Surgical infections
-
Surgical infections · Dec 2014
Case ReportsDaptomycin-associated eosinophilic pneumonia in two patients with prosthetic joint infection.
Daptomycin is used increasingly to treat prosthetic joint infection (PJI). A possible side effect of this drug is eosinophilic pneumonia. We describe two patients with PJI treated with daptomycin who had this side effect with different clinical presentations. ⋯ Daptomycin-induced pneumonia can present with a wide range of symptoms, from fever alone to severe lung symptoms. Surgeons should be aware of this possible side effect when prescribing daptomycin.
-
Surgical infections · Dec 2014
Insulin resistance increases before ventilator-associated pneumonia in euglycemic trauma patients.
Hyperglycemia caused by stress-induced insulin resistance is associated with both infection and mortality in critically injured patients. The onset of infection may increase stress-induced insulin resistance, leading to hyperglycemia. Hyperglycemia has been shown to precede the diagnosis of ventilator-associated pneumonia (VAP) in critically injured adults and has been suggested to have potential diagnostic importance. However, glycemic control (GC) protocols in critically ill patients limit the development of hyperglycemia despite increasing insulin resistance. Our computer-assisted GC protocol achieves excellent GC, limiting infection-related hyperglycemia while capturing prospectively all glucose values, insulin infusion rates, and the multiplier (M) used to calculate the insulin rate. We hypothesized that surrogate measures of insulin resistance, the insulin infusion rate and multiplier M, would increase prior to the clinical suspicion of VAP, even in euglycemic critically injured patients. ⋯ Measures of insulin resistance increase in the two days prior to the clinical suspicion of VAP for critically injured patients on the GC protocol. These changes occur despite the protocol maintaining euglycemia. This data suggests that markers of insulin resistance may provide clinically useful information in the early diagnosis of VAP.
-
Surgical infections · Dec 2014
Lack of added predictive value of portable chest radiography in diagnosing ventilator-associated pulmonary infection.
The accurate diagnosis of ventilator-associated pulmonary infection (VAPI) poses an ongoing challenge. At our institution, patients in whom VAPI is strongly suspected on the basis of the Clinical Pulmonary Infection Score (CPIS) undergo diagnostic mini-bronchoalveolar lavage (mBAL) with quantitative cultures, followed by empiric antibiotic therapy in our surgical intensive care unit (sICU). We sought to determine the role of portable chest X-radiography (pCXR) in the diagnosis of VAPI. ⋯ Portable chest X-radiography has no added predictive value in identifying patients who should be evaluated further for VAPI. This supports the elimination of findings on chest X-radiography as defining characteristics of VAP, which accords with the U.S. Centers for Disease Control and Prevention's recent definition of VAP as but one of a number of types of ventilator-associated pulmonary infection (VAPI).
-
Surgical infections · Dec 2014
Surgical site infection and timing of prophylactic antibiotics for appendectomy.
Pre-operative prophylactic antibiotics may decrease the frequency of surgical site infection after appendectomy. However, the optimal timing for administration of pre-operative prophylactic antibiotics is unknown. The purpose of this study was to evaluate the effect of timing of prophylactic antibiotics on the frequency of surgical site infection after appendectomy. ⋯ The frequency of surgical site infection was independent of timing of preoperative prophylactic antibiotics but was associated with the presence of medical comorbidity.
-
Surgical infections · Dec 2014
Preventing infective complications following leech therapy: elimination of symbiotic Aeromonas spp. from the intestine of Hirudo verbana using antibiotic feeding.
Hirudotherapy is often used successfully in modern medicine, especially in plastic and reconstructive surgery. However, Aeromonas infections are the most common complications of post-operative leech application. Hence, prophylactic antibiotic administration is recommended before and during leech therapy. It has been confirmed that patient safety and achieving the desired therapeutic effect depend mainly on the microbiologic purity of the animals used. The aims of this study were to find a safe and practical way to eradicate symbiotic Aeromonas spp. occuring in the intestine of Hirudo verbana. ⋯ All leeches were ready to take a blood meal after treatment, suggesting the possibility of using ciprofloxacin-treated or cefotaxime-treated leeches instead of chemoprophylaxis in patients undergoing hirudotherapy.