Surgical infections
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Surgical infections · Feb 2009
Randomized Controlled TrialRandomized, double-blind, placebo-controlled trial of effects of enteral iron supplementation on anemia and risk of infection during surgical critical illness.
Critical illness is characterized by hypoferremia, iron-deficient erythropoiesis (IDE), and anemia. The relative risks and benefits of iron supplementation in this setting are unknown. ⋯ Enteral iron supplementation of anemic, critically ill surgical patients does not increase the risk of infection and may benefit those with baseline IDE by decreasing the risk of RBC transfusion. A trial comparing enteral and parenteral iron supplementation in this setting is warranted (ClinicalTrials.gov number, NCT00450177).
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Surgical infections · Feb 2009
Comparative StudyWho is monitoring your infections: shouldn't you be?
In the era of pay for performance and outcome comparisons among institutions, it is imperative to have reliable and accurate surveillance methodology for monitoring infectious complications. The current monitoring standard often involves a combination of prospective and retrospective analysis by trained infection control (IC) teams. We have developed a medical informatics application, the Surgical Intensive Care-Infection Registry (SIC-IR), to assist with infection surveillance. The objectives of this study were to: (1) Evaluate for differences in data gathered between the current IC practices and SIC-IR; and (2) determine which method has the best sensitivity and specificity for identifying ventilator-associated pneumonia (VAP). ⋯ Utilizing SIC-IR at the point of patient care by a multidisciplinary STICU team offers more accurate infection surveillance with high sensitivity and specificity. This monitoring can be accomplished without additional resources and engages the physicians treating the patient.
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Each year, as many as two million operations are complicated by surgical site infections in the United States, and surgical patients account for 30% of patients with sepsis. The purpose of this study was to determine recent trends in sepsis incidence, severity, and mortality rate after surgical procedures and to evaluate changes in the pattern of septicemia pathogens over time. ⋯ Sepsis and death were more likely after non-elective than elective surgery. Sepsis and severe sepsis has increased significantly after elective and non-elective procedures over the last 17 years. The hospital mortality rate was reduced significantly after non-elective surgery, but no improvements were found for elective surgery patients who developed sepsis. Disparities in age, sex, and ethnicity and the development of postoperative surgical sepsis were found. Population-based studies may assist in defining temporal trends, disparities, and outcomes in sepsis not elucidated in smaller studies.
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Elective colon surgery has the highest rate of surgical site infection (SSI) of any elective procedure in surgery. The evolution of strategies for the prevention of SSI has had the correct use of preventive antibiotics as a crucial component. ⋯ The best outcomes in the prevention of SSI in elective colon surgery are achieved when appropriate systemic antibiotics are employed in conjunction with the appropriate use of oral antibiotic bowel preparation.
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Mechanical bowel preparation has been a mainstay in the management of patients undergoing elective colorectal surgery, but in recent years, this practice has been challenged; and a number of clinical reports have demonstrated no benefit, as judged by reduction of surgical site infections. This paper presents the advantages and disadvantages of mechanical bowel preparation. ⋯ Additional stratified studies of different mechanical bowel preparation methods, compared with no preparation, are required to address whether the practice should be abandoned.