Antibiotic susceptibility pattern of organisms in chronic rhinosinusitis

Namit Kant Singh, Lakshmi Narayan Garg, Nitish Baisakhiya, Hitesh Kuhar, Shubhranshu Shekhar, Naiya Rao, Anshul Singh


Background: Chronic rhinosinusitis is an ever increasing problem faced by all sectors of the population throughout the world. Various etiologic factors have been associated with the disease entity but the main concern throughout the world is the increasing antimicrobial resistance which is leading to less compliance and higher treatment cost.

Methods: A total of 60 cases and 60 controls were selected and nasal swabs were collected under endoscopic guidance from middle meatus and were sent for culture and sensitivity.  

Results: The data collected showed that the most common pathogen isolated from the cases was methicillin resistant Staphylococcus aureus (MRSA) accounting for 58.33% followed by fungi and methicillin susceptible Staphylococcus aureus (MSSA). The antibiotic sensitivity showed that MRSA is having the most resistant pattern with only Vancomycin, Teicoplanin and Linezolid having 100% sensitivity followed by Rifampicin, Netilmicin and Clindamycin.

Conclusions: From this study we conclude that MRSA is the most common pathogen affecting the cases of chronic sinusitis and it shows a high degree of resistance towards antibiotics which is responsible for incurring higher cost of treatment and low compliance.


Rhinosinusitis, Antibiotics, Staphylococcus, H. influenzae, Osteomeatal complex

Full Text:



Brook I, Foote PA, Hausfeld JN. Increase in the frequency of recovery of meticillin-resistant Staphylococcus aureus in acute and chronic maxillary sinusitis. J Med Microbiol. 2008;57:1015-7.

Brook I. Acute and chronic bacterial sinusitis. Infect Dis Clin North Am. 2007;21(2):427-48.

Brook I. Bacteriology of chronic maxillary sinusitis in adults. Ann Otol Rhinol Laryngol. 1989;98(6):426-8.

Ferguson BJ. Definitions of fungal rhinosinusitis. Otolaryngol Clin North Am. 2000;33(2):227-35.

Antimicrobial resistance: global report on surveillance 2014. World Health Organization; 2014. Available at: Accessed on 4 March, 2015.

Ochiai K, Yamanaka T, Kimura K, Sawada O. Inheritance of drug resistance (and its transfer) between Shigella strains and Between Shigella and E.coli strains. Hihon Iji Shimpor (in Japanese). 1951;1867:34.

Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology. 2012;50(1):1-12.

Chambers HF. Penicillin-binding protein-mediated resistance in pneumococci and staphylococci. J Infect Dis. 1999;179(2):353-9.

Cui L, Iwamoto A, Lian JQ, Neoh HM, Maruyama T, Horikawa Y, et al. Novel mechanism of antibiotic resistance originating in vancomycin-intermediate Staphylococcus aureus. Antimicrobial Agents and Chemotherapy. 2006;50:428-38.

Howden BP, Davies JK, Johnson PDR, Stinear TP, Grayson ML. Reduced vancomycin susceptibility in Staphylococcus aureus, including vancomycin-intermediate and heterogeneous vancomycin-intermediate strains: resistance mechanisms, laboratory detection, and clinical implications. Clin Microbiol Rev. 2010;23:99-139.

Healy, VL, Lessard, IAD, Roper, DI, Knox, JR, Walsh, CT. Vancomycin resistance in enterococci: reprogramming of the DAla- D-Ala ligases in bacterial peptidoglycan biosynthesis. Chem Biol. 2000;7:109-19.

Zhu W, Murray PR, Huskins WC, Jernigan JA, McDonald LC, Clark NC, et al. Dissemination of an Enterococcus Inc18-like vanA plasmid associated with vancomycin-resistant Staphylococcus aureus. Antimicrobial Agents Chemotherapy. 2010;54:4314-20.

Mingeot-Leclercq MP, Glupczynski Y, Tulkens PM. Aminoglycosides: activity and resistance. Antimicrobial Agents Chemotherapy. 1999;43:727-37.

Chandrakanth RK, Raju S, Patil SA. Aminoglycoside-resistance mechanisms in multidrug-resistant Staphylococcus aureus clinical isolates. Current Microbiol. 2008;56:558-62.

Trzcinski K, Cooper BS, Hryniewicz W, Dowson CG. Expression of resistance to tetracyclines in strains of methicillinresistant Staphylococcus aureus. J Antimicrobial Chemotherapy. 2000;45:763-70.

Chopra, I, Roberts, M. Tetracycline antibiotics: mode of action, applications, molecular biology, and epidemiology of bacterial resistance. Microbiol Molecular Biol Rev. 2001;65:232-60.

Schwarz S, Kehrenberg C, Doublet B, Cloeckaert A. Molecular basis of bacterial resistance to chloramphenicol and florfenicol. FEMS Microbiol Rev. 2004;28:519-42.

Lina G, Quaglia A, Reverdy ME, Leclercq R, Vandenesch F, Etienne J. Distribution of genes encoding resistance to macrolides, lincosamides, and streptogramins among staphylococci. Antimicrobial Agents Chemotherapy. 1999;43:1062- 6.

Lim JA, Kwon AR, Kim SK, Chong Y, Lee K, Choi EC. Prevalence of resistance to macrolide, lincosamide and streptogramin antibiotics in gram-positive cocci isolated in a Korean hospital. J Antimicrobial Chemotherapy. 2002;49:489-95.

Gul HC, Kilic A, Guclu AU, Bedir O, Orphon M, Basustaoglu AC. Macrolide-lincosamide-streptogramin B resistant phenotypes and genotypes for methicillin-resistant Staphylococcus aureus in Turkey, from 2003 to 2006. Polish J Microbiol. 2008;57:307-12.

Long KS, Poehlsgaard J, Kehrenberg C, Schwarz S, Vester B. The Cfr rRNA methyltransferase confers resistance to phenicols, lincosamides, oxazolidinones, pleuromutilins, and streptogramin A antibiotics. Antimicrobial Agents Chemotherapy. 2006;50:2500-5.

Arias CA, Vallejo M, Reyes J, Panesso D, Moreno J, Castañeda E, et al. Clinical and microbiological aspects of linezolid resistance mediated by the cfr gene encoding a 23S rRNA methyltransferase. J Clin Microbiol. 2008;46:892-6.

Winston LG, Chambers HF. Antimicrobial resistance in staphylococci: mechanisms of resistance and clinical implications. In: Mayers DL, ed. Antimicrobial Drug Resistance. Volume 2. Clinical and Epidemiological Aspects. New York, NY: Humana Press; 2009: 735-748.

Houvinen P. Resistance to trimethoprim-sulfamethoxazole. Clin Infect Dis. 2001;32:1608-14.

Brook, I. Microbiology of chronic rhinosinusitis. Eur J Clin Microbiol Infect Dis. 2016;35:1059.