Journal Article

Acute Paranasal Sinusitis in Critically Ill Patients: Guidelines for Prevention, Diagnosis, and Treatment

Mia Talmor, Paul Li and Philip S. Barie

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 25, issue 6, pages 1441-1446
Published in print December 1997 | ISSN: 1058-4838
Published online December 1997 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/516155
Acute Paranasal Sinusitis in Critically Ill Patients: Guidelines for Prevention, Diagnosis, and Treatment

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Nosocomial sinusitis is common in critical illness. Randomized trials indicate that radiographic sinusitis (RS) occurs in 25%–75% of all critically ill patients and that 18%–32% of endotracheally intubated patients will develop sinusitis. Variability in the estimated incidence of RS stems from the many radiographic techniques used for diagnosis. Critically ill patients with suspected sinusitis should undergo computed tomographic scanning of all paranasal sinuses. If the scans are positive (opacification, mucosal thickening, air-fluid level), aspiration is performed after meticulous nasal disinfection. Infection is confirmed if a pathogen is identified along with neutrophils. Nosocomial sinusitis is usually caused by gram-negative bacilli or is polymicrobial. Pseudomonas aeruginosa, the most common causative organism, represents 15.9% of isolates. The most common gram-positive isolate is Staphylococcus aureus (10.6%); fungi represent 8.5% of isolates. Infection is treated with aspiration and systemic antibiotics. Treatment failures are common; drainage with indwelling catheters is sometimes necessary.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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