Evaluation of Children Diagnosed with Acute Bacterial Sinusitis: Single-center Experience

Abstract

Objectives: Acute bacterial sinusitis (ABS) is among frequent infections in children. Its diagnosis is clinical unless a suspicion of complication exists. This study aimed to evaluate pediatricians’ clinical approaches to ABS. Materials and Methods: This retrospective study analyzed diagnosis, treatment and complication data of patients diagnosed with ABS between June 2015 and June 2018 in our pediatric primary care unit. Results: The study group consisted of 536 patients [female/male 235/301 (43.8%/56.2%)]. The median age was 6.6 (7 months-17.9 years) years. Median duration of symptoms was 7 (1-46) days. Major complaints were cough (n=379, 70.7%), nasal discharge (n=234, 43.7%) and fever (n=168, 31.3%). Among 468 patients with available data, persistent (>10 days) upper respiratory tract infection (URTI) was present in 198 (42.3%) while 8 (1.7%) had severe URTI. Worsening URTI data could not be defined because of inadequate records. Duration of symptoms was <3 days in 26 (16.2%) patients. Physical examination revealed postnasal discharge (n=393, 73.3%), frontal pain (n=26, 4.9%) and sinus tenderness when pressure was applied (n=25, 4.7%). Water’s paranasal sinus radiograph was performed in 38 (7.1%) patients. Most preferred antibiotics were amoxicillinclavulanate 167 (78.4%), clarithromycin 18 (8.5%) and cefdinir 13 (6.1%). Symptomatic treatment was rarely prescribed [nasal decongestant (n=38, 17.8%), systemic antihistamines (n=23, 10.8%]. The median treatment period was 10 (3-30) days. Five patients (0.9%) were hospitalized for complications [preseptal cellulitis (n=4), frontal bone osteomyelitis and subdural abscess secondary to facial cellulitis (n=1)]. Patients with preseptal cellulitis were treated with parenteral ampicillin-sulbactam and the patient with osteomyelitis and abscess received ceftriaxone, vancomycin and metronidazole treatment following abscess drainage. Conclusion: Our results indicate that the diagnosis was substantially based on clinical evaluation even though complete compliance to clinical definitions recommended by current guidelines was lacking, and antibiotic treatment plans were often correct. Moreover, although rare, performance of further investigations and/or prescription of symptomatic treatment were observed. It was aimed to emphasize that clinicians should be encouraged for complete patient records and compliance to current guidelines.

Keywords

• Bacterial Sinusitis
• Children
• Current Guideline

Akut Bakteriyel Sinüzit Tanısı Konulan Çocukların Değerlendirilmesi: Tek Merkez Deneyimi

Abstract

Amaç: Akut bakteriyel sinüzit (ABS) çocukluk çağının sık görülen enfeksiyonlarındandır. Tanısı komplikasyon şüphesi olmadıkça klinik olarak konulmaktadır. Bu çalışmanın amacı çocuk hekimlerinin ABS konusunda klinik yaklaşımlarının değerlendirilmesidir. Gereç ve Yöntem: Bu retrospektif çalışmada Haziran 2015-Haziran 2018 arasında hastanemiz genel polikliniğinde ABS tanısı alan hastaların tanı, tedavi ve komplikasyon verileri araştırılmıştır. Bulgular: Çalışma grubunu 536 hasta [kız/erkek 235/301 (%43,8/%56,2)] oluşturdu. Yaş ortancası 6,6 (7 ay-17,9 yıl) yıldı. Ortanca yakınma süresi 7 (1-46) gündü. Başlıca yakınmalar öksürük (n=379, %70,7), burun akıntısı (n=234, %43,7) ve ateş yüksekliği (n=168, %31,3) idi. Yakınma süresi kaydedilen 468 hastanın 198’inde (%42,3) uzamış (>10 gün) üst solunum yolu enfeksiyonu (ÜSYE), 8’inde (%1,7) şiddetli ÜSYE mevcuttu. Kötüleşen ÜSYE olan hasta sayısı kayıt yetersizliği nedeniyle belirlenemedi. Yetmiş altı (%16,2) hastanın yakınma süresi 3 günden kısaydı. Fizik incelemede postnazal akıntı (n=393, %73,3), başın öne eğilmesiyle alında ağrı (n=26, %4,9) ve sinüslere basıyla hassasiyet (n=25, %4,7) mevcuttu. Waters sinüs grafisi 38 hastada (%7,1) çekilmişti. En sık tercih edilen antibiyotikler amoksisilin-klavulonat 167 (%78,4), klaritromisin 18 (%8,5) ve sefdinir 13 (%6,1) idi. Semptomatik tedaviler nadiren reçete edilmişti [nazal dekonjestan (n=38, %17,8), sistemik antihistaminik (n=23, %10,8]. Tedavi süresi ortancası 10 (3-30) gün idi. Beş hasta (%0,9) komplikasyon nedeniyle hospitalize edilmişti [preseptal selülit (n=4), fasiyal selülite ikincil frontal kemik osteomiyeliti, subdural apse (n=1)]. Preseptal selülit tanısı alan hastalar parenteral ampisilin-sulbaktam, frontal osteomiyelit ve apsesi olan hasta apse drenajı sonrası seftriakson, vankomisin ve metronidazol tedavisi almıştı. Sonuç: Çalışmamızda ABS tanısında güncel kılavuzlarda önerilen klinik tanımlamalara uyum tam olmasa da tanının büyük oranda klinik olarak konulduğu ve antibiyotik tedavi planının sıklıkla doğru olduğu görülmüştür. Bununla birlikte nadiren de olsa tanı amaçlı ek incelemelerin yapıldığı ve/veya semptomatik tedavilerin reçete edildiği dikkati çekmiştir. Klinisyenlerin hasta kayıtlarının eksiksiz olması ve güncel kılavuzlara uyum konusunda desteklenmesi gerektiği vurgulanmak istenmiştir.

Keywords

• Akut Bakteriyel Sinüzit
• Çocukluk Çağı
• Güncel Kılavuz

Ethical Statement

Bu çalışma için etik komite onayı alınmıştır.

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