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Gómez-García M, Moreno-Jimenez E, Morgado N, García-Sánchez A, Gil-Melcón M, Pérez-Pazos J, Estravís M, Isidoro-García M, Dávila I, Sanz C. The Role of the Gut and Airway Microbiota in Chronic Rhinosinusitis with Nasal Polyps: A Systematic Review. Int J Mol Sci 2024; 25:8223. [PMID: 39125792 PMCID: PMC11311313 DOI: 10.3390/ijms25158223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 08/12/2024] Open
Abstract
In recent years, there has been growing interest in understanding the potential role of microbiota dysbiosis or alterations in the composition and function of human microbiota in the development of chronic rhinosinusitis with nasal polyposis (CRSwNP). This systematic review evaluated the literature on CRSwNP and host microbiota for the last ten years, including mainly nasal bacteria, viruses, and fungi, following the PRISMA guidelines and using the major scientific publication databases. Seventy original papers, mainly from Asia and Europe, met the inclusion criteria, providing a comprehensive overview of the microbiota composition in CRSwNP patients and its implications for inflammatory processes in nasal polyps. This review also explores the potential impact of microbiota-modulating therapies for the CRSwNP treatment. Despite variability in study populations and methodologies, findings suggest that fluctuations in specific taxa abundance and reduced bacterial diversity can be accepted as critical factors influencing the onset or severity of CRSwNP. These microbiota alterations appear to be implicated in triggering cell-mediated immune responses, cytokine cascade changes, and defects in the epithelial barrier. Although further human studies are required, microbiota-modulating strategies could become integral to future combined CRSwNP treatments, complementing current therapies that mainly target inflammatory mediators and potentially improving patient outcomes.
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Affiliation(s)
- Manuel Gómez-García
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (M.G.-G.); (E.M.-J.); (N.M.); (A.G.-S.); (M.G.-M.); (J.P.-P.); (M.I.-G.); (I.D.); (C.S.)
- Pharmacogenetics and Precision Medicine Unit, Clinical Biochemistry Department, University Hospital of Salamanca, 37007 Salamanca, Spain
| | - Emma Moreno-Jimenez
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (M.G.-G.); (E.M.-J.); (N.M.); (A.G.-S.); (M.G.-M.); (J.P.-P.); (M.I.-G.); (I.D.); (C.S.)
- Department of Microbiology and Genetics, University of Salamanca, 37007 Salamanca, Spain
| | - Natalia Morgado
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (M.G.-G.); (E.M.-J.); (N.M.); (A.G.-S.); (M.G.-M.); (J.P.-P.); (M.I.-G.); (I.D.); (C.S.)
- Biomedical and Diagnostics Sciences Department, University of Salamanca, 37007 Salamanca, Spain
| | - Asunción García-Sánchez
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (M.G.-G.); (E.M.-J.); (N.M.); (A.G.-S.); (M.G.-M.); (J.P.-P.); (M.I.-G.); (I.D.); (C.S.)
- Biomedical and Diagnostics Sciences Department, University of Salamanca, 37007 Salamanca, Spain
- Results-Oriented Cooperative Research Networks in Health—Red de Enfermedades Inflamatorias, Carlos III Health Institute, 28220 Madrid, Spain
| | - María Gil-Melcón
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (M.G.-G.); (E.M.-J.); (N.M.); (A.G.-S.); (M.G.-M.); (J.P.-P.); (M.I.-G.); (I.D.); (C.S.)
- Otorhinolaryngology and Head and Neck Surgery Department, University Hospital of Salamanca, 37007 Salamanca, Spain
| | - Jacqueline Pérez-Pazos
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (M.G.-G.); (E.M.-J.); (N.M.); (A.G.-S.); (M.G.-M.); (J.P.-P.); (M.I.-G.); (I.D.); (C.S.)
- Pharmacogenetics and Precision Medicine Unit, Clinical Biochemistry Department, University Hospital of Salamanca, 37007 Salamanca, Spain
- Centre for Networked Biomedical Research in Cardiovascular Diseases (CIBERCV), Carlos III Health Institute, 28220 Madrid, Spain
| | - Miguel Estravís
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (M.G.-G.); (E.M.-J.); (N.M.); (A.G.-S.); (M.G.-M.); (J.P.-P.); (M.I.-G.); (I.D.); (C.S.)
- Results-Oriented Cooperative Research Networks in Health—Red de Enfermedades Inflamatorias, Carlos III Health Institute, 28220 Madrid, Spain
| | - María Isidoro-García
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (M.G.-G.); (E.M.-J.); (N.M.); (A.G.-S.); (M.G.-M.); (J.P.-P.); (M.I.-G.); (I.D.); (C.S.)
- Pharmacogenetics and Precision Medicine Unit, Clinical Biochemistry Department, University Hospital of Salamanca, 37007 Salamanca, Spain
- Results-Oriented Cooperative Research Networks in Health—Red de Enfermedades Inflamatorias, Carlos III Health Institute, 28220 Madrid, Spain
- Medicine Department, University of Salamanca, 37007 Salamanca, Spain
| | - Ignacio Dávila
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (M.G.-G.); (E.M.-J.); (N.M.); (A.G.-S.); (M.G.-M.); (J.P.-P.); (M.I.-G.); (I.D.); (C.S.)
- Biomedical and Diagnostics Sciences Department, University of Salamanca, 37007 Salamanca, Spain
- Results-Oriented Cooperative Research Networks in Health—Red de Enfermedades Inflamatorias, Carlos III Health Institute, 28220 Madrid, Spain
- Department of Allergy, University Hospital of Salamanca, 37007 Salamanca, Spain
| | - Catalina Sanz
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (M.G.-G.); (E.M.-J.); (N.M.); (A.G.-S.); (M.G.-M.); (J.P.-P.); (M.I.-G.); (I.D.); (C.S.)
- Department of Microbiology and Genetics, University of Salamanca, 37007 Salamanca, Spain
- Results-Oriented Cooperative Research Networks in Health—Red de Enfermedades Inflamatorias, Carlos III Health Institute, 28220 Madrid, Spain
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Cha CH, Chen WC, Wang YM, Wu SC, Chiu TJ, Wu CN, Wee Y, Wang CS, Yang YH, Luo SD. Comparison of Fungal and Non-Fungal Rhinosinusitis by Culture-Based Analysis. J Pers Med 2023; 13:1368. [PMID: 37763136 PMCID: PMC10532977 DOI: 10.3390/jpm13091368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Incidence of fungal rhinosinusitis has increased in recent few years. We investigated the differences in microbiological findings between patients with fungal and non-fungal rhinosinusitis by growing microbiological cultures from samples obtained from sinus surgery. METHODS Using the Chang Gung Research Database, we enrolled all chronic rhinosinusitis (CRS) patients who had ever undergone sinus surgery from 2001 to 2019 and had microbiological culture during sinus surgery. Enrolled patients were divided into fungal and non-fungal groups, based on fungal culture and surgical pathology. RESULTS A total of 898 patients were diagnosed with fungal rhinosinusitis and 2884 with non-fungal rhinosinusitis. The fungal group had a higher age distribution (56.9 ± 13.1 vs. 47.0 ± 14.9), a larger proportion of females (62.4% vs. 37.0%), more unilateral lesions (80.4% vs. 41.6%), a lower incidence of the need for revision surgery (3.6% vs. 6.0%, p = 0.004), and a higher proportion of Pseudomonas aeruginosa in the culture (14.3% vs. 4.6%, p < 0.001). CONCLUSIONS This large-scale study showed that Pseudomonas aeruginosa are more commonly found in patients with fungal rhinosinusitis and in patients who needed revision surgery, suggesting that efforts aimed at eliminating Pseudomonas are needed in order to improve the disease outcomes of patients with fungal rhinosinusitis.
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Affiliation(s)
- Chih-Hung Cha
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (C.-H.C.)
| | - Wei-Chih Chen
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (C.-H.C.)
| | - Yu-Ming Wang
- Department of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Tai-Jan Chiu
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Ching-Nung Wu
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (C.-H.C.)
| | - Yinshen Wee
- Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA
| | - Ching-Shuen Wang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan;
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (C.-H.C.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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Martinez-Paredes JF, Donaldson AM, Marino M, Choby G, Olomu O, Alfakir R, Stokken JK, O'Brien E, Lal D. Sinonasal Outcomes Using Oral Corticosteroids in Patients with Chronic Rhinosinusitis with Nasal Polyps and Positive Sinonasal Cultures. Int Arch Otorhinolaryngol 2022; 27:e286-e295. [PMID: 37125375 PMCID: PMC10147476 DOI: 10.1055/s-0042-1743275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 12/21/2021] [Indexed: 12/24/2022] Open
Abstract
Abstract
Introduction Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and positive sinonasal bacterial cultures may be recalcitrant to topical therapy alone due to the additional local inflammatory burden associated with bacterial infection/colonization.
Objective To evaluate sinonasal outcomes in CRSwNP patients with a positive perioperative bacterial culture, who were treated with postoperative intranasal corticosteroids (INCS) alone versus INCS in combination with a short-term course of oral corticosteroids (OCS).
Methods This is a retrospective chart review of CRSwNP patients. A total of 59 patients met inclusion criteria, including positive perioperative bacterial culture and treatment with INCS with or without concomitant use of OCS. Two cohorts were formed based on the chosen postoperative medical treatment; 32 patients underwent postoperative INCS alone, while 27 underwent INCS plus a ≤ 2-week course of OCS. The 22-item sinonasal outcome test (SNOT-22) scores and Lund-Kennedy scores (LKS) were assessed preoperatively, and at 2-week, 4-week, and 4 to 6 months after endoscopic sinus surgery (ESS).
Results There were no statistically significant differences in postoperative sinonasal symptoms or endoscopic scores between the cohorts treated with INCS plus OCS versus those prescribed INCS alone (p > 0.05). Our regression model failed to demonstrate a relationship between the use of OCS and better sinonasal outcomes at 2-week, 4-week, and 4 to 6 months after ESS (p > 0.05).
Conclusion Our study suggests that in a cohort of CRSwNP patients with recent bacterial infections, the postoperative use of combined OCS and INCS did not result in a statistical improvement of endoscopic and symptomatic outcomes over INCS irrigation alone. However, both treatment groups had a clinically significant improvement based on the Minimal Clinically Important Difference.
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Affiliation(s)
- Jhon F. Martinez-Paredes
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, United States
- Department of Surgery, University of Texas – Rio Grande Valley, Edinburg, Texas, United States
| | - Angela M. Donaldson
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Michael Marino
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, United States
| | - Garret Choby
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Osarenoma Olomu
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Razan Alfakir
- Department of Speech, Language & Hearing Sciences, Auburn University, Alabama, United States
| | - Janalee K. Stokken
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Erin O'Brien
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Devyani Lal
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, United States
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Wang JJ, Chen CY, Liang KL, Jiang RS. Predictors of nasal bacterial culture rates in patients with chronic rhinosinusitis. Eur J Clin Microbiol Infect Dis 2019; 39:711-716. [PMID: 31828684 DOI: 10.1007/s10096-019-03775-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/25/2019] [Indexed: 11/30/2022]
Abstract
All nontechnical factors were analyzed to predict nasal bacterial culture results in patients with chronic rhinosinusitis (CRS). Four hundred and ninety-six CRS patients, who underwent functional endoscopic sinus surgery (FESS), were enrolled. Prior to FESS, the severity of each patient's CRS was evaluated using a questionnaire, endoscopic examination, acoustic rhinometry, smell test, saccharine transit test, and CT scan. Nasal bacterial cultures were collected from both middle meati using a cotton-tipped stick. Our results showed that the symptom severity complained of by patients and their loss of smell function did not influence the bacterial culture rate. We discovered that the bacterial culture rate was significantly higher in nostrils with nasal polyps than those without polyps, along with nostrils experiencing thick, purulent discharge as opposed to those without discharge. Additionally, this result also occurred in nostrils with a saccharin transit time of more than 30 min than it did in those with a saccharin transit time of less than or equal to 30 min. Both the total endoscopic score and anterior group CT score were significantly higher in nostrils with positive culture than those with negative culture, while the second minimal cross-sectional area (MCA2) of the nasal cavity was significantly lower in nostrils with positive culture than those with negative culture. Multiple logistic regression analysis showed that both nasal polyps and MCA2 were the predictors for positive nasal bacterial culture results. It was concluded that nasal polyps and MCA2 were the predictors for positive nasal bacterial culture results in CRS patients.
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Affiliation(s)
- Jing-Jie Wang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Departments of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chih-Yi Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Division of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Kai-Li Liang
- Departments of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine, National Yang-Ming Medical University, Taipei, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Rong-San Jiang
- Departments of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan. .,Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
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Kim D, Assiri AM, Kim JH. Recent Trends in Bacteriology of Adult Patients with Chronic Rhinosinusitis. J Clin Med 2019; 8:jcm8111889. [PMID: 31698781 PMCID: PMC6912634 DOI: 10.3390/jcm8111889] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023] Open
Abstract
This study aimed to identify trends in bacteria isolated from Korean adults with chronic rhinosinusitis (CRS). Enrolled were CRS patients who underwent sinus bacterial culture during endoscopic sinus surgery between 2007–2008, 2011–2012, and 2017–2018 (n = 510). Patients’ clinical characteristics, bacterial culture results, and antibiotic resistance were reviewed. The bacteria isolation rate was 76.3% (73.9% for CRS with nasal polyps and 82.8% for CRS without nasal polyps; p = 0.038). In total, 650 strains were isolated, the most common was Coagulase Negative Staphylococci (CNS) (28.0%), followed by Streptococcus species (12.2%), Propionibacterium species (8.0%), Corynebacterium species (7.5%), Staphylococcus aureus (6.2%), Haemophilus species (5.7%), Klebsiella species (5.1%), and Pseudomonas aeruginosa (4.2%). Furthermore, an analysis of the bacterial trends in the three groups showed significant increases over time for the isolation of CNS (p = 0.006), Klebsiella (p = 0.002), and P. aeruginosa (p = 0.007) and extended-spectrum beta-lactamase (ESBL) producing Klebsiella (p < 0.001) and Enterobacter (p = 0.007) species in terms of antibiotics resistance. This study demonstrates that the frequency of CNS, Klebsiella, and P. aeruginosa in CRS patients and the ESBL-producing Klebsiella and Enterobacter species has significantly increased in CRS patients over the last decade.
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Affiliation(s)
- Doyeon Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Abdullah M. Assiri
- Department of Otorhinolaryngology–Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Najran University, King Abdulaziz Road, Najran 1988, Saudi Arabia
| | - Ji Heui Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
- Correspondence: ; Tel.: +82-3010-3710
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Chronic rhinosinusitis with nasal polyps is characterized by dysbacteriosis of the nasal microbiota. Sci Rep 2018; 8:7926. [PMID: 29784985 PMCID: PMC5962583 DOI: 10.1038/s41598-018-26327-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 05/04/2018] [Indexed: 02/07/2023] Open
Abstract
Chronic rhinosinusitis with nasal polyp (CRSwNP) patients are often characterized by asthma comorbidity and a type-2 inflammation of the sinonasal mucosa. The mucosal microbiota has been suggested to be implicated in the persistence of inflammation, but associations have not been well defined. To compare the bacterial communities of healthy subjects with CRSwNP patients, we collected nasal swabs from 17 healthy subjects, 21 CRSwNP patients without asthma (CRSwNP-A), and 20 CRSwNP patients with co-morbid asthma (CRSwNP+A). We analysed the microbiota using high-throughput sequencing of the bacterial 16S rRNA. Bacterial communities were different between the three groups. Haemophilus influenzae was significantly enriched in CRSwNP patients, Propionibacterium acnes in the healthy group; Staphylococcus aureus was abundant in the CRSwNP-A group, even though present in 57% of patients. Escherichia coli was found in high amounts in CRSwNP+A patients. Nasal tissues of CRSwNP+A patients expressed significantly higher concentrations of IgE, SE-IgE, and IL-5 compared to those of CRSwNP-A patients. Co-cultivation demonstrated that P. acnes growth was inhibited by H. influenzae, E. coli and S. aureus. The nasal microbiota of healthy subjects are different from those of CRSwNP-A and CRSwNP+A patients. However, the most abundant species in healthy status could not inhibit those in CRSwNP disease.
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Maxillary Osteomyelitis Caused by Kocuria Species in a Patient Who Is on Long-Term Uncontrolled Use of Methylprednisolone. J Craniofac Surg 2017; 29:e118-e120. [PMID: 29084112 DOI: 10.1097/scs.0000000000004090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Uncontrolled use of medicines bring with it serious health problems. Long-term and uncontrolled use of steroids, without the supervision of a healthcare professional, may cause unexpected infections due to immunosuppression. The authors present a patient with maxillary osteomyelitis caused by Kocuria species in a 41-year-old male who has been receiving methylprednisolone without control for 1.5 years.
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López-Chacón M, Mullol J, Pujols L. Clinical and biological markers of difficult-to-treat severe chronic rhinosinusitis. Curr Allergy Asthma Rep 2015; 15:19. [PMID: 26134430 DOI: 10.1007/s11882-015-0520-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the upper airways of which two major phenotypes exist, CRS without nasal polyps (CRSsNP) and CRS with nasal polyps (CRSwNP). Some patients with CRS have suboptimal response to current guideline treatments. These patients remain severe and uncontrolled by treatment and have a poor quality of life. It is highly important to identify both clinical and biological markers, so-called biomarkers, in this subset of patients. The presence of nasal polyps and comorbidity with asthma and with aspirin-exacerbated respiratory disease (AERD) are the most common clinical traits that have been associated to difficult-to-treat severe CRS. In addition to clinical traits, numerous biological markers, with known etiopathogenic roles in CRS, have been associated to difficult-to-treat or recalcitrant CRS. This review summarizes the existing knowledge of the clinical and biological markers associated to difficult-to-treat or uncontrolled severe CRS.
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Affiliation(s)
- Mauricio López-Chacón
- Clinical and Experimental Respiratory Immunoallergy, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Centre de Recerca Biomèdica CELLEX, Casanova 143, 08036, Barcelona, Catalonia, Spain,
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Abstract
PURPOSE OF REVIEW To review and discuss recent literature regarding the use of antibiotics in relation to endoscopic sinus surgery (ESS), including perioperative antibiotics, postoperative antibiotics, and antibiotic usage in the setting of postoperative packing. RECENT FINDINGS Perioperative antibiotics are not recommended by the American Society of Health-System Pharmacists. The necessity of antibiotics following ESS is a heavily debated topic. Most studies show little to no improvement in outcomes. Significant improvement in quality-of-life outcomes and endoscopic scoring appears limited to the early postoperative period using conventional postoperative antibiotics. Prolonged macrolide therapy may improve long-term outcomes. There is no convincing evidence to show the need for antibiotics in the setting of postoperative packing. SUMMARY The available evidence regarding antibiotic use in relation to ESS overall fails to demonstrate routine benefit; however, the studies have various limitations. Overall, future, well designed, large-scale prospective studies would be beneficial to direct appropriate antibiotic use, whether systemic or topical, in relation to ESS.
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