Investigation of bacterial repopulation after sinus surgery and perioperative antibiotics

• Published in: International forum of allergy & rhinology Vol. 6; no. 1; pp. 34 - 40
• Main Authors: Hauser, Leah J., Ir, Diana, Kingdom, Todd T., Robertson, Charles E., Frank, Daniel N., Ramakrishnan, Vijay R.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.01.2016; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Anti-Bacterial Agents - therapeutic use; Antibiotic Prophylaxis - adverse effects; Antibiotics; bacteria; bacterial repopulation; Chronic Disease; chronic rhinosinusitis; Cross-Sectional Studies; Endoscopy; Ethmoid Sinus - microbiology; Female; Humans; Male; microbiome; Microbiota; Middle Aged; Nasopharynx - microbiology; Nose; Perioperative Care - adverse effects; Perioperative Care - methods; pyrosequencing; Rhinitis - microbiology; Rhinitis - surgery; Sinuses; sinusitis; Sinusitis - microbiology; Sinusitis - surgery; Surgery; Surgical Wound Infection - prevention & control; Treatment Outcome; chronic rhinosinusitis; sinusitis; pyrosequencing; bacteria; bacterial repopulation; microbiome
• ISSN: 2042-6976; 2042-6984
• DOI: 10.1002/alr.21630

Background Endoscopic sinus surgery (ESS) enjoys high success rates, but repopulation with pathogenic bacteria is 1 of the hallmarks of poorer outcomes. There are many hypothesized sources of repopulating bacteria; however, this process remains largely unexplored. This study examined changes in the sinus microbiome after ESS and medical therapies to identify potential sources for postsurgical microbial repopulation. Methods Samples from the anterior nares, ethmoid sinus, and nasopharynx were taken at the time of surgery from 13 subjects undergoing ESS for chronic rhinosinusitis (CRS). Patients were treated postoperatively with 2 weeks of oral antibiotics and saline rinses. The ethmoid sinus was sampled at 2 and 6 weeks postoperatively; microbiota were characterized using quantitative polymerase chain reaction (qPCR) and 16S ribosomal RNA (rRNA) gene sequencing. The Morisita‐Horn beta‐diversity index (M‐H) was used to compare similarity between samples. Results The bacterial burden of the ethmoid was higher 2 weeks postoperatively than 6 weeks postoperatively (p = 0.01). The 6‐week samples most closely represented the anterior nares and ethmoid at surgery (M‐H = 0.58 and 0.59, respectively), and were least similar to the nasopharynx (M‐H = 0.28). Principal coordinates analysis (PCoA) plots illustrate that the ethmoid microbiota temporarily shifted after surgery and antibiotics but returned toward baseline in many subjects. Conclusion Bacterial communities colonizing the ethmoid 6 weeks postoperatively were most similar to anterior nasal cavity and pretreatment sinus microbial profiles, indicating a high degree of resilience in the sinonasal microbiome of most subjects. Interestingly, surgery and postoperative antibiotic therapy does not appear to reduce bacterial burden, but rather, shifts the microbial consortia.