Pseudomonas in sinuses

Hi @betsey, I'm tagging @sueinmn on this discussion.
Several members talk about pseudomonas in the MAC & Bronchiectasis support group here https://connect.mayoclinic.org/group/mac-bronchiectasis/

You may wish to review this discussion:
- Pseudomonas: What antibiotic treatment worked for you?: https://connect.mayoclinic.org/discussion/pseudomonastobramycin-meropenem/

@betsey Pseudomonas infections are considered "opportunists" so if you have primary immunodeficiency, it can crop up in many places. Sinuses are definitely one of them.
Unfortunately, pseudomonas is slow to respond to treatment, but for sinus involvement Tobramycin rinse is considered the "gold standard." When it was in my lungs, each antibiotic was used for at least 4 weeks before reevaluation - it took 3 months to conquer.
So I would say you need to have a little patience, but if you don't begin to feel better after 3 weeks, it is probably time for a test of the sensitivity of your strain - a second oral or injected antibiotic might need to be added. That has it's own downside because these can have their own side effects.
Are you seeing an ENT ot ID doc for this?
Sue

What ended up working for you? I'm the same and going through the same thing. the Tobr isn't working for me in sinuses..

How long did it take to feel it was working in the sinuses? I've been on it two weeks and it weeks worse, plus now my face of swollen. I have CVID too and Myasthenia Gravis Gen.. I am about to go to the ER for help, can't get into an ID doc for weeks.

I have this and the tobramycin and levaquin isnt working for me. It keeps coming back. What type of IV medication is the alternative?

Im not a doctor but I have had repetitive sinus infections until Mayo Clinic diagnosed me with Acute eosinophilic sinus disease in 2007. I was put on Kenalog injections which helped for several years. Then in 2014, Mayo clinic diagnosed AERD, Aspirin Exacerbated respiratory disease. This is a somewhat rare but becoming more prevalent problem that was difficult to diagnose. However, it reveals itself with chronic sinusitis, nasal polyps, and asthma like symptoms. Also known as Samter's Triad. If I took aspirin or nsaids (ibuprofen), I would go into a severe asthmatic eruption that I had never experienced before. That was the tell tail sign of AERD according to the allergist at Mayo Clinic, Rochester Mn. Most recently, my Mayo ENT suggested trying Dupixent rather than oral steroids as I was diagnosed with bone loss due to the prednisone and Kenalog injections. So far, Dupixent has been controlling the symptoms of AERD very well. I never get sinus infections but some occasional swelling and use sea salt nasal flushes with Budesonide to further sooth the sinuses.

In addition to this, back in 2007, I was diagnosed by an integrative health specialist to have food intolerances to: wheat, corn, and soy. Also any type of beer, wine, and fermented food would cause running nose, and sinus infection symptoms for a day or so. The doctor attributed this condition to dysbiosis or an im-balance of gut flora or yeast overgrowth (thrush). The overuse of antibiotics (six courses in 3 months) killed all of the good bacteria and allowed the bad bacteria to proliferate. I learned to avoid all of those foods and drinks but due to cross contamination at restaurants, I have to be very careful and always discuss with the Chef so they know how to keep it clean. I was treated with pro-biotics, gut repair supplements, and controlled diet. Intolerances still exist regardless of all the treatments.

I hope this is helpful and perhaps leads to a diagnosis for you. Your condition may be totally due to the strong bacterial infection you mentioned. I just cringe when I hear about the continued use of broad spectrum anti-biotics and damage they do to the gut flora.
Seek alternative advice from other doctors if possible. Best of Health to you!

@betsey I too have been diagnosed with pseudomonas in my sinus (right maxillary) after a few years of chronic sinusitis. Did you find an antibiotic that worked to eradicate it? I recently had oral surgery to remove infection from the bone above a root canal (and the root debris left in there), had a bone graft, and it seems to be healing. However the infection in my sinus is not gone. I've been on several antibiotics (now on colistimethate in a rinse which isn't doing anything). I'm beginning to think I need to find a different doctor that will have more of a sense of urgency in eradicating it. I mean it was in my jaw bone...what is to say it hasn't spread to other bones in my sinuses! Anyway, any news on your journey would be appreciated.

@meli2024 What symptoms did you have with the Pseudomonas in your maxillary sinus? I had sinus surgery for a complete blockage of my left maxillary sinus and the doctor said it was one of the worst he has seen, but keeps insisting it wasn't in the bone. The infection has not gone away, and he just did a culture. Waiting for results. He did mention possible Pseudomonas. I have a horrible smell in my sinus all of the time, to the point where it makes me nauseated. I'm doing saline rinses with baby shampoo, but he has so far declined to do any antibiotic rinses. I'm not sure why. I have been on 6 courses of antibiotics over the past 4 months, and he has prescribed my 7th course, but I have refused to take it. I'm currently battling side effects from the many courses of antibiotics, and am just not willing unless I have systemic effects from the infection. He finally referred me to someone else, but I can't get in until August. Did the bone infection show up on a scan? Thanks!

@caltex Really sorry to hear of your struggles with this! My history is a bit of a book but here goes.

I had surgery to open up my sinuses about 25 years ago, but for the past 3+ years now I've had chronic sinus infections that won't clear up. The usual symptoms of a sinus infection to begin with (sinus headache, discharge, stuffy head, etc.), but developed into a nasty discharge from my right sinus, complete opacification of my right maxillary sinus, an infection smell that would lighten slightly but always return with a vengeance, and no antibiotic could eradicate it. After 3+ years of antibiotics in sinus rinses, orally and eventually via a picc line when a culture was finally done and Pseu was discovered. Even then, the ENT #2 who sent the specimen in told me not to worry about the Pseu results and to just keep doing the sinus rinse he prescribed. Eventually I saw an ID doctor and she put me on the picc line with cefepime 3x/day for 4 weeks - but that didn't work either. ENT #3 took a look at the lab results and saw that in addition to the Pseu bacteria there was also a bacteria usually associated with dental infections. She told me to go see my dentist to rule out any issues there - I had an infection around the remnants of an old root canal, so had an Endodontist surgery to remove the infection and root remnant (he went into the bone above the tooth/crown and drilled out the infection, then did a bone graft and tissue regeneration). BUT I still have the infection and my ENT now wants to do a mega-antrostomy. She took another "sample" yesterday so I should have the results soon to know if it is still Pseu or something else. One of my concerns is that my right eye has been swollen underneath for several months now and I'm concerned the infection has spread/is affecting that area. The only scan my ENT has ordered for me is a CT of my sinuses, but I want some type of imaging that could help detect infection in the bone/tissues on the entire right side of my head/face. If there is such an animal.

I am hoping to get an appointment at Mayo in Jacksonville - I would like to have someone who can do a complete review and imaging - no more guessing and throwing different things at this to see if something works!

I don't know if my saga is of any help to you. I do wish you luck in finding the care you need to get healthy...I know it is out there - we just have to be persistent and our own advocate...no matter how exhausting! All the best - M

@meli2024 Thank you so much for sharing your story. Wow. You have been through so much! I pray you get your answers in Jacksonville. I finally got a call from my doctor 10 days after I sent a message saying I have been unable to take round 7 of antibiotics due to the side effects becoming intolerable. I've been managing just with rinses. He said the culture came back resistant staph, not pseudomonas as we both thought. I hope the results are correct. Starting vancomycin irrigation and oral clindamycin so I can further wreck the rest of my body haha. Hopefully this will be the end!! Our stories do sound eerily similar. Hang in there.