Staphylococcus aureus is a major pathogen in acute bacterial rhinosinusitis: a meta-analysis.

BACKGROUND: Acute bacterial rhinosinusitis is a common health problem in the United States. Appropriate recommendations for the treatment of acute bacterial rhinosinusitis are based on the prevalence and expected antimicrobial susceptibilities of specific pathogens.

METHODS: A meta-analysis was performed on the English language literature from the period 1990-2006, including prospective studies of antibiotic therapy for acute bacterial rhinosinusitis for which sinus cultures were required in the form of either maxillary sinus taps or middle meatal cultures. Weighted mean culture rates for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus were abstracted from the included articles and compared according to culture technique.

RESULTS: Culture rates (i.e., the percentage of patients with positive culture results) were 32.7% for S. pneumoniae, 31.6% for H. influenzae, 10.1% for S. aureus, and 8.8% for M. catarrhalis. No statistically significant difference was seen between the culture rates for S. aureus and M. catarrhalis. Analysis of the effect of culture technique on the culture rates revealed no statistically significant difference.

CONCLUSIONS: The prevalence of S. aureus among sinus cultures warrants its reconsideration as a major pathogen in acute bacterial rhinosinusitis. As a result, increasing trends of drug-resistant strains may complicate antibiotic recommendations.