Fungal isolates and their antifungal susceptibility in cases of chronic rhinosinusitis: A hospital-based observational study.

Background:Chronic rhinosinusitis (CRS) is a persistent inflammatory disorder of the paranasal sinuses, and fungal involvement has gained increasing attention in recent years. Early identification of fungal etiological agents and their antifungal susceptibility patterns is essential for guiding effective therapy and improving outcomes. Objectives: To isolate and identify fungal pathogens in patients with chronic rhinosinusitis and to determine their antifungal susceptibility patterns along with associated clinical factors. Methods: This hospital-based observational study included 100 clinically diagnosed CRS patients. Sinonasal samples were obtained and processed using direct microscopy and fungal culture. Fungal isolates were identified by standard morphological methods. Antifungal susceptibility testing was performed using the CLSI guidelines. Patient demographics, clinical features, and associated comorbidities were recorded and analyzed. Results: The majority of patients belonged to the 31–45 year age group (44%), and 58% were males. Nasal obstruction (82%), post-nasal drip (67%), and facial pain (59%) were the common presenting symptoms. Fungal culture positivity was observed in 42% of cases. Among the isolates, Aspergillus species predominated, with Aspergillus flavus (42.9%) being the most frequent, followed by A. fumigatus (21.4%) and A. niger (9.5%). Candida albicans and Mucor species accounted for 14.3% and 11.9% of isolates, respectively. History of allergic rhinitis (47.6%), diabetes mellitus (28.6%), and prior steroid use (33.3%) were more frequent among fungal-positive cases. Voriconazole showed the highest susceptibility for Aspergillus isolates (85%), while Amphotericin-B was consistently effective for Mucor species. Conclusion: Fungal involvement in CRS is significant, with Aspergillus species being the dominant pathogens. Antifungal susceptibility testing plays a key role in guiding appropriate therapy to prevent complications. Recommendations: Routine fungal culture should be incorporated in CRS evaluation, especially in patients with nasal polyposis, allergic rhinitis, or diabetes. Judicious use of steroids is advised.