Surgical infections
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Surgical infections · Feb 2008
Fever and leukocytosis in critically ill trauma patients: it's not the urine.
Infectious complications are a major cause of morbidity and mortality in critically ill trauma patients. Therefore, fever and leukocytosis often trigger an extensive laboratory workup that includes a urine culture (UCx). The purposes of this study were to: 1) Define the current practice for obtaining UCxs in trauma patients admitted to the surgical and trauma intensive care unit (STICU); and 2) determine if there is an association between fever or leukocytosis and urinary tract infections (UTIs) during the initial 14 hospital days. ⋯ The practice of obtaining a UCx from the STICU trauma patient was related to fever and fever with leukocytosis. However, neither fever nor leukocytosis nor both were associated with UTIs. These data suggest that there is an unnecessary emphasis on UTI as a source of fever and leukocytosis in injured patients during their first 14 STICU days. Our results suggest that the paradigm for evaluating UTI as a cause of fever needs to be reevaluated in critically ill trauma patients.
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Surgical infections · Jan 2008
ReviewEarly appropriate parenteral antimicrobial treatment of complicated skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus.
Complicated skin and soft tissue infections (cSSTIs) are a major clinical problem, in part because of the increasing resistance of infecting bacteria to our current antibiotic therapies. Prompt appropriate treatment of infections in hospitalized patients reduces the mortality rate. Furthermore, appropriate and timely antibiotic therapy improves outcomes for cSSTIs caused by methicillin-resistant Staphylococcus aureus (MRSA). This review delineates factors to consider in the choice of initial antibiotic treatment for cSSTIs and describes the antimicrobial agents available or under clinical development for the treatment of cSSTIs caused by MRSA. ⋯ Severe and progressive cSSTIs should be treated promptly with appropriate antibiotic agents. The choice of agent should be guided by a number of factors, including suspected CA-MRSA or HA-MRSA infection. Available agents should be evaluated carefully for efficacy in the treatment of MRSA cSSTIs.
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Surgical infections · Jan 2008
ReviewTreatment options for uncomplicated community-acquired skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus: oral antimicrobial agents.
In the United States, methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of skin and soft tissue infections (SSTIs), and toxin-producing community-acquired MRSA (CA-MRSA) strains are becoming the leading cause of SSTIs presenting to emergency departments and outpatient settings. Many of these infections can be treated with oral antibiotics. This review is intended to delineate the types of SSTIs that require antibiotic treatment and to explain which CA-MRSA SSTIs can be treated with oral antibacterial agents. ⋯ The growing prevalence of CA-MRSA in SSTIs and the increasing number of these infections observed in both the community and the hospital setting indicates that early, appropriate recognition and treatment are necessary. Many oral antimicrobial agents are available for the treatment of these infections.
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Surgical infections · Dec 2007
Does body mass index affect infection-related outcomes in the intensive care unit?
Obesity is a worldwide healthcare concern, but its impact on critical care (intensive care unit; ICU) outcomes is not well understood. The general hypothesis is that obesity worsens ICU outcomes, but published reports fail to demonstrate this effect consistently. We hypothesized that increasing BMI would be an independent predictor of higher mortality rates in the surgical/trauma ICU. ⋯ Contrary to the hypothesis, the data suggest no discernable independent association of increasing BMI with heightened mortality rate in the surgical/trauma ICU patient with infection.