The Surgical clinics of North America
-
Sepsis can be defined as a systemic inflammatory response syndrome occurring in the presence of an infectious source. Over the past 25 years, numerous guidelines have been established to clarify definitions and improve the overall management of clinical sepsis. In light of these multiple paradigm shifts, this review attempts to summarize the innate immunologic alterations that manifest during sepsis, establish and compare mouse models of sepsis with the clinical course, and discuss the authors' views on additional elements that should be considered in modeling and predicting clinical sepsis from the standpoint of a basic research setting.
-
Intra-abdominal infections are multifactorial, but all require prompt identification, diagnosis, and treatment. Resuscitation, early antibiotic administration, and source control are crucial. ⋯ The method of source control depends on the anatomic site, site accessibility, and the patient's clinical condition. Patient-specific factors (advanced age and chronic medical conditions) as well as disease-specific factors (health care-associated infections and inability to obtain source control) combine to affect patient morbidity and mortality.
-
Catheter-associated urinary tract infections (CAUTI) are common in surgical patients. CAUTI are associated with adverse patient outcomes, and negatively affects public safety reporting and reimbursement. ⋯ CAUTI pathogenesis and treatment are complicated by the presence of biofilms. Prevention strategies include accurate identification and tracking of CAUTIs, and the development of institutional guidelines for the appropriate use, duration, alternatives, and removal of indwelling urinary catheters.
-
Surg. Clin. North Am. · Dec 2014
ReviewPneumonia: challenges in the definition, diagnosis, and management of disease.
Defining health care-associated pneumonia, which includes both hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), is problematic and controversial. Aspiration pneumonia is often included as a subtype of HAP but may be related to community-acquired aspiration events. ⋯ Management and prevention should follow recommendations, including early empirical therapy, targeted therapy, and limited duration of treatment. Patients with trauma present a challenge to the diagnosis and management of pneumonia, because of increased risk for aspiration and underlying chest and pulmonary injury.
-
It is critical for health care personnel to recognize and appreciate the detrimental impact of intensive care unit (ICU)-acquired infections. The economic, clinical, and social expenses to patients and hospitals are overwhelming. ⋯ A multifaceted approach, including infection prevention committees, antimicrobial stewardship programs, daily reassessments-intervention bundles, identifying and minimizing risk factors, and continuing staff education programs, is essential. Infection control in the ICU is an evolving area of critical care research.