The prevalence of bacterial infection in acute rhinosinusitis: a Systematic review and meta-analysis.
OBJECTIVE
To systematically assess the prevalence of bacterial infection in adults with acute rhinosinusitis (ARS).


METHODS
Electronic databases were systematically searched for relevant studies published up to June 2012.


RESULTS
Twenty-nine articles, evaluating a total of 9,595 patients with a clinical diagnosis of ARS, were included in the study. Of these, 14 (48%) studies required radiographic confirmation of sinusitis, one study (3%) required evidence of purulence, 10 studies (35%) required both for inclusion in the study population, and four studies (14%) required neither. The random effects model estimate of prevalence of bacterial growth on all cultures was 53.7% (CI 48.4%-59.0%), ranging from 52.5% (CI 46.7%-58.3%) in studies requiring radiographic confirmation of sinusitis to 61.1% (CI 54.0%-68.1%) in studies requiring neither radiographic evidence nor purulence on exam. Studies that obtained cultures from antral swab had a prevalence of bacterial growth of 61.0% (CI 54.7%-67.2%), whereas those utilizing endoscopic meatal sampling had a prevalence of 32.9% (CI 19.0%-46.8%).


CONCLUSIONS
Few studies evaluate the recovery of bacteria via culture in adults with a diagnosis of ABRS or ARS based on clinical criteria alone. With radiographic and/or endoscopic confirmation, antral puncture and endoscopically guided cultures produce positive bacterial cultures in approximately one-half of patients. Opportunities exist to improve diagnostic accuracy for bacterial infection in ARS.
Department of Otolaryngology-Head and Neck Surgery, Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago; Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago.
Stephanie S
SS
Smith
Elisabeth H
EH
Ference
Charlesnika T
CT
Evans
Bruce K
BK
Tan
Robert C
RC
Kern
Rakesh K
RK
Chandra
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology; D001431:Bacteriological Techniques; D003430:Cross-Sectional Studies; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012220:Rhinitis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult
Systematic review; acute rhinosinusitis; antral puncture; bacterial infection; endoscopic middle meatus culture; meta-analysis