Surgical infections
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Surgical infections · Dec 2014
Surgical site infection and timing of prophylactic antibiotics for appendectomy.
Pre-operative prophylactic antibiotics may decrease the frequency of surgical site infection after appendectomy. However, the optimal timing for administration of pre-operative prophylactic antibiotics is unknown. The purpose of this study was to evaluate the effect of timing of prophylactic antibiotics on the frequency of surgical site infection after appendectomy. ⋯ The frequency of surgical site infection was independent of timing of preoperative prophylactic antibiotics but was associated with the presence of medical comorbidity.
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Surgical infections · Dec 2014
The geriatric cytokine response to trauma: time to consider a new threshold.
Inflammatory responses to trauma, especially if exaggerated, drive mortality and morbidities including infectious complications. Geriatric patients are particularly susceptible to profound inflammation. Age-related declines in inflammatory and immune systems are known to occur. Geriatric patients display dampened inflammatory responses to non-critical disease processes. Specific inflammatory responses in critically ill geriatric trauma patients, and how the inflammatory profile associated with subsequent infections or mortality, remain unknown. ⋯ A lowered inflammatory response in geriatric patients is associated with the development of a subsequent infection. However, geriatric patients exhibiting inflammatory responses as robust as their younger counterparts have increased mortality. Redefining our understanding of an appropriate geriatric inflammatory response to trauma will help future therapy, thereby improving morbidity and mortality.
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Surgical infections · Dec 2014
Differential impact of infection control strategies on rates of resistant hospital-acquired pathogens in critically ill surgical patients.
There were two major outbreaks of multi-drug resistant Acinetobacter baumannii (MDRA) in our general surgery and trauma intensive care units (ICUs) in 2004 and 2011. Both required aggressive multi-faceted interventions to control. We hypothesized that the infection control response may have had a secondary benefit of reducing rates of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Clostridium difficile (C. diff). ⋯ Rates of resistant pathogens were lower in the general surgery ICU after response to MDRA outbreaks in both 2004 and 2011 although the rates increased again with time. There were no changes in rates of resistant pathogens in the trauma ICU after MDRA outbreaks in 2004 and 2011. Outbreak responses may have a differential impact in general surgery ICU versus trauma ICUs.