Surgical infections
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Surgical infections · Feb 2011
Prophylactic antibiotic days as a predictor of sensitivity patterns in Acinetobacter pneumonia.
Ventilator-associated pneumonia (VAP) secondary to Acinetobacter spp. in critically ill trauma patients has increased. More importantly, the incidence of multi-drug-resistant (MDR) Acinetobacter VAP has increased. The risk factors for this increase in resistance have yet to be elucidated. The purpose of this study was to evaluate the change in Acinetobacter sensitivity over time and determine which risk factors predict resistance in trauma patients. ⋯ The incidence of MDR Acinetobacter VAP has increased over time. More severe extremity injuries, as measured by the AIS, may contribute to prolonged antibiotic exposure in those patients with MDR Acinetobacter VAP. Multiple logistic regression identified Pro antibiotic days as an independent risk factor for MDR Acinetobacter VAP in trauma patients.
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Surgical infections · Feb 2011
Automated electronic reminders to improve redosing of antibiotics during surgical cases: comparison of two approaches.
Timely re-dosing of antibiotic for prolonged surgical cases is an important measure in reducing the risk of surgical site infections. For the anesthesia team, which generally administers the antibiotic re-doses, it is difficult to keep track of and remember the exact timing requirements. We explored the efficacy of two types of electronic reminders to aid the anesthesia team in performing timely antibiotic re-doses. ⋯ Compared with the simple reminders generated with AIMS, the relevant, informative messages generated with SAM were more effective in improving compliance with timely antibiotic re-doses.
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Surgical infections · Feb 2011
Infection reduction strategies including antibiotic stewardship protocols in surgical and trauma intensive care units are associated with reduced resistant gram-negative healthcare-associated infections.
Resistance to broad-spectrum antibiotics by gram-negative organisms is increasing. Resistance demands more resource utilization and is associated with patient morbidity and death. We describe the implementation of infection reduction protocols, including antibiotic stewardship, and assess their impact on multi-drug-resistant (MDR) healthcare-acquired gram-negative infections. ⋯ Implementation of an antibiotic stewardship protocol as a component of an infection reduction campaign was associated with a decrease in resistant gram-negative healthcare-acquired infections in intensive care units. These results further support widespread implementation of such initiatives.
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Surgical infections · Feb 2011
Does delaying early intravenous fat emulsion during parenteral nutrition reduce infections during critical illness?
Because early administration of intravenous fat emulsions (IVFEs) has been linked to infectious complications in trauma patients, we began withholding IVFE for the first seven to ten days of parenteral nutrition (PN) in all surgical intensive care unit (SICU) patients. Prior to this, IVFE had been infused from the start of PN. ⋯ Withholding IVFE therapy during the first seven to ten days of PN did not influence infectious complications or the mortality rate in SICU patients. The benefits of delaying IVFE therefore may not be generalizable to all critically ill patients.
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Surgical infections · Feb 2011
Prevention of catheter-related blood stream infection: back to basics?
Central venous catheter (CVC)-related infections are a substantial problem in the intensive care unit (ICU). Our infection control team initiated the routine use of antiseptic-coated (chlorhexidine-silver sulfadiazine; Chx-SS) CVCs in our adult ICUs to reduce catheter-associated (CA) and catheter-related (CR) blood stream infection (BSI) as we implemented other educational and best practice standardization strategies. Prior randomized studies documented that the use of Chx-SS catheters reduces microbial colonization of the catheter compared with an uncoated standard (Std) CVC but does not reduce CR-BSI. We therefore implemented the routine use of uncoated Std CVCs in our surgical ICU (SICU) and examined the impact of this change. ⋯ Eliminating the universal use of Chx-SS-coated CVCs in an SICU with a low background incidence of CR-BSIs did not result in an increase in the rate of CR-BSIs. This study documents the greater importance of adherence to standardization of the processes of care related to CVC placement than of coated CVC use in the reduction of CR-BSI.