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However, the impact of some bacterial species isolated from inflamed sinus mucosa on biofilm formation is unclear. In particular, the role of<jats:italic>Staphylococcus epidermidis<\/jats:italic>as aetiological agents of<jats:styled-content style=\"fixed-case\">CRS<\/jats:styled-content>is controversial. Moreover, the effect of biofilm formation on neutrophil infiltration and activity in<jats:styled-content style=\"fixed-case\">CRS<\/jats:styled-content>w<jats:styled-content style=\"fixed-case\">NP<\/jats:styled-content>calls for explanation. In this study, biofilms were found in three of 10 patients (mean age\u00a0=\u00a046\u00a0\u00b1\u00a014) with<jats:styled-content style=\"fixed-case\">CRS<\/jats:styled-content>undergoing endoscopic sinus surgery by means of scanning electron microscopy. Unexpectedly,<jats:italic>S.\u00a0epidermidis<\/jats:italic>was the primary isolated bacteria and was also found to be present in all biofilm\u2010positive mucosa specimens, indicating its pivotal role in the pathogenesis of severe chronic infections associated with biofilm formation. We have also measured the activity of myeloperoxidase (<jats:styled-content style=\"fixed-case\">MPO<\/jats:styled-content>), the most abundant neutrophil enzyme, to demonstrate the presence of neutrophils in the samples tested. Our present results show that the level of<jats:styled-content style=\"fixed-case\">MPO<\/jats:styled-content>in<jats:styled-content style=\"fixed-case\">CRS<\/jats:styled-content>associated with biofilm is lower than that without biofilm. It may suggest either a low number of neutrophils or the presence of a type of neutrophils with compromised antimicrobial activity, described as biofilm\u2010associated neutrophils (<jats:styled-content style=\"fixed-case\">BAN<\/jats:styled-content>). Finally, we conclude that further studies with a large number of<jats:styled-content style=\"fixed-case\">CRS<\/jats:styled-content>cases should be performed to establish the association between<jats:italic>S.\u00a0epidermidis<\/jats:italic>and other frequently isolated bacterial species from paranasal sinuses, with the severity of<jats:styled-content style=\"fixed-case\">CRS<\/jats:styled-content>, biofilm formation and the infiltration of<jats:styled-content style=\"fixed-case\">BAN<\/jats:styled-content>.<\/jats:p>","DOI":"10.1111\/iep.12156","type":"journal-article","created":{"date-parts":[[2016,1,14]],"date-time":"2016-01-14T17:30:56Z","timestamp":1452792656000},"page":"378-386","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["<i>Staphylococcus epidermidis<\/i>and biofilm\u2010associated neutrophils in chronic rhinosinusitis. 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