APMIS : acta pathologica, microbiologica, et immunologica Scandinavica
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Systemic administered lipopolysaccharide (LPS) induces a cytokine response in peripheral blood without correlations with cytokine content at the organ level. We hypothesised (1) that cytokine mRNA expression in peripheral blood mononuclear cells (PBMCs) preceded the plasma cytokine increase during endotoxaemia and (2) that statins as anti-inflammatory agents modified the LPS-induced cytokine responses. 30 pigs were randomised into 3 groups: placebo (I) or atorvastatin 80 mg (II) for 21 days, followed by LPS-infusion on day 22, or controls (III). LPS was infused at increasing concentrations (2.5 to 15 microg/kg/h) for 30 min, followed by sustained infusion (2.5 microg/kg/h) for 330 min. ⋯ There were no correlations with plasma cytokines, which peaked at 60 min (IL-10 and TNF-alpha) and 240 min (IL-6). Cytokine content did not increase in organs, and no effects of statins could be demonstrated. In conclusion, LPS-infusion reduced leukocyte TNF-alpha mRNA and increased IL-6 mRNA, whereas plasma TNF-alpha, IL-6, and IL-10 increased markedly.
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Randomized Controlled Trial Multicenter Study
Local collagen-gentamicin for prevention of sternal wound infections: the LOGIP trial.
In cardiac surgery, sternal wound infection (SWI) continues to be one of the most serious postoperative complications. Coagulase-negative staphylococci (CoNS) have become the most common causative agents of SWI. However, many CoNS species are resistant to routine intravenous antibiotic prophylaxis. 2000 cardiac surgery patients were randomised to routine prophylaxis with intravenous isoxazolyl penicillin alone (control group) or to this prophylaxis combined with application of collagen-gentamicin (260 mg gentamicin) sponges within the sternotomy before wound closure. ⋯ The incidence of any sternal wound infection was 4.3% in the treatment group and 9.0% in the control group (relative risk=0.47; 95% confidence interval 0.33 to 0.68; P<0.001). Local gentamicin reduced the incidence of SWI caused by all major clinically important microbiological agents, including CoNS. Routine use of the described prophylaxis in all adult cardiac surgery patients could be recommended.
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Appropriate antibiotic prophylaxis in cardiac surgery can substantially reduce the number of postoperative infections. To avoid misuse, special concerns - such as timing and duration of antibiotics - must be taken into account. ⋯ The prophylactic antibiotic should cover the spectrum of bacteria that are likely to be encountered. The emergence of MRSA raises special questions of antibiotic choice as well as route of administration.
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Review
Postoperative surgical site infections in cardiac surgery--an overview of preventive measures.
Postoperative surgical site infections are a major cause of postoperative morbidity and mortality in cardiac surgery. A surgical site infection occurs when the contaminating pathogens overcome the host defense systems and an infectious process begins. Bacteria may enter the operating site either by direct contamination from the patient's skin or internal organs, through the hands and instruments of the surgical staff or by bacteria-carrying particles that float around in the operating theatre and may land in the wound. ⋯ Compliance with these preventive procedures must be enforced through regular reviews of performance. Non-compliance with hygiene routines is often due to ignorance and poor planning. Education of personnel in these issues is a continuous process.
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In order to prevent deep sternal wound infection after cardiac surgery we decided at the Sahlgrenska University Hospital to revise our protocol for antibiotic prophylaxis by adding an application of local collagen-gentamicin between the sternum halves to our standard prophylaxis. In addition, we focused specifically on the wiring technique. ⋯ The infection rate during 2006 is the lowest rate we have recorded since we started measuring it in 1995. We conclude that with application of local collagen-gentamicin and modification of the sternal closure method we have been able to significantly decrease the incidence of wound infections after cardiac surgery.