In vitro analysis of growth patterns of invasive fungal species on commonly used endonasal hemostatic agents

• Published in: American journal of otolaryngology Vol. 40; no. 1; pp. 101 - 105
• Main Authors: Ito, Christopher, Sharbel, Daniel, McMullen, Allison, Kountakis, Stilianos
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2019; Elsevier Limited
• Subjects: Aspergillus - drug effects; Aspergillus - growth & development; Bone marrow; Carboxymethylcellulose Sodium - pharmacology; Culture Techniques; Endoscopy; Fungi; Fusarium; Fusarium - drug effects; Fusarium - growth & development; Gelatin; Gelatin Sponge, Absorbable - pharmacology; Growth patterns; Hemorrhage; Hemostasis; Hemostatics - pharmacology; In vivo methods and tests; Invasive fungal sinusitis; Invasive species; Low concentrations; Methylcellulose; Model testing; Mucor; Mucor - drug effects; Mucor - growth & development; Nasal packing; Nutrient sources; Nutrients; Paranasal Sinuses - surgery; Patients; Potatoes; Sinuses; Sinusitis; Species; Stains & staining; Starch; Starch - pharmacology; Substrates; Surgeons; Surgery; Thrombin; Thrombin - pharmacology; United States > US; Nasal packing; Hemostasis; Invasive fungal sinusitis
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/j.amjoto.2018.09.016

Previous studies have not examined the potential role of endonasal hemostatic agents in facilitating growth of fungal species. We aim to determine the possibility of these to serve as a nutrient source for fungal growth.
Cultures of Aspergillus, Fusarium, and Mucor were harvested and placed in solution in sterile saline at standardized high and low concentrations. Thrombin gelatin matrix, carboxyl methylcelluose, and potato starch derivative agents were prepared following manufacturer instructions and applied to two separate Petri dishes per agent. Each substrate was then inoculated with either high or low concentrations of fungal species. Negative and positive control plates with each organism were included. Dishes were sealed, incubated, and examined daily for fourteen days for microscopic and macroscopic growth.
Thrombin gelatin matrix was relatively resilient to growth, although Fusarium growth was noted on all packing material by day three. Carboxyl methylcellulose also supported growth of high-concentration Mucor appreciated on day five. The potato starch derivative supported fulminant growth of all fungal species.
Endonasal hemostatic agents may be nutrient sources that facilitate growth of fungal species. This may be a consideration in a surgeon's decision to use a hemostatic agent. Prompt initial post-operative debridement may be warranted in select patients. Our findings serve as a model for further testing of fungal growth on other hemostatic materials. Future studies are needed to confirm the clinical significance of these findings in vivo.