Effect of nasal mometasone furoate on the nasal and nasopharyngeal flora

The microbiome of the nasopharynx

The nasopharyngeal microbiome is a dynamic microbial interface of the aerodigestive tract, and a diagnostic window in the fight against respiratory infections and antimicrobial resistance. As its constituent bacteria, viruses and mycobacteria become better understood and sampling accuracy improves, diagnostics of the nasopharynx could guide more personalized care of infections of surrounding areas including the lungs, ears and sinuses. This review will summarize the current literature from a clinical perspective and highlight its growing importance in diagnostics and infectious disease management.

Effects of azelastine nasal spray on nasal and nasopharyngeal microflora

OBJECTIVE

Azelastine nasal spray is a topical antihistaminic drug for the symptomatic treatment of allergic rhinitis. This study aimed to investigate the effects of azelastine on nasal and nasopharyngeal microflora.

METHODS

Swab samples from 25 patients prescribed azelastine nasal spray monotherapy were collected just before treatment and after 1 month of treatment. After incubation of inoculates, the number of bacteria present in cultures was measured (in colony-forming units per millilitre).

RESULTS

Evaluation of the number of microflora revealed increased bacterial reproduction after treatment, but this difference was not statistically significant. The use of azelastine nasal spray decreased the reproduction of three potentially pathogenic bacteria; however, it did not affect the reproduction of other potentially pathogenic bacteria.

CONCLUSION

The use of azelastine nasal spray for one month did not have a statistically significant effect on the numbers of nasal and nasopharyngeal microflora; it is therefore safe from a microbiological viewpoint.

When and how should we treat biofilms in chronic sinusitis?

PURPOSE OF REVIEW

Biofilms have been observed on the sinus mucosa of patients with chronic rhinosinusitis and are associated with poor clinical outcomes after surgery. This article summarizes the recent studies which describe the efficacy of treating biofilms in chronic rhinosinusitis.

RECENT FINDINGS

Biofilms are polymicrobial communities comprised of bacteria that tend to be more antibiotic-resistant than when in planktonic forms. Antibiotic therapy against biofilms is usually associated with relapse following cessation of treatment and may also have an adverse effect on normal commensal microflora. Surfactants can improve clinical symptoms, but their use has been limited by side effects. Other treatment modalities that physically remove or disrupt biofilms, such as ultrasound, have shown some efficacy in small trials. The impact of surgery on biofilms has not been extensively investigated.

SUMMARY

The nature of biofilms makes their removal difficult. No currently available treatment directed against them has demonstrated lasting efficacy.

The microbiological spectrum and antibiotic sensitivity profile of extubated silicone stents following dacryocystorhinostomy

PURPOSE

We aim to report the microbiological spectrum of organisms cultured from extubated silicone stents after a dacryocystorhinostomy and their antibiotic sensitivity patterns.

STUDY DESIGN

Prospective interventional study.

METHODS

50 silicone stents of 50 consecutive patients who underwent either external or endonasal dacryocystorhinostomy were enrolled for the study. All the stents were retrieved under endoscopic guidance from the nasal cavity at 3 months following surgery. All the tubes were immediately inoculated onto blood agar, chocolate agar, brain-heart infusion broth, Saboraud's dextrose agar and potato dextrose agar. Data collected and analyzed include demographics, diagnosis, type of dacryocystorhinostomy and the microbiological profile. The culture results, organisms isolated and their antibiotic sensitivity were studied.

RESULTS

The mean age of patients at the time of dacyrocystorhinostomy was 34.4 years. Bacterial growth was noted in 88% (44/50) of all the stents cultured, whereas 60% (30/50) grew fungi and 6% (3/50) showed sterile cultures. 48% (24/50) of the stents showed mixed bacterial and fungal isolates. Among the fungal isolates, Aspergillus species accounted for 66.6% (20/30) followed by Fusarium species, which were seen in 26.6% (8/30). Among the bacterial isolates, gram negative organisms were the most common seen in 54.5% (24/44) and the commonest species isolated was Pseudomonas aeruginosa from 27% (12/44) of the stents. Staphylococcus aureus was the commonest gram positive isolate accounting for 18% of all the bacterial isolates. Gram positive organisms were commonly sensitive to cephalosporins and vancomycin whereas gram negative organisms were sensitive to quinolones and aminoglycosides. The surgical success rate was 96% (48/50).

CONCLUSIONS

Fungal isolates were cultured from significant number of stents retrieved following dacryocystorhinostomy. Gram negative organisms are more common as compared to the gram positive. The organisms isolated were not found to influence the success of dacryocystorhinostomy.