Surgical infections
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Surgical infections · Oct 2008
Near-infrared spectroscopy in patients with severe sepsis: correlation with invasive hemodynamic measurements.
Clinicians have begun using near-infrared spectroscopy (NIRS) to monitor tissue perfusion in hemorrhagic shock, as the technique allows continuous noninvasive monitoring of tissue hemoglobin oxygen saturation (StO(2)) and the tissue hemoglobin index (THI). We hypothesized that StO(2) measurements in patients with severe sepsis would be associated with the severity of their illness and would correlate with invasive hemodynamic measurements. ⋯ Near-infrared spectroscopic measurements of StO(2) correlated with invasive hemodynamic measurements in patients with severe sepsis but did not correlate with severity of illness. These findings suggest that NIRStO(2) may be a clinically useful measurement in monitoring patients with severe sepsis. Further study of this device in early resuscitation of patients with sepsis is necessary.
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Surgical infections · Aug 2008
Reduction in rates of methicillin-resistant Staphylococcus aureus infection after introduction of quarterly linezolid-vancomycin cycling in a surgical intensive care unit.
The burden of infection with antibiotic-resistant gram-positive cocci, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), continues to increase, leading to substantial morbidity and high mortality rates, particularly in intensive care units (ICUs). Creative interventions may be required to reverse or stabilize this trend. ⋯ Quarterly cycling of linezolid and vancomycin in the ICU is a promising method to reduce infections with MRSA.
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Appendectomy for acute appendicitis is an effective, universally accepted procedure performed more than 300,000 times annually in the United States. It is generally believed that appendicitis progresses invariably from early inflammation to later gangrene and perforation, and that appendectomy is required for surgical source control. Although non-operative management with antibiotics of uncomplicated diverticulitis, salpingitis, and neonatal enterocolitis is now established, the non-operative management of appendicitis remains largely unexplored. ⋯ Appendectomy may not be necessary for the majority of patients with acute uncomplicated appendicitis, as many patients resolve spontaneously and others may be treatable with antibiotics alone. However, the supporting documentation is scant and of poor quality. A randomized, prospective trial of non-operative management versus early appendectomy of acute uncomplicated appendicitis corroborated by radiologic imaging is called for.
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Surgical infections · Aug 2008
Case ReportsContinued lumbar spinal erosion after repair of chronic contained rupture of a mycotic abdominal aortic aneurysm.
Mycotic aneurysm of the aorta is a rare, dangerous condition. We report a case of an abdominal aortic aneurysm (AAA) caused by Candida albicans. ⋯ Aggressive multimodality therapy of infected AAA and associated vertebral osteomyelitis is necessary for a successful outcome.
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Surgical infections · Aug 2008
Blood product transfusion and ventilator-associated pneumonia in trauma patients.
Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in trauma patients, with a high mortality rate. Blood transfusion has been identified as an independent risk factor for VAP in critically ill patients. Prior studies in trauma are limited by retrospective design, lack of multivariable analyses, and scant data on the timing of transfusion. We examined critically the relation between blood product transfusion and VAP in trauma patients. ⋯ Blood product transfusion is an independent risk factor for VAP in trauma, and the odds ratio is significantly higher (3.34-4.41) than in published studies of other types of ICU patients (1.89). To reduce the incidence of VAP, all efforts to reduce the transfusion of blood products to trauma patients should be implemented.