Evolution of microbial etiology in acute and chronic rhinosinusitis and its role in the current management of antibiotic treatment

Acute and chronic rhinosinusitis (CRS) are common conditions worldwide. In most cases, the etiology of acute rhinosinusitis (ARS) is viral, but there can be cases complicated by bacterial infection. The bacterial pathogens responsible for acute bacterial rhinosinusitis (ABRS) in most cases are Streptococcus pneumoniae, Haemophilus influenza and Moraxella catarrhalis. In recent years, some changes regarding this issue have been communicated. Also, the pathophysiology of CRS becomes a problem due to the increasing percentage of resistant or recurrent cases. To identify the bacterial spectrum in patients diagnosed with ABRS and CRS and to establish the actual resistance rates of the most prescribed antibiotics for these affections in order to initiate the correct antibiotic treatment. We performed a prospective study on 40 adult patients with ABRS and 70 patients with CRS. The standard microbiological procedures were performed in order to identify the involved microorganisms. The Antibiotic Susceptibility Test of the clinical isolates was performed to routinely used antibiotics according to EUCAST. ABRS: A total of 21 types of pathogenic bacteria were isolated. The results indicated changes in the percentages of the traditionally involved bacteria, other species of streptococci and Staphylococcus aureus representing important pathogens. Almost half of the samples were polymicrobial. CRS: 12 bacteria were incriminated for CRS, Staphylococcus aureus and Pseudomonas aeruginosa being the most frequently identified pathogens. Regarding the antibiotic treatment, we established that in our country the resistance rates are higher than the ones communicated by WHO (especially for macrolides) and the fluoroquinolones seem to be the class with the highest safety profile. Study results demonstrate some changes of the bacteriologic spectrum in ABRS in this geographic area. The pathogens responsible for CRS are found in approximately the same percentage as presented in other studies. Antibiotic treatment demands attention considering the increasing trend of antibiotic resistance of the bacteria causing ABRS and CRS.