Intensive care unit nosocomial sinusitis at the Rasoul Akram Hospital: Tehran,Iran,2007-2008

Background: nosocomial rhino sinusitis causes major problems in all intensive care units (icus). objective: to describe incidence,epidemiologic,clinical manifestations,and microbiologic findings in icus admitted cases with nosocomial sinusitis. materials and methods: a prospective,cross sectional study done in pediatric & adult icus in rasoul akram hospital; tehran iran (2007-2008). para-nasal sinus computed tomography (ct) was performed in all adults with fever of unknown origin (fuo) within 48h of admission and repeated thereafter (4-7 days). infectious sinusitis was diagnosed by microbiological analysis of sinus fluid aspirates. results: acute bacterial nosocomial sinusitis proved in 82% (51/ 63) of all cases. head trauma was the most common cause (n = 22,45%) of cases. the results of culture were positive for 45 cases (82%). of 45 culture positives,19 yielded gram negative organisms (41%) and 9 (22%) gave gram positives (s. aureous,streptococus spp). the remainders (n = 17,37%) consisted of mixed aerobic/anaerobic bacteria. seven cases,were positive in gram staining of sinus drainage and these were positive in culture for s. pneumonia (n = 5),hemophilus influenza (n = 2). the type of organisms were not related to glasgow coma scale in cases (p = 0.3). conclusion: nosocomial organisms isolated were quite different from community acquired rhino sinusitis cases. investigation of ct scan and drainage of para-nasal sinuses would be helpful in undiagnosed fuo cases,especially in traumatic patients. optimal treatment usually consists of removal of the tubes,mobilizing the patient,and administration the broad-spectrum antibiotics.