title: Are nasopharyngeal cultures useful in diagnosis of acute bacterial sinusitis in children?
abstract: The diagnosis of acute bacterial sinusitis can be challenging because symptoms of acute sinusitis and an upper respiratory tract infection (URI) overlap. A rapid test, if accurate in differentiating sinusitis from URI, could be helpful in the diagnostic process. We examined the utility of nasopharyngeal cultures in identifying the subgroup of children with a clinical diagnosis of acute sinusitis who are least likely to benefit from antimicrobial therapy (those with completely normal sinus radiographs). Nasopharyngeal swabs were collected from 204 children meeting a priori clinical criteria for acute sinusitis. All children had sinus X-rays at the time of diagnosis. To determine if negative nasopharyngeal culture results could reliably identify the subgroup of children with normal radiographs, we calculated negative predictive values and negative likelihood ratios. Absence of pathogens in the nasopharynx was not helpful in identifying this low-risk subgroup.
authors.affiliation: 1University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Nader
authors.initials: N
authors.lastname: Shaikh
authors.forename: Alejandro
authors.initials: A
authors.lastname: Hoberman
authors.forename: D Kathleen
authors.initials: DK
authors.lastname: Colborn
authors.forename: Diana H
authors.initials: DH
authors.lastname: Kearney
authors.forename: Jong H
authors.initials: JH
authors.lastname: Jeong
authors.forename: Marcia
authors.initials: M
authors.lastname: Kurs-Lasky
authors.forename: Karen A
authors.initials: KA
authors.lastname: Barbadora
authors.forename: A'delbert
authors.initials: A
authors.lastname: Bowen
authors.forename: Lynda L
authors.initials: LL
authors.lastname: Flom
authors.forename: Ellen R
authors.initials: ER
authors.lastname: Wald
mesh_terms: D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D046508:Culture Techniques; D003937:Diagnosis, Differential; D005260:Female; D006192:Haemophilus Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006193:Haemophilus influenzae / Q000302:isolation & purification*; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D001936:Moraxella catarrhalis / Q000302:isolation & purification*; D045828:Moraxellaceae Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging; D009305:Nasopharynx / Q000382:microbiology*; D011008:Pneumococcal Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D012852:Sinusitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000382:microbiology
keywords: colonization; flora; nasopharyngeal; pediatrics; symptoms