Surgical infections
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Surgical infections · Jan 2003
Candidemia: the impact of antifungal prophylaxis in a surgical intensive care unit.
Candidemia is fourfold more common in 1990 compared to 1980. In addition, a shift to non-albicans species has occurred in some institutions. Antifungal prophylaxis (AP) is effective in high-risk patients including critically ill surgical patients, but its use has been attributed to a resultant shift to non-albicans candida species. We hypothesized that the use of fluconazole prophylaxis would lead to a decreased incidence of candidemia but a possible increased incidence of resistant species of Candida, especially Candida glabrata (CG). ⋯ Unfortunately, the mortality of candidemia remains high in SICU patients (52%). In the SICU, risk factors for candidemia and mortality are common. However, antifungal prophylaxis has significantly decreased the annual incidence of candidemia without a statistically significant shift to non-albicans pathogens.
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Spondylodiscitis is a rare bacterial infection of the vertebra and intervertebral discs with an inflammatory, destructive course. ⋯ Spondylodiscitis requires immediate debridement of the focus, with decompression and stabilization through a ventral approach, when conservative management fails. Otherwise, severe complications occur, such as sepsis, vertebral body destruction, abscess, or neurological deficits.
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Surgical infections · Jan 2003
Spider Bites Presenting with Methicillin-Resistant Staphylococcus aureus Soft Tissue Infection Require Early Aggressive Treatment.
Occasionally, spider bites result in necrotizing soft tissue infections that require aggressive surgical debridement and treatment with intravenous antibiotics. With the rise of microbial resistance in the community, management with standard gram-positive intravenous antibiotic coverage may be ineffective. Our objective was to determine the infectious organisms cultured following wide local excision of soft tissue infections caused by spider bites. We hypothesized that the majority of isolated organisms would be sensitive to penicillin based antibiotics. ⋯ In our experience, patients who presented with soft tissue infections as result of spider bites predominantly had methicillin-resistant S. aureus infections, corresponding to the increased incidence of MRSA reported in the community. Therefore, a more aggressive approach to the management of spider bites presenting with severe cellulitis is warranted. Routine treatment should include aggressive surgical debridement, intraoperative wound cultures, the empiric use of antibiotics with activity against MRSA, and adjustment of antimicrobial therapy based on culture and sensitivity data.
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Surgical infections · Jan 2003
Randomized Controlled Trial Clinical TrialEffect of linezolid versus vancomycin on length of hospital stay in patients with complicated skin and soft tissue infections caused by known or suspected methicillin-resistant staphylococci: results from a randomized clinical trial.
Complicated skin and soft tissue infections are common surgical indications usually requiring patients to be hospitalized, and are often caused by gram-positive bacteria, including methicillin-resistant staphylococci such as MRSA. Vancomycin has been the standard treatment for methicillin-resistant staphylococcal infections in many countries, but its intravenous-only formulation for systemic infections often confines patients to the hospital for the treatment. Linezolid, a novel oxazolidinone antibiotic available in intravenous and 100% bioavailable oral forms, was shown in a randomized trial to be as efficacious as vancomycin for suspected or proven methicillin-resistant staphylococcal infections. To determine if oral linezolid can reduce length of hospital stay (LOS) when compared to vancomycin, we compared the LOS for the 230 complicated skin and soft tissue infection patients enrolled in this trial. ⋯ Results from this randomized trial show that linezolid can significantly reduce LOS for patients with complicated skin and soft tissue infections from suspected or confirmed methicillin-resistant staphylococci.
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Surgical infections · Jan 2003
Comparative StudyInfections in 346 consecutive video-assisted thoracoscopic procedures.
Postoperative infections, as related to risk factors, in patients undergoing video-assisted thoracoscopic surgery (VATS) procedures have been studied infrequently. ⋯ This prospective study confirms that the wound infection rate is low (1.7%) after minimally invasive VATS procedures. The cumulative incidence of postoperative infections (including wound infection, pneumonia, empyema) was similar after lung wedge resection and after pleural or mediastinal mass biopsy procedures. Among the infection risk parameters, COPD was the only parameter associated with a significantly increased incidence of postoperative infection. Our results suggest that patients with COPD who undergo VATS for lung wedge resections and for pleural/mediastinal biopsy should receive antibiotic prophylaxis to prevent surgical site infection.