The prevalence of bacterial infection in acute rhinosinusitis: A systematic review and meta-Analysis

Stephanie S. Smith*, Elisabeth H. Ference, Charlesnika T. Evans, Bruce K. Tan, Robert C. Kern, Rakesh K. Chandra

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Objectives/Hypothesis: To systematically assess the prevalence of bacterial infection in adults with acute rhinosinusitis (ARS).

Methods: Electronic databases were systematically searched for relevant studies published up to June 2012.

Results: Twenty-nine articles, evaluating a total of 9,595 patients with a clinical diagnosis of ARS, were included in the study. Of these, 14 (48%) studies required radiographic confirmation of sinusitis, one study (3%) required evidence of purulence, 10 studies (35%) required both for inclusion in the study population, and four studies (14%) required neither. The random effects model estimate of prevalence of bacterial growth on all cultures was 53.7% (CI 48.4%-59.0%), ranging from 52.5% (CI 46.7%-58.3%) in studies requiring radiographic confirmation of sinusitis to 61.1% (CI 54.0%-68.1%) in studies requiring neither radiographic evidence nor purulence on exam. Studies that obtained cultures from antral swab had a prevalence of bacterial growth of 61.0% (CI 54.7%-67.2%), whereas those utilizing endoscopic meatal sampling had a prevalence of 32.9% (CI 19.0%-46.8%).

Conclusions: Few studies evaluate the recovery of bacteria via culture in adults with a diagnosis of ABRS or ARS based on clinical criteria alone. With radiographic and/or endoscopic confirmation, antral puncture and endoscopically guided cultures produce positive bacterial cultures in approximately one-half of patients. Opportunities exist to improve diagnostic accuracy for bacterial infection in ARS.

Original languageEnglish (US)
Pages (from-to)57-69
Number of pages13
Issue number1
StatePublished - Jan 1 2015


  • Acute rhinosinusitis
  • Antral puncture
  • Bacterial infection
  • Endoscopic middle meatus culture
  • Meta-Analysis
  • Systematic review

ASJC Scopus subject areas

  • Otorhinolaryngology

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