Impact of the Mask Mandate on the Microbiology of Complicated Sinusitis During the COVID-19 Pandemic at a Tertiary Academic Hospital

Abstract Background The COVID-19 pandemic led to widespread mask mandates, significantly altering respiratory infection patterns. This study evaluates the impact of these mandates on the microbiology, clinical presentations, and complications of complicated acute sinusitis. Objective To assess changes in the clinical presentation, microbiological patterns, and bacterial antimicrobial resistance (AMR) trends of complicated acute sinusitis before and during the COVID-19 pandemic. Methods This retrospective observational study analysed cases of complicated acute sinusitis requiring surgical intervention at Chris Hani Baragwanath Academic Hospital from January 2017 to June 2022. Data on demographics, microbiology, complications, and AMR were compared between the pre-COVID (January 2017–February 2020) and COVID (March 2020–June 2022) periods. Results Seventy-three patients met the inclusion criteria. The median age was lower during the COVID period (14.7 years) compared to pre-COVID (17.8 years). A significant increase in Chandler 3 orbital complications (5 vs. 15 cases) and extradural abscesses (3 vs. 10 cases) was observed during the Covid-19 period as against to before Covid-19 period. The predominance of Streptococcus species increased from 45% pre-COVID to 60% during COVID, with a concerning rise in AMR trends, particularly among Gram-positive organisms. Conclusion The COVID-19 pandemic and associated public health measures influenced the clinical and microbiological characteristics of complicated sinusitis. These findings highlight the importance of timely diagnostics, robust antimicrobial stewardship, and public health strategies that balance infection control measures with mitigating unintended consequences of prolonged mask use and delayed healthcare access.