Surgical infections
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Patients who suffer severe burns are at higher risk for local and systemic infections. In recent years, emerging resistant pathogens have forced burn care providers world wide to search for alternative forms of treatment. Multidrug-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter spp., and various fungal strains have been the major contributors to the increase in morbidity and mortality rates. Multi-drug-resistant S. aureus remains the major cause of gram-positive burn wound infections world wide. Treatment strategies include rigorous isolation protocols and new types of antibiotics where necessary. ⋯ Innovations in fluid management, ventilatory support, surgical care, and antimicrobial therapy have contributed to a significant reduction in morbidity and mortality rates in burn patients. Vancomycin and clindamycin are the two most important reserve antibiotics for methicillin-resistant Staphylococcus aureus infection. Oxazolidinones and streptogramins have showed high effectiveness against gram-positive infections. Colistin has re-emerged as a highly effective antibiotic against multiresistant Pseudomonas and Acinetobacter infections. Current challenges include Candida, Aspergillus, and molds. The development of new agents, prudent and appropriate use of antibiotics, and better infection control protocols are paramount in the ongoing battle against multi-resistant organisms.
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Surgical infections · Oct 2009
Soluble triggering receptor expressed on myeloid cells-1 is an early marker of infection in the surgical intensive care unit.
To determine the value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in early differentiation of systemic inflammatory response syndrome (SIRS) from infection in patients in a surgical intensive care unit (ICU). ⋯ In the present study, sTREM-1 was an accurate tool for differentiating SIRS from infection in patients in the surgical ICU.
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Surgical infections · Oct 2009
Optimal fluid resuscitation: timing and composition of intravenous fluids.
Recent data suggest that the timing of fluid resuscitation and the type of fluid used to treat hemorrhagic shock contribute to the inflammatory response as well as cell death. ⋯ Cellular destruction and a pro-inflammatory response follow hemorrhagic shock. Early resuscitation with isotonic crystalloid fluids decreases these responses.
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Surgical infections · Oct 2009
ReviewNonoperative management of blunt abdominal trauma: have we gone too far?
The paradigm shift in the management of blunt abdominal trauma has been to become less invasive with both diagnostic tools and management. Avoidance of a laparotomy with its short-term and long-term risks is of obvious benefit to the patient. ⋯ Safe nonoperative management requires adherence to cardinal surgical principles, examination and re-examination of the patient, and fastidious clinical judgment.
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Surgical infections · Oct 2009
The development of a regional system for care of the burn-injured patients.
In the mid-20th century, it was recognized that patients with major burn injury required a dedicated, multidisciplinary team approach to receive optimal care. In the subsequent years, regionalized systems of care were developed to provide this level of care to the entire populations. There have been no reports on how an individual regional system evolved and the impact it had on the delivery of care for burn-injured patients. ⋯ Although there has been a significant decrease in the number of patients requiring hospitalization for burn injuries, there are still a large number of patients who suffer these injuries. Regionalization of burn care has been associated with care for patients in designated facilities in over 75% of the cases and a reduction in mortality by almost 50%.