Paranasal sinus pathogens in children with cystic fibrosis: do they relate to lower respiratory tract pathogens and is eradication successful?
BACKGROUND
The study aims were to assess the association of microflora between the paranasal sinus and the lower airways of children attending a regional paediatric cystic fibrosis centre and to determine the performance of an eradication treatment protocol for positive paranasal sinus samples.


METHODS
Paired nasal lavage and lower airway samples (cough swabs or sputum) were taken from 54 children with cystic fibrosis (median age 11 years). Positive paranasal sinus samples received eradication treatment, using oral and sinonasal nebulised antibiotics.


RESULTS
A correlation between paranasal sinus and lower airways was detected in 33/54 paired timed samples (p<0.02). Of 4/54 children who reported sinus symptoms, only 2 had paranasal sinus positive samples. 28 positive nasal lavage samples cultured 8 Pseudomonas aeruginosa (PA), 8 Staphylococcus aureus (SA) and 12 other bacterial pathogens. Eradication using sinonasal nebulised antibiotics and oral antibiotics showed a success of 14/21 (67%) treated paranasal sinus positive samples at 1 month & 3 months after treatment. Success rate was 75% in the PA group and 71% in the SA group. Ongoing monitoring with nasal lavage will continue.


CONCLUSIONS
There was agreement between pathogens or lack of them found in the paranasal sinus and lower airways. Paranasal infection is often asymptomatic in children with cystic fibrosis. The eradication protocol for paranasal sinus pathogens had a good success rate.
Paediatric Cystic Fibrosis Team, Royal London Children's Hospital, Royal London Hospital, Whitechapel Road, London E1 1BB, United Kingdom. Electronic address: Paul.wilson@bartshealth.nhs.uk.
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Wilson
Paediatric Cystic Fibrosis Team, Royal London Children's Hospital, Royal London Hospital, Whitechapel Road, London E1 1BB, United Kingdom.
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Lambert
Paediatric Respiratory Department, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom.
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Carr
Paediatric Cystic Fibrosis Team, Royal London Children's Hospital, Royal London Hospital, Whitechapel Road, London E1 1BB, United Kingdom.
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Pao
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D003550:Cystic Fibrosis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010256:Paranasal Sinuses / Q000382:microbiology*; D011552:Pseudomonas Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*
D000900:Anti-Bacterial Agents