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Original Investigation |

Alteration in Bacterial Culture After Treatment With Topical Mupirocin for Recalcitrant Chronic Rhinosinusitis

Tara F. Carr, MD1; Jennifer L. Hill, MD2; Alex Chiu, MD1; Eugene H. Chang, MD1
[+] Author Affiliations
1Department of Otolaryngology, University of Arizona, Tucson
2Division of Allergy/Immunology, National Jewish Health, Denver, Colorado
JAMA Otolaryngol Head Neck Surg. 2016;142(2):138-142. doi:10.1001/jamaoto.2015.3059.
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Importance  Topical mupirocin therapy is used to treat symptomatic chronic sinusitis (CRS). However, the potential adverse impact of this therapy on the sinus microbiota has not been well quantified.

Objective  To determine changes in microbiologic culture results before and after topical mupirocin therapy in patients with CRS with medically and surgically refractory disease.

Design, Setting, and Participants  We performed a retrospective medical chart review for 22 consecutive adults evaluated and treated between January 1, 2012, and January 1, 2014, at an otolaryngology-rhinology clinic at a regional academic medical center. The patients were 14 men and 8 women, who had undergone functional endoscopic sinus surgery for CRS, and in whom sinus aspirate cultures were performed before and after topical mupirocin therapy for symptomatic disease. Analyses were performed in April 2014.

Exposures  Patients underwent treatment with saline sinus rinse, with the addition of mupirocin, for at least 1 week.

Main Outcomes and Measures  Bacterial isolates from sinus aspirate culture.

Results  The patients included 14 men and 8 women, 18 to 75 years old, who underwent a mean of 1.9 functional endoscopic sinus surgical procedures. The mean (range) duration of mupirocin therapy was 6 (2-12) weeks. Before mupirocin therapy, cultures from symptomatic patients (14 men and 8 women, ages 18-75 years) revealed common bacteria implicated in CRS, which are characteristically gram-positive. After mupirocin therapy, cultures from symptomatic patients shifted significantly: 19 were gram-positive vs 3 gram-negative before treatment; 9 were gram-positive vs 13 gram-negative after treatment (P = .004), with increased growth of pathogenic gram-negative bacteria and Corynebacterium.

Conclusions and Relevance  These data present evidence supporting the distinct abrogation of culturable sinus bacteria after mupirocin rinses, identifying a shift toward increased pathogenic bacteria. Consideration of healthy host microbiome and immune dysfunction should guide future treatment considerations.

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Figure.
Frequency of Sinus Culture Isolates From Participants, Before and After Topical Treatment With Mupirocin

Coagulase-neg staph indicates coagulase-negative Staphylococci; Spp species.

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