Acute bacterial nosocomial rhino sinusitis proved in 82% of studied cases with CDC criteria. Nosocomial sinusitis might be a major problem causing morbidity and mortality in critically ill patients in our center particularly in cases with head trauma (45%). The
majority of diagnosed cases (20.4%) had medical diseases (uraemia, aspiration pneumonia, etc. or brain tumour (16.3%). If a careful search for this disease and appropriate treatment are found, decrease in morbidity, mortality and subsequent other nosocomial infections would happen (1
). Diagnosis of rhino sinusitis can be made on the basis of a careful history and physical examination. Imaging studies reserved for confirmation of clinical impression or documentation of disease (4
Although fibrotic rhinoscopies used more frequently as an adjunct in adults for the evaluation and management of sinusitis, more studies need to be performed to document its clinical usefulness in children (5
In present study, 86.5% of cases with nosocomial rhino sinusitis had NGT, which is very close to Van Zanten et al.
). They reported hospital-acquired sinusitis as a common cause of FUO in orotracheally intubated critically ill patients (7
). Indeed, Arroyo-Sánchez et al
) reported fever and endotracheal intubation in all the cases; nasogastric tube in 89%, and purulent rhinorrhea or oral secretions in 83%. In that study, low incidence (1.1%) of nosocomial sinusitis observed in the ICU, but the risk of infectious complications was high (13
The most common organisms were Gram positive organisms (S. aureus, Streptococcus
spp) in %22; Gram negative organisms (K. pneumoniae, P. aeruginosa
spp) in 41% (n = 19), mixed aerobic/anaerobic organisms in 37% (n = 17) of cases. Similarly, Stein et al.
described nosocomial sinusitis which frequently isolated Staphylococcus
spp., Pseudomonas spp
. and other nosocomial organisms (11
). Kriukov et al.
reported poly bacterial and mono bacterial etiology for nosocomial rhino sinusitis in 70% and 30% respectively (12
). The link of late nosocomial pneumonia with nosocomial rhino sinusitis was suggested in 59% patients (14
Levin et al.
described severe nosocomial infections with imipenem-resistant Acinetobacter spp; 72.5% of all occurred in the ICU (17
). In deed, previous study in our center determined the Acinetobacter
Infections as one of the nosocomial infections (21
Previous studies in Tehran showed sinusitis is common in Iranian children. Community acquired rhino sinusitis is one of the most common cause of medical visit by physicians especially paediatricians in our hospital (18
). Immunologic evaluation in children with sinusitis is necessary, especially in chronic or resistant ones (18
Nosocomial rhino sinusitis is a well-recognized but insufficiently understood complication of critical illness in patients admitted by ICU in our center. Barati et al.
explained bacteriological profile and antimicrobial resistance of blood culture isolates, from 456 isolates were obtained from blood cultures, 98 cases had nosocomial infection (21
). Here, we observed nosocomial organisms with high antimicrobial resistance like as Barati et al.
study in our center (21
spp. was the most common agent which isolated from blood cultures of hospital acquired cases (32%), followed by E. coli
(13.7%) and Klebsiella
spp. (12%). They did not report any vancomycin-resistant strains of S. aureus
. Rifampin and ciprofloxacin had good activity against most of Gram-positive and Gram-negative organisms (21
). The most effective antibiotics against Gram-negative and Gram-positive bacteria were ciprofloxacin (13% resistance), vancomycin and oxacillin (13% resistance). 43% of Acinetobacter
spp; 15.4% of P .aeruginosa
were multi drug resistant (MDR), while 48.7% of Klebsiella spp
were ESBL-producing isolates. 15% of S. aureus
were oxacillin-resistant. Carbapenems were highly active against Enterobacteriaceae
a) strains with cephalosporines resistance (21
In 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.