title: Streptococcus viridans has a leading role in rhinosinusitis complications.
abstract: OBJECTIVE
  We sought to determine whether the bacteria in complicated rhinosinusitis were the typical acute rhinosinusitis triad of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. We also compared the difference in yield between infection sites and blood cultures.
  
  
  METHODS
  We performed a retrospective review of all patients who had required surgical intervention for rhinosinusitis complications over 7 years at a tertiary care pediatric hospital.
  
  
  RESULTS
  There were a total of 28 patients during the review period. Twenty-five organisms were isolated from 21 patients, of which Streptococcus viridans formed 44% of the isolates (11 of the 25). The typical triad of bacteria only formed 20% of the isolates (5 of the 25), and none of these bacteria were found in the group with intracranial complications. Infection site cultures had a superior yield compared to blood cultures (p < .001). Ninety-six percent of the bacteria were sensitive to a combination of amoxicillin-clavulanate and cloxacillin.
  
  
  CONCLUSIONS
  In distinction to the typical bacteria of acute rhinosinusitis, S. viridans is the leading cause of rhinosinusitis complications. It is not merely a commensal organism of the upper respiratory tract.
authors.affiliation: Department of Otolaryngology, Changi General Hospital, Singapore.
authors.forename: Siew Yoong
authors.initials: SY
authors.lastname: Hwang
authors.forename: Kun Kiaang
authors.initials: KK
authors.lastname: Tan
mesh_terms: D000293:Adolescent; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003023:Cloxacillin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012220:Rhinitis / Q000188:drug therapy / Q000382:microbiology*; D012852:Sinusitis / Q000188:drug therapy / Q000382:microbiology*; D034363:Viridans Streptococci / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D019980:Amoxicillin-Potassium Clavulanate Combination; D003023:Cloxacillin