Characteristics of Bacterial Culture Results in Patients With Aspergilloma

Background and Objectives Preoperative suspicion of aspergilloma remains challenging due to overlapping clinical manifestations with bacterial rhinosinusitis and nonspecific early radiologic findings. Although sinonasal bacterial cultures are routinely obtained, their clinical utility as a supportive screening tool remains unclear. This study evaluated whether potential pathogens (PP) or gram-negative organisms in perioperative cultures could serve as a supportive screening tool to facilitate clinical suspicion of aspergilloma.Subjects and Method This retrospective single-center study analyzed 126 patients with pathologically confirmed aspergilloma and 232 non-fungal controls between January 2016 and December 2025. Culture-negative patients were included as a distinct category to minimize selection bias. Sinonasal cultures were collected under endoscopic guidance perioperatively. Isolates were classified based on gram stain and PP, defined as bacteria associated with clinically significant sinonasal infections, including gram-negative groups such as <i>Pseudomonas species</i> and <i>Enterobacterales</i>. Multivariable logistic regression identified culture profiles independently associated with aspergilloma.Results A total of 358 patients were included. The aspergilloma group was older (68.33± 11.54 vs. 50.26±16.25, <i>p</i><0.001) with female predominance. Monomicrobial gram-negative isolates (46.0% vs. 27.2%) and PP (56.3% vs. 31.9%) were more prevalent in the aspergilloma group. Multivariable analysis showed that aspergilloma was independently associated with PP detection (adjusted odds ratio 2.63; 95% confidence interval, 1.51-4.58; <i>p</i><0.001). In the preoperative outpatient subgroup, gram-negative organisms demonstrated a high specificity of 72.4%.Conclusion Detection of PP or gram-negative organisms in sinonasal cultures is significantly associated with pathologically confirmed aspergilloma. These microbiological patterns may serve as a cost-effective, supportive screening tool to complement clinical suspicion of aspergilloma, helping clinicians reconsider prolonged antibiotic use and guide further diagnostic imaging or surgical evaluation.