Surgical infections
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In spite of all efforts, surgical site infection (SSI) continues to be a common and costly complication of surgical procedures and thus a major concern for surgeons, patients, and hospitals. Laboratory observations that high concentrations of oxygen in tissues enhance bacterial killing and improve wound healing have prompted the study of peri-operative oxygenation as a means of reducing SSI. ⋯ Given the divergent results of this relatively large number of randomized studies, no definitive consensus has emerged. At present, clinicians should proceed with caution, and the administration of greater amounts of supplemental oxygen probably should be restricted to well-designed and -conducted clinical trials.
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Surgical infections · Aug 2012
ReviewAdherence to surgical care improvement project measures and post-operative surgical site infections.
Surgical site infection (SSI) is unequivocally morbid and costly. The estimated 300,000 SSIs annually in the United States represent the second most common infection among surgical patients, prolong hospitalization by 7-10 days, and have an estimated annual incremental cost of $1 billion. The mortality rate associated with SSI is 3%, with about three quarters of deaths being attributable directly to the infection. Prevention is possible for the most part, and concerted effort has been made to limit these infections, arguably to little effect. ⋯ Required reporting has increased awareness of the problem of SSI, but just as the complexity of SSI risk, pathogenesis, and preventions reflects the complexity of the disease, many other factors must be taken into account, including the skill and knowledge of the surgical team and promulgation of a culture of quality and safety in surgical patient care.
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Surgical infections · Aug 2012
ReviewThe vagus nerve and the inflammatory reflex: wandering on a new treatment paradigm for systemic inflammation and sepsis.
The immune system protects the host against dangerous pathogens and toxins. The central nervous system is charged with monitoring and coordinating appropriate responses to internal and external stimuli. The inflammatory reflex sits at the crossroads of these crucial homeostatic systems. This review highlights how the vagus nerve-mediated inflammatory reflex facilitates rapid and specific exchange of information between the nervous and immune systems to prevent tissue injury and infection. ⋯ The vagus nerve-mediated inflammatory reflex is a powerful ally in the fight against lethal tissue damage after injury and infection. Further studies will help translate the beneficial effects of this pathway into clinical use for our surgical patients.
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Sepsis is an excessive systemic inflammatory response activated by invasive infection. There has been substantial epidemiologic literature addressing perceived disparities in sepsis by demographic factors such as gender and race. There also have been multiple examinations of the disparities of sepsis with regard to environmental and socioeconomic factors. This paper reviews the current epidemiologic literature evaluating the association of race with the development of sepsis and its associated outcomes. ⋯ Race is a surrogate for many intangible factors that lead to the development of sepsis and inferior outcomes.
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Abscess incision and drainage (I&D) operations form the bulk of surgical procedures in the emergency department (ED). Nevertheless, epidemiologic, clinical, and bacteriology data are lacking for patients with abscesses presenting at Sudanese hospitals. Information also is unavailable on the magnitude of the problem of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) and its susceptibility to the most commonly used antibiotics. Our objectives were (1) to identify and document the epidemiologic and clinical variables of patients with superficial abscesses; (2) to isolate the causative organism(s) from the pus and determine their antibiotic sensitivity; (3) to determine the prevalence of CA-MRSA and its antibiotic susceptibility; and (4) to audit our practice of I&D of abscesses. ⋯ This study documents some epidemiologic and bacteriological data on one of the most common surgical problems. We found a substantial proportion of the infecting organisms to be CA-MRSA. This reflects the abuse of antibiotics in the community and stresses the importance of health education. Standardized surgical and anesthetic guidelines should be followed for I&D of abscesses to avoid recurrence. Further studies are needed urgently.