Surgical infections
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Surgical infections · Dec 2007
The burden of Clostridium difficile in surgical patients in the United States.
Clostridium difficile colitis is the predominant hospital-acquired gastrointestinal infection in the United States and has emerged as an important nosocomial cause of morbidity and death. Although several institutional studies have examined the effects of C. difficile on hospitalized patients, its nationwide impact on surgical patients has yet to be defined. ⋯ Epidemiologic data suggest that the incidence of C. difficile infection is increasing in U.S. surgical patients and that the infection is most prevalent after emergency operations and among patients having intestinal tract resections. Infection with C. difficile is an independent predictor of increased LOS, total charges, and mortality rate after surgery and represents a considerable burden to both patients and hospitals. Preventing C. difficile infection offers a potentially significant improvement in patient outcomes, as well as a reduction in hospital costs and resource expenditures.
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Surgical infections · Dec 2007
Case ReportsDescending necrotizing mediastinitis: unique complication of central venous catheterization.
Central venous catheter placement is a common procedure in the intensive care unit. However, these devices are not without complications. We describe the first reported case of descending necrotizing mediastinitis secondary to central venous catheterization without evidence of associated vascular perforation. ⋯ Prompt recognition, adequate operative drainage, and appropriate antibiotics remain the best treatment for descending necrotizing mediastinitis.
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Surgical infections · Dec 2007
Duration of antibiotic therapy for ventilator-associated pneumonia caused by non-fermentative gram-negative bacilli.
Chastre et al. compared eight and 15 days of antibiotic therapy for ventilator-associated pneumonia (VAP), finding no difference in outcome with the exception of VAP caused by non-fermentative gram-negative bacilli (NFGNB), for which a higher recurrence rate was seen in the shorter-duration group (JAMA 2003;290:2588-2598). We recently examined our institutional experience with VAP caused by NFGNB to determine whether shorter courses of antibiotic therapy were associated with higher rates of recurrence. ⋯ We did not find a higher recurrence rate in patients with VAP caused by NFGNB who received shorter courses of antibiotic therapy. On the contrary, those patients receiving shorter courses trended toward lower rates of recurrence. Pending further prospective trials addressing the duration of antibiotic treatment for patients with VAP caused by NFGNB, shorter courses of treatment, perhaps based on improvement in clinical parameters, may be warranted.
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Surgical infections · Oct 2007
Efficacy of a pneumonia prevention protocol in the reduction of ventilator-associated pneumonia in trauma patients.
We hypothesized that implementing evidence-based ventilator-associated pneumonia (VAP) prevention (VAPP) strategies would decrease the incidence of VAP, and that VAP affects patient outcomes. ⋯ These data suggest that a VAPP protocol may reduce VAP in trauma patients. Ventilator-associated pneumonia may result in more hospital, ICU, and ventilator days and higher patient charges.
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Surgical infections · Oct 2007
Case ReportsA distinct cause of necrotizing fasciitis: Aeromonas veronii biovar sobria.
Aeromonas veronii biovar sobria (veronii var. sobria) has not been implicated in the pathogenesis of necrotizing fasciitis in North America. ⋯ A. veronii var. sobria should be recognized as one of the causative organisms for necrotizing fasciitis in immunocompromised patients. Early administration of proper antibiotics and aggressive surgical treatment may reduce morbidity and mortality rates in such infections.