Surgical infections
-
Surgical infections · Oct 2010
Empiric, broad-spectrum antibiotic therapy with an aggressive de-escalation strategy does not induce gram-negative pathogen resistance in ventilator-associated pneumonia.
Early, empiric, broad-spectrum antibiotics followed by de-escalation to pathogen-specific therapy is the standard of care for ventilator-associated pneumonia (VAP). In our surgical intensive care unit (SICU), imipenem-cilastatin (I-C) in combination with tobramycin (TOB) or levofloxacin (LEV) has been used until quantitative bronchoalveolar lavage results are finalized, at which time de-escalation occurs to pathogen-specific agents. With this practice, however, alterations in antimicrobial resistance remain a concern. Our hypothesis was that this strict regimen does not alter antimicrobial susceptibility of common gram-negative VAP pathogens in our SICU. ⋯ In our SICU, early, empiric broad-spectrum VAP therapy followed by de-escalation to pathogen-specific agents did not alter antimicrobial resistance and is a valid practice. Further, our compliance with de-escalation practices was higher than published rates.
-
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.
-
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.
-
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.
-
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.