Journal Reading

Endoscopically-derived bacterial cultures in chronic

rhinosinusitis: A systematic review

Cahya Alfaliza
(2012730120)

Pembimbing:
dr. Sondang Berlian Rosalind Silalahi, Sp.THT, MARS
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Pendahuluan

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 Tujuan Penelitian
Mengetahui prevalensi mikroorganisme patogen aerobik dan
anerobik melalui kultur endoskopik

Pengaturan klinis Sinus paranasal

Teknik pengujian

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Metode

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Fig. 1 – Flowchart of literature retrieval in systematic review 5
 Pengumpulan Data

1. Jumlah pasien
2. Usia
3. Jenis kelamin
4. Riwayat operasi sebelumnya
5. Jumlah spesimen kultur
6. Jumlah isolasi kultur (swab, aspirasi, & biopsi mukosa)
7. Hasil diagnosa dari organisme aerobik & anaerobik

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 Pengumpulan Data
1.932 laki-
laki

43 3528 Pasien
Studi
1.288
perempuan

Rata-rata berusia
36 tahun (6-50
tahun)

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Kriteria Inklusi

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 Hasil
Clinical Categories No.
Percent
characteristic   studies
Diagnosis of CRS CRS 37 86.0%
subset Acute exacerbation of CRS 3 7.0%
  CRS w/ or w/o polyps 2 4.7%
  CRS or Acute exacerbation 1 2.3%
  of CRS    
Previous Surgery No 36 83.7%
  Yes 6 14.0%
  Not assigned 1 2.3%
Site of Culture Maxillary sinus 18 41.9%
  Middle meatus 12 27.9%
  Multiple 9 20.9%
  Ethmoid cavity 4 9.3%
Specimen Operating Room 33 76.7%
Collection Site Clinic 10 23.3%
Technique Swab 19 44.2%
  Aspirate 12 27.9%
  Swab/Aspirate 4 9.3%
  Swab/Aspirate/Mucosal 3 7.0%
  biopsy    
  Mucosal biopsy 2 4.7%
  Swab/Mucosal biopsy 2 4.7%
  Aspirate/Mucosal biopsy 1 2.3%
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Table 1 – Salient characteristics of the 43 studies
 Table 2 – Salient features of the 43 studies

Number Total of Media Minimu Maximu

Label of all n m m
  studies studies      
           

Age (years) 37   36 6.3 50.4

No. of patients 43 3528 52 6 419
Male 39 1932 31 4 268
Female 39 1288 24 2 151
Total culture specimens 43 6005 91 12 609
Positive culture specimens 39 3826 54 12 442
Negative culture specimens 39 1703 16 0 181
No. isolated per positive specimen: swab 25   1.3 0.7 4.2
No. isolated per positive specimen: aspirate 13   1.3 0.7 4
No. isolated per positive specimen:
mucosal biopsy 6   1.7 1.2 3.8
No. isolated per positive specimen: not
separated by technique 3   3.3 2.1 3.3

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Table 3 – Most common aerobic and anaerobic bacteria from the cultures

Type Organism Bacterial Percent

    Count  
Coagulase negative 630 24.8%
Total
Staphylococcus    
 
Staphylococcus aureus 481 18.9%
 
  Haemophilus influenzae 245 9.6%
  Streptococcus viridans 233 9.2%
  Pseudomonas aeruginosa 198 7.8%
  Streptococcus pneumoniae 179 7.0%
  Peptostreptococcus species 156 6.1%
  Bacteroides species 153 6.0%
  Alpha hemolytic 135 5.3%
  Streptococcus    
  Propionibacterium acnes 131 5.2%
Coagulase negative 630 34.7%
Gram Positive
Staphylococcus    
Aerobes
Staphylococcus aureus 481 26.5%
 
  Streptococcus viridans 233 12.8%
  Streptococcus pneumoniae 179 9.9%
  Alpha hemolytic 135 7.4%
  Streptococcus    
  Corynebacterium species 69 3.8%
  Beta-hemolytic Group A 31 1.7%
  Streptococcus    
  Streptococcus pyogenes 24 1.3%
  Diphtheria bacillus 20 1.1% 11
  Micrococcus 16 0.9%
Table 3 – Most common aerobic and anaerobic bacteria from the cultures

Haemophilus influenzae 245 26.7%

Pseudomonas aeruginosa 198 21.6%
Klebsiella pneumoniae 100 10.9%
Escherichia coli 98 10.7%
Moraxella (Branhamella) 64 7.0%
catarrhalis    
Haemophilus parainfluenzae 52 5.7%
Enterobacter aerogenes 47 5.1%
Proteus mirabilis 47 5.1%
Klebsiella oxytoca 37 4.0%
Gram Negative
Aerobes
 
 
 
 
 
 
 
 
  Stenotrophomonas maltophilia 30 3.3%
Anaerobes Peptostreptococcus species 156 19.6%
  Bacteroides species 153 19.2%
  Propionibacterium acnes 131 16.4%
Peptococcus species 108 13.6%
 
Bacteroides melaninogenicus 62 7.8%
  Propionibacterium species 60 7.5%
  Bacteroides fragilis 41 5.1%
  Fusobacterium species 31 3.9%
  Fusobacterium nucleatum 29 3.6% 12
Diskusi
CRS

Coagulase Negative Staphylococcus (CNS),

S. aureus, H. influenzae , &
Peptostreptococcus species

Resistensi obat  kultur untuk pengobatan

sinus yang akurat

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 Data Mikrobiologis

CNS 34,7%
Bakteri
gram (+)
S. aureus 26,5%

H. influenzae
26,7%,
P. aeruginosa
Bakteri 21,6%
gram (-) K. pneumoniae
10,9%
E. coli
10,7% 14
Nadel et al.

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 Finegold et al.

Studi multicenter open-label  bakteriologi Sinusitis maksilaris

134 organisme diisolasi dari 150 pasien  patogen

Streptococcus (21,4%), H. influenzae (15,7%), P. aeruginosa (15,7%),

dan S. aureus dan M. catarrhalis (10%)

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Nord et al.

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Hal-hal yang dapat mengubah hasil kultur dari masing-
masing organisme :

Usia & Jenis kelamin Durasi penyakit Situs spesimen

Waktu antara
Teknik pengumpulan
Metode transportasi pengumpulan dan
sampel
kultur

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Kesimpulan

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 Kesimpulan

Bakteri gram positif :

Coagulase Negative Staphylococcus (CNS) dan S. Aureus

Bakteri gram negatif :

H. influenzae dan P. aeruginosa

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Thank You!

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