By :

Norman Aji 012085741

Tsaniatul Afifah 012085798
Destrian Ekoputro 012075364

Advisor :
Dr. Djoko PA, Sp. THT-KL
JOURNAL IDENTITY
Title : Microbiology of Acute and Chronic Maxillary
Sinusitis in Smokers and Nonsmokers
Writers : Itzhak Brook, MD, MSc
Jeffrey N. Hausfeld, MD
Publisher : Annals of Otology, Rhinology & Laryngology
120(11):7O7-7I2. 2011. Annals Publishing
Company

INTRODUCTION
Smoking has a significant impact on the oropharyngeal
bacterial flora of children, as well as adults.
Active smokers and those exposed to secondhand
smoke are at increased risk of bacterial infections.
No previous study has compared the microbiology of
sinus aspirates obtained from smokers to that of those
obtained from nonsmokers.
PATIENTS AND METHODS
The population studied was a middle-class one residing
in suburban locations in the vicinity of Washington, DC.
Cultures were obtained from 458 patients, 244 (87
smokers and 157 nonsmokers) of whom had acute
maxillary sinusitis and 214 patients (84 smokers and 130
nonsmokers) of whom had chronic maxillary sinusitis,
between 2001 and 2007.
CRITERIA INCLUSION
The patients with acute infection had symptoms that had
lasted between 10 and 30 days
Those with chronic infection had symptoms for more
than 90 days
None of those with chronic sinusitis had previous sinus
surgery.
Smokers were defined as individuals who had smoked at
least 10 cigarettes a day for the past 5 years
RADIOGRAPHY

Radiography with occipitomental (Waters view), lateral,
oblique, and verticomental views or computed
tomography was performed.
Sinusitis was defined radiographically as complete sinus
opacity, ie, an air-fluid level or mucous membrane
thickening of at least 6 mm in the maxillary sinus.
For the Waters view, mucosal thickening of the maxillary
sinuses was measured as the shortest distance from the
air-mucosal interface to the most lateral part of the
maxillary sinus wall.
SPECIMENS
Specimens were obtained through endoscopy, and the
sinus secretions were collected with calcium alginate-
tipped microswabs.
Cultures were obtained endoscopically before therapy
with calcium alginate swabs that were immediately
plated into media supportive of the growth of aerobic and
anaerobic bacteria.
RESULTS
This study evaluated 458 patients (244 with acute and
214 with chronic maxillary sinusitis) after exclusion of an
additional 110 patients (62 with acute and 48 with
chronic sinusitis) whose culture did not show any
bacterial growth.
The patients' ages ranged from 18 to 75 years (mean, 42
years 4 months).
265 were male and 193 were female.
No differences were noted in the age distribution,
ethnicity, or gender of the patients.




DISCUSSION
Our study confirms the predominance of S. pneumoniae,
H. influenzae, M. catarrhalis, group A. beta-hemolytic
streptococci, and S. aureus in community-acquired acute
sinusitis in adults.
Similarly, S. aureus and anaerobic bacteria (Prevotella,
Porphyromonas, Fusobacterium, and
Peptostreptococcus spp.) were found to be the main
isolates in chronic sinusitis.
Adults who smoke have an increased risk of respiratory
tract infections, including sinusitis, and of oral
colonization by potentially pathogenic bacteria.
These phenomena were explained by enhanced
bacterial binding to epithelial cells of smokers, and by
the low number of aerobic and anaerobic organisms with
inhibitory activity against bacterial pathogens (interfering
organisms) in the oral cavity of smokers.
Tobacco smoke also compromises the antibacterial
function of leukocytes, including neutrophils, monocytes,
T cells, and B cells, providing a mechanistic explanation
for increased infection risk.
It is therefore not surprising that smokers are more often
exposed than nonsmokers to antimicrobial therapies,
which subsequently lead to greater acquisition of
antimicrobial resistance
The presence of MRSA in the infected sinus may not
only lead to failure of antimicrobial therapy, but can also
serve as a potential source for the spread of these
organisms to other body sites, as well as an origin for
dissemination to other individuals.
Furthermore, MRSA that also produces beta-lactamase
can survive treatment with beta-lactam antibiotics and
continue to protect penicillin-susceptible pathogens from
penicillins.
The association between previous use of antimicrobial
therapy and increased isolation of MRS A has been
noticed in community- and hospital-acquired infections,
as well as in patients with sinusitis.
This study found that the majority of patients with
sinusitis infected with MRSA who were previously
treated with antimicrobials had been treated with either a
fluoroquinolone or an extended-spectrum macrolide
antibiotic.
Newer treatment options for MRSA include linezolid,
quinupristin-dalfopristin, daptomycin, and tigecycline.
Antimicrobials effective against aerobic and anaerobic
BLPB are amoxicillin plus clavulanic acid, moxifloxacin,
and the carbapenems.
Clindamycin is effective against anaerobic BLPB, but
has no activity against H influenzae.
Topical antibiotic therapy has been effectively utilized in
treatment of MRSA, as well as BLPB-associated
sinusitis.
Topical application of antibiotics to the sinus membranes
offers the potential benefit of a high concentration of the
drug at the site of infection. Such topical antibiotics
include gentamicin, tobramycin, vancomycin,
ciprofloxacin, and mupirocin.