Comparison of Antral Tap With Endoscopically Directed Nasal Culture

Laryngoscope - Tập 111 Số 8 - Trang 1333-1337 - 2001
Roy R. Casiano1, Stephen M. Cohn1, Eloy Villasuso1, Margaret Brown1, Faramarz Memari1, Erik Barquist1, Nicholas Namias1
1University of Miami

Tóm tắt

AbstractObjectives/Hypothesis The diagnosis of acute bacterial rhinosinusitis continues to generate controversy in critically ill patients. The efficacy of endoscopically directed cultures in these patients is unknown. We compared antral tap (AT) with endoscopic tissue culture (ETC) of the osteomeatal complex in an intensive care unit (ICU) setting.Methods Twenty patients admitted to a surgical/trauma ICU were evaluated by AT and ENB for the presence of rhinosinusitis. All patients had 1) a fever of unknown origin without resolution on empiric antibiotic therapy for ≥48 hrs; 2) other sources of fever ruled out; 3) computed tomography scan evidence of mucoperiosteal thickening ± sinus air/fluid levels; and 4) attempt at conservative treatment with topical decongestants and removal of all nasal intubation. Microbiologic data were collected and analyzed for any statistical difference between groups.Results A total of 29 sides underwent simultaneous tap and endoscopically directed tissue culture. The mean age was 40 years (range, 23–77 y) with 85% being males. Fifteen of 20 (75%) patients in the AT group were culture‐positive. Of the 49 isolates from the AT, 55% yielded Gram‐negative bacilli (Acinetobacter sp. 37%) and 45% yielded Gram‐positive cocci. The ETC group was culture‐positive in 18 of 20 (90%) patients. Of the 52 isolates from the ETC, Gram‐negative bacilli were found in 58% (Acinetobacter sp. 33%) and 42% yielded Gram‐positive cocci. The ETCs were culture‐positive in all but 1 patient with positive taps. There appeared to be a concordance between AT and ETC in 60% of the patients. In five instances (25%), results of the AT or ETC changed ICU management. Two patients ultimately required sinus surgery.Conclusions Sinus taps and/or endoscopically directed tissue cultures led to a change in ICU care in 25% of ICU patients studied. In patients with fever of unknown origin and computed tomography evidence of sinusitis, an antral tap continues to provide important information concerning maxillary sinusitis. However, ETC may give as good a representation of the microbiology and secondary inflammatory changes responsible for bacterial ICU rhinosinusitis causing fever of unknown origin. Further study on a larger group of patients is needed.

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Tài liệu tham khảo

10.1097/00000542-197404000-00024

10.1001/jama.1982.03320300043020

10.1086/514711

Mevio E, 1996, Sinus infections in intensive care patients, Rhinology, 34, 232

10.1016/0002-9610(84)90122-3

10.1016/S0002-9610(05)81171-7

10.1016/S1043-1810(10)80115-0

10.2500/105065897782537133

10.1097/00005537-199712000-00002

10.1067/mhn.2000.100751

10.1288/00005537-198911000-00009

10.2500/105065897781751848

10.1016/S0194-5998(97)70127-X

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Laryngoscope

Tập 111 Số 8

1333-1337

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