Clinical and bacteriologic features of chronic sinusitis in children
D. G. Tinkelman and H. J. Silk
Department of Pediatrics, Medical College of Georgia, Augusta.
The clinical and bacteriologic aspects of chronic sinusitis in childhood
were studied. Of 35 children who underwent surgical procedures for chronic
sinusitis, 22 had positive bacteriologic cultures of aspirates from the
sinus. The most common organisms isolated were Haemophilus influenzae,
Streptococcus pneumoniae, and Branhamella catarrhalis. Five of eight S
pneumoniae strains were relatively resistant to penicillin and resistant to
sulfamethoxazole-trimethoprim. All of the B catarrhalis and 20% of the H
influenzae organisms were beta-lactamase positive. Overall, 14 of 28 of the
bacteria were penicillin resistant. In addition, all 12 children 2 years of
age or younger had a positive bacterial culture as compared with much lower
rates in older children. Although the incidence of S pneumoniae strains
that are relatively resistant seems to be rising, to our knowledge we
report the first description of these organisms as significant pathogens in
chronic childhood sinusitis. These results indicate that chronic, difficult
to manage sinusitis in very young children is frequently bacterial in
origin, especially if the patient is 2 years old or younger. In light of
the frequent failure of antibiotic therapy and considering the incidence of
relatively resistant S pneumoniae strains, puncture of the sinus should be
considered early in the course of chronic sinusitis to isolate pathogenic
organisms and determine appropriate antimicrobial therapy.
