Nosocomial sinusitis: a unique subset of sinusitis

Abstract

Purpose of review: Nosocomial sinusitis is a complication of critically ill patients that is frequently not considered as a cause of fever and infection. While this disease has been described in the literature there have been few recent citations on this subject. This brief review will familiarize the reader with the current state of the art with regard to diagnosis complications and treatment of this problem.

Recent findings: Nasal and oral tubes have been the prime inciting events. Other risk factors have been facial trauma, inability to mobilize the patient and prior sinus disease. Patients usually present while in the intensive care unit; and there are few signs that suggest sinusitis to the critical care team. A number of complications including direct extension to the brain, lung and blood stream, as well as sepsis and even death have been described. The diagnosis is usually made with the help of specific radiographs or computed tomography scans when these modalities are used. The microbiology is quite different than sinusitis in the community. Staphylococcus spp., Pseudomonas spp. and other nosocomial organisms are frequently isolated when specific cultures are obtained. Treatment usually consists of removal of the tubes mobilizing the patient and institution of broad-spectrum antibiotics aimed at the offending organisms.

Summary: Nosocomial sinusitis continues to be a major problem causing morbidity and occasionally mortality in critically ill patients. Recent findings have suggested that a careful search for this disease and appropriate treatment if found can decrease both morbidity, mortality and subsequent other nosocomial infections.