Surgical infections
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Surgical infections · Jan 2005
ReviewClinical challenges and unmet needs in the management of complicated skin and skin structure, and soft tissue infections.
Skin and soft tissue infections remain among the most frequently encountered infections in surgery, and their severity ranges from mild cellulitis to severe, necrotizing infections with high incidences of morbidity and mortality. Most commonly, these disorders result from skin lesions in a susceptible host, but sometimes develop following hematogenous spread from a previously unknown focus. ⋯ New, promising agents, with activity against multi-drug resistant gram-positive and gram-negative organisms, are aimed at filling the gap in the treatment of complicated skin and skin-structure infections.
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Surgical infections · Jan 2005
Improving timely surgical antibiotic prophylaxis redosing administration using computerized record prompts.
Timely prophylactic antibiotic administration aids in preventing postoperative superficial surgical site infections. However, during lengthy surgical procedures, redosing of prophylactic antibiotics may be unintentionally omitted. We assessed the utility of a computerized reminder as part of the anesthesia charting system to increase the rate of timely intraoperative prophylactic antibiotic redosing. ⋯ A computerized reminder system is an effective tool to assist in appropriate intraoperative redosing of prophylactic antibiotics during lengthy surgical procedures.
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Anemia is a common complication of critical illness. Because tissue hypoxia is a prominent factor in the development of organ dysfunction in the critically ill, conventional wisdom has argued that the transfusion of packed red blood cells can attenuate tissue hypoxia and so improve outcome. ⋯ A conservative transfusion strategy appears safe in nearly all critically ill patients without active hemorrhage, including patients with cardiovascular disease. Whether a lower transfusion threshold could be adopted is unknown.
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Surgical infections · Jan 2005
Pharmacodynamic modeling of imipenem-cilastatin, meropenem, and piperacillin-tazobactam for empiric therapy of skin and soft tissue infections: a report from the OPTAMA Program.
The bactericidal exposures necessary for positive clinical outcomes among skin and soft tissue infections are largely dependent on interpatient pharmacokinetic variability and pathogen drug susceptibility. By simulating the probability of achieving target bactericidal exposures, the pharmacodynamics of three beta-lactam agents were compared against a range of pathogens implicated commonly in complicated skin and soft tissue infections. ⋯ When the incidence of MRSA is low, imipenem-cilastatin, meropenem and piperacillin-tazobactam 3.375 g q6h would be optimal choices for the empiric treatment of complicated skin and soft tissue infections among the regimens studied. When MRSA is suspected, a drug that retains activity against this pathogen should be considered.
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Surgical infections · Jan 2005
Comparative StudyThe impact of diabetes in patients with necrotizing soft tissue infections.
Given the association of diabetes with necrotizing soft tissue infections (NSTIs) and hyperglycemia with mortality in critically ill patients, this study investigates the impact of diabetes and hyperglycemia in NSTI patients. ⋯ Diabetes mellitus and admission hyperglycemia may increase infectious complications in NSTI patients, predicting a longer and more complicated hospital course. Further study is required to define the optimal metabolic target in this patient population.