Ventilator-associated sinusitis: antroscopic findings and bacteriology when excluding contaminants

The objective of this study was to investigate maxillary sinus infectious or inflammatory disease in long-term mechanically ventilated patients, using a prospective case series design. The subjects were 33 critically ill patients receiving ventilator treatment for more than 7 days, in the general and neurosurgical intensive care units of a tertiary care hospital. Bilateral antroscopies were performed, and antral secretion and mucosal samples were collected for bacterial culturing. Different stages of inflammatory disease were found in 85% of the antra. Infectious sinusitis was diagnosed in 6%, with a predominance of mixed anaerobic infections. Monoisolates of anaerobic or facultative anaerobic bacteria were found in 5% of the antra without clinical signs of infection. In conclusion, more stringent requirements are needed for the diagnosis of infectious sinusitis in ventilator-treated patients. With improved diagnostic techniques there was a significantly lower frequency of infectious sinusitis than presented in previous reports. The bacteria predominating as infectious agents were different to those in previous reports. Furthermore, reactive inflammatory disease with bacterial colonization occurred.