Surgical infections
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Surgical infections · Apr 2014
Randomized Controlled TrialComparison of digital planimetry and ruler technique to measure ABSSSI lesion sizes in the ESTABLISH-1 study.
In August 2010, the U.S. Food and Drug Administration issued draft guidelines for developing antibiotics for treating acute bacterial skin and skin structure infections (ABSSSI), with the outcome measure of such treatment relying primarily on the cessation of spread or on the decrease in size of skin lesions at 48-72 h after the initiation of such treatment. In 2012, the Foundation for the National Institutes of Health proposed an interim outcome measure defined as a reduction in lesion size by ≥20% at a 48-72 h examination. These recent changes make it necessary to identify reliable methods for measuring the lesions in acute infections of the skin. ⋯ The results of the ESTABLISH-1 study show that both the RT method and DP are consistent and reliable techniques for measuring the sizes of ABSSSI lesions. Ultimately, changes in lesion size, rather than the absolute value of lesion size, will be used to assess the outcomes of treatment for ABSSSI in clinical research.
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Surgical infections · Apr 2014
Bacteremia and ventilator-associated pneumonia: a marker for contemporaneous extra-pulmonic infection.
Ventilator-associated pneumonia (VAP) is a well-known complication of mechanical ventilation in severely injured patients. A subset of patients with VAP develop an associated bacteremia (B-VAP), but the risk factors, microbiology, morbidity, and mortality in this group are not well described. The goal of this study was to examine the incidence, predictors, and outcome of B-VAP in adult trauma patients. ⋯ Trauma patients with B-VAP have a similar mortality but greater morbidity than those with VAP alone. The number of PRBC received is the most significant risk factor for developing B-VAP. More than two-thirds of patients with B-VAP have contemporaneous extra-pulmonic infections. Trauma patients with B-VAP may benefit from increased surveillance for additional concomitant infections and from more aggressive empiric antimicrobial coverage.