Prevalence of etiologic bacteria and beta-lactamase-producing bacteria in acute and chronic maxillary sinusitis at Phramongkutklao Hospital.

BACKGROUND: To date, there is an increasing trend of prescribing antibiotics that cover beta-lactamase-producing bacteria as the first line drug for sinusitis patients in Thailand This practice dose not only increases the treatment cost but might also induce resistance to antimicrobial agents. OBJECTIVE: To determine the prevalence of the pathogenic bacteria in acute and chronic maxillary sinusitis as well as the prevalence of beta-lactamase-producing bacteria. MATERIAL AND METHOD: The maxillary aspiration fluid specimens of 52 acute and chronic sinusitis patients at Phramongkutklao Hospital, Bangkok, Thailand during May 2002-May 2003, were collected. Aerobic and anaerobic cultures were performed and the beta-lactamase activities of isolated bacteria were determined. RESULTS: Of 58 specimens, 44 (75.9%) and 14 (24.1%) specimens were collected from acute and chronic maxillary sinusitis patients, respectively. Of 44 specimens of acute maxillary sinusitis, the predominant isolates were Haemophilus influenzae (13, 29.5%), Streptococcus pneumoniae (4, 9%), Streptococcus viridan (4, 9%), and Klebsiella pneumoniae (4, 9%). 6 (13.6%) of them were beta-lactamase-producing bacteria. Of 14 specimens of chronic maxillary sinusitis, the predominant isolates were Pseudomonas aeruginosa (3, 16.6%), Staphylococcus spp (3, 17.5%) and Streptococcus spp. (2, 11.6%). 1 (7.1%) Haemophilus influenza isolate from this group was beta-lactamase-producing bacteria. The percentage of anaerobe was 8.9%, 23.3% for acute and chronic maxillary sinusitis, respectively. CONCLUSION: The present study was indicated that the common organisms in acute maxillary sinusitis were Haemophilus influenzae and Streptococcus pneumoniae, Streptococcus viridians which were similar to a previous study. But the authors found an increased prevalence of anaerobe bacteria in acute maxillary sinusitis and also found beta-lactamase-producing bacteria, 21.4% Hemophilus influenzae less than the previous studies (which found beta-lactamase-producing bacteria around 50% to 70%). The authors found 23.3% anaerobe bacteria in the chronic maxillary sinusitis, less than the previous studies, and the authors also found 8.9% anaerobe in acute maxillary sinusitis.

Outbreak of uncommon type of group A streptococcal pharyngitis among cadets at the Chulachomklao Royal Military Academy, Nakhon Nayok, Thailand.

A large outbreak of group A Streptococcus (GAS) pharyngitis occurred among 285 cadets at the Chulachomklao Royal Military Academy, Nakhon Nayok between September 22 and 27, 1996. An epidemiologic investigation was conducted to determine the source of infection. It seemed that respiratory droplets were the mechanism of spread, although foodborne transmission could not be excluded. To assess the presence of the outbreak strain in the community, conventional serotyping and molecular typing by emm sequencing were performed. The results demonstrated the advantage of molecular typing compared to serotyping and suggested that the outbreak was caused by the same strain. Interestingly, the involvement of the causative emm79 strain, which is an uncommon type of GAS disease, in a large number of patients may imply the invasive potential of this organism.