Surgical infections
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Elective colon surgery has the highest rate of surgical site infection (SSI) of any elective procedure in surgery. The evolution of strategies for the prevention of SSI has had the correct use of preventive antibiotics as a crucial component. ⋯ The best outcomes in the prevention of SSI in elective colon surgery are achieved when appropriate systemic antibiotics are employed in conjunction with the appropriate use of oral antibiotic bowel preparation.
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Mechanical bowel preparation has been a mainstay in the management of patients undergoing elective colorectal surgery, but in recent years, this practice has been challenged; and a number of clinical reports have demonstrated no benefit, as judged by reduction of surgical site infections. This paper presents the advantages and disadvantages of mechanical bowel preparation. ⋯ Additional stratified studies of different mechanical bowel preparation methods, compared with no preparation, are required to address whether the practice should be abandoned.
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Necrotizing soft tissue infections (NSTIs) continue to pose major problems in diagnosis and management. ⋯ The mortality rate of necrotizing soft tissue infection remains approximately 25% despite optimal care. Delayed definitive debridement remains the single most important risk factor for death.
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Surgical infections · Dec 2008
Vancomycin-resistant enterococcus: risk factors, surveillance, infections, and treatment.
The use of vancomycin has continued to expand because of the increasing number of patients infected or colonized with methicillin-resistant Staphylococcus aureus, causing an increase in the prevalence of vancomycin-resistant Enterococcus (VRE). ⋯ The reservoir of resistance in enterococci looms as a major threat for genetic transfer and the emergence of increasing numbers of vancomycin-resistant S. aureus.
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Surgical infections · Dec 2008
Surgical site infections and the surgical care improvement project (SCIP): evolution of national quality measures.
Surgical site infection (SSI) continues to be a common if often times preventable infection. Considerable patient morbidity and economic cost are the consequences. ⋯ Surgeons must use all documented strategies to prevent SSIs.