Utility of Middle Meatus Cultures and Blood Cultures in the Management of Pediatric Patients with Acute Bacterial Rhinosinusitis Who Required Surgical Intervention

Introduction: Orbital and intracranial complications of acute bacterial rhinosinusitis (ABRS) in children relies on empiric and/or culture-directed antibiotics for treatment Objective: The goal of our study is to determine the reliability of preoperative cultures, including bedside Middle Meatus Cultures (MMCx) and Blood Cultures (BCx), and their correspondence to intraoperative sinus culture in children with orbital and intracranial complications of ABRS in children. Methods: We performed a retrospective review of patients who underwent endoscopic sinus surgery (ESS) for orbital and intracranial complications of ABRS at a tertiary children’s hospital. Demographic information and data including diagnosis, imaging, indications for surgery and surgery type, preoperative MMCx and BCx, and surgical sinus cultures were analyzed. Results: Seventy-eight patients admitted for ABRS required surgical intervention. Patients were 76% male, and between 2 and 202 months of age (mean 127 months, SD 47.6). 34.6% experienced intracranial complications. Of the 78.2% with orbital complications, 48.7% were diagnosed with orbital cellulitis, and 38.4% with a subperiosteal abscess. The presence of an abscess was the most common indication for surgery, with a mean abscess length of 23.7mm on AP dimension. 59 patients required a repeat ESS. Fifteen patients underwent MMCx, while 55 had BCx. 60% of MMCx and 5.5% of BCx corresponded with surgical cultures. Eighty-seven percent of BCx had no growth of organisms. On Fischer’s exact test, only growth of staphylococcus aureus on MMCx was statistically significant in predicting growth on surgical cultures (p = 0.009). Conclusions: Most middle meatus cultures correlate with intraoperative sinus cultures. Growth of staphylococcus aureus on MMCx was statistically significant in predicting growth on surgical cultures. Blood cultures do not correlate with surgical cultures. Middle meatus cultures may be useful in tailoring antibiotic therapy in children with complications of ABRS. Keywords: Acute bacterial rhinosinusitis; Pediatric; Middle meatus culture