Fluoroquinolone-resistant Pseudomonas aeruginosa in chronic rhinosinusitis.
BACKGROUND
Pseudomonas aeruginosa is cultured in nearly 1 of 5 patients with chronic rhinosinusitis and a history of sinus surgery. Fluoroquinolones are the only enterally administered antibiotics with efficacy against P. aeruginosa, but their frequent empiric use in the community raises concern for a rise in resistance.


OBJECTIVE
It was the aim of this study to determine the prevalence of fluoroquinolone-resistant P. aeruginosa in a tertiary rhinology practice.


METHODS
All bacterial sinus culture results from the outpatient otolaryngology clinic that yielded P. aeruginosa over a 5-year period (2002-2007) were reviewed along with the medical records of a randomly selected subset of patients.


RESULTS
In total, 689 culture results of 324 patients were examined. Nearly all patients had a history of endoscopic sinus surgery. Of all P. aeruginosa cultured, 13% were resistant to levofloxacin and 5% were intermediately sensitive, while 5% were resistant to ciprofloxacin and 7% intermediately sensitive. Of the 324 patients in the study, 19 and 15% had a history of a P. aeruginosa culture resistant to levofloxacin or ciprofloxacin, respectively. Mucoid strains of P. aeruginosa were significantly more likely to be fluoroquinolone resistant. No patient comorbidities were associated with a higher rate of resistance. The prevalence of resistant cultures remained stable over the 5-year study period.


CONCLUSIONS
P. aeruginosa is cultured primarily in patients with previous sinus surgery. Nearly 20% of isolates are resistant to fluoroquinolones. Resistance to levofloxacin is more common than resistance to ciprofloxacin. This study supports the use of culture-directed therapy in the management of the postfunctional endoscopic sinus surgery patient and the avoidance of empiric use of fluoroquinolones.
Guss
Joel
J
Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Abuzeid
W M
WM
Doghramji
Laurel
L
Edelstein
Paul H
PH
Chiu
Alexander G
AG
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D002939:Ciprofloxacin / Q000627:therapeutic use; D015897:Comorbidity; D024881:Drug Resistance, Bacterial; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D064704:Levofloxacin; D015242:Ofloxacin / Q000627:therapeutic use; D010045:Outpatients / Q000706:statistics & numerical data; D015995:Prevalence; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000453:epidemiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D012189:Retrospective Studies; D012220:Rhinitis / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D012852:Sinusitis / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D002939:Ciprofloxacin; D064704:Levofloxacin; D015242:Ofloxacin