Surgical infections
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Surgical infections · Dec 2019
Clinical Outcome and Risk Factors for Emergency Department Adult Patients with Thoracic Empyema after Video-Assisted Thoracic Surgical Procedure.
Background: Empyema is a purulent infection of the pleural cavity that is most relevant to parapneumonia effusion. Video-assisted thoracoscopic surgery (VATS) is an option for stage 2 (fibrinopurulent) and stage 3 (organizational). Surgeons may see critically ill patients with pleural empyema who present to the emergency department (ED). ⋯ Two groups (survivors and non-survivors) significantly differed in age (p = 0.013), sex (p = 0.026), comorbidity (p = 0.017), cough (p = 0.024), chest pain (p = 0.016), serum hemoglobin (p = 0.001), and potassium (p = 0.004) levels. Further logistic regression analysis showed statistically significant differences in age, hemoglobin levels, and potassium levels. Conclusion: Among the ED patients with thoracic empyema, older age, lower hemoglobin levels, and higher potassium levels are associated with post-operative death after VATS. These findings underline the importance of careful peri-operative treatment in older patients with signs of empyema when they present to the ED.
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Background: Sepsis is an uncommon occurrence after appendectomy, but the morbidity and mortality of patients who develop sepsis after appendectomy remains exceedingly high. The purpose of this study is to identify risk factors and adverse post-operative outcomes associated with sepsis after appendectomy in adults. Patients and Methods: The American College of Surgery National Surgical Quality Improvement Program participant user database was queried from 2012 to 2015. Patients who underwent appendectomy were identified and demographic data, intra-operative variables, and post-operative outcomes were collected. ⋯ Patients who developed sepsis after appendectomy were more likely to return to the operating room (24.76 vs. 0.77%, p < 0.001), be re-admitted for any cause (53.38% vs. 2.70%, p < 0.0001), and die within 30 days of surgery (5.47% vs. 0.05%, p < 0.001). Conclusion: Patients who become septic after appendectomy are at risk for adverse post-operative morbidity and mortality. Age 60 years or more, African American race, morbid obesity, acute renal failure or dialysis, disseminated malignancy, and open appendectomy increase the risk for sepsis after appendectomy and sepsis-related morbidity and mortality. Given the remarkably large number of appendectomies that are performed each year, the findings of this study can assist in identifying at-risk patients, facilitate physician-patient discussion and shared decision-making, and guide appropriate care to further reduce the incidence of sepsis after appendectomy.
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Background: We examined clinical outcomes among combat casualties with genitourinary injuries after blast trauma. Methods: Characteristics, clinical care, urologic complications, and infections for subjects enrolled in the Trauma Infectious Disease Outcomes Study (TIDOS) were collected from Department of Defense (DOD) and Department of Veterans Affairs (VA) sources. Logistic regression identified predictors for urinary tract infections (UTIs) after genitourinary trauma. Results: Among 530 TIDOS enrollees who entered VA care, 89 (17%) sustained genitourinary trauma. The majority of subjects (93%) were injured via a blast and 27% had a dismounted complex blast injury (DCBI). ⋯ Subjects with UTIs had a higher proportion of bladder injury (53% vs. 13%; p < 0.001), posterior urethral injury (26% vs. 1%; p = 0.001), pelvic fracture (47% vs. 4%; p < 0.001), soft-tissue infection of the pelvis/hip (37% vs. 4%; p = 0.001), urinary catheterization (47% vs. 11%; p < 0.001), urinary retention or incontinence (42% vs. 6%; p < 0.001), and stricture (26% vs. 3%; p = 0.004) compared with patients with genitourinary trauma and no UTI. Independent UTI risk factors were occurrence of a soft-tissue infection at the pelvis/hip, trauma to the urinary tract, and transtibial amputation. Conclusions: Among combat casualties with genitourinary trauma, UTIs are a common complication, particularly with severe blast injury and urologic sequelae. Episodes of UTIs typically occur early after the initial injury while in DOD care, however, recurrent infections may continue into long-term VA care.
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Surgical infections · Dec 2019
Randomized Controlled TrialEffect of Triclosan-Coated Suture on Surgical Site Infection of Abdominal Fascial Closures.
Background: Surgical site infections (SSIs) are a serious problem after abdominal surgery. This study aimed to compare closure of fascia with triclosan-coated monofilament polydioxanone (PDS) or standard PDS in decreasing the incidence of SSIs in patients who underwent abdominal surgery. Methods: In this randomized study, a total of 890 consecutive patients undergoing laparotomy for any gastrointestinal pathology were allocated to closure of the fascia with triclosan-coated PDS (treatment group; TG) or standard PDS (control group; CG). ⋯ Conclusions: Closure of the fascia with triclosan-coated PDS decreased SSI rates as much as 24%. Also, SSIs were decreased significantly at clean, clean-contaminated, and contaminated sites. Therefore, triclosan-coated PDS might be recommended for fascial closure as a means of decreasing SSIs.
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Surgical infections · Dec 2019
Albumin/Procalcitonin Ratio Is a Sensitive Early Marker of Nosocomial Blood Stream Infection in Patients with Intra-Cerebral Hemorrhage.
Background: This study was performed to investigate the combination of admission serum procalcitonin (PCT) and albumin (alb) concentrations as a diagnostic predictor for discriminating patients with nosocomial blood stream infection (BSI) among those with spontaneous intra-cerebral hemorrhage (ICH). Methods: We conducted a retrospective study on patients with ICH and hospital-acquired BSI. Clinical and microbiological data were compared in patients who experienced nosocomial BSI during a hospital stay and those who did not. Multivariable logistic regression analyses were used to identify independent risk factors for nosocomial BSI. ⋯ In the subgroup of 85 patients with nosocomial BSI, the albumin:PCT ratio in patients with shock was lower than that in those without shock (7.154 [2.975-26.267] vs 28.000 [3.818-57.812]; p = 0.027). Conclusion: The albumin:PCT ratio can be used as an early diagnostic predictor for nosocomial BSI in patients with ICH. Additionally, BSI patients with lower albumin:PCT ratios are more likely to experience shock. The albumin:PCT ratio is expected to be a rapid and low-cost tool for clinical practice.