Surgical infections
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Surgical infections · Jan 2005
ReviewHyperglycemia in the intensive care unit: no longer just a marker of illness severity.
Hyperglycemia is a common occurrence in critically ill patients. Recent evidence has demonstrated improved survival in patients in surgical intensive care units (SICUs) receiving "tight glycemic control." The mechanisms of this survival advantage are not well understood. ⋯ A number of human studies have demonstrated improved outcomes in critically ill patient populations receiving insulin therapy with a target of euglycemia, suggesting at least part of the benefit of this therapy is normal blood sugar and not the effects of insulin. An important population not studied to date is patients in the medical ICU. However, aggressive control of hyperglycemia now remains an important component of care for all surgical patients in the ICU.
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Surgical site infections are the third most common healthcare-associated infection, often leading to prolonged hospital stay and excessive expenditures. Management of these infections has become more challenging due to rising rates of multi-drug-resistant organisms and few new antibiotic options. ⋯ Multi-drug-resistant pathogens are threatening the success of available antibiotic therapy. Many new options are useful for infections due to multi-drug-resistant, gram-positive bacteria. Tigecycline is a promising new agent that provides coverage against a broad spectrum of gram-positive and gram-negative, aerobic, facultative, and anaerobic strains, including resistant isolates, and may make broad-spectrum, single-agent therapy possible.
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Surgical infections · Jan 2005
ReviewEmerging issues in the management of infections caused by multi-drug-resistant, gram-negative bacilli.
The past decade has witnessed the continued emergence and spread of multidrug resistance in gram-negative bacilli. Infections caused by multi-drug-resistant, gram-negative bacilli lead, in many instances, to increased morbidity and mortality, prolonged hospital stays, and the use of broad-spectrum antibiotics. ⋯ Tigecycline promises to be an important addition to our monotherapy armamentarium, complementing essential efforts to promote compliance with good infection control measures and rational use of currently available antimicrobial agents.
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The inherent risks of blood transfusion have led to concerted efforts to find alternatives to allogeneic blood transfusion. Among these alternatives are supplementation with iron and treatment with erythropoietin, autologous pre-donation before major elective surgery, intraoperative blood salvage (particularly for emergency cases or when major blood loss is unanticipated), acute normovolemic hemodilution, and artificial blood substitutes. ⋯ Acute normovolemic hemodilution achieves equivalent outcomes at lower cost compared with autologous pre-donation. Patient safety is increased, and if pharmacologic strategies are combined with acute normovolemic hemodilution, allogeneic blood transfusion may be eliminated entirely.
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Surgical infections · Jan 2005
Randomized Controlled Trial Multicenter Study Comparative StudyMeropenem versus imipenem-cilastatin for the treatment of hospitalized patients with complicated skin and skin structure infections: results of a multicenter, randomized, double-blind comparative study.
Meropenem, a broad-spectrum carbapenem with potent in vitro activity, is postulated to be an effective monotherapy for the treatment of complicated skin and skin structure infections (cSSSI). ⋯ In one of the largest studies conducted to date of hospitalized patients with cSSSI, meropenem, 500 mg IV q8h had comparable safety and efficacy to imipenem-cilastatin, 500 mg IV q8h.