Surgical infections
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Surgical site infections are the third most common healthcare-associated infection, often leading to prolonged hospital stay and excessive expenditures. Management of these infections has become more challenging due to rising rates of multi-drug-resistant organisms and few new antibiotic options. ⋯ Multi-drug-resistant pathogens are threatening the success of available antibiotic therapy. Many new options are useful for infections due to multi-drug-resistant, gram-positive bacteria. Tigecycline is a promising new agent that provides coverage against a broad spectrum of gram-positive and gram-negative, aerobic, facultative, and anaerobic strains, including resistant isolates, and may make broad-spectrum, single-agent therapy possible.
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Anemia is a common complication of critical illness. Because tissue hypoxia is a prominent factor in the development of organ dysfunction in the critically ill, conventional wisdom has argued that the transfusion of packed red blood cells can attenuate tissue hypoxia and so improve outcome. ⋯ A conservative transfusion strategy appears safe in nearly all critically ill patients without active hemorrhage, including patients with cardiovascular disease. Whether a lower transfusion threshold could be adopted is unknown.
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Surgical infections · Jan 2005
ReviewClinical challenges and unmet needs in the management of complicated intra-abdominal infections.
Management of complicated intra-abdominal infections involves invasive procedures for control of the source of the infection and antimicrobial therapy directed against gram-negative and anaerobic pathogens. Application of these management principles to the individual patient is essential to optimize the patient's chances for recovery, while also avoiding unnecessary therapy that may have no clinical benefits, or that may carry risk. ⋯ The management of lower-risk patients with intra-abdominal infections is distinct compared with patients at higher risk due to compromised physiological status, extent of intra-abdominal infection, or presence of nosocomial pathogens associated with higher-risk patients. Carefully designed, multidisciplinary-sponsored, clinical trials in patients with specific clinical risk factors are needed to better assess the role of various antimicrobial regimens in the treatment of higher-risk patients with intra-abdominal infections.
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Surgical infections · Jan 2005
ReviewHyperglycemia in the intensive care unit: no longer just a marker of illness severity.
Hyperglycemia is a common occurrence in critically ill patients. Recent evidence has demonstrated improved survival in patients in surgical intensive care units (SICUs) receiving "tight glycemic control." The mechanisms of this survival advantage are not well understood. ⋯ A number of human studies have demonstrated improved outcomes in critically ill patient populations receiving insulin therapy with a target of euglycemia, suggesting at least part of the benefit of this therapy is normal blood sugar and not the effects of insulin. An important population not studied to date is patients in the medical ICU. However, aggressive control of hyperglycemia now remains an important component of care for all surgical patients in the ICU.
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Surgical infections · Jan 2005
ReviewEmerging issues in the diagnosis and management of infections caused by multi-drug-resistant, gram-positive cocci.
Rising rates of multi-drug-resistant, gram-positive cocci (e.g., methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant Enterococcus spp. [VRE]) have created treatment challenges for clinicians in both the hospital and community settings. These organisms have become especially problematic for hospitalized patients with pneumonia, complicated intra-abdominal infections, and skin and skin-structure infections (SSSIs). ⋯ New antimicrobial agents are needed to combat the increasing prevalence of multi-drug-resistant, gram-positive pathogens such as MRSA. The emergence of resistance to available therapies such as vancomycin underscores this urgency.