Surgical infections
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Surgical infections · Oct 2017
Review Meta AnalysisMeta-Analysis of Comparative Trials Evaluating a Prophylactic Single-Use Negative Pressure Wound Therapy System for the Prevention of Surgical Site Complications.
We report the first meta-analysis on the impact of prophylactic use of a specific design of negative pressure wound therapy (NPWT) device on surgical site complications. ⋯ The significant reduction in SSI, wound dehiscence, and LOS on the basis of pooled data from 16 studies shows a benefit of the PICO single-use NPWT system compared with standard care in closed surgical incisions.
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Surgical infections · Oct 2017
Fungal Infections Increase the Mortality Rate Three-Fold in Necrotizing Soft-Tissue Infections.
Necrotizing soft-tissue infections (NSTIs) result in significant morbidity and mortality rates, with as many as 76% of patients dying during their index admission. Published data suggest NSTIs rarely involve fungal infections in immunocompetent patients. However, because of the recent recognition of fungal infections in our population, we hypothesized that such infections frequently complicate NSTIs and are associated with higher morbidity and mortality rates. ⋯ This is the largest series to date describing the impact of fungal infection in NSTIs. Our data demonstrate a three-fold increase in the mortality rate and the need for two additional operations. Consideration should be given to starting patients on empiric anti-fungal therapy in certain circumstances.
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Surgical infections · Aug 2017
Mortality Rate and Antibiotic Resistance in Complicated Diverticulitis: Report of 272 Consecutive Patients Worldwide: A Prospective Cohort Study.
Background: Complicated diverticulitis (CD) is a common problem for surgeons. In treating it, as a general principle, every verified source of infection should be controlled. Supplementary antimicrobial management involves a delicate balance of optimizing empirical therapy while reducing unnecessary antibiotic use. ⋯ By univariable analysis, the only statistically significant factor associated with resistant bacteria was inadequacy of the empirical antimicrobial therapy (p = 0.004). The factors associated with death were delay in initial intervention (p = 0.006) and ICU admission because of severe sepsis on admission (p = 0.004). Conclusion: Early source control is mandatory to reduce the mortality rate in complicated diverticulitis. Effective empirical antimicrobial agent therapy is necessary to reduce resistance and improve the clinical outcome.
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Surgical infections · Aug 2017
A Prognostic Scoring Tool for Cesarean Organ/Space Surgical Site Infections: Derivation and Internal Validation.
Organ/space surgical site infections (SSIs) are serious complications after cesarean delivery. However, no scoring tool to predict these complications has yet been developed. This study sought to develop and validate a prognostic scoring tool for cesarean organ/space SSIs. ⋯ This scoring tool showed a high predictive ability regarding cesarean organ/space SSIs on the derivation data and reproducibility was demonstrated on internal validation. It could assist practitioners prioritize patient care and management depending on risk category and decrease SSI rates in cesarean deliveries.
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Surgical infections · Aug 2017
Factors of Pelvic Infection and Death in Patients with Open Pelvic Fractures and Rectal Injuries.
Open pelvic fractures associated with rectal injuries are uncommon. They often cause serious pelvic infection, even death. This combination of injuries has been reviewed infrequently. Herein, we report factors associated with pelvic infection and death in a group of patients with open pelvic fractures and concurrent rectal injuries. ⋯ The incidence of pelvic infection was lower in patients having early colostomy (p < 0.05). Patients with shock had a higher risk of pelvic infection, and we recommend aggressive measures to treat these patients. According to our results, RTS ≤8 could be a predictor of poor outcomes in patients with open pelvic fracture and concurrent rectal injury. Open reduction and internal fixation after extensive debridement is recommended in patients with unstable pelvic fractures.