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- Westergren, Viveka, 1958-, et al.
(author)
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Nosocomial sinusitis
- 2005
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In: Nosocomial sinusitis: a unique subset of sinusitis. - New York : Taylor and Francis. ; , s. 319-356
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Book chapter (other academic/artistic)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
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- Westergren, Viveka
(author)
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Ventilator-associated sinusitis : a clinical investigation into the inflammatory response : reactive – infective – infectious?
- 1997
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Doctoral thesis (other academic/artistic)abstract
- Critically ill mechanically ventilated patients regularly have inflammatory reactions in the paranasal sinuses. Infectious sinusitis, which is difficult to diagnose, may occur, mainly in the maxillary sinuses. This study was performed with the object of improving the knowledge of inflammatory and/or infectious disease. Ultrasound, as an indirect diagnostic facility, was evaluated against visual criteria at endoscopy. Assessments by endoscopy were calibrated with the help of video recordings evaluated by an expert panel. To improve bacteriological diagnostics of the antra a new technique for sampling was developed to reduce contaminations. A routine was set up to identify false positive cultures by comparative quantitative cultures from the antra and the corresponding passage route. Anaerobic cultures from antral mucosa were made. Correlations between endoscopic and bacteriologic diagnostics were analysed. To find out if antibiotics used in the ICU reach the antra, concentrations were determined by a bio-assay method. As markers of inflammatory diseased antral mucosa, the cytokines lL-6, IL- 12 and the chemokine RANTES were determined by RT-PCR. The expression of the adhesion molecules ICAM-1, VCAM-I, E- and P-selectin was demonstrated by immunocytochemistry. Ultrasound had a low capacity for differential diagnostics. The expert panel verified the reliability of endoscopic assessments. There was an almost perfect concordance on infectious sinusitis. The endoscopic diagnosis of infectious sinusitis correlated to positive anaerobic cultures. The rate of false positive cultures was significantly reduced by the improved sampling technique. Three antra, with positive cultures, were assessed endoscopically as inflammatory reaction without signs of infection. They were thus colonised. The bacterial findings were mostly anaerobic or facultative anaerobic. The most common pathogens, as previously described, Staphylococcus aureus and Pseudomonas aeruginosa, were only present in gingival cultures or as contaminants but not identified as the cause of infection. Different stages of inflammatory disease were found in 85%. But only 6% (4 antra) were infectious Sinusitis. Lactobacillus were monoisolates in 2 out of 3 colonisations. In all infected or colonised antra, mRNA of RANTES was found (p= 0.005). The predominant adhesion molecule expressed in all specimens examined was P-selectin. The antibiotic concentrations in intracellular tissue were related to the serum levels and thus strongly support an appropriate localisation of the drugs included. The four infections diagnosed were empyema as with retained secretion constituting biofilm formations where the bacteria were inaccessible to antibiotics. In summary, the rate of infectious sinusitis was markedly less in this study compared to previous publications. The main pathogens of the infections diagnosed also differed. Antral colonisation of bacteria, regarded as nonpathogenic, has not been reported in mechanically ventilated patients previously.
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