Pathogen Culture And Analysis Of Refractory Rhinosinusitis

【Objective】To observe the bacteriological characteristics of nasal cavity and sinuses in patients with refractory rhinosinusitis,and analyze whether there are changes in the structure of bacterial flora during its development.【Methods】1.Patients with chronic rhinosinusitis with nasal polyps who have undergone open sinus surgery and nasal polypectomy are closely followed up after surgery,and their symptoms and quality of life are evaluated regularly,as well as morphological evaluation of endoscopic sinus surgery and evaluation of accompanying diseases,and corresponding local treatment and corresponding drug treatment are given.Following up for at least 6 months,35 patients were included in the control group and 21 patients were included in the uncontrolled group according to clinical characteristics and grouping conditions.2.21 patients who were included in the uncontrolled group were taken again for bacterial culture and drug sensitivity test during follow-up.3.The bacterial culture and drug sensitivity test results of nasal secretions obtained during the surgery of patients included in the uncontrolled group and the controlled group were collected.4.25 patients with nasal septum deviation admitted to hospital at the same time for septoplasty were taken as the contrast group.During the operation,sterile cotton swabs were used to obtain nasal secretions in the middle meatus,and bacterial culture and drug sensitivity tests were performed.5.comparative analysis:(1)Bacterial culture results of nasal secretions from uncontrolled group(during operation),control group and contrast group.(2)Bacterial culture results of nasal secretions of the two groups included in the uncontrolled group during surgery and follow-up.【Results】1.The positive rates of bacterial culture in the uncontrolled group(during operation),the controlled group and the control group were 61.9%,65.7% and 56.0% respectively,and thecomparative analysis was P > 0.05,with no statistical significance.The bacteria detection rates of uncontrolled group patients during surgery and follow-up were 61.9% and 85.7%respectively,with a comparative analysis P > 0.05,and the difference was not statistically significant.2.G-bacilli were dominant in uncontrolled group(during operation),while G+ coccus were dominant in control group and contrast group.The detection rates of G+ coccus,Gbacilli and other bacterial species in the three groups were not significantly different.3.The drug resistance rates of bacteria in uncontrolled group(during operation),control group and contrast group were 61.5%,34.8% and 7.1% respectively,p < 0.05.the drug resistance rate of bacteria in uncontrolled group was significantly higher than that in other two groups.4.There was no significant difference in the detection rate of various bacterial species and the proportion of drug-resistant bacterial species between the two samples before and after the uncontrolled group,and G-bacilli were the main bacterial species.5.85.7%(18/21)of the bacterial species of refractory sinusitis patients changed during postoperative follow-up.【Conclusion】1.Bacterial infection may be a secondary result in refractory sinusitis.Bacteria do not play a key role in its pathogenesis,but are closely related to the severity and persistence of sinusitis.2.G-bacilli infection is the main infection in refractory sinusitis,but compared with common chronic sinusitis,its flora distribution may not be specific,which needs further research and confirmation.3.One of the causes of persistent refractory sinusitis is related to the presence of drug-resistant bacterial strains.4.The flora structure of refractory rhinosinusitis has changed during the progress of the disease,which is mainly manifested by the change of bacterial strains,but there is no obvious difference in the distribution of different kinds of bacteria,and G-bacilli are the main bacterial species.Pathogenic bacteria of refractory sinusitis have high resistance to antibacterial drugs and their resistance is changeable.Even the same bacteria hascorresponding antibacterial spectrum.Therefore,antibacterial drugs cannot be blindly used,and the importance of bacterial culture results and drug sensitivity tests is emphasized.