Nosocomial sinusitis in the intensive care unit

Nosocomial sinusitis is a frequent but underdiagnosed complication of ICU care. Nasal intubation is thought to play a major role in pathogenesis, but the lack of sinus ventilation and pooling and stagnation of fluid in the sinuses of patients with depressed mental status who remain in the supine position may also contribute to the pathogenesis of this infection. Clinical manifestations of infection may be minimal. They include purulent nasal discharge and fever without an obvious source. Most cases of nosocomial sinusitis are caused by Staphylococcus aureus, Pseudomonas aeruginosa, and other gram-negative bacilli. Diagnosis is made by computed tomography scan of the sinuses and puncture and aspiration of fluid for culture from maxillary sinuses with radiographic evidence of sinusitis. Treatment includes removal of nasal tubes, application of topical decongestants to the nasal mucosa, and administration of antibiotics based on culture and susceptibility tests done on fluid aspirated from the involved sinus.