Surgical infections
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Surgical infections · Jan 2004
Comparative StudyMethicillin-resistant Staphylococcus aureus infections in vascular surgery: increasing prevalence.
Methicillin-resistant Staphylococcus aureus (MRSA) is a virulent organism that causes substantial infection-related morbidity and mortality in hospitalized patients. For example, MRSA infection of prosthetic vascular grafts can be limb- and life-threatening in surgical patients. We investigated the incidence of MRSA infection in vascular surgical patients who developed postoperative infectious complications. ⋯ Methicillin-resistant S. aureus has emerged as the leading cause of postoperative infection in vascular surgery patients, and is associated with substantial morbidity, increased hospital LOS, and higher incidences of amputation and graft removal. Greater emphasis on preoperative screening protocols for MRSA colonization is warranted, in conjunction with aggressive infection control measures, alteration of preoperative prophylactic antimicrobial use in MRSA-colonized patients, and meticulous postoperative surveillance for MRSA infection. Furthermore, antimicrobial treatment of postoperative infectious complications in vascular surgery patients should include empiric coverage for MRSA in institutions where MRSA is endemic.
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Surgical infections · Jan 2004
Longitudinal outcomes of intra-abdominal infection complicated by critical illness.
Critically ill surgical patients remain at high risk of adverse outcomes as a result of intra-abdominal infections, including prolonged length of stay, organ dysfunction, and death despite advances in critical care and innovations in management of the peritoneal cavity. We evaluated the causes and consequences of intra-abdominal infections among critically ill surgical patients in a single tertiary-care intensive care unit (ICU) over a decade. ⋯ Although outcomes are improving, generalized peritonitis still causes high organ dysfunction-related mortality among critically ill surgical patients. Further improvements in resuscitation, surgical technique, and pharmacotherapy of severe intra-abdominal infections are needed.
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Surgical infections · Jan 2004
Sepsis-induced changes in macrophage co-stimulatory molecule expression: CD86 as a regulator of anti-inflammatory IL-10 response.
Sepsis remains a substantial risk after surgery or other trauma. Macrophage dysfunction, as a component of immune suppression seen during trauma and sepsis, appears to be one of the contributing factors to morbidity and mortality. However, whereas it is known that the ability of macrophages to present antigen and express major histocompatibility complex MHC class II molecules is decreased during sepsis, it is not known to what extent this is associated with the loss of co-stimulatory receptor expression. Our objectives in this study were, therefore, to determine if the expression of co-stimulatory molecules, such as CD40, CD80, or CD86, on peritoneal/splenic/liver macrophages were altered by sepsis (cecal ligation [CL] and puncture [CLP] or necrotic tissue injury (CL) alone; and to establish the contribution of such changes to the response to septic challenge using mice that are deficient in these receptors. ⋯ Together, these data suggest a potential role for the co-stimulatory receptor CD86/B7-2 beyond that of simply promoting competent antigen presentation to T-cells, but also as a regulator of the anti-inflammatory IL-10 response. Such a role may implicate the latter response in the development of sepsis-induced immune dysfunction.
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Surgical infections · Jan 2004
Randomized Controlled Trial Comparative Study Clinical TrialSafety of drotrecogin alfa (activated) in surgical patients with severe sepsis.
We conducted a retrospective evaluation of the overall safety of drotrecogin alfa (activated) in surgical patients with severe sepsis enrolled in PROWESS. ⋯ Although treatment of surgical patients with drotrecogin alfa (activated) for severe sepsis is associated with a higher incidence of serious bleeding and subsequent treatment- emergent bleeding events, the magnitude of this increase is small and clinically acceptable.
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Surgical infections · Jan 2004
Comparative StudyNosocomial infections adversely affect the outcomes of patients with serious intraabdominal infections.
Patients with serious intraabdominal infections (IAI) who subsequently acquire nosocomial infections (NI) have been shown to have adverse outcomes. We evaluated factors that put patients at risk for developing NI and examined the effect of the NI on outcomes. ⋯ The development of NI following treatment of an IAI significantly affects mortality, hospital length of stay, and treatment. Early recognition and treatment of these infections, combined with strategies to prevent NI, may be important to improve outcomes in this patient population.