Surgical infections
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Surgical infections · Jun 2015
Impact of Device-Associated Infection on Trauma Patient Outcomes at a Major Trauma Center.
Catheter-associated urinary tract infection (CAUTI) and ventilator-associated pneumonia (VAP) are considered performance measures. We analyzed the incidence, prevalence, and risk of CAUTI and VAP in trauma patients, as well as the demographic and injury factors related to these infections and their relative risks of negative outcomes (prolonged length of stay [LOS], sepsis, and death). ⋯ Development of CAUTI and VAP are significantly associated with a higher risk of sepsis in trauma patients after adjustment for age and injury type, location, and severity. This study suggests the importance of device-associated infections as vectors for sepsis in trauma and highlights the importance of prevention initiatives.
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Surgical infections · Apr 2015
Pre-operative antiseptic shower and bath policy decreases the rate of S. aureus and methicillin-resistant S. aureus surgical site infections in patients undergoing joint arthroplasty.
Surgical site infection (SSI) following joint arthroplasty increases length of stay, hospital cost, and leads to patient and healthcare provider dissatisfaction. Due to the presence of non-biologic implants (the prosthetic joint) in these procedures, infection is often devastating and treatment of the infection is more difficult. For this reason, prevention of SSI is of crucial importance in this population. Staphylococcus aureus colonizes the nares of approximately 30-40% of the population, is the most common pathogen causing SSI, and is associated with high morbidity and mortality rate. A pre-operative shower or bath with an antiseptic is an inexpensive and effective method of removal of these transient skin pathogens prior to the procedure and may be used to decrease SSI. ⋯ A pre-operative antiseptic shower and bath policy was associated with a significant decrease in S. aureus and MRSA SSI, but did not decrease the total incidence of SSI. This intervention may decrease the morbidity of S. aureus SSI in this population.
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Surgical infections · Feb 2015
ReviewNecrotizing pancreatitis: new definitions and a new era in surgical management.
Necrotizing pancreatitis is a challenging condition that requires surgical treatment commonly and is associated with substantial morbidity and mortality. Over the past decade, new definitions have been developed for standardization of severity of acute and necrotizing pancreatitis, and new management techniques have emerged based on prospective, randomized clinical trials. ⋯ Severe acute and necrotizing pancreatitis requires a multi-disciplinary treatment strategy that must be individualized for each patient. Optimal treatment of necrotizing pancreatitis now requires a staged, multi-disciplinary, minimally invasive "step-up" approach that includes a team of interventional radiologists, therapeutic endoscopists, and surgeons.
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Surgical infections · Feb 2015
Comparative StudyDivergent invariant natural killer T-cell response to sepsis of abdominal vs. non-abdominal origin in human beings.
The etiology of sepsis is broad. The peritoneal cavity displays compartmentalization with respect to inflammatory responses, so peripheral blood responses to sepsis of abdominal vs. non-abdominal origin are expected to be divergent. Lymphocytes and invariant natural killer T (iNKT) cells play important roles in survival from sepsis, as they dampen the neutrophil and macrophage responses. We assessed whether circulating iNKT cells display distinct phenotypic profiles depending on the presence of abdominal vs. non-abdominal infection with sepsis. ⋯ Divergent sepsis etiologies display distinct blood iNKT cell population changes. In non-abdominal infection, this difference was associated with septic shock and death. Elucidating the importance and basis for these changes relative to the response to sources of infection will help clarify appropriate diagnosis and management of the patient with sepsis.