Surgical infections
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Surgical infections · Feb 2010
The pathogen of ventilator-associated pneumonia does not influence the mortality rate of surgical intensive care unit patients treated with a rotational antibiotic system.
Ventilator-associated pneumonia (VAP) is one of the leading causes of morbidity in critically ill surgical patients. Certain pathogens (e.g., methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa) have been associated with an excess mortality rate from sepsis in several studies, but not in the surgical setting specifically or when protocol-driven antibiotic therapy is administered. ⋯ The type of pathogen does not influence death in surgical ICU patients with VAP diagnosed rigorously and treated by a rotational antibiotic system. The high proportion of AIT as a result of the rotational antibiotic administration system optimizes bacterial killing and negates the impact of bacterial resistance, contributing to better outcomes.
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Surgical infections · Feb 2010
Risk factors for treatment failure in patients receiving vancomycin for hospital-acquired methicillin-resistant Staphylococcus aureus pneumonia.
The rate of vancomycin failure in patients with hospital-acquired pneumonia (HAP) caused by methicillin-resistant Staphylococcus aureus (MRSA) has exceeded 40% in several studies. This observation was attributed initially to the lack of weight-based dosing and targeting of lower trough concentrations. However, a subsequent study demonstrated no additional benefit in patients who achieved trough vancomycin concentrations >15 mg/L compared with patients with concentrations between 5 and 15 mg/L. We sought to identify contributors to vancomycin failure in patients with MRSA HAP. ⋯ These data suggest that patients who have recent exposure to vancomycin are at high risk for vancomycin failure and may benefit from an appropriate alternative when a diagnosis of MRSA HAP is made.
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Surgical infections · Feb 2010
Effects of human immunodeficiency virus status on trauma outcomes: a review of the national trauma database.
The prevalence of human immunodeficiency virus (HIV) is disproportionately elevated in trauma patients. Although HIV traditionally has been associated with poorer outcomes among the critically ill, recent evidence suggests that the outcomes of surgical patients have improved with the greater use of antiretroviral regimens. The purpose of this study was to utilize the National Trauma Data Bank (NTDB) to examine the impact of HIV on surgical outcomes in a large group of trauma patients. ⋯ These findings are consistent with those of recent smaller studies that demonstrated no significant difference in the mortality rate for patients with HIV. Although mortality rates are similar, HIV-positive patients are more likely to develop certain infectious complications and to require a longer LOS. Infection with HIV remains a major public health issue in the U.S. and internationally, and further research is necessary to explore the relation between HIV status and trauma outcomes, particularly with regard to the possible effects of antiretroviral treatment and individual immune status.