Surgical infections
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Surgical infections · Jan 2002
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialSurgical infections with enterococcus: outcome in patients treated with ertapenem versus piperacillin-tazobactam.
The pathogenicity of Enterococcus in polymicrobial surgical infections is controversial. The objective of this analysis was two-fold. The impact of Enterococcus on clinical outcome was assessed in adults with complicated intra-abdominal (IAI), complicated skin and skin structure (CSSSI), or acute pelvic (PI) infection treated with ertapenem or piperacillin-tazobactam, which is more active in vitro against enterococci than ertapenem. Baseline characteristics were identified that were associated with Enterococcus infection and with treatment failure. ⋯ Choice of antimicrobial therapy did not affect cure rates in patients with or without Enterococcus. The strongest predictors of failure were postoperative infection at study entry in patients with IAI and older age in patients with CSSSI.
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Surgical infections · Jan 2002
Multicenter StudyAssociation between patient-controlled analgesia pump use and postoperative surgical site infection in intestinal surgery patients.
Patient-controlled analgesia (PCA) pumps are widely used after surgery, but their association with various outcomes is not completely understood. Is PCA pump use related to the incidence of postoperative surgical site infections among patients undergoing open intestinal surgery? ⋯ No confounding variables explained the significant association between PCA pump use and in-hospital surgical site infection. These results stand firmly on data that merit additional study to further elucidate possible immunologic effects of PCA pumps.
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Surgical infections · Jan 2002
Practice GuidelineThe Surgical Infection Society guidelines on antimicrobial therapy for intra-abdominal infections: an executive summary.
The Surgical Infection Society last published guidelines on antimicrobial therapy for intra-abdominal infections in 1992 (Bohnen JMA, et al., Arch Surg 1992;127:83-89). Since then, an appreciable body of literature has been published on this subject. Therefore, the Therapeutics Agents Committee of the Society undertook an effort to update the previous guidelines, primarily using data published over the past decade. ⋯ Topics discussed include the selection of patients needing therapeutic antimicrobials, duration of antimicrobial therapy, acceptable antimicrobial regimens, and identification and treatment of higher-risk patients. Guidelines for patient selection and specific antimicrobial regimens were based on relatively good evidence, but those regarding optimal duration of therapy and treatment of higher-risk patients relied mostly on expert opinion, since there was a paucity of high-quality studies on those issues. Relevant areas for future investigation include the safety, convenience, and cost-effectiveness of available antimicrobial regimens for lower-risk patients, and better means for identifying and treating higher-risk patients with intra-abdominal infections.
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Surgical infections · Jan 2002
Comparative StudyEmergence of resistant microbes in critical care units is transient, despite an unrestricted formulary and multiple antibiotic trials.
Antimicrobial resistance is a growing problem in the intensive care setting. This study was designed to evaluate the trends in bacterial prevalence and changes in antibiotic resistance at a large university hospital over the past decade. Antimicrobial resistance data were compared among the surgical intensive care unit (SICU), medical intensive care unit (MICU), and burn unit (BNU). ⋯ Hospital-wide antibiotic resistance data may be misleading and may not reflect individual critical care units throughout the hospital. Bacterial flora, including resistant organisms, changed little over 10 years, despite an unrestricted formulary. The emergence of resistant and opportunistic organisms is related to antibiotic usage and can vary significantly over time. This suggests that a policy of administering limited duration, narrow spectrum antibiotics may reduce drug resistance.
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Surgical infections · Jan 2002
In vitro antimicrobial evaluation of Coated VICRYL* Plus Antibacterial Suture (coated polyglactin 910 with triclosan) using zone of inhibition assays.
In this study, coated polyglactin 910 suture with triclosan was evaluated for its ability to inhibit the growth of wild-type and methicillin-resistant Staphylococcus aureus and S. epidermidis using several in vitro models. ⋯ These data support the conclusion that coated polyglactin 910 suture with triclosan provides antimicrobial effect sufficient to prevent in vitro colonization by S. aureus and S. epidermidis.