STUDY OF BACTERIAL CULTURE IN SINONASAL POLYPOSIS PATIENTS UNDERGOING

Dr Venkateswaran P, MS DLO and Dr Dhinakaran N. 1. Assistant Professor , Department of ENT, Madurai Medical College, Madurai. 2. Prof MS ENT, Professor and HOD , Department of ENT Madurai Medical College, Madurai. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

Chronic rhinosinusitis in one of the most common condition for which a patient seeks advice of a physician. Chronic rhinosinusitis is the inflammation of nose and para nasal sinuses for more than 12 weeks. In US, about 30 million patients per year visit ENT clinics for sinusitis. Sinonasal polyposis (chronic rhinosinusitis with nasal polyps) are a subcategory of sinusitis and constitutes roughly 2-5% of patients with sinusitis. Although polyps are technically tumours, they are not malignant ones. Importance of polyp lies in the fact that nose has several vital functions in humans. First it is an entry point for air that we all breathe. It processes the air, acting as an excellent humidifier. Mucus productionallows particulate trapping. It acts as a radiator that warms air. In addition to all this, it is the seat of sense of smell. Finally nose and paranasal sinuses adds resonance to voice. Cause of nasal polyp in still not clear. Many theories are being hypothesised but not proven beyond doubt. Whatever be the cause, polyp can cause nasal obstruction and affect the quality of life of patients. Hence treatment is a must for any symptomatic nasal polyp. Judicious use of antibiotics are a must for successful outcome of any surgery especially head and neck surgeries. Endoscopic Sinus Surgery is not an exception. Antibiotics, however do not have a direct impact on the immediate postoperative outcome. Its effect is by controlling the bacterial load (both normal and pathogenic), which affects long term outcome. Antibiotics resistance mainly due to rampant and injudicious use of antibiotics is now a major factor affecting many treatment decisions. Infact it is now proven to be one of important causes for failure in Endoscopic Sinus Surgery, but not the most common. Hence it was necessary to evaluate the bacterial culture and sensitivity in polyposis cases and to determine the effectiveness of commonly used antibiotics.
3 . To  evaluate  the  efficacy  of  most  commonly  used  antibiotics  in  our hospital.

Materials And Methods:-
Study was carried out during the period between August 2016to January 2017 at the Department of Otorhinolaryngology of Government Rajaji Hospital attached to Madurai Medical College, Madurai.
Patients subjected to the study were those with sinonasal polyposis posted for endoscopic sinus surgeries after taking anaesthesia fitness. Nasal swabs of patients were taken 1 day prior to surgery. Swabs were taken from nasal cavity floor, lateral wall and from the surface of the polyp on both sides. Postoperative swabs were taken on the 10th postoperative day.Postoperative swabs were from the nasal cavity floor and postoperative middle meatus. Revision FESS cases were not taken up for study.
Swabs obtained from the patients were sent to the microbiology department of Madurai Medical College for bacterial culture and sensitivity after proper labelling with a request form mentioning the pre or postoperative status of the sample. Bacterial culture was done for all the samples made available. Sensitivity was tested for the most commonly used antibiotics in our department (ampicillin, gentamicin, cotrimoxazole, erythromycin cephalexin cefotaxime. ceftriaxone, cloxacillin, doxycycline and ciprofloxacin.
Results obtained from the study were compiled and compared with those done at higher centres.  Ampicillin  21  0  Gentamycin  21  0  Cotrimoxazole  8  13  Ciprofloxacin  0  21  Cefotaxime  21  0  Doxycycline  4  17  Cephalexine  21  0  Ceftriaxone  7  14  Erythromycin  0  21  Cloxacillin  8 13 CONS was seen in 21 cases. All cases had resistance to ampicillin, gentamycin, cefotaxime and cephalexin. Ceftriajxone resistance was seen only in 7 out of 21 cultures. Erythromycin and ciprofloxacin were sensitive in all cases. Cloxacillin 0 9 9 cases of postoperative culture showed coagulase negative staphylococcus. Ampicillin, gentamycin, cephalexin resistance was seen in all cases. Interestingly one case of ceftriaxone sensitivity was seen. Ceftriaxone was resistant in 6 out of 9 cases.