Autologous fibrin sealant co-delivered with antibiotics is a robust method for topical antibiotic treatment after sinus surgery

Abstract

Background

Most patients with cystic fibrosis have the risk of pathogenic bacteria being exchanged between their sinuses and lungs.

Aims

A method for topical application of antibiotics where the antibiotics persist for a long period of time is needed.

Material and methods

Ten patients with cystic fibrosis and bacterial sinusitis were included. Autologous platelet rich fibrin was mixed with an antibiotic solution and sprayed onto the mucosa at the end of an endoscopic sinus surgery; Colistin, a Ciprofloxacin-Colistin combination or Tobramycin was used. The antibiotic concentration was measured in the sinonasal mucus four, seven and 13 days after surgery.

Results

Nine patients had Pseudomonas aeruginosa in their nose/sinuses at the time of surgery; in eight of these P. aeruginosa was not detected by culture at the final visit. In the majority of the ten included patients the antibiotics were continuously released for more than 7 days. No severe side effects were seen.

Conclusions

Autologous platelet rich fibrin co-delivered with antibiotics is a feasible method for topical antibiotic treatment in supplementary to sinus surgery.

Significance

We expect that this treatment is successful for eradication of sinonasal bacterial infections in immunosuppressed patients suffering from recalcitrant sinus infections. The efficacy should be evaluated in randomized controlled trials.

Chinese abstract

背景：大多数患有囊性纤维化的患者都有病原细菌在鼻窦和肺之间交换的风险。

目的：如果需要抗生素持续长时间的话, 可用一种局部施用抗生素的方法。

材料和方法：纳入10例囊性纤维化和细菌性鼻窦炎患者。将自体富含血小板的纤维蛋白与抗生素溶液混合, 并在内窥镜鼻窦手术结束时喷洒在粘膜上。使用共价霉素, 即环丙沙星-共价霉素组合或妥布霉素。在手术后四天、七天和十三天测量鼻窦粘液中的抗生素浓度。

结果：9例患者在手术时鼻/鼻窦有铜绿假单胞菌的存在。在最后一次访视时, 其中八例没有检测到培养的铜绿假单胞菌。在十名患者中, 多数出现抗生素持续释放超过7天。没有看到严重的副作用。

结论：自体富含血小板的纤维蛋白与抗生素共同给药是鼻窦手术的辅助局部抗生素治疗的可行方法。

意义：我们期望这种治疗方法能够为患顽固性鼻窦感染的免疫抑制患者成功根除鼻窦细菌感染。应在随机对照试验中评估疗效。

Keywords:

• Cystic fibrosis
• antibiotics
• platelet rich fibrin
• bacterial sinusitis
• topical treatment
• postoperative treatment

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contributions

All authors contributed in planning the study, commented on and approved the final paper. KA enrolled the patients. KA and NH interpreted the data. KA wrote the paper.