Surgical infections
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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.
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Surgical infections · Aug 2010
Case ReportsOsteomyelitis of the iliac crest: a rare complication following perforated appendicitis.
Appendicitis is a common surgical emergency with numerous postoperative infective complications. We report an unusual case of iliac crest osteomyelitis as a late complication following emergency appendectomy for perforated gangrenous appendicitis. ⋯ Iliac crest osteomyelitis is indeed a rare complication of appendicitis. A heightened awareness and better understanding of this complication would necessitate early diagnosis and treatment.
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Surgical infections · Aug 2010
Randomized Controlled TrialRole of prophylactic antibiotics in laparoscopic cholecystectomy and risk factors for surgical site infection: a randomized controlled trial.
The aim of this clinical trial was to determine whether prophylactic antibiotics could prevent surgical site infection (SSI) after laparoscopic cholecystectomy and to identify any risk factors for infection. ⋯ A single dose of prophylactic antibiotic failed to decrease the likelihood of SSI after laparoscopic cholecystectomy.
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Surgical infections · Aug 2010
Preoperative verification of timely antimicrobial prophylaxis does not improve compliance with guidelines.
Surgical site infections are reduced by appropriate and timely antimicrobial prophylaxis. Consensus guidelines recommend that antimicrobial infusion begin within 60 min prior to creation of the incision. An internal audit of our institution suggested poor guideline compliance. We hypothesized that the addition of a oral antibiotic verification to the routine preoperative patient identification, operation, and surgical site verification would increase compliance. To this end, we compared compliance with the guidelines before and after the addition of a verification of antibiotic administration to the routine preoperative protocol. ⋯ The addition of verification of timely antimicrobial prophylaxis to the routine preoperative verifications does not improve compliance with the prophylaxis guidelines in the setting of good pre-intervention compliance.
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The Surviving Sepsis Campaign (SSC) was launched in 2002 as a collaborative initiative of the European Society of Intensive Care Medicine (ESICM), the International Sepsis Forum (ISF), and the Society of Critical Care Medicine (SCCM). Its objective was, through the development and promulgation of evidence-based guidelines that facilitated the application of knowledge derived from clinical trials to bedside practice, to effect a 25% reduction in the relative risk of death from severe sepsis and septic shock. ⋯ The SSC has impacted the care of septic patients and catalyzed changes that are likely to persist and evolve.