Surgical infections
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Surgical infections · Jan 2005
ReviewClinical challenges and unmet needs in the management of complicated intra-abdominal infections.
Management of complicated intra-abdominal infections involves invasive procedures for control of the source of the infection and antimicrobial therapy directed against gram-negative and anaerobic pathogens. Application of these management principles to the individual patient is essential to optimize the patient's chances for recovery, while also avoiding unnecessary therapy that may have no clinical benefits, or that may carry risk. ⋯ The management of lower-risk patients with intra-abdominal infections is distinct compared with patients at higher risk due to compromised physiological status, extent of intra-abdominal infection, or presence of nosocomial pathogens associated with higher-risk patients. Carefully designed, multidisciplinary-sponsored, clinical trials in patients with specific clinical risk factors are needed to better assess the role of various antimicrobial regimens in the treatment of higher-risk patients with intra-abdominal infections.
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Surgical infections · Jan 2005
Case ReportsAbdominal complications of ventricular assist device placement.
Ventricular assist devices (VADs) provide a bridge to transplantation for patients awaiting heart transplant. Because of its intra-abdominal placement, the potential exists for major abdominal complications. The purpose of this study is to identify VAD-associated abdominal complications and their incidence, and to describe preventive measures. ⋯ Abdominal complications after VAD placement are common. Intra-abdominal VAD infection is the most common and serious complication, leading to a mortality rate of 60% in our population. Additionally, small bowel obstructions, incisional and inguinal hernias, acalculous cholecystitis, and pancreatitis also occurred. Appropriate preventive measures may decrease the risk of developing many of these complications.
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Surgical infections · Jan 2005
ReviewEmerging issues in the diagnosis and management of infections caused by multi-drug-resistant, gram-positive cocci.
Rising rates of multi-drug-resistant, gram-positive cocci (e.g., methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant Enterococcus spp. [VRE]) have created treatment challenges for clinicians in both the hospital and community settings. These organisms have become especially problematic for hospitalized patients with pneumonia, complicated intra-abdominal infections, and skin and skin-structure infections (SSSIs). ⋯ New antimicrobial agents are needed to combat the increasing prevalence of multi-drug-resistant, gram-positive pathogens such as MRSA. The emergence of resistance to available therapies such as vancomycin underscores this urgency.
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Exposure of patients to allogeneic blood transfusion can be minimized or avoided by the systematic use of multiple blood conservation techniques. Current use of these technologies is variable. ⋯ Pharmacologic stimulation of erythropoiesis offers substantial potential to progress toward a goal of bloodless medicine. The potential of artificial blood substitutes is still being defined.
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Surgical infections · Jan 2005
Randomized Controlled TrialThe effect of antipyretic therapy upon outcomes in critically ill patients: a randomized, prospective study.
Despite the large body of evidence suggesting a beneficial role of fever in the host response, antipyretic therapy is commonly employed for febrile critically ill patients. Our objective was to evaluate the impact of antipyretic therapy strategies on the outcomes of critically ill patients. ⋯ Aggressively treating fever in critically ill patients may lead to a higher mortality rate.