Objective: Chronic rhinosinusitis (CRS) is a common upper respiratory disease with a significant role of microbes in worsening the disease and its associated co-morbidities. In India, studies on the etiology and antibiotic resistance in CRS are limited, especially in children. Antibiotic administration can facilitate the subsequent proliferation of a variety of bacteria, frequently leading to the emergence of novel multidrug-resistant strains on the mucosal epithelium, with such frequencies and alterations potentially varying according to the type of antibiotics employed, age demographics, and clinical presentations.
Aim: The present study aimed to determine the prevalence of common
causative microbes and their antibiotic resistance in children and adolescents
with CRS in the South Indian population.
Subjects and Methods: The present study was conducted on 89
children and 99 adolescents with CRS who visited MAA ENT Hospital, Hyderabad,
South India. Conventional and VITEK-2 methods were used for the identification
and antibiotic sensitivity of the microbes. The diagnostic criteria for nasal allergy
were primarily determined through the presence of symptoms including nasal
discharge, nasal pruritus, and sneezing occurring more than five times daily.
Chi-square test and multinomial logistic regression were applied to determine
statistical differences between the variables using PASW v. 18.0 software (SPSS
Inc., Chicago, IL).
Results: The male-female ratio was 2:1 with an average children
age of 8.9 ± 3.65 years and 16.1 ± 1.23 years in adolescents. The risk for
adenoids was seen in 49.4 % of children (OR; 2.6: 95% CI: 1.63-4.06) while
allergic fungal sinusitis (18.1%, OR: 2.7; 95% CI: 1.12-6.57) and nasal polyps
(26.3%, OR: 2.3; 95% CI: 1.07-4.86) was commonly seen in adolescents. Bacterial
culture rate was positive in 46.8% of the total subjects of which
Staphylococcus aureus was the most common bacteria (59.1%) followed by
Streptococcus pnuemoniae (21.2%), Klebsiella sps (11.4%), Pseudomonas aeruginosa (11.4%) and β hemolytic streptococci (1.1%).
Streptococcus pneumonia (63.2%) was
commonly identified in younger children and Pseudomonas
aeruginosa (80%) was mostly seen in adolescents. High antibiotic resistance
in Staphylococcus aureus was seen
towards gentamicin (73%) and co-trimoxazole (64%), Streptococcus pnuemoniae to gentamicin (58%), co-trimoxazole (68%)
and meropenem (32%), Pseudomonas aeruginosa to co-trimoxazole (100%),
cefatoximine (60%) and cefatazidime (50%) while Klebsiella sps to gentamicin
(80%) and co-trimoxazole (60%). Streptococcus
aureus showed high sensitivity to cefatoximine (95.8%) and Streptococcus pnuemoniae for ofloxacin
(100%), ciprofloxacin (89.5%) and cefazolin (89.5%). Pseudomonas aeruginosa
showed a high sensitivity for amikacin (100%) and ciprofloxacin (80%) and
Klebsiella sps for amikacin (100%). Prompt detection and treatment of bacterial
infections may reduce the severity of CRS episodes and enhance patient
outcomes. It is also critical to think about how these discoveries may affect
treatment plans and public health campaigns in South India.
Conclusion: Significant regional-specific variation and high
antimicrobial resistance in the cultures of CRS patients warrant an urgent need
for early initiation of personalized interventions for better management of
infectious disease. The elevated rates of antibiotic resistance observed in all
microbial isolates, including Staphylococcus aureus, Streptococcus pneumoniae,
Pseudomonas aeruginosa, and Klebsiella sps underscore the imperative for the
prompt initiation of personalized interventions and management strategies in
the pediatric and adolescent population suffering from CRS.
Author
(s) Details
Madhavi
Jangala
MAA Research Foundation, Hyderabad, Telangana, India and Institute
of Genetics and Hospital for Genetic Diseases, Osmania University, Hyderabad,
Telangana, India.
Raja
Meghanadh Koralla
MAA Research Foundation, Hyderabad, Telangana, India.
Santoshi
Kumari Manche
MAA Research Foundation, Hyderabad, Telangana, India and Institute
of Genetics and Hospital for Genetic Diseases, Osmania University, Hyderabad,
Telangana, India.
Pardhanandana
Reddy Penuguluru
MAA Research Foundation, Hyderabad, Telangana, India.
Jyothy
Akka
Institute of Genetics and Hospital for Genetic Diseases, Osmania
University, Hyderabad, Telangana, India.
Please see the book here: https://doi.org/10.9734/bpi/rpmab/v7/2332
