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.
Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Joel
J
Guss
W M
WM
Abuzeid
Laurel
L
Doghramji
Paul H
PH
Edelstein
Alexander G
AG
Chiu
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