- Design
- Systematic review and meta-analysis of culture studies
- Population
- 57 studies of acute (16) and chronic (41) rhinosinusitis, 1980 to 2024
- Primary outcome
- Pooled prevalence of bacterial isolates
- Effect
- Acute: S. aureus 20.5%, pneumococcus 16.3%; chronic: coagulase-negative staphylococci 24.3%
A meta-analysis in the International Journal of Infectious Diseases (28 May 2026) pooled 57 culture studies from 1980 to 2024, 16 in acute and 41 in chronic rhinosinusitis.
In acute disease, methicillin-susceptible Staphylococcus aureus was the commonest isolate (20.5%), followed by coagulase-negative staphylococci (16.9%), Streptococcus pneumoniae (16.3%), viridans streptococci (13.0%) and Haemophilus influenzae (12.2%). In chronic disease, coagulase-negative staphylococci (24.3%) and S. aureus (22.5%) led, and pneumococcus was less common (9.4%).
The cultures came from patients sick enough to be sampled, often at surgery or by swab, and staphylococci are also colonisers, so these figures overstate their role in typical acute sinusitis seen in primary care. Guidelines on empirical treatment of acute bacterial sinusitis have not changed, and most acute rhinosinusitis is viral and needs no antibiotic at all.
- Do not prescribe antibiotics for most acute rhinosinusitis; it is usually viral.
- Follow current guidance for empirical choice when bacterial sinusitis is likely.
- Take an endoscopically guided culture in chronic or refractory disease before broadening cover.
- Treat a staphylococcal isolate from a nasal swab with caution; it may be colonisation.
Why it matters
It explains why some cases fail first-line treatment, and argues for culture rather than guesswork in refractory disease.
Don't overread it
Culture studies from sampled patients overrepresent severe disease and colonisers; this is not a reason to change first-line antibiotics.
The statistics, in plain English
Pooled prevalence is the share of isolates belonging to each organism across studies. Studies differed in how and when they sampled, so the true mix in any one clinic may be quite different.
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