Surgical infections
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Surgical infections · Jun 2011
Case ReportsAeromonas pneumonia in a trauma patient requiring extracorporeal membrane oxygenation for severe acute respiratory distress syndrome: case report and literature review.
Aeromonas species, particularly Aeromonas hydrophila, cause a wide spectrum of diseases in human being such as gastroenteritis; soft tissue infections including necrotizing fasciitis, meningitis, peritonitis, and bacteremia; but pneumonia and respiratory tract infections are uncommon. ⋯ This is the first case, to our knowledge, of the use of ECMO in a trauma patient with severe fulminant A. hydrophila pneumonia. Clinicians should be aware of the characteristics of this pathogen and associated clinical infections.
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Surgical infections · Apr 2011
ReviewExtracorporeal membrane oxygenation in the context of the 2009 H1N1 influenza A pandemic.
Extracorporeal membrane oxygenation (ECMO) incorporates surgical techniques as adjuncts in the management of refractory respiratory dysfunction. For many years, its primary application was for support of neonatal infants in cardiorespiratory failure. As the 2009 H1N1 influenza A pandemic developed, more reports came in of severe respiratory dysfunction and even death that seemed to be occurring preferentially in younger adults. Centers with the capability began to use ECMO to salvage these patients. ⋯ Supportive management is continued along with ECMO. Antiviral drugs and antimicrobial agents should be given as appropriate, as should nutritional support. Volume management should be used. Ventilator settings should be reduced as ECMO support allows, with a goal of reducing airway pressures, ventilator rate, and FiO(2). Complications of ECMO are common. Bleeding, the most common, can result in death, especially if it occurs intracranially.
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Surgical infections · Apr 2011
Implementation and enforcement of ventilator-associated pneumonia prevention strategies in trauma patients.
We hypothesized that strict enforcement of ventilator-associated pneumonia (VAP) prevention (VAPP) strategies would decrease the incidence of VAP and improve patient outcomes. ⋯ There was a statistically significant decrease in the occurrence of VAP with strict enforcement of a VAPP protocol, regardless of head AIS score. Although the difference in patients with a head AIS score <3 was not statistically significant, it was clinically meaningful, decreasing the already-low rate of VAP by half. Strict enforcement of VAPP protocols may be cost efficient for hospitals and prevent decreased reimbursement under the Medicare pay-for-performance strategies.
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Surgical infections · Feb 2011
Prophylactic antibiotic days as a predictor of sensitivity patterns in Acinetobacter pneumonia.
Ventilator-associated pneumonia (VAP) secondary to Acinetobacter spp. in critically ill trauma patients has increased. More importantly, the incidence of multi-drug-resistant (MDR) Acinetobacter VAP has increased. The risk factors for this increase in resistance have yet to be elucidated. The purpose of this study was to evaluate the change in Acinetobacter sensitivity over time and determine which risk factors predict resistance in trauma patients. ⋯ The incidence of MDR Acinetobacter VAP has increased over time. More severe extremity injuries, as measured by the AIS, may contribute to prolonged antibiotic exposure in those patients with MDR Acinetobacter VAP. Multiple logistic regression identified Pro antibiotic days as an independent risk factor for MDR Acinetobacter VAP in trauma patients.
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Surgical infections · Feb 2011
Automated electronic reminders to improve redosing of antibiotics during surgical cases: comparison of two approaches.
Timely re-dosing of antibiotic for prolonged surgical cases is an important measure in reducing the risk of surgical site infections. For the anesthesia team, which generally administers the antibiotic re-doses, it is difficult to keep track of and remember the exact timing requirements. We explored the efficacy of two types of electronic reminders to aid the anesthesia team in performing timely antibiotic re-doses. ⋯ Compared with the simple reminders generated with AIMS, the relevant, informative messages generated with SAM were more effective in improving compliance with timely antibiotic re-doses.