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Olarte et al The Pediatric Infectious Disease Journal • Volume 33, Number 10, October 2014
| © 2014 Lippincott Williams &Wilkins
We did not identify an association with a particular pneumococ-
cal serotype and S. pneumoniae-only infections. Moreover, we did
not observe a higher rate of recurrence or complications in patients
with S. pneumoniae-only infections. H. influenzae (52%) was over-
all the most common organism co-isolated with S. pneumoniae.
The proportion of sinus cultures positive for S. pneumoniae and H.
influenzae remained unchanged in the post-PCV13 era. However,
we found an increase of Prevotella spp. (+11%; P = 0.02) after the
introduction of PCV13. The importance of anaerobes in chronic
sinusitis has been previously described2,3,5 and their role in pediatric
sinusitis seems to be controversial.4 A recent study from Nether-
lands22 reported that vaccination with PCV7 resulted in a shift in
bacterial composition of the nasopharyngeal microbiota of vacci-
nated healthy children, with an increase in abundance of anaerobic
bacteria, especially Prevotella spp. The change in the isolation rate
of Prevotella spp. that we observed could be related to variations
in the nasopharyngeal microbiota as a result of the introduction of
PCVs or secondary to sampling techniques and improved isolation
of anaerobic organisms.
Some limitations of our study should be recognized. First,
we only studied children with chronic sinusitis, mainly because
pediatric patients with acute sinusitis do not usually undergo a
sinus tap or endoscopic sinus procedure unless their presentation is
complicated with an orbital abscess or an intracranial process that
requires surgical drainage. Therefore, we cannot extrapolate these
results to patients with acute sinusitis. Second, 3 patients had recur-
rence of pneumococcal sinusitis during the study period, but their
isolates were not available. Thus, it is possible that we missed some
cases of chronic sinusitis positive for S. pneumoniae, underestimat-
ing the prevalence of pneumococcal chronic sinusitis. Third, it is
possible that cultures positive for S. pneumoniae reflect inadvertent
contamination of sinus specimen with nasopharyngeal flora and not
a true pathogen.
In conclusion, our study provides evidence of important
epidemiologic changes of pneumococcal chronic sinusitis among
children after the introduction of PCV13. We reported a significant
decline of S. pneumoniae isolation rate in children with chronic
sinusitis at TCH. This decrease of pneumococcal chronic sinusitis
cases was driven by a substantial reduction of PCV13 serotypes,
predominantly serotype 19A. S. pneumoniae continues to represent
an important pathogen in chronic sinusitis especially in children <5
years of age; however, additional studies are needed to fully under-
stand the microbiology of chronic sinusitis in children, particularly
in the PCV13 era.
ACKNOWLEDGMENTS
The authors thank Wendy Hammerman and Andrea Forbes
for their assistance obtaining the pneumococcal isolates and
immunization records.
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