Surgical infections

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• Surgical infections · Aug 2006

  Review

  Surgical Infection Society guideline: prophylactic antibiotic use in open fractures: an evidence-based guideline.

  Prolonged courses of broad-spectrum antibiotics are often cited as the standard of care for prevention of infective complications of open fractures. The origins of these recommendations are obscure, however, and multi-drug-resistant systemic infections attributable to antibiotic overuse are common life-threatening problems in current intensive care unit practice. ⋯ The data support the conclusion that a short course of first-generation cephalosporins, begun as soon as possible after injury, significantly lowers the risk of infection when used in combination with prompt, modern orthopedic fracture wound management. There is insufficient evidence to support other common management practices, such as prolonged courses or repeated short courses of antibiotics, the use of antibiotic coverage extending to gram-negative bacilli or clostridial species, or the use of local antibiotic therapies such as beads. Large, randomized, blinded trials are needed to prove or disprove the value of these traditional approaches. Such trials should be performed in patients with high-grade fractures who (1) are well-stratified according to the degree of local injury and (2) undergo standardized fracture and wound management. Trials also must be powered to study the effects of extended antibiotic coverage on nosocomial infections. Antibiotic regimens confirmed to improve local fracture outcomes in such studies could then be used rationally, balancing the risks of local fracture-related infections and of multi-drug-resistant systemic infections to achieve optimal global outcomes.

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• Surgical infections · Aug 2006

  Can the clinical pulmonary infection score impact ICU antibiotic days?

  The Clinical Pulmonary Infection Score (CPIS) has been used in the intensive care unit (ICU) as a decision tool for initiation of antibiotics in suspected pneumonia and also for discontinuing antibiotics if the CPIS score is 6 on day one receiving antibiotics empirically for pneumonia. ⋯ This prospective evaluation confirms that 50% of antibiotic-days in our ICU are used empirically for pneumonia when that infection is not likely to be present by either CDC or CPIS criteria. Although the CPIS has good reliability and acceptable sensitivity and specificity, PC review and CPIS

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