title: Changes in the bacterial microbiome of patients with chronic rhinosinusitis after endoscopic sinus surgery.
abstract: Endoscopic sinus surgery (ESS) improves symptoms for many chronic rhinosinusitis (CRS) patients by enlarging the size of sinus ostia, improving mucociliary clearance, and facilitating access for topical therapies. However, the effect of surgery on the sinonasal microbiota remains poorly understood. This study examined changes in bacterial communities in CRS patients before and after surgery.
  
  
  
  Swab samples were taken from the middle meatus of 23 patients undergoing ESS. Follow-up swabs were taken in clinic (mean 120 days postsurgery). Symptom scores and antibiotic use were recorded. Bacterial communities were characterized using 16s ribosomal RNA (rRNA) gene-targeted amplicon sequencing and bacterial abundance was measured using quantitative polymerase chain reaction (PCR). Coexisting asthma, aspirin sensitivity, antibiotic use, and presence of polyps were controlled for.
  
  
  
  Unpredictable shifts in bacterial community composition were seen postoperatively. ESS was associated with increased bacterial richness. Many taxa had changes in average relative abundance and prevalence. Staphylococcus was the only dominant taxa to increase significantly in relative abundance (p = 0.002). Changes in bacterial communities were driven more by intersubject variability (p = 0.007) than other study factors. Finegoldia, a minority taxon, was associated with a reduction in abundance following ESS, increases in patients with higher symptoms scores, and reductions in patients with reduced total bacterial burden.
  
  
  
  This study documented changes in bacterial composition and abundance in the middle meatus following ESS. The complexity of these changes reflects the variability between patients. Modern molecular techniques highlight the currently limited knowledge of the impact of therapies on the microbiology of CRS.
authors.affiliation: Department of Surgery, The University of Auckland, Auckland, New Zealand.
authors.forename: Ravi
authors.initials: R
authors.lastname: Jain
authors.affiliation: School of Biological Sciences, The University of Auckland, Auckland, New Zealand.
authors.forename: Michael
authors.initials: M
authors.lastname: Hoggard
authors.affiliation: Department of Surgery, The University of Auckland, Auckland, New Zealand.
authors.forename: Kristi
authors.initials: K
authors.lastname: Biswas
authors.affiliation: Department of Surgery, The University of Auckland, Auckland, New Zealand.
authors.forename: Melissa
authors.initials: M
authors.lastname: Zoing
authors.affiliation: Department of Statistics, The University of Auckland, Auckland, New Zealand.
authors.forename: Yannan
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Surgery, The University of Auckland, Auckland, New Zealand.
authors.forename: Richard
authors.initials: R
authors.lastname: Douglas
mesh_terms: D000328:Adult; D000368:Aged; D001419:Bacteria / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D000068298:Fluticasone / Q000627:therapeutic use; D006801:Humans; D008297:Male; D064307:Microbiota; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000382:microbiology / Q000601:surgery; D012329:RNA, Bacterial / Q000235:genetics; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D012220:Rhinitis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery*; D012852:Sinusitis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery*
chemical_list: D012329:RNA, Bacterial; D012336:RNA, Ribosomal, 16S; D000068298:Fluticasone
keywords: bacteria; microbiota; postoperative period; sinusitis; surgery