Comparison of antral tap with endoscopically directed nasal culture

Objectives/Hypothesis: The diagnosis of acute bacterial rhinosinusitis cont inues to generate controversy in critically ill patients. The efficacy of e ndoscopically directed cultures in these patients is unknown. We compared a ntral tap (AT) with endoscopic tissue culture (ETC) of the osteomeatal comp lex in an intensive care unit (ICU) setting. Methods. Twenty patients admit ted 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 re solution on empiric antibiotic therapy for greater than or equal to 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 statisti cal difference between groups. Results. A total of 29 sides underwent simul taneous 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 Gramnegative bacilli (Acinetobacter sp. 37%) and 45% yielded Gram-p ositive cocci. The ETC group was culture-positive in 18 of 20 (90%) patient s. 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 t o be a concordance between AT and ETC in 60% of the patients. In five insta nces (25%), results of the AT or ETC changed ICU management. Two patients u ltimately required sinus surgery. Conclusions. Sinus taps and/or endoscopic ally directed tissue cultures led to a change in ICU care in 25% of ICU pat ients studied. In patients with fever of unknown origin and computed tomogr aphy evidence of sinusitis, an antral tap continues to provide important in formation concerning maxillary sinusitis. However, ETC may give as good a r epresentation of the microbiology and secondary inflammatory changes respon sible for bacterial ICU rhinosinusitis causing fever of unknown origin. Fur ther study on a larger group of patients is needed.