Acute Paranasal Sinusitis in Critically Ill Patients: Guidelines for Prevention, Diagnosis, and Treatment (original) (raw)
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Clinical Infectious Diseases, 1998
A prospective observational cohort study of nosocomial sinusitis was carried out in two medical intensive care units. Sinusitis was diagnosed by computed tomographic scanning and the culture of sinus fluid obtained by puncture of a maxillary sinus. Clinical and epidemiological data were collected at the time of admission to the unit and daily thereafter. Specimens from the nares, oropharynx, trachea, and stomach were cultured on admission and daily thereafter. The cumulative incidence of nosocomial sinusitis was 7.7%, and the incidence rates were 12 cases per 1,000 patientdays and 19.8 cases per 1,000 nasoenteric tube -days. Risk factors for nosocomial sinusitis, as determined by multiple logistic regression analysis, included nasal colonization with enteric gramnegative bacilli (odds ratio [OR], 6.4; 95% confidence interval [95% CI], 2.2 -18.8; P Å .007), feeding via nasoenteric tube (OR, 14.1; 95% CI, 1.7 -117.6; P Å .015), sedation (OR, 15.9; 95% CI, 1.9 -133.5; P Å .011), and a Glasgow coma score of £7 (OR, 9.1; 95% CI, 3.0 -27.3; P Å .0001).
Evaluation of sinusitis in the intensive care unit patient
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2003
The purposes of this study were to evaluate the effectiveness of radiologic studies in diagnosing sinusitis in the intensive care unit (ICU) patient and to compare it with the effectiveness of endoscopic examination of the middle meatus. We conducted a prospective collection of data in 141 ICU patients consulted for sinusitis over a 5-year period beginning in the 1994. Antral lavage was performed at least unilaterally in 112 patients, with a total of 195 lavages performed. Plain films and computer tomography scans predicted purulence in 41% (chi(2) = 2.9, P = 0.09) and 47% (chi(2) = 2.2, P = 0.14) of the cases, respectively, whereas the presence of purulence in the middle meatus as seen on endoscopy predicted purulence in the maxillary sinus in 78% of the lavages (chi(2) = 28.9, P = 8 x 10(-8)). When there was no evidence of purulence in the middle meatus on endoscopy, 73% of the lavages were negative. The most important predictor of a positive antral lavage in the ICU patient with ...
Role of antral puncture in the treatment of sinusitis in the intensive care unit
Otolaryngology - Head and Neck Surgery, 1998
OBJECTIVE: The objective of this study was to determine whether maxillary sinus puncture caused an alteration in antibiotic treatment and thus affected the outcome of sinusitis in the intensive care unit. STUDY DESIGN: A retrospective review was done of cases of maxillary sinus puncture between 1991 and 1994. RESULTS: Forty-two patients were identified. All patients had findings suggestive of sinusitis on plain sinus films or CT scans of the sinuses. Twenty-five punctures (60%) recovered pus, of which 80% grew organisms. Fourteen patients (33%) had a negative lavage, and 12% of these samples grew organisms (p = 0.001). Sixty-eight percent of the cultures identified a single organism compared with 32% with multiple organisms. Gram-negative organisms were found most commonly, followed by anaerobes. In 57% of the cases antibiotic therapy was changed. In 77% of the cases the change was directed by the culture result and in 35% the therapy was changed despite a negative culture result (p = 0.002). Resolution of symptoms occurred in 83% of patients who had antibiotics changed whereas with no change in antibiotics only 42% had resolution (p = 0.001). CONCLUSION: A sinus puncture seems to be helpful in patients with fever and positive findings on sinus films. If pus is obtained by maxillary puncture, a positive culture may be found in 80% of the cases. Changes in antibiotic regimen on the basis of culture findings seem to give a better outcome.
Critical care (London, England), 2005
Sinusitis is a well recognised but insufficiently understood complication of critical illness. It has been linked to nasotracheal intubation, but its occurrence after orotracheal intubation is less clear. We studied the incidence of sinusitis in patients with fever of unknown origin (FUO) in our intensive care unit with the aim of establishing a protocol that would be applicable in everyday clinical practice. Sinus X-rays (SXRs) were performed in all patients with fever for which an initial screening (physical examination, microbiological cultures and chest X-ray) revealed no obvious cause. All patients were followed with a predefined protocol, including antral drainage in all patients with abnormal or equivocal results on their SXR. Initial screening revealed probable causes of fever in 153 of 351 patients (43.6%). SXRs were taken in the other 198 patients (56.4%); 129 had obvious or equivocal abnormalities. Sinus drainage revealed purulent material and positive cultures (predomina...
Acute sinusitis: pitfalls in diagnosis and management
Clinical Risk, 2010
Acute sinusitis is one of the most common conditions that can present to a wide variety of clinicians ranging from general practitioners, Accident and Emergency, physicians, ophthalmologists and otolaryngologists to intensivists and even neurosurgeons. Delayed diagnosis with failure to recognize and manage (albeit rare) complications can be devastating for patients, potentially resulting in blindness or even death. Management of the condition itself can lead to complications. This article reviews the current guidelines for diagnosis and management of acute sinusitis with emphasis on medicolegal aspects. Adverse events affecting patients with acute sinusitis are also presented illustrating the challenges in the assessment and management of this condition.
Medical Management of the Paranasal Sinus Infections
Challenging Issues on Paranasal Sinuses, 2018
Rhinosinusitis is a common disease among all the sinus diseases, and unsuccessful attempts to these infections may result not only in economic burdens but also in increasing the numbers of untreated patients in the community. Medical management of the rhinosinusitis includes antibiotics, antihistamines, nasal decongestants, corticosteroids, mucolytics, leukotriene antagonists, and nasal irrigations. Each treatment option must be selected for appropriate patient and prescriptions must be tailored according to the patient's need. These needs must depend on the endoscopic examination, symptoms, and sinus cultures and computed tomography. It is also a matter of debate whether these investigations lead to treatment or not, but it would be wrong to expect that a single examination method and physical examination alone should direct treatment in the first place. As a result, managing the process with the most appropriate examination methods for the patient's complaints will be the most beneficial approach.
Microbiology of acute complicated bacterial sinusitis at the University of the Witwatersrand
South African Medical Journal, 2010
The microbiology of bacterial sinusitis has been studied extensively. The most common pathogens cited are aerobes and facultative anaerobes that include Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis, Klebsiella pneumoniae, Pseudomonas aeruginosa and S. milleri. 1-9 Anaerobic organisms, isolated from as many as one-third of patients, include Propionibacterium acnes and Peptostreptococcus, Prevotella, Enterobacter, Bacteroides and Fusobacterium species. 9,10 Despite the abundance of published studies there are very few that report on the microbiology of acute complicated sinusitis. 3-8,11,12 Complicated sinusitis is associated with debilitating and potentially life-threatening orbital, intracranial, bone and soft-tissue complications; its treatment is both a medical and a surgical emergency. 3,5,6,11,13,14 At the University of the Witwatersrand, patients with complicated sinusitis are referred to the Department of Otorhinolaryngology where they usually present with any combination of sinus involvement (maxillary, ethmoid, frontal and sphenoid) and one or more associated complications. 3,5,6,11,13,14 A routine clinical assessment and computed tomography scan diagnosis is made before any surgery. Prompt medical treatment, with or without surgery, is then commenced. This entails initial empirical use of antibiotics
Acute bacterial sinusitis in children: an updated review
Drugs in Context
Background: In the pediatric age group, approximately 7.5% of upper respiratory tract infections (URIs) are complicated by acute bacterial sinusitis (ABS). Despite its prevalence, ABS is often overlooked in young children. The diagnosis and management present unique challenges in primary care. This is an updated narrative review on the evaluation, diagnosis, and management of ABS. Methods: A PubMed search was performed using the key term 'acute sinusitis'. The search strategy included clinical trials, metaanalyses, randomized controlled trials, observational studies, and reviews. The search was restricted to the English literature and children. Results: Haemophilus influenzae (non-typeable), Streptococcus pneumoniae, and Moraxella catarrhalis are the major pathogens in uncomplicated ABS in otherwise healthy children. In complicated ABS, polymicrobial infections are common. The diagnosis of acute sinusitis is mainly clinical and based on stringent criteria, including persistent symptoms and signs of a URI beyond 10 days, without appreciable improvement; a URI with high fever and purulent nasal discharge at onset lasting for at least 3 consecutive days; and biphasic or worsening symptoms. Conclusion: Data from high-quality studies on the management of ABS are limited. The present consensus is that amoxicillinclavulanate, at a standard dose of 45 mg/kg/day orally, is the drug of choice for most cases of uncomplicated ABS in children in whom antibacterial resistance is not suspected. Alternatively, oral amoxicillin 90 mg/kg/day can be administered. For those with severe ABS or uncomplicated acute sinusitis who are at risk for severe disease or antibiotic resistance, oral high-dose amoxicillin-clavulanate (90 mg/kg/day) is the drug of choice.
International Journal of Otolaryngology, 2015
Objective. To study the complications of sinusitis in a referral hospital and the outcome of the treatment according to the type of complication. Methods. A retrospective study was performed on patients with sinusitis who were admitted to a referral hospital from 2003 to 2012. The data for the sinusitis patients who had complications were reviewed. Results and Discussion. Eighty-five patients were included in the study, of whom 50 were male (58.8%). Fourteen of the cases were less than 15 years old, and 27 of the patients (31.7%) had more than one type of complication. The most common complication was of the orbital type (100% in the children, 38% in the adults). After the treatment, all of the children and 45 of the adults (63.4%) recovered, eight of the adult patients died (11.3%), and 18 of the adults were cured with morbidity (25.3%). The patients with more numerous complications had poorer outcomes. When the types of complications were compared (adjusted for age, gender, and comorbidities), the intracranial complication was the only one that was statistically significant for mortality. Conclusion. The outcomes of the treatment depended on the number and type of complications, with the poorest results achieved in cases of intracranial complications.