Diagnosis Of Bacterial Sinusitis Research Articles

Endoscopically directed middle meatal cultures vs computed tomographic scans in the diagnosis of bacterial sinusitis in intensive care units

PurposeThe objective of the study was to evaluate the accuracy of endoscopically directed middle meatal cultures in the diagnosis of bacterial sinusitis in intensive care unit (ICU) patients in comparison with computed tomographic (CT) scans. Patients and MethodsThe study was conducted at Alexandria University Hospitals on 51 ICU patients with occult fever and clinical signs suggestive of sinusitis. Sinus CT scans were done for all patients, and Calgi swabs were obtained from the middle meatus bilaterally under endoscopic vision using sterile endoscopes with avoidance of any contamination of the swabs. The results of middle meatal cultures were compared with the results of CT scans. ResultsRadiologic signs of sinusitis were bilateral in 10 patients (19.6%), unilateral in 31 patients (60.8%), and negative in 10 patients (19.6%). Middle meatal swabs yielded positive cultures on both sides in 13 patients (25.5%) and on one side in 27 patients (52.9%). On the other hand, the cultures were negative in 11 patients (21.6%). Middle meatal cultures had a sensitivity of 92.8%, a specificity of 80.0%, and an accuracy of 90.2% in comparison with CT scans. Polymicrobial colonization was more frequent than monomicrobial colonization. The organisms isolated most frequently were coagulase-negative staphylococci, Staphylococcus aureus, and Pseudomonas aeurginosa. Of 47 patients with actual or previous intubation, 38 (80.9%) had positive cultures. In addition, 92.3% of patients with unilateral positive cultures acquired sinusitis on the same side of previous intubation. ConclusionsThe data of the present study indicated that endoscopically directed middle meatal cultures had high positive and negative predictive values and accurately diagnosed bacterial sinusitis and identified the causative bacteria with high sensitivity and specificity in comparison with the criterion standard CT scans. The procedure is simple, noninvasive, and can be easily performed at the bedside without discomfort or morbidity. Based on our data, the procedure can be considered as a trustworthy substitute to sinus CT scans in ICU patients especially when it is difficult to transport the patients for imaging. Computed tomographic scans can, therefore, be reserved for patients who do not respond to culture-specific antibiotherapy. A further advantage of this approach is avoidance of the cumulative effect of unnecessary radiation. The study also confirmed the role of nasogastric and nasotracheal intubation in the pathogenesis of ICU sinusitis.

Mat á greiningu og meðferð bráðrar skútabólgu á þremur heilsugæslustöðvum

The objective of this study was to evaluate the diagnosis and treatment of acute sinusitis at three health care centers in northern and eastern Iceland. Information on all those diagnosed with acute sinusitis (ICD 10 J01.0, J01.9) in the year 2004 at the communal health care centers in Akureyri, Husavik and Egilsstadir was obtained retrospectively from computerized clinical records. Key factors used for diagnosis and treatment were recorded. In order to obtain an equal distribution in population size only about one-third of the diagnoses made in Akureyri were included in the search (the first ten days of every month). The search yielded a total of 468 individuals. The average incidence of acute sinusitis was found to be 3.4 per 100 inhabitants per year. Adherence to clinical guidelines (albeit from other countries) regarding diagnosis of bacterial sinusitis was nearly nonexistent. There were considerable differences found between health care centers as to whether x-rays were used for diagnostic purposes. Blood tests were hardly used at all. The disease was diagnosed over the telephone in 28% of the cases (Husavik 38%, Akureyri 32%, Egilsstadir 10%). Over 90% of all individuals diagnosed with acute sinusitis received antibiotics, regardless of symptom duration. The antibiotics most often prescribed were Doxycyclin and Amoxicillin. The incidence of acute sinusitis in these three communities seems to be similar to other western countries. Acute bacterial sinusitis seems to be overdiagnosed and the use of antibiotics is in no context with clinical guidelines. Our results support the hypothesis that physicians tend to regard acute sinusitis as a bacterial disease, and treat it accordingly.

Diagnosis and management of sinusitis in children

Acute bacterial sinusitis is a common clinical problem. The usual predisposing events are either viral upper respiratory infection or allergic inflammation. Patients present with either persistent or severe respiratory symptoms. Subacute and chronic sinusitis are characterized by very protracted respiratory symptoms that include nasal discharge, cough, or both. A precise diagnosis of bacterial sinusitis is made when sinus aspiration is performed and yields pus and bacteria in high colony count. Images, either plain radiographs or computer tomographic scans, can be used to confirm the diagnosis of bacterial sinusitis in patients whose signs and symptoms suggest the diagnosis. Streptococcus pneumoniae, Haemophilus influenzae , and Moraxella catarrhalis are the usual pathogens retrieved from patients with acute, subacute, and recurrent acute sinusitis. These same pathogens cause acute exacerbations of chronic sinusitis. In patients with chronic persistent sinusitis, the role of bacterial agents is less clear. The prescription of antimicrobials is the backbone of the medical management of acute bacterial sinusitis. Clinical improvement is prompt in nearly all children treated with an appropriate agent.

Possible errors in diagnosis of bacterial sinusitis in tracheal intubated patients

Bacterial sinusitis is recognized as a complication of prolonged nasotracheal intubation. Verification of the diagnosis, however, requires culture findings from a "true" sample from the maxillary antrum. A "true" antral sample can only be obtained after passing either the nasal or oral mucosae with their rich aerobic and anaerobic bacterial flora. No properly controlled study has been made into the problem of contaminated samples in bacterial sinusitis complicating prolonged nasotracheal intubation. The design of the study was a case series in an intensive care unit. The patients had either had endotracheal tube or tracheal cannula for seven days or were septic, having an endothracheal tube or a tracheal cannula and therefore due to an investigation of infection foci. Antral cultures obtained via the canine fossa were compared with oral cultures to exclude the contribution of oral bacterial contamination and thereby to improve the reliability of diagnosis based on culture results. The contamination rate was lowered significantly from 67% to 5% when an area of free bone was prepared in the canine fossa thus avoiding instrument contact with the oral mucosa. A high contamination risk can be dealt with by adjusting the technique of sampling thereby increasing the culture reliability.