Surgical infections
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Surgical infections · Jun 2011
ReviewPrevention of nosocomial pneumonia in the intensive care unit: beyond the use of bundles.
The occurrence of nosocomial pneumonia (NP) in the hospital setting is especially problematic, as it is associated with a greater risk of in-hospital death, longer stays on mechanical ventilation and in the intensive care unit (ICU), more need for tracheostomy, and significantly higher medical care costs. ⋯ Clinicians working in ICUs should consider the following recommendations: (1) Develop a VAP prevention bundle based on evidence-based guidelines; (2) monitor the rates of VAP prior to and during implementation of the program; (3) make adjustments according to VAP occurrence; and (4) integrate VAP prevention with other quality improvement programs.
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Surgical infections · Jun 2011
ReviewBest strategies in recurrent or persistent Clostridium difficile infection.
Clostridium difficile infection (CDI) is the primary cause of antibiotic-associated colitis and 15-25% of nosocomial antibiotic-associated diarrhea. Its clinical manifestations can range from mild diarrhea to toxic megacolon, bowel perforation, septic shock, and death. Over the past decade, more virulent strains have become increasingly common causes, and the incidence of CDI has risen, especially in elderly patients. These developments have led to an increase in recurrent CDI, which is more difficult to treat. This review focuses on recurrent CDI and its treatment. ⋯ Treatment of recurrent CDI remains challenging. Because of the lack of high-quality studies, recommendations for treatment are based on expert opinion. Metronidazole and vancomycin are the mainstays of treatment for both the initial infection and the first recurrence. For second recurrences, a vancomycin course plus taper is recommended. For subsequent recurrences, treatment options are many, with no one approach being entirely satisfactory. New drugs (fidaximicin) and treatments (monoclonal antibodies against the causative toxin) appear promising.
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Surgical infections · Jun 2011
Case ReportsAeromonas pneumonia in a trauma patient requiring extracorporeal membrane oxygenation for severe acute respiratory distress syndrome: case report and literature review.
Aeromonas species, particularly Aeromonas hydrophila, cause a wide spectrum of diseases in human being such as gastroenteritis; soft tissue infections including necrotizing fasciitis, meningitis, peritonitis, and bacteremia; but pneumonia and respiratory tract infections are uncommon. ⋯ This is the first case, to our knowledge, of the use of ECMO in a trauma patient with severe fulminant A. hydrophila pneumonia. Clinicians should be aware of the characteristics of this pathogen and associated clinical infections.