Monday, February 13, 2012

Nosocomial sinusitis

Nosocomial sinusitis

Patients who have to spend long time in an intensive care unit (ICU), or  other parts of the hospital, and / or use nasogastric or endotracheal tubes may suffer from nosocomial sinusitis, a ‘hospital-borne’ infection. The prolonged usage of nasogastric or endotracheal tubes increase chances of developing signs of sinus infection. Many patients using nasotracheal tubes for more than five days suffer from nosocomial sinusitis. The hospital stay of patients with burns and serious trauma, and patients who have undergone surgery may prolong, increasing risk of catching the sinusitis. Head trauma and neurological disorders may also trigger the sinusitis.

The nasogastric or nasotracheal tubes plug the sinus ostia and thereby the secretions accumulate in the area. As a result, the drainage system of the paranasal sinuses is affected severely. This mechanical obstruction hinders normal bacteria drainage process. The bacteria, therefore, multiply in the sinuses causing inflammation and other signs of sinus infection.
Gram-negative enterics, including Serratia marcescens, Proteus mirabilis, Enterobacter species, Klebsiella pneumoniae and Pseudomonas aeruginosa are the main pathogens causing nosocomial sinusitis. Nosocomial sinusitis is a non-airborne infection because endogenous microbes causing the disease come in direct contact of the sinus via intubations.
In the patients with acute nosocomial sinusitis associated with nasogastric and nasotracheal tubes, population of gram-negative organisms, such as Staphylococcus aureus and Staphylococcus epidermidis, is large. Common signs of the sinusitis include leukocytosis and fever. The patients may also complain about purulent rhinorrhea.
The signs of sinus infection may develop in the patients using mechanical ventilation for a long time and oropharyngeal tubes simultaneously, or nasoenteric tubes. Anaerobes, including S. aureus, Acinetobacter spp. and P. aeruginosa are the primary source of sinus infection in these patients. They may also suffer from sepsis and fever.
During microbiological analysis of the acute nosocomial sinusitis, polymicrobial infection in conjunction with Bacteroides species, P. aeruginosa and S. aureus has been identified.  If younger patients use blind nasotracheal intubations in emergency, chances of staphylococci infection are high. If older patients who are operated in an ICU or operating room require elective intubations, gram-negative organisms may cause the sinusitis. 
The organisms causing a wide range of nosocomial infections are also responsible for nosocomial sinusitis. For example, gram-positive cocci and gram-negative enterics, such as Proteus mirabilis, Enterobacter sp, K. pneumoniae and P. aeruginosa, are the main pathogens associated with nosocomial infection.  The bacteriology of chronic and acute nosocomial sinusitis is quite similar if edema and inflammation of tissue play an important role.  An untreated infectious nosocomial sinusitis may lead to nosocomial pneumonia. So, timely treatment is necessary. Here is an overview of the sinusitis treatment:
Lavage and drain the sinus.

Administer the suitable antibiotics.

Remove all types of nasal tubes to minimize mucosal edema and nasal irritation.

If a maxillary puncture is done to diagnose the disease, a simultaneous antral wash will be useful.

Elevate the patients’ head and use topical nasal vasoconstrictor drops to open the sinus ostia for draining out the accumulated mucus.

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