Nosocomial Sinusitis in ICU Patients

Microbiology and Clinical Presentation

Nosocomial sinusitis in ICU patients is typically polymicrobial and predominantly caused by gram-negative bacilli, with the most frequently isolated pathogens including Pseudomonas aeruginosa, and the clinical features often being subtle and limited to unexplained fever and mucopurulent nasal discharge, according to the Infectious Diseases Society of America 1
The presence of devices such as nasotracheal intubation and nasogastric tubes can obstruct normal sinus drainage, creating an environment conducive to bacterial growth, as stated by the Society of Critical Care Medicine 2

Diagnosis of nosocomial sinusitis in ICU patients requires a high index of suspicion and may involve CT scan of paranasal sinuses and sinus aspiration for culture and sensitivity testing, as recommended by the European Society of Intensive Care Medicine 2
Treatment involves removal of all nasal tubes when possible, sinus drainage and lavage, and appropriate antimicrobial therapy based on culture results, with consideration of antimicrobial resistance patterns, according to the Infectious Diseases Society of America 1