Sinusitis nosocomial

Figure 2 Example of an intubated patient with continuous aspiration of subglottic secretions as reported by Valles and coworkers (29). Removal of subglottic secretions decreases colonization of the trachea and the risk of ventilator-associated pneumonia. This system has recently become available in the United States. Ideally, an endotracheal tube is preferred to a nasotracheal tube and placing the gastric tube through the mouth rather than the nose may reduce the risk of nosocomial sinusitis and pneumonia. (From Ref. 20, with permission.)...

Nasotracheal intubation and placement of a nasogastric tube are underappreciated risk factors for nosocomial sinusitis and VAP (128,147). The association between the development of sinusitis and VAP is difficult to demonstrate. However, the presence of sinusitis has been shown to be associated with a substantial increase in the number of nosocomial pathogens that are identified in patients with VAP. In a study by Rouby and coworkers, maxillary sinusitis, diagnosed by baseline and serial computer axial tomographic scan and needle... 

Bach A, Boehrer H, Schmidt H, Geiss HK. Nosocomial sinusitis in ventilated patients nosotracheal versus orotracheal intubation. Anaesthesia 1992 47 335-339. 

Levofloxacin (1), the levo-isomer or the (5)-enantiomer of ofloxacin, received FDA approval in 1996 (Fish, 2003 Hurst et al., 2002 Mascaretti, 2003 Norrby, 1999 North et al., 1998). The initial approval covered community-acquired pneumonia, acute bacterial exacerbation of chronic bronchitis, acute maxillary sinusitis, uncomplicated skin and skin structure infections, acute pyelonephritis, and complicated urinary tract infections (North et al., 1998). Four years later, the levofloxacin indication list grew to include community-acquired pneumonia caused by penicillin-resistant Streptococcus pneumoniae. In addition, in 2002, nosocomial (hospital-acquired) pneumonia caused by methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Haemophilus influenzae, Kliebsella pneumoniae, and Escherichia coli was added (Hurst et al., 2002). Finally in 2004, LVX was approved as a post-exposure treatment for individuals exposed to Bacillus anthracis, the microbe that causes anthrax, via inhalation (FDA, 2004). 

Ciprofloxacin is a fluoroquinolone antibiotic that interferes with microbial DNA synthesis. It is indicated in the treatment of infections of the lower respiratory tract, skin and skin structure, bones and joints, urinary tract gonorrhea, chancroid, and infectious diarrhea caused by susceptible strains of specific organisms typhoid fever uncomplicated cervical and urethral gonorrhea women with acute uncomplicated cystitis acute sinusitis nosocomial pneumonia chronic bacterial prostatitis complicated intra-abdominal infections reduction of incidence or progression of inhalational anthrax following exposure to aerosolized Bacillus anthracis. Cipro IV Used for empirical therapy for febrile neutropenic patients. 

Levofloxacin is a fluoroquinolone/ophthalmic/antibiotic that interferes with microbial DNA synthesis. It is indicated in the treatment of acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis, nosocomial pneumonia, community-acquired pneumonia, skin and skin structure infections, chronic bacterial prostatitis, urinary tract infection (UTI), inhalational anthrax (postexposure), and acute pyelonephritis caused by susceptible strains of specific microorganisms. Ophthalmic use is for the treatment of conjunctivitis caused by susceptible strains of aerobic Gram-positive and aerobic Gram-negative microorganisms. 

Rouby J, Laurent P, Gosnach M, Cambau E, Lamas G, Zouaoui A, et al. Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill. Am J Respir Crit Care Med 1994 150 776-783. 

Holzapfel L, Chevret S, Madinier G, Ohen F, Demingeon G, Coupry A, et al. Influence of long-term oro- or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia results of a prospective, randomized, clinical trial. Crit Care Med 1993 21 1132-1138. 

---