ROLE OF ANTRAL PUNCTURE IN THE TREATMENT OF SINUSITIS IN THE INTENSIVE-CARE UNIT

OBJECTIVE: The objective of this study was to determine whether maxill ary sinus puncture caused an alteration in antibiotic treatment and th us affected the outcome of sinusitis in the intensive care unit. STUDY DESIGN: A retrospective review was done of cases of maxillary sinus p uncture between 1991 and 1994. RESULTS: Forty-two patients were identi fied. All patients had findings suggestive of sinusitis on plain sinus films or CT scans of the sinuses. Twenty-five punctures (60%) recover ed pus, of which 80% grew organisms. Fourteen patients (33%) had a neg ative ravage, and 12% of these samples grew organisms (p = 0.001). Six ty-eight percent of the cultures identified a single organism compared with 32% with multiple organisms. Gram-negative organisms were found most commonly, followed by anaerobes, In 57% of the cases antibiotic t herapy was changed. In 77% of the cases the change was directed by the culture result and in 35% the therapy was changed despite a negative culture result (p = 0.002). Resolution of symptoms occurred in 83% of patients who had antibiotics changed whereas with no change in antibio tics only 42% had resolution (p = 0.001). CONCLUSION: A sinus puncture seems to be helpful in patients with fever and positive findings on s inus films, If pus is obtained by maxillary puncture, a positive cultu re may be found in 80% of the cases. Changes in antibiotic regimen on the basis of culture findings seem to give a better outcome.