Nosocomial
sinusitis is a complication of endotracheal intubation and
mechanical ventilation in
critically ill patients. Its incidence is often underestimated because of a lack of clinical signs. It is suspected in patients with nasal discharge or unexplained
fever. Its diagnosis is based on radiological examination, by radiograph or computed tomography scan, and microbiological cultures of maxillary sinus aspirate.
Maxillary sinusitis is often associated with involvement of the sphenoid, ethmoid, and/or frontal sinuses. Its incidence varies greatly according to diagnostic criteria and the population studied. Infectious
sinusitis is less frequent than noninfectious
sinusitis, occurring in 20 to 30% of patients intubated for at least seven days. Its incidence is higher in nasotracheally than in orotracheally intubated patients. Other risk factors include nasogastric tubes and
head trauma. The main causative agents are gram-negative bacilli, primarily Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacteriaceae, but Staphylococcus aureus and yeasts are also common. Patients with nosocomial
sinusitis are more likely to develop
pneumonia than those without
sinusitis. The sinus provides a bacterial reservoir from which organisms may seed the tracheobronchial tree. The association of
sinusitis and
pneumonia is mainly due to Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii. The treatment of
sinusitis is based on the removal of all nasal tubes, topical
decongestants, and maxillary sinus drainage and lavage. The role of intravenous
antibiotics is controversial.