Surgical infections
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Surgical infections · Apr 2016
ReviewPersistent Inflammation, Immunosuppression, and Catabolism: Evolution of Multiple Organ Dysfunction.
Multiple organ dysfunction (MOD) has plagued intensive care units (ICUs) for more than four decades, and its epidemiology has evolved because more patients are surviving previously lethal insults. Over the years, different predominant phenotypes of MOD have been described, all of which have consumed tremendous healthcare resources and have been associated with prolonged ICU stays and prohibitive mortality rates. ⋯ Unfortunately, as our population ages and peri-operative care improves, PICS will become an insurmountable epidemic. We believe PICS is the next horizon in surgical critical care and have developed a program to study the pathogenesis and novel therapies for this vexing problem.
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Surgical infections · Apr 2016
Multicenter StudySurgical Site Infection Rates in Seven Cities in Vietnam: Findings of the International Nosocomial Infection Control Consortium.
Surgical site infections (SSIs) are the most common healthcare-associated infections (HAI) in lower-income countries. This is the first study to report the results of surveillance on SSI stratified by surgical procedure in seven Vietnamese cities. ⋯ Our SSIs rates were significantly higher for 11 of the 26 types of SPs than for the CDC-NHSN. This study advances our knowledge of SSI epidemiology in Vietnam and will allow us to introduce targeted interventions.
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Surgical infections · Apr 2016
Educational Antimicrobial Stewardship Intervention Ineffective in Changing Surgical Prophylactic Antibiotic Prescribing.
High rates of inappropriate use of prophylactic antibiotics in surgery continue to be reported in the literature, with many institutions designing interventions aimed at improving prescription. This study evaluates the surgical arm of a clinician-focused educational antimicrobial stewardship program implemented in February 2014 at Blacktown Hospital, Australia. ⋯ The educational intervention studied demonstrated no substantial change to overall adherence. Given the frequent failure of such interventions, stronger and more directly mandated adoption of prescribing guidelines is recommended for surgical services. Future consideration should be given to focused computer-based solutions, integrated with electronic medical records where possible.
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Surgical site infections (SSI) due to Staphylococcus aureus are associated with substantial mortality rates and morbidity. Hence, various strategies are being investigated to prevent them. We explore time trends and risk factors associated with S. aureus SSI to identify high risk patients who might benefit the most from these strategies. ⋯ Future S.aureus SSI prevention measures should focus on patients with risk profiles identified from this and other similar studies.
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A retrospective study was conducted to investigate the validity and the effectiveness of early empiric antibiotic and de-escalation therapy for the treatment of severe sepsis and septic shock patients in the intensive care unit (ICU). ⋯ Empiric antibiotic therapy was acceptable for severe sepsis and septic shock patients treated in the ICU. The appropriate selection of empiric antibiotics was related to a greater rate of de-escalation and better survival. The risk of multi-drug-resistant bacterial infections was not as high as expected, but will need further attention in the future.