Analysis of nasal secretion culture results in diabetic patients with chronic rhinosinusitis and factors influencing postoperative recurrence

Abstract

Background: In diabetic patients, persistent hyperglycemia creates an optimal environment for the proliferation of pathogenic bacteria, resulting in severe complications. Consequently, chronic rhinosinusitis (CRS) complicated by diabetes is highly prevalent in clinical settings.

Aim: To analyze the results of nasal secretion cultures in diabetic patients with CRS and identify the factors influencing postoperative recurrence.

Methods: A retrospective analysis was conducted on the clinical data of 203 diabetic patients with CRS with nasal polyps who underwent the Messerklinger technique at Qingdao Hiser Hospital Affiliated of Qingdao University between January 2021 and January 2023. Preoperative nasal secretions were cultured to determine the types and distribution of pathogenic bacteria and assess antimicrobial susceptibility. Based on a one-year follow-up, patients were categorized into recurrence and nonrecurrence groups to analyze differences in their clinical data. Univariate and multivariate analyses were used to identify factors influencing postoperative recurrence.

Results: Pathogens were detected in 153 of the 203 nasal secretion specimens collected from diabetic patients with CRS. A total of 134 pathogenic bacteria strains were isolated and identified, including 81 strains (60.4%) of gram-positive bacteria and 53 strains (39.6%) of gram-negative bacteria. Gram-positive bacteria exhibited relatively high resistance to penicillin G and erythromycin, while remaining highly sensitive to vancomycin, gentamicin, and rifampicin. Gram-negative bacteria demonstrated relatively high resistance to cefazolin and gentamicin, but showed high sensitivity to imipenem, meropenem, cefepime, and ceftazidime. Univariate analysis revealed statistically significant differences between the recurrence and nonrecurrence groups in fasting blood glucose levels, smoking history, Lund-Mackay scores, visual analog scale (VAS) scores, nasal septum deviation, allergic rhinitis, bronchial asthma, postoperative infection, long-term use of nasal decongestants, and adherence to medical prescriptions. Multivariate regression analysis identified fasting blood glucose levels and VAS-measured nasal symptom severity scores as independent factors influencing postoperative recurrence.

Conclusion: In CRS patients with nasal polyps (CRSwNP), the detection rate of nasal pathogens is relatively high, and most of the isolated bacteria exhibit antimicrobial resistance. Additionally, the blood glucose level of patients with CRS combined with CRSwNP is a risk factor for postoperative recurrence.

Keywords: Chronic rhinosinusitis; Diabetes; Nasal secretions; Pathogen; Postoperative recurrence.