Research Article - Otolaryngology Online Journal (2018) Volume 8, Issue 2

The Role of Achromobacter xylosoxidans Positive Sinus Cultures in Patients with Refractory Chronic Rhinosinusitis

Background: Bacteria have been implicated in the pathogenesis of chronic rhinosinusitis (CRS), but their role as instigator or propagator is poorly understood. A. xylosoxidans has been rarely reported in bacterial sinus cultures in the literature, but may play a role in patients with CRS. This study aims to examine the clinical and microbiological characteristics, risk factors, and recalcitrance in patients with CRS who had Achromobacter identified by routine culture and/or molecular-based sequencing methods. Methods: Retrospective chart review was performed on all patients who had A. xylosoxidans identified by sinus cultures and/or molecular sequencing and were under care at UF Health rhinology practice between August 2013 to February 2017. Setting: Tertiary rhinology practice. Results: 18/18 CRS patients with Achromobacter identified by sinus sampling underwent previous functional endoscopic sinus surgery (FESS) (mean 2.2). These patients had undergone an average of 4.6 courses of oral antibiotics in the previous 24 months. 12/18 patients had asthma and 17/18 patients had CRS with polyps. 7/11 patients grew other bacteria in addition to Achromobacter on culture. A. xylosoxidans was identified by routine culture in 11 of 18 patients. Among these 11 patients, only 4 patients also had A. xylosoxidans identified by sequencing. All the Achromobacter isolates were susceptible to Trimethoprim/sulfamethoxazole (TMP/SMX) in vitro . Conclusions: To our knowledge, this is the first literature that reports the clinical characteristics of CRS patients with Achromobacter. Achromobacter infection in the sinuses may be a post-surgical disease, may have an association with airway disease, or may have an association with polymicrobial infections. Oral TMP/SMX may be an effective therapy in this patient population. Achromobacter may be a bystander or an instigator of this recalcitrant disease, and their role in CRS warrants further investigation.

Author(s): Dobson BC*, Bernard SH, Varadarajan VV, Wang GP, Justice JM

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