Microbiology of Pediatric Chronic Rhinosinusitis in Mid-Taiwan: A Study from 2001-2005

Pediatric chronic rhinosinusitis is a complex disease with varying patterns of bacteriology. The patterns of causative pathogens and antibiotic resistance may differ by region or country. We conducted a study to characterize the patterns of pathogens and antibiotic resistance in children with chronic rhinosinusitis in the middle region of Taiwan. A retrospective chart review was conducted on pediatric patients with radiograph-proven chronic rhinosinusitis who underwent maxillary sinus puncture at Chung Shan Medical University Hospital from January 2001 through December 2005. Pathogens were recovered and identified, and their resistance to antibiotics was tested. A total of 200 samples from 116 children were collected through maxillary sinus puncture, and yielded 274 isolates. The most common identified bacteria were o-hemolytic streptococcus (21.2%), Hemophilus influenzae (17.9%), Streptococcus pneumonia (15.3%), coagulase-negative staphylococcus (13.1%). and Staphylococcus aureus (8.8%). Anaerobes were found in 8.4% of all isolates. Of all the H. influenzae tested for susceptibility, 63.3% was nonsusceptible to ampicillin. 61.2% to co-trimoxazole, 0% to ciprofloxacin, and 0% to cefuroxime. Among S. pneumoniae isolates, 26.2% were nonsusceptible to penicillin. 92.9% to erythromycin, and 66.7% to clindamycin. Of S. aureus isolates, 79.2% were nonsusceptible to penicillin and 0% to vancomycin. We concluded that the microbiology of chronic rhinosinusitis in these children was different from that in adult patients and previous studies in other regions. Antibiotic therapy for pediatric patients with chronic rhinosinusitis should consider individual microbiology of the disease and the local patterns of resistance.