Exacerbations of Chronic Rhinosinusitis—Microbiology and Perspectives of Phage Therapy
Abstract
:1. Introduction
1.1. Antimicrobial Treatment in Patients with CRS
- (1)
- Antibiotics are expected to alleviate the baseline symptoms of CRS, because they decrease the load of bacteria that may supposedly play a role in perpetuating the inflammation [6];
- (2)
- (3)
- Antibiotics eliminate bacteria that cause acute exacerbations of CRS (AECRS) i.e., acute infections that temporarily worsen the chronic symptoms.
1.2. Bacteriophage Therapy Versus Antibiotic Therapy for AECRS
- Increasing prevalence of antibiotic-resistant bacteria is observed in sinonasal infections worldwide;
- Biofilms that constitute a bacterial reservoir for recurrent exacerbations prove virtually impossible to eradicate with antibiotics;
- Non-selective elimination of both pathogenic and potentially beneficial bacteria caused by antibiotics results in uncontrolled repopulation of the empty niches. This process cannot be controlled and may not lead to restoration of an ‘optimal’ microbial community. The role of potential probiotics is still too poorly understood to prevent reintroduction of pathogenic species;
- Repeated courses of antibiotic therapy may contribute to increasing antibiotic resistance of the patient’s microbiota;
- In some patients, antibiotics cause serious adverse effects or allergic reactions.
- The mechanisms of antibiotic and phage resistance are entirely different. Therefore, bacterial strains that acquired antibiotic resistance frequently remain sensitive to phages;
- Some phages are able to penetrate and disrupt bacterial biofilms;
- The phages are highly selective. They eliminate only selected bacterial strains and leave the rest of the microbial community intact;
- Introduction of phage therapy instead of repeated antibiotic courses may prevent further selection of antibiotic-resistant strains;
- Phage preparations were shown to be generally safe and well-tolerated.
1.3. Aims of the Study
2. Results
3. Discussion
3.1. Microbiology and Antibiotic Resistance in AECRS
3.2. Phage Therapy for AECRS
3.3. Limitations of the Study
- Culture provides limited information compared to molecular methods that would allow for more profound analysis of the microbiota in AECRS [13]. Culture-dependent techniques were utilized in this study because they were required for phage typing, which was the essential part of the project.
- The current study did not include identification of anaerobes; further research is required to address this problem.
- Phage susceptibility testing was limited to the contents of the collection available for our study. However, the collection is still being developed and there is a possibility of phage isolation on demand.
- Further research is required to test the phage sensitivity of bacteria in biofilms and in polymicrobial communities.
4. Materials and Methods
4.1. Patient Recruitment
4.2. Specimen Collection
4.3. Bacterial Culture and Identification
4.4. Determination of Antibiotic Resistance
4.5. Phage Typing—Spot Test
- n—no clearing—no bacterial lysis in the spot;
- p—a few single plaques in the spot;
- o3—turbid spot—very weak bacterial lysis in the spot;
- o2—medium turbid spot—weak bacterial lysis in the spot;
- o1—almost clear spot—very weak bacterial growth in the spot;
- c—completely clear spot—complete bacterial lysis in the spot.
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Gender | Male 23 (46%) Female 27 (54%) |
---|---|
Age | 25–80 (mean 51) |
Nasal polyps | 45 (90%) |
Comorbidities | |
Asthma | 27 (54%) |
Allergy (to pollen, dust mites, etc.) | 19 (38%) |
Aspirin-exacerbated respiratory disease | 10 (20%) |
Gastroesophageal reflux | 8 (16%) |
History of CRS (years) | 1.5–45 (median 10) |
History of recurrent exacerbations and repeated antibiotic treatment | 31 (62%) |
Number of prior ESS procedures | 1–5 (median 1.5) |
Time since the last ESS (months) | 1–96 (median 11) |
Lund–Mackay computed tomography staging score [29] prior to surgery (total 0–24) | 6–24 (median 15) |
Modified Lund–Kennedy endoscopic score [30] on enrollment (0–2 for polyps, edema, discharge on each side, total 0–12) | 2–12 (mean 6) |
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Szaleniec, J.; Gibała, A.; Pobiega, M.; Parasion, S.; Składzień, J.; Stręk, P.; Gosiewski, T.; Szaleniec, M. Exacerbations of Chronic Rhinosinusitis—Microbiology and Perspectives of Phage Therapy. Antibiotics 2019, 8, 175. https://doi.org/10.3390/antibiotics8040175
Szaleniec J, Gibała A, Pobiega M, Parasion S, Składzień J, Stręk P, Gosiewski T, Szaleniec M. Exacerbations of Chronic Rhinosinusitis—Microbiology and Perspectives of Phage Therapy. Antibiotics. 2019; 8(4):175. https://doi.org/10.3390/antibiotics8040175
Chicago/Turabian StyleSzaleniec, Joanna, Agnieszka Gibała, Monika Pobiega, Sylwia Parasion, Jacek Składzień, Paweł Stręk, Tomasz Gosiewski, and Maciej Szaleniec. 2019. "Exacerbations of Chronic Rhinosinusitis—Microbiology and Perspectives of Phage Therapy" Antibiotics 8, no. 4: 175. https://doi.org/10.3390/antibiotics8040175