The more surgery, the more biofilms ?

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Based on 157 chronic rhinosinusitis patients, U Penn found that about 30% had biofilms, but that figure fell to 15% among patients who never had FESS surgery, while it increased in correlation with the number of surgeries !One can imagine several hypotheses to explain this interesting finding :- FESS may scar the nasal epithelium, reduce ciliary clearance, promote growth of an atypical microbial flora, resulting in worsened condition,- or FESS may be poorly done in the first place, and subsequent surgeries may aggravate the situation,- or there may be nosocomial contamination during FESS,- or...patients who undergo the greatest number of FESS are those whose condition is the worst to begin with, and it simply aggravates over time, while the patient tries more FESS.------Prevalence of biofilm-forming bacteria in chronic rhinosinusitisAuthors: Prince, A.1; Steiger, D.2; Khalid, Ayesha N.3; Dogrhamji, Laurel2; Reger, 2; , Eau2; Chiu, G.4; Kennedy, W.2; Palmer, N.4; Cohen, Noam A.4Source: American Journal of Rhinology, Volume 22, Number 3, 5/6 2008 , pp. 239-245(7)Background: Recently, biofilms have been implicated in the pathogenesis of recalcitrant chronic rhinosinusitis (CRS). We sought to determine the prevalence of biofilm-forming cultures obtained from patients with CRS and clinical factors that may contribute to biofilm formation.Methods: Endoscopically guided sinonasal cultures were obtained in duplicate from CRS patients with evidence of mucopurulence. Bacterial swabs were sent for microbiological characterization and were simultaneously evaluated for biofilm-forming capacity by a modified Calgary Biofilm Detection Assay. Biofilm formation was based on concomitant values of biofilm-forming Pseudomonas aeruginosa O1 (PAO1) (positive control) and non-biofilm-forming mutants sad-31 (type IV pili) and sad-36 (flagella K; negative control). Samples, with growth greater than the sad-31 mutant, were designated as biofilm formers.Results: Sinonasal cultures were obtained from 157 consecutive patients (83 female patients) over a 4-month period. Forty-five samples (28.6%) showed biofilm formation. Among patients with a prior history of functional endoscopic sinus surgery (FESS), 30.7% (n = 42) showed biofilm growth. For patients naive to surgical intervention (n = 20), only 15% showed biofilm formation. A positive, statistically significant correlation existed between biofilm formation and number of prior FESS procedures. Polymicrobial cultures, Pseudomonas aeruginosa, and/or Staphylococcus aureus comprised 71% of samples. Chi-squared analysis showed an association with prior infections, but not with any pharmacologic therapy or comorbidies.Conclusion: We show a high percentage of CRS patients (28.6%) whose sinonasal mucopurulence has biofilm-forming capacity. Postsurgical patients had a high prevalence of biofilm-forming bacteria, a possible reflection of the severe nature of their disease. Additional studies are warranted.Affiliations: 1: From The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, 2: Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, 3: Division of Otolaryngology-Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, and 4: Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, Division of Otolaryngology-Head and Neck Surgery, Philadelphia Veterans Administration Medical Center, Philadelphia, Pennsylvania