Sinusitis in neurologically impaired children.
The microbiologic features of infected sinus aspirates in nine children with neurologic impairment were studied. Anaerobic bacteria, always mixed with aerobic and facultative bacteria, were isolated in 6 (67%) aspirates and aerobic bacteria only in 3 (33%). There were 24 bacterial isolates, 12 aerobic or facultative and 12 anaerobic. The predominant aerobic isolates were Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus (2 each) and Proteus mirabilis, Pseudomonas aeruginosa, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae (1 each). The predominant anaerobes were Prevotella sp. (5), Peptostreptococcus sp. (4), Fusobacterium nucleatum (2), and Bacteroides fragilis (1). Beta-lactamase-producing bacteria were isolated from 8 (89%) patients. Organisms similar to those recovered from the sinuses were also isolated from tracheostomy site and gastrostomy wound aspirates in five of seven instances. This study demonstrates the uniqueness of the microbiologic features of sinusitis in neurologically impaired children, in which, in addition to the organisms known to cause infection in children without neurologic impairment, facultative and anaerobic gram-negative organisms that can colonize other body sites are predominant.
Department of Pediatrics, Georgetown University, Washington, DC, USA.
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Shah
D000293:Adolescent; D016866:Bacteroidaceae Infections / Q000601:surgery; D001442:Bacteroides Infections / Q000601:surgery; D001441:Bacteroides fragilis; D001927:Brain Diseases / Q000150:complications*; D002648:Child; D004927:Escherichia coli Infections / Q000601:surgery; D005260:Female; D005674:Fusobacterium Infections / Q000601:surgery; D016967:Fusobacterium nucleatum; D005774:Gastrostomy; D016908:Gram-Positive Bacterial Infections / Q000601:surgery; D006192:Haemophilus Infections / Q000601:surgery; D006193:Haemophilus influenzae; D006801:Humans; D007710:Klebsiella Infections / Q000601:surgery; D007711:Klebsiella pneumoniae; D008297:Male; D001936:Moraxella catarrhalis; D016870:Neisseriaceae Infections / Q000601:surgery; D010462:Peptostreptococcus; D011008:Pneumococcal Infections / Q000601:surgery; D018720:Prevotella; D011512:Proteus Infections / Q000601:surgery; D011513:Proteus mirabilis; D011552:Pseudomonas Infections / Q000601:surgery; D011550:Pseudomonas aeruginosa; D012189:Retrospective Studies; D012852:Sinusitis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D013203:Staphylococcal Infections / Q000601:surgery; D014139:Tracheostomy