Topical therapy for refractory rhinosinusitis caused by methicillin-resistant Staphylococcus aureus: First report in a prospective series.
Topical therapy for refractory rhinosinusitis caused by methicillin-resistant Staphylococcus aureus: First report in a prospective series.
- 2018
Available online through MWHC library: 2008 - present
CONCLUSION: Our findings demonstrate that topical therapy is an effective method for treating MRSA-associated refractory CRS. Copyright (c) 2018. Published by Elsevier B.V. METHODS: Seventeen patients with refractory CRS caused by MRSA were treated with a topical therapy protocol. Treatment consisted of weekly endoscopic sinus debridement followed by intra-sinus installation of a hydroxyl-ethylcellulose gel that releases mometasone and a culture-directed antibiotic for a period of 6 weeks, along with daily nasal nebulization of mometasone with the same antibiotic and saline rinses. Clinical outcome was assessed using the Lund-Kennedy (LK) symptom and endoscopic appearance scores. Sinus mucosal tissue was homogenized and cultured, and microbial biofilm burden was assessed based on colony forming units (CFUs) counts. OBJECTIVE: The incidence of refractory chronic rhinosinusitis (CRS) associated with methicillin-resistant Staphylococcus aureus (MRSA) is rising and remains a therapeutic challenge. The goal of this study is to demonstrate the efficacy of a non-invasive topical therapy against MRSA in these patients. RESULTS: Rhinotopic therapy resulted in clearance of MRSA in 13 of 16 patients (81.2%). Treated patients also demonstrated significant improvement clinically as measured by the LK scores. In addition, a significant decrease in mucosal CFUs was observed post-therapy.
English
0385-8146
10.1016/j.anl.2018.01.009 [doi] S0385-8146(17)30613-2 [pii]
*Anti-Bacterial Agents/ad [Administration & Dosage]
*Rhinitis/dt [Drug Therapy]
*Sinusitis/dt [Drug Therapy]
*Staphylococcal Infections/dt [Drug Therapy]
Administration, Intranasal
Administration, Topical
Adult
Aged
Anti-Inflammatory Agents/ad [Administration & Dosage]
Cellulose/aa [Analogs & Derivatives]
Culture Techniques
Debridement
Endoscopy
Female
Humans
Instillation, Drug
Male
Methicillin-Resistant Staphylococcus aureus
Microbial Sensitivity Tests
Middle Aged
Mometasone Furoate/ad [Administration & Dosage]
Mupirocin/ad [Administration & Dosage]
Nebulizers and Vaporizers
Prospective Studies
Rhinitis/mi [Microbiology]
Rhinitis/su [Surgery]
Sinusitis/mi [Microbiology]
Sinusitis/su [Surgery]
Staphylococcal Infections/mi [Microbiology]
Staphylococcal Infections/su [Surgery]
Therapeutic Irrigation
Tobramycin/ad [Administration & Dosage]
Treatment Outcome
Vancomycin/ad [Administration & Dosage]
MedStar Union Memorial Hospital
Maryland Nose & Sinus Center
Journal Article
Available online through MWHC library: 2008 - present
CONCLUSION: Our findings demonstrate that topical therapy is an effective method for treating MRSA-associated refractory CRS. Copyright (c) 2018. Published by Elsevier B.V. METHODS: Seventeen patients with refractory CRS caused by MRSA were treated with a topical therapy protocol. Treatment consisted of weekly endoscopic sinus debridement followed by intra-sinus installation of a hydroxyl-ethylcellulose gel that releases mometasone and a culture-directed antibiotic for a period of 6 weeks, along with daily nasal nebulization of mometasone with the same antibiotic and saline rinses. Clinical outcome was assessed using the Lund-Kennedy (LK) symptom and endoscopic appearance scores. Sinus mucosal tissue was homogenized and cultured, and microbial biofilm burden was assessed based on colony forming units (CFUs) counts. OBJECTIVE: The incidence of refractory chronic rhinosinusitis (CRS) associated with methicillin-resistant Staphylococcus aureus (MRSA) is rising and remains a therapeutic challenge. The goal of this study is to demonstrate the efficacy of a non-invasive topical therapy against MRSA in these patients. RESULTS: Rhinotopic therapy resulted in clearance of MRSA in 13 of 16 patients (81.2%). Treated patients also demonstrated significant improvement clinically as measured by the LK scores. In addition, a significant decrease in mucosal CFUs was observed post-therapy.
English
0385-8146
10.1016/j.anl.2018.01.009 [doi] S0385-8146(17)30613-2 [pii]
*Anti-Bacterial Agents/ad [Administration & Dosage]
*Rhinitis/dt [Drug Therapy]
*Sinusitis/dt [Drug Therapy]
*Staphylococcal Infections/dt [Drug Therapy]
Administration, Intranasal
Administration, Topical
Adult
Aged
Anti-Inflammatory Agents/ad [Administration & Dosage]
Cellulose/aa [Analogs & Derivatives]
Culture Techniques
Debridement
Endoscopy
Female
Humans
Instillation, Drug
Male
Methicillin-Resistant Staphylococcus aureus
Microbial Sensitivity Tests
Middle Aged
Mometasone Furoate/ad [Administration & Dosage]
Mupirocin/ad [Administration & Dosage]
Nebulizers and Vaporizers
Prospective Studies
Rhinitis/mi [Microbiology]
Rhinitis/su [Surgery]
Sinusitis/mi [Microbiology]
Sinusitis/su [Surgery]
Staphylococcal Infections/mi [Microbiology]
Staphylococcal Infections/su [Surgery]
Therapeutic Irrigation
Tobramycin/ad [Administration & Dosage]
Treatment Outcome
Vancomycin/ad [Administration & Dosage]
MedStar Union Memorial Hospital
Maryland Nose & Sinus Center
Journal Article