title: The effect of sinus surgery with intensive follow-up on pathogenic sinus bacteria in patients with cystic fibrosis.
abstract: BACKGROUND
  Most patients with cystic fibrosis (CF) have chronic rhinosinusitis; their sinuses are often colonized with bacteria that can initiate and maintain deleterious pulmonary infections. Theoretically, eradication of the sinus bacteria should reduce the frequency of  lung infections and thereby reduce pulmonary morbidity. This article addressed whether bacteria in CF sinuses are eligible for eradication by sinus surgery and postoperative treatment.
  
  
  METHODS
  A prospective study including 58 CF patients, who had extensive sinus surgery  and growth of Pseudomonas aeruginosa, Achromobacter xylosoxidans, and/or Burkholderia multivorans in their sinuses, was initiated. All patients followed a systematic postoperative treatment program of nasal irrigations with saline and colistimethate sodium and systematic  endoscopic cleansing. All patients had follow-up examinations including sinus cultures; each side of the nose was cultured separately.
  
  
  RESULTS
  At the 6-month follow-up visit, 49 patients were cultured; 66 of 98 maxillary-ethmoidal complexes (67%) showed no growth  of pathogenic bacteria. Some patients were not free from CF pathogenic bacteria at all cultures; however, 20 (41%) patients had no bilateral regrowth (p < 0.01) and 4 patients had no unilateral regrowth at any time during 6 months of follow-up. The eradication of CF pathogens was accomplished  in patients from all three lung infection groups: intermittently colonized, chronically infected, and lung transplanted. The patient with the longest follow-up had no bacterial growth for 3 years.
  
  
  CONCLUSIONS
  Extensive sinus surgery combined with intensive follow-up can  eradicate pathogenic bacteria from CF sinuses.
authors: Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. kasperaanaes@hotmail.com
authors: Kasper
authors: K
authors: Aanaes
authors: Christian
authors: C
authors: von Buchwald
authors: Thomas
authors: T
authors: Hjuler
authors: Marianne
authors: M
authors: Skov
authors: Mikkel
authors: M
authors: Alanin
authors: Helle Krogh
authors: HK
authors: Johansen
mesh_terms: D042441:Achromobacter denitrificans / Q000302:isolation & purification; D000293:Adolescent; D000328:Adult; D019117:Burkholderia / Q000302:isolation & purification; D019121:Burkholderia Infections / Q000382:microbiology / Q000601:surgery*; D002648:Child; D002908:Chronic Disease; D003091:Colistin / Q000008:administration & dosage / Q000031:analogs & derivatives; D003550:Cystic Fibrosis / Q000150:complications / Q000382:microbiology*; D005260:Female; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055556:Nasal Lavage; D010256:Paranasal Sinuses / Q000187:drug effects / Q000382:microbiology / Q000601:surgery*; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000601:surgery*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012220:Rhinitis / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D012852:Sinusitis / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C004691:colistinmethanesulfonic acid; D003091:Colistin