title: General antibiotic exposure is associated with increased risk of developing chronic rhinosinusitis.
abstract: Antibiotic use and chronic rhinosinusitis (CRS) have been independently associated with microbiome diversity depletion and opportunistic infections. This study was undertaken to investigate whether antibiotic use may be an unrecognized risk factor for developing CRS.
  
  
  
  Case-control study of 1,162 patients referred to a tertiary sinus center for a range of sinonasal disorders.
  
  
  
  Patients diagnosed with CRS according to established consensus criteria (n = 410) were assigned to the case group (273 without nasal polyps [CRSsNP], 137 with nasal polyps [CRSwNP]). Patients with all other diagnoses (n = 752) were assigned to the control group. Chronic rhinosinusitis disease severity was determined using a validated quality of life (QOL) instrument. The class, diagnosis, and timing of previous nonsinusitis-related antibiotic exposures were recorded. Results were validated using a randomized administrative data review of 452 (38.9%) of patient charts. The odds ratio of developing CRS following antibiotic exposure were calculated, as well as the impact of antibiotic use on the subsequent QOL.
  
  
  
  Antibiotic use significantly increased the odds of developing CRSsNP (odds ratio: 2.21, 95% confidence interval, 1.66-2.93, P < 0.0001) as compared to nonusers. Antibiotic exposure was significantly associated with worse CRS QOL scores (P = 0.0009) over at least the subsequent 2 years. These findings were confirmed by the administrative data review.
  
  
  
  Use of antibiotics more than doubles the odds of developing CRSsNP and is associated with a worse QOL for at least 2 years following exposure. These findings expose an unrecognized and concerning consequence of general antibiotic use.
  
  
  
  3b. Laryngoscope, 2016 127:296-302, 2017.
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Alice Z
authors.initials: AZ
authors.lastname: Maxfield
authors.affiliation: Department of Otorhinolaryngology, Ordu University Faculty of Medicine, Ordu, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Korkmaz
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Luciano L
authors.initials: LL
authors.lastname: Gregorio
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Nicolas Y
authors.initials: NY
authors.lastname: Busaba
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Stacey T
authors.initials: ST
authors.lastname: Gray
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Holbrook
authors.affiliation: Department of Biostatistics, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Rong
authors.initials: R
authors.lastname: Guo
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Bleier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D064307:Microbiota / Q000187:drug effects; D008875:Middle Aged; D009298:Nasal Polyps / Q000150:complications; D016017:Odds Ratio; D009894:Opportunistic Infections / Q000139:chemically induced; D012220:Rhinitis / Q000139:chemically induced*; D012306:Risk; D012852:Sinusitis / Q000139:chemically induced*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; chronic rhinosinusitis; microbiome; quality of life; side effects