- Design
- Systematic review and meta-analysis of prevalence
- Population
- 57 studies of sinus bacteriology (16 acute, 41 chronic rhinosinusitis)
- Primary outcome
- Pooled prevalence of bacterial isolates
- Effect
- Acute: S. aureus 20.5%, S. pneumoniae 16.3%; chronic: coagulase-negative staphylococci 24.3%, S. aureus 22.5%
This meta-analysis pooled 57 bacteriology studies published over four decades: 16 in acute and 41 in chronic rhinosinusitis.
In acute rhinosinusitis cultures, the commonest organisms were methicillin-susceptible Staphylococcus aureus (20.5%), 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 catch is selection: acute sinusitis is usually viral and rarely cultured, so these samples come from patients with severe, persistent or complicated disease, and coagulase-negative staphylococci are often contaminants. The findings do not change first-line empirical treatment of uncomplicated acute sinusitis. Where they matter is in persistent or complicated disease, which should be cultured, ideally from an endoscopically guided sample, rather than treated with repeated empirical courses.
- Do not change first-line empirical antibiotics for uncomplicated acute sinusitis on the basis of this review.
- Avoid antibiotics for most acute sinusitis, which is viral and self-limiting.
- Take an endoscopically guided culture in persistent, recurrent or complicated sinusitis before repeated antibiotic courses.
- Interpret coagulase-negative staphylococci in sinus cultures with caution; they are often contaminants.
Why it matters
Repeated empirical courses in chronic sinusitis drive resistance, and the organisms involved differ from acute disease.
Don't overread it
Cultured patients are a selected, more severe group; the prevalence figures do not represent typical acute sinusitis in primary care.
The statistics, in plain English
Pooled prevalence is the share of culture results in which an organism was found. Across 57 studies spanning decades, sampling methods varied widely, so these are rough estimates.
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