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LETTER TO THE EDITOR
Year : 2013  |  Volume : 3  |  Issue : 2  |  Page : 163

Considering multidrug resistant nosocomial sinusitis in intensive care unit patients as a cause of pyrexia


1 ENT Unit, Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
2 Department of Critical Care Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India

Date of Web Publication29-Jun-2013

Correspondence Address:
Sushil K Aggarwal
Department of Neurosurgery, SGPGIMS, Lucknow - 226014, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5151.114280

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How to cite this article:
Aggarwal SK, Azim A, Sehgal S, Ahmed A. Considering multidrug resistant nosocomial sinusitis in intensive care unit patients as a cause of pyrexia. Int J Crit Illn Inj Sci 2013;3:163

How to cite this URL:
Aggarwal SK, Azim A, Sehgal S, Ahmed A. Considering multidrug resistant nosocomial sinusitis in intensive care unit patients as a cause of pyrexia. Int J Crit Illn Inj Sci [serial online] 2013 [cited 2019 Nov 20];3:163. Available from: http://www.ijciis.org/text.asp?2013/3/2/163/114280

Sir,

Rhinosinusitis [1] is difficult to diagnose in the intensive care unit (ICU) patients on mechanical ventilation as the usual clinical signs and symptoms cannot be confirmed from the patient. The only modality to diagnose nosocomial sinusitis (NS) in an ICU setting is the high index of suspicion, which is confirmed by contrast-enhanced computed tomography (CECT) scan.

An 18-year-old girl diagnosed with a case of acute hepatic encephalopathy was transferred to ICU for mechanical ventilation. Initially, her encephalopathy, fever and liver functions improved but again after 1 week, she developed a new onset of high grade fever. In view of predisposing factors for NS and all other body fluid cultures being sterile, CECT of paranasal sinuses, nose and orbit was done, which showed bilateral extensive sinusitis. Urgent endoscopic clearance of disease was done and as tissue culture was positive for multidrug resistant Acinetobacter baumanii, sensitivity-based antibiotics were given. Patient improved dramatically and was discharged from ICU after 7 days [Figure 1] and [Figure 2].
Figure 1: Axial bony window cut of contrast-enhanced computed tomography PNS, nose and orbit showing bilateral ethmoidal sinusitis

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Figure 2: Axial bone window cut of contrast-enhanced computed tomography PNS, nose and orbit showing left maxillary and ethmoidal sinusitis with DNS to left side

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Acute purulent NS, which is often overlooked, is a significant cause of fever and sepsis in ICU patients. [2] Studies suggest that nasotracheal intubation, [2],[3] nasogastric tubes, [2],[3] nasal colonization, sedation, supine posture and a GCS of 7 or less are risk factors for NS. [2] Most of the ICU patients have one or more risk factors for development of nosocomial sinusitis and hence strict vigilance is required.

If the patient presents with signs of sepsis with common sites of infection being ruled out, then nosocomial sinusitis should be kept in mind and if diagnosed, then urgent surgical drainage along with appropriate antibiotics should be considered early in the hospital course.

 
   References Top

1.Fokkens W, Lund V, Mullol J; European Position Paper on Rhinosinusitis and Nasal Polyps group. European position paper on rhinosinusitis and nasal polyps 2007. Rhinol Suppl 2007;20:1-136.  Back to cited text no. 1
[PUBMED]    
2.George DL, Falk PS, Umberto Meduri G, Leeper KV Jr, Wunderink RG, Steere EL, et al. Nosocomial sinusitis in patients in the medical intensive care unit: A prospective epidemiological study. Clin Infect Dis 1998;27:463-70.  Back to cited text no. 2
[PUBMED]    
3.Michelson A, Schuster B, Kamp HD. Paranasal sinusitis associated with nasotracheal and orotracheal longterm intubation. Arch Otolaryngol Head Neck Surg 1992;118:937-9.  Back to cited text no. 3
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    Figures

  [Figure 1], [Figure 2]



 

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