test strip measuring pH, levels of protein, nitrites, and leukocyte esterase.</p> </sec> <sec id="alr21102-sec-0030" sec-type="section"> <title>Results</title> <p>Sixty‐one percent (61%) of nasopharyngeal and 48% of middle meatal samples grew pathogenic bacteria. The concordance rate was 84% between the 2 sites (<italic>p</italic> = 0.0006). The following pathogenic organisms were detected: <italic>Moraxella catarrhalis</italic>, <italic>Streptococcus pneumoniae</italic>, <italic>Haemophilus influenzae</italic>, <italic>Pseudomonas aeruginosa</italic>, and <italic>Staphylococcus aureus</italic>. For nasopharyngeal samples, reliance on Gram stain alone exhibited a sensitivity of 31% and specificity of 100% and, similarly, for middle meatus samples, 47% and 93%, respectively. The rapid sinus test revealed a sensitivity of 83% and specificity of 7%.</p> </sec> <sec id="alr21102-sec-0040" sec-type="section"> <title>Conclusion</title> <p>Nasopharyngeal and middle meatal cultures exhibited high concordance for pathogenic bacteria. Gram stain exhibited moderate sensitivity and excellent specificity. Nasopharyngeal cultures could provide a viable method, especially in a primary care setting, for determining the appropriateness of antibiotic therapy. The rapid sinus test's lack of specificity precluded its utility in the differentiation between bacterial and nonbacterial rhinosinusitis.</p> </sec> </abstract>