Acute rhinosinusitis complications: risks and role of prior antibiotics

Sinus infections account for more adult outpatient antibiotic prescriptions than any other diagnosis. Every year, sinus infections affect approximately 15% of the adult population, account for 14 million adult outpatient visits, and impart a direct cost burden of $5.8 billion. Despite major guidelines recommending against antibiotics for typical sinus infections lasting less than 12 weeks (acute rhinosinusitis, ARS), antibiotics are prescribed in more than 80% of ARS patient visits. Thus, ARS is a major target in national efforts to decrease unnecessary antibiotic intervention, reduce costs, and improve quality of care. The most defensible rationale for the high rate of antibiotic treatment of ARS is concern for the rare, but devastating occurrence of bloodstream, eye, or brain complications due to spread of bacterial infections. However, little is known about who is at risk of developing complications. Furthermore, the role of antibiotics in preventing complications, or lack of such a role, is unknown. Two recent studies from Europe suggest that antibiotics do not play a role in preventing ARS complications. Our preliminary data demonstrate that ARS complications are more common in young males and patients of lower socioeconomic status. Our long term goal is to improve guidelines, eliminate disparities, and improve outcomes for ARS complications. Identifying which ARS patients at greatest risk for complications and the contributing factors will elucidate ways to achieve the long-term goal, and will be accomplished by two main specific aims to: (1) Analyze existing data from the AHRQ’s Healthcare Cost and Utilization Project Nationwide Inpatient Sample database to establish national estimates of ARS complications and clarify the patients at greatest risk; and (2) Analyze data from the Chicago Health Atlas Database, a clinical data research network with over 6 million electronic health records of all patients at 8 major Chicago-area healthcare institutions, to determine whether antibiotics in the outpatient setting prevent development of severe ARS complications.