Medical therapy reduces microbiota diversity and evenness in surgically recalcitrant chronic rhinosinusitis

Authors

  • Cindy M. Liu MD, MPH,

    1. Center for Microbial Genetics and Genomics, Northern Arizona University, Flagstaff, AZ
    2. Center for Microbiomics and Human Health, Translational Genomics Research Institute, Flagstaff, AZ
    3. Department of Pathology, The Johns Hopkins School of Medicine, Baltimore, MD
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  • Katerina Soldanova BS,

    1. Center for Microbial Genetics and Genomics, Northern Arizona University, Flagstaff, AZ
    2. Center for Microbiomics and Human Health, Translational Genomics Research Institute, Flagstaff, AZ
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  • Lora Nordstrom PhD,

    1. Center for Microbiomics and Human Health, Translational Genomics Research Institute, Flagstaff, AZ
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  • Michael G. Dwan BS,

    1. Center for Microbial Genetics and Genomics, Northern Arizona University, Flagstaff, AZ
    2. Center for Microbiomics and Human Health, Translational Genomics Research Institute, Flagstaff, AZ
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  • Owain L. Moss BS,

    1. Center for Microbiomics and Human Health, Translational Genomics Research Institute, Flagstaff, AZ
    2. Department of Pathology, The Johns Hopkins School of Medicine, Baltimore, MD
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  • Tania L. Contente-Cuomo MS,

    1. Center for Microbiomics and Human Health, Translational Genomics Research Institute, Flagstaff, AZ
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  • Paul Keim PhD,

    1. Center for Microbial Genetics and Genomics, Northern Arizona University, Flagstaff, AZ
    2. Center for Microbiomics and Human Health, Translational Genomics Research Institute, Flagstaff, AZ
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  • Lance B. Price PhD,

    1. Center for Microbiomics and Human Health, Translational Genomics Research Institute, Flagstaff, AZ
    2. Department of School of Public Health and Health Services, George Washington University, Washington, DC
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  • Andrew P. Lane MD

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, MD
    • Correspondence to: Andrew P. Lane, MD, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Outpatient Center, 6th Floor, 601 N. Caroline Street, Baltimore, MD 21287; e-mail: alane3@jhmi.edu

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  • Funding sources for the study: National Institutes of Health (1R15DE021194-01) NIDCR/NIAID to CML, LBP, and APL; Translational Genomics Research Institute Sylvia Chase Postdoctoral Fellow Grant; Northern Arizona University Technology and Research Initiative Fund (TRIF) fund; Cowden Endowment in Microbiology.

  • Potential conflict of interest: None provided.

Abstract

Background

Chronic rhinosinusitis (CRS) is a highly prevalent and heterogeneous condition frequently treated with antibiotics and corticosteroid therapy. However, the effect of medical therapy on sinus microbiota remains unknown.

Methods

We enrolled CRS patients (n = 6) with patent maxillary antrostomies and active mucosal inflammation, who had not received antibiotics or corticosteroids in the previous 8 weeks. A pretreatment and posttreatment maxillary sinus swab was collected, from which DNA was extracted, pyrosequenced, and analyzed using a naïve Bayesian classifier and ecological analyses.

Results

Four patients showed significant improvement in endoscopic appearance. The shifts in microbiota in response to therapy were highly individualized. There was no single common microbiota profile among patients with similar clinical outcomes, but overall there was significant decrease in microbiota diversity (t(5) = 2.05, p = 0.10) and evenness (t(5) = 2.28, p = 0.07) after treatment.

Conclusion

Our findings strongly correlate with earlier studies that examined the impact of antibiotics on human microbiota. We observed that posttreatment, patients frequently became colonized by taxa that are less susceptible to the prescribed antibiotics. Our findings highlight the challenge in seeking generalizable diagnostic and therapeutic options in CRS, particularly regarding microbiological response and outcomes.

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