Role of Anaerobes in Chronic Sinusitis: Will Polymerase Chain Reaction Solve the Debate
Authors: Ramadan Hassan H. , Mathers Peter H. , Schwartzbauer Heather 
Published: February 2003

BACKGROUND

Bacteriology of chronic sinusitis continues to be a matter of debate, particularly the role of anaerobes. Some authors suggest that anaerobes play a significant role whereas others suggest a minimal role. Those who suggest a significant role argue that standard culture techniques are the culprits.

OBJECTIVE

The purpose of this study was to use polymerase chain reaction (PCR) on sinus specimens for the presence of anaerobes and to compare them with standard culture techniques.

METHODS

Sixty‐four samples were obtained in a sterile fashion during sinus surgery and were sent for standard anaerobic cultures as well as anaerobic PCR analysis.

RESULTS

Anaerobic bacteria were demonstrated in 5% of culture specimens, which is similar to recently published data. PCR identified anaerobic bacteria in 19% of the specimens (P= 0.01)

CONCLUSION

PCR analysis of surgical samples obtained during endoscopic sinus surgery for chronic sinusitis identified a significantly higher incidence of anaerobes (x4) compared with standard anaerobic culture technique.

Chronic rhinosinusitis is one of the most common chronic diseases that affects individuals in the United States. It is estimated that >25 million office visits are made for sinusitis.1The financial impact of chronic sinusitis includes not only the direct medical costs of treatment but also the millions of hours of lost productivity caused by the disease.1Chronic rhinosinusitisis defined as the signs and symptoms of sinus inflammation that last longer than 12 weeks associated with documented sinus inflammation with imaging techniques ≥4 weeks after appropriate antibiotic therapy.2There is agreement in the literature regarding the bacterial etiology of acute rhinosinusitis. However, the etiology of chronic rhinosinusitis is still unclear despite numerous articles about the bacteriology of chronic rhinosinusitis.3–10The role of aerobes is more clear than the role of anaerobes in chronic rhinosinusitis; many conflicting reports have been published about the role of anaerobes as etiologic factors in chronic rhinosinusitis.3–10The incidence of anaerobes obtained on standard cultures from patients with chronic rhinosinusitis ranges from 0% to 56%.3–10The reports that show a high yield of anaerobes argue that the technique used to obtain the specimens, the method of transportation, and even specimen collection are reasons why other reports did not yield high levels of anaerobes.4–5

With increasing numbers of patients with chronic rhinosinusitis and with increasing bacterial resistance to antimicrobials, which is blamed on the improper use of antimicrobials, knowledge of the bacteriology becomes important in the treatment. The role of aerobes was addressed in a prior publication11; the role of anaerobic bacteria as an etiologic cause of chronic rhinosinusitis is addressed in this report. The goal of this study was to test specimens, using 2 different techniques, obtained during endoscopic sinus surgery from individuals who had chronic rhinosinusitis.