Surgical infections
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Surgical infections · Dec 2010
Comparative StudyNasal swabs collected routinely to screen for colonization by methicillin-resistant Staphylococcus aureus in intensive care units are a sensitive screening test for the organism in clinical cultures.
Many hospitals screen patients for methicillin-resistant Staphylococcus aureus (MRSA) on admission to the intensive care unit (ICU). We hypothesized that this screening information could be used to assist with empiric antibiotic decisions. ⋯ Screening with PCR analysis of nasal swab specimens is a highly sensitive test for MRSA in clinical cultures. Clinicians may be able to use the swab results to tailor more appropriate empiric antimicrobial regimens. The results with chromogenic medium screening are markedly poorer, which suggests that clinicians should view them with caution.
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Surgical infections · Oct 2010
Case ReportsExtended retroperitoneal necrotizing fasciitis with genital involvement, resembling fournier gangrene.
Necrotizing fasciitis is a serious infection that originates in the subcutaneous tissues. Although many reports have been published about necrotizing infections of other anatomical sites, retroperitoneal necrotizing soft tissue infection is a rare entity that has been described in only a few case reports. The etiology and clinical course of retroperitoneal necrotizing fasciitis can be variable and it is often difficult to identify the etiology of the infective process. ⋯ Similar to necrotizing infections at other anatomical sites, early diagnosis and timely surgical intervention and systemic antimicrobial therapy are mandatory for treating patients with retroperitoneal necrotizing fasciitis.
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Surgical infections · Oct 2010
Review Meta AnalysisGlycopeptide vs. non-glycopeptide antibiotics for prophylaxis of surgical site infections: a systematic review.
Patients receive prophylactic antibiotics against surgical site infections (SSIs) before or during many procedures. Glycopeptide antibiotics are effective against most strains of methicillin-resistant Staphylococcus aureus (MRSA), but their wider use risks increasing resistance. Our objective was to review the evidence for clinical effectiveness that might help to determine whether there is a threshold of MRSA prevalence at which switching from non-glycopeptide to glycopeptide antibiotic prophylaxis might be justified. ⋯ This systematic review did not find any evidence to support the use of glycopeptides in preference to other antibiotics for the prevention of MRSA infections and SSIs. The limitations of the evidence make it difficult to identify a threshold at which a switch from non-glycopeptide to glycopeptide prophylaxis should be recommended. Given the difficulties of addressing this issue through randomized trials, further research should focus on hospital infection control policies, MRSA screening, and the isolation and treatment of anyone infected with MRSA prior to surgery.
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Surgical infections · Oct 2010
Multicenter StudyPostoperative outcomes associated with topical skin adhesives among women having hysterectomies.
Multiple options are available for closure of hysterectomy incisions. This study compared postoperative clinical and economic outcomes using topical skin adhesive (2-octyl cyanoacrylate; OCA) vs. conventional skin closure in women undergoing total abdominal hysterectomy. ⋯ 2-octyl cyanoacrylate appears to be a safe and cost-effective alternative to topical sutures for patients having total abdominal hysterectomy. There were less favorable outcomes in groups receiving staples.
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Surgical infections · Oct 2010
Cost-effectiveness model of empiric doripenem compared with imipenem-cilastatin in ventilator-associated pneumonia.
Ventilator-associated pneumonia (VAP) is a common complication of critical illness among surgical and trauma patients. Inappropriate empiric treatment of VAP increases the mortality rate. The rates of Pseudomonas aeruginosa (PA) VAP susceptibility to doripenem (DOR) are higher than those to imipenem-cilastatin (IMI). We developed a model to quantify outcome differences between strategies of empiric treatment of VAP with DOR vs. IMI. ⋯ Given the current microbiologic sensitivity profile of PA to DOR and IMI, and depending on the local susceptibility patterns and in institutions where DOR in vitro susceptibilities are superior to those of other carbapenems for PA clinical isolates, empiric treatment of VAP with DOR may dominate that with IMI by being both life- and cost-saving.