The Surgical clinics of North America
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Surg. Clin. North Am. · Apr 2009
ReviewAdjunctive measures for treating surgical infections and sepsis.
The history of adjunctive treatments for severe sepsis has been fraught with more failures than successes. To date, there have been few interventions that have been demonstrated to be efficacious by multiple large, well-designed, multicenter randomized clinical trials. ⋯ Further research is being conducted to verify the success of these initial trials. This article summarizes some of the available adjunctive treatments for severe sepsis.
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Surgical site infections are a frequent cause of morbidity following surgical procedures. Gram-positive cocci, particularly staphylococci, cause many of these infections, although gram-negative organisms are also frequently involved. ⋯ Both nonpharmacologic measures and antimicrobial prophylaxis for selected procedures are used to prevent development of these infections. Compliance with these generally accepted preventive principles may lead to overall decreases in the incidence of these infections.
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Antimicrobial drugs are useful for the empiric and definitive treatment of infections in surgical patients. They are also important agents for perioperative antimicrobial prophylaxis. The proper selection and use of these drugs is a critical skill for surgeons. Although these agents have many beneficial effects, they also possess occasional adverse effects and should not be used indiscriminately.
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Catheter-related bloodstream infections (CR-BSIs) are a common, frequently preventable complication of central venous catheterization. CR-BSIs can be prevented by strict attention to insertion and maintenance of central venous catheters and removing unneeded catheters as soon as possible. ⋯ The diagnosis of CR-BSI is made largely based on culture results. CR-BSIs should always be treated with antibiotics, and except in rare circumstances the infected catheter needs to be removed.