Surgical infections
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Surgical infections · Jan 2006
ReviewRecommendations and reports about central venous catheter-related infection.
Central venous catheters (CVCs) are used to deliver a variety of therapies, as well as for measurement of hemodynamic parameters. The major associated complication is catheter-related blood stream infection (CRBSI). ⋯ Central venous catheters are used commonly to deliver a variety of therapies, such as large amounts of fluid or blood products during surgery or in intensive care units, chemotherapy, and parenteral nutrition, as well as for measurement of hemodynamic variables. The major complication associated with CVCs is CRBSI.
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Yeasts and molds now rank among the most common pathogens in intensive care units. Whereas the incidence of Candida infections peaked in the late 1970s, aspergillosis is still increasing. ⋯ The incidence of invasive fungal infection is increasing, but so too are the choices of agents for therapy. For reasons of efficacy and safety, therapy with an echinocandin or azole antifungal agent is supplanting the use of polyenes.
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Sepsis is a major cause of morbidity and death in hospitalized patients worldwide and one of the largest current challenges in critical care. ⋯ A multidisciplinary team, including the critical care physician, the microbiologist, the infectious disease specialist, the surgeon, and the clinical pharmacologist, is necessary for optimal patient outcome.
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A substantial proportion of patients become colonized with Candida spp. after surgery, but only a minority subsequently develop invasive candidiasis. However, clinical signs of severe infection manifest only late, presenting a challenge for diagnosis. Better knowledge of the pathogenesis of candidiasis and new compounds have improved the prognosis but also encouraged the emergence of non-albicans strains of Candida. ⋯ After surgery, empiric treatment must be restricted to patients in whom the dynamics of Candida colonization predict a very high risk of invasive candidiasis. Prophylaxis should be limited to the small group of patients in whom its efficacy is proven.
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Severe sepsis is defined as sepsis plus organ dysfunction. There is a need to quantify this dysfunction, and several scoring systems have been developed. ⋯ Quantifying organ dysfunction in patients with sepsis can assist in assessing prognosis and determining treatment effectiveness. The simplicity, reliability, and reproducibility of current scores facilitate their widespread use.