Assess the outcome of pre and postoperative bacterial culture in sinonasal polyposis cases under FESS

INTRODUCTION

Sinonasal polyposis (NP) are mass like lesions from mucosa of nose and paranasal sinuses usually accompany allergic rhinitis.¹ NP is gelatinous and freely movable, often associated with chronic inflammation of nose and sinuses.² NP affects quality of life of cases and its management is a challenging task for otolaryngologists. Sinonasal polyps are associated with several conditions and pathological conditions i.e. infection, allergic fungal sinusitis, allergy and cystic fibrosis.³

Functional endoscopic sinus surgery (FESS), is a surgical choice for nasal related complications which helps to restore normal sinus function and anatomy.⁴ Ideal pre and post-operative outcome not only depends on surgical technique but also on pre and post-operative medical management.⁵ Preoperative use of antibiotics in FESS for sinonasal polyposis is to prevent associated infections, whereas postoperative management will be different which aim to prevent infection and bring back to the normal condition.⁶

This study aimed to assess the pre and postoperative bacterial profile in sinonasal polyposis cases undergoing Functional endoscopic sinus surgery.

METHODS

The present study was carried out in Department of ENT, MNR Medical College, Sangareddy and Maheshwara Medical College, Patancheru in the period of March 2017 to June 2018. A total 100 cases ready for endonasal endoscopic surgery with chief complaints of sinonasal polyposis were recruited for the study.

Inclusion criteria: Cases with sinonasal polyps, undergoing endoscopic sinus surgery.

Exclusion criteria: Cases not willing to participate, post-operative middle meatus revision FESS and other associated complications i.e. nasal obstruction, and discharge were excluded.

Informed consent was obtained from all the participants and the study protocol was approved by institutional ethics committee. Detailed clinical history was collected from all the cases and all cases were subjected to complete haemogram. Pre and post-operative nasal swabs were collected from lateral wall, floor and area over the polyps. To check bacterial profile and sensitivity, all collected swabs are cultured in Department of Microbiology. Sensitivity test was performed by using commonly available antibiotics i.e. ceftriaxone, erythromycin, ampicillin, gentamycin, ciprofloxacin, cephalexin, doxycycline and co-trimoxazole. Study data was extracted in to Microsoft office excel sheet and calculated the percentages.

RESULTS

Among 100 cases majority were belongs to second to fifth decade (Figure 1). Among the participants males were more than females.

Pre-operative bacterial culture showed, Staphylococcus coagulase negative (CONS) in 32% cases, Staphylococcus aureus in 24% cases and gram –ve bacteria i.e. Pseudomonas aeruginosa in 10%, Klebsiella pneumoniae in 12%, Klebsiella ozenae in 8%, Escherichia coli in 8% cases. Post-operative bacteria culture showed CONS (22%), Staphylococcus aureus (22%) and gram –ve bacteria i.e. Pseudomonas aeruginosa in 6%, Klebsiella pneumoniae in 9% cases (Table 1).

Antibiotic sensitivity (pre-operative) for CONS showed high resistance for ampicillin, gentamycin and cephalexin in al microbial culture mediums (Table 2). Antibiotic sensitivity of pre and post-operative cases for Staphylococcus aureus showed high resistance gentamycin and ampicillin and high sensitivity to ceftriaxone, ciprofloxacin and Cephalexin (Table 3).

DISCUSSION

Sinonasal polyps develop in association with sinus infection, which shows a purulent nasal discharge composed with eosinophils. Polyps are swellings with shiny and movable mucosal extensions from ethmoid sinuses or middle meatus and easily found in nasal cavity during frontal rhinoscopic examination.⁷ Sinonasal polyps are associated with several conditions and pathological conditions i.e. infection, allergic fungal sinusitis, allergy and cystic fibrosis.⁸ Studies suggested that cultures of polyps showed Streptococcus, S. aureus, S. albus and Aerobacter aerogenes and another study found Blastomyces dermatitidis in a culture of chronic nasal polyps cases.^9,10 This study designed to assess the pre and postoperative bacterial profile in sinonasal polyposis cases undergoing Functional endoscopic sinus surgery. Study comprise one hundred cases belongs to 2^nd to 5^th decade of both sexes with male dominance (Figure 1).

Results of pre-operative bacterial culture showed growth of gram +ve bacteria i.e. CONS in 32% cases, Staphylococcus aureus in 24% cases and gram –ve bacteria i.e. Pseudomonas aeruginosa in 10%, Klebsiella pneumoniae in 12%, Klebsiella ozenae in 8%, Escherichia coli in 8% cases. In 6% of cases found no growth of any kind of bacterial flora (Table 1). Post-operative bacteria culture showed CONS in 22% cases, Staphylococcus aureus in 22% cases and gram –ve bacteria i.e. Pseudomonas aeruginosa in 6%, Klebsiella pneumoniae in 9%, Klebsiella ozenae in 5%, Escherichia coli in 3% cases and n growth in 33% cases (Table 1). Zernotti et al, in his study on 12 cases detected S. aureus (in 3 patients), Streptococcus viridans in 2 cases and coagulase-negative staphylococci in 2 cases, and Pseudomonas aeruginosa, Enterococcus faecalis, and Streptococcus viridans associated with Corynebacterium in 1 case each.¹¹

In this study results of antibiotic sensitivity (Pre-operative) for CONS showed high resistance for ampicillin, gentamycin and cephalexin in al microbial culture mediums. CONS showed high sensitivity to erythromycin, ciprofloxacin, Doxycycline, co-trimoxazole and ceftriaxone. Post-operative antibiotic sensitivity showed high resistance to Gentamycin, Ampicillin, Cephalexin and ceftriaxone. Whereas cases had high sensitivity to co-trimoxazole, doxycycline, ciprofloxacin and erythromycin (Table 2).

Antibiotic sensitivity (pre-operative) for Staphylococcus aureus showed high resistance to gentamycin and ampicillin. Cases had high sensitivity to Cephalexin, ciprofloxacin and ceftriaxone. In post-operative sensitivity analysis for Staphylococcus aureus showed high resistance to gentamycin and ampicillin. Whereas cases had high sensitivity to ciprofloxacin, cephalexin, co-trimoxazole and ceftriaxone (Table 3). Ampicillin, gentamicin, cefotaxime and ceftriaxone are primary choice for intravenous antibiotics in current clinical practice and in al surgical procedures including endoscopic sinus procedures. Resistance was found to these antibiotics in a majority of bacterial culture irrespective of being pre or post-operative.

CONCLUSION

The results of this study concludes CONS and Staphylococcus aureus are gram +ve bacteria and Pseudomonas aeruginosa and Klebsiella pneumoniae are gram –ve bacteria isolated commonly in pre and post-operative bacteria culture. CONS had resistance to Ampicillin and Gentamycin and had high sensitivity to erythromycin, ciprofloxacin and doxycycline. Staphylococcus aureus had resistance to ampicillin and gentamycin and had high sensitivity to cephalexin, ciprofloxacin and co-trimoxazole

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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