Surgical infections
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Surgical infections · Jun 2010
ReviewAvoiding colectomy during surgical management of fulminant Clostridium difficile colitis.
Clostridium difficile is the most common cause of nosocomial diarrhea in adults. Over the last decade, there has been a substantial increase in the disease-associated morbidity and mortality rate from this infection accompanied by identification of new hypervirulent strains. Fulminant colitis, a severe and complicated form of the disease that frequently necessitates surgical intervention, occurs in 3-8% of patients infected with C. difficile. The postoperative mortality rate for fulminant colitis continues to be dire, ranging from 34-57%. ⋯ A high clinical suspicion and careful patient selection for colectomy is imperative to improve postoperative survival. An alternative surgical strategy for fulminant C. difficile colitis is laparoscopic creation of an ileostomy with total colonic washout.
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Surgical infections · Jun 2010
Case ReportsPrimary omental abscess caused by Streptococcus constellatus: a case report.
The presentation of primary abscess of the greater omentum is similar to other acute abdominal disorders. It is a rarely reported phenomenon, and correct diagnosis is typically made during abdominal exploration. ⋯ Abdominal exploration and resection is a reasonable approach to primary abscess of the greater omentum.
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Surgical infections · Apr 2010
Critical analysis of empiric antibiotic utilization: establishing benchmarks.
We critically evaluated empiric antibiotic practice in the surgical and trauma intensive care unit (STICU) with three specific objectives: (1) To characterize empiric antibiotics practice prospectively; (2) to determine how frequently STICU patients started on empiric antibiotics subsequently have a confirmed infection; and (3) to elucidate the complications associated with unnecessary empiric antibiotic therapy. ⋯ After admission to the STICU, 26% of patients received at least one course of empiric antibiotics. Only 25.6% of these patients were confirmed to have an infection. These results provide key benchmark data for the critical care community to improve antibiotic stewardship.
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Surgical infections · Apr 2010
Toll-like receptor-4 mediates intestinal barrier breakdown after thermal injury.
Toll-like receptor 4 (TLR-4) activation after sterile injury leads to organ dysfunction at distant sites. We have shown previously that intestinal barrier breakdown and alteration of tight junction proteins follows thermal injury; however, the role of TLR-4 in this process remains unclear. We hypothesized that increased intestinal permeability and barrier breakdown after burns is a TLR-4 dependent process; hence, knocking down the TLR-4 gene would have a protective effect on burn-induced intestinal dysfunction. ⋯ Mice with TLR-4 KO have less intestinal permeability to FITC-dextran than do TLR-4 WT mice after burn injury as a result of alterations in the tight junction protein occludin. These findings suggest that the greater intestinal permeability and barrier breakdown after burn injury is a TLR-4-dependent process. Toll-like receptor 4 may provide a useful target for the prevention and treatment of systemic inflammatory response syndrome and multisystem organ failure after injury.
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Surgical infections · Feb 2010
The pathogen of ventilator-associated pneumonia does not influence the mortality rate of surgical intensive care unit patients treated with a rotational antibiotic system.
Ventilator-associated pneumonia (VAP) is one of the leading causes of morbidity in critically ill surgical patients. Certain pathogens (e.g., methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa) have been associated with an excess mortality rate from sepsis in several studies, but not in the surgical setting specifically or when protocol-driven antibiotic therapy is administered. ⋯ The type of pathogen does not influence death in surgical ICU patients with VAP diagnosed rigorously and treated by a rotational antibiotic system. The high proportion of AIT as a result of the rotational antibiotic administration system optimizes bacterial killing and negates the impact of bacterial resistance, contributing to better outcomes.