Microbial Analysis in Chronic Rhinosinusitis Patients with Chronic Kidney Disease and End‐Stage Renal Disease

Abstract

IntroductionThis study aimed to elucidate the bacterial profile of chronic rhinosinusitis (CRS) in patients with end‐stage renal disease (ESRD) and chronic kidney disease (CKD) compared with nonrenal patients, guiding antibiotic selection for clinicians.MethodsWe retrospectively analyzed 13,906 inpatients from the Chang Gung Research Database who underwent sinus surgery (2004–2018). Patients were categorized into ESRD‐CRS, CKD‐CRS, and non‐CKD‐CRS based on the estimated glomerular filtration rate. Bacterial cultures from surgical samples were classified as facultative anaerobes or aerobes (e.g., Klebsiella pneumoniae [KP], Pseudomonas aeruginosa [Ps.a]), anaerobes, and fungi and ranked by prevalence.ResultsData from 47 ESRD‐CRS, 230 CKD‐CRS, and 13,123 non‐CKD‐CRS patients were analyzed. In ESRD‐CRS, the predominant species were KP (31.6%), Ps.a (21.1%), and Coagulase‐negative Staphylococcus (CoNS, 15.8%). CKD‐CRS showed Staphylococcus epidermidis (27.7%), CoNS (20.5%), and Ps.a (20.5%). Non‐CKD‐CRS had Staphylococcus epidermidis (29.8%), CoNS (25.0%), and Staphylococcus aureus (15.5%). For anaerobes, ESRD‐CRS was dominated by Fusobacterium nucleatum (10.5%) and Peptostreptococcus micros (10.5%), whereas CKD‐CRS and non‐CKD‐CRS showed Propionibacterium acnes as a primary strain (14.5% and 28.7%, respectively).ConclusionFor CRS in ESRD, antibiotics targeting KP and Fusobacterium nucleatum are recommended. In CKD‐CRS, a focus on Staphylococcus epidermidis and Propionibacterium acnes is suggested.Level of Evidence4 Laryngoscope, 134:3499–3507, 2024