Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
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Clin. Microbiol. Infect. · Nov 2019
Meta AnalysisNegative pressure wound therapy for surgical site infections: a systematic review and meta-analysis of randomized controlled trials.
Previous studies showed the effectiveness of negative pressure wound therapy (NPWT) in preventing surgical site infections (SSIs), but current guidelines do not recommend its routine use for surgical wounds. The aim was to compare the effectiveness and safety of NPWT with standard surgical dressing or conventional therapy for preventing SSIs. ⋯ Compared with standard wound care, NPWT may reduce the risk of SSIs. We are uncertain whether NPWT reduces or increases the risk of wound dehiscence, haematoma, hospital readmission and all adverse event-related outcomes or if it shortens or prolongs length of hospital stay.
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Clin. Microbiol. Infect. · Nov 2019
Meta AnalysisA systematic review and meta-analysis of patient data from the West Africa (2013-16) Ebola virus disease epidemic.
Over 28 000 individuals were infected with Ebola virus during the West Africa (2013-2016) epidemic, yet there has been criticism of the lack of robust clinical descriptions of Ebola virus disease (EVD) illness from that outbreak. ⋯ We have quantified a missed opportunity to generate reliable estimates of the clinical manifestations of EVD during the West Africa epidemic. Clinical data standards and data capture platforms are urgently needed.
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Clin. Microbiol. Infect. · Oct 2019
Barriers to the adoption of ventilator-associated events surveillance and prevention.
The CDC expanded the purview of safety surveillance for ventilated patients from ventilator-associated pneumonia (VAP) to ventilator-associated events (VAE) in 2013. CDC created VAE definitions to simplify surveillance, increase objectivity, and broaden prevention efforts. Many U. ⋯ Potential interventions to prevent VAEs include avoiding intubation, minimizing sedation, paired daily spontaneous awakening and breathing trials, conservative fluid management, conservative transfusion thresholds, low tidal volume ventilation, and early mobility. There are important limitations to all existing prevention studies, however, and no study has thus far has tested a VAE prevention bundle that includes all these interventions. Further work is needed to better define the clinical significance of VAPs missed by VAE surveillance, to rigorously evaluate the impact of an optimized VAE prevention bundle on VAEs and other outcomes, and to weigh whether these additional data provide adequate evidence to support mandating VAE surveillance and prevention.
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Adding procalcitonin (PCT) to antibiotic stewardship algorithms may improve antibiotic use. However, PCT protocols need to be adapted to clinical settings and patient populations. ⋯ As an adjunct to other clinical and laboratory parameters, PCT provides information about risk for bacterial infection and resolution of infection, and improves antibiotic stewardship decisions, thereby offering more individualized treatment courses with overall reduced antibiotic exposure.
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Adding procalcitonin (PCT) to antibiotic stewardship algorithms may improve antibiotic use. However, PCT protocols need to be adapted to clinical settings and patient populations. ⋯ As an adjunct to other clinical and laboratory parameters, PCT provides information about risk for bacterial infection and resolution of infection, and improves antibiotic stewardship decisions, thereby offering more individualized treatment courses with overall reduced antibiotic exposure.