Surgical infections
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Fever is common in surgical patients. The list of potential causes is long and includes many noninfective etiologies. ⋯ The workup and therapy for the individual patient may differ, depending on the underlying disease and clinical appearance and the clinician's suspicion for infection. Subsequent testing should be based on the clinical findings. Perhaps more money is wasted in the evaluation of early postoperative fever than on any other aspect of postoperative care.
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Nosocomial infections are the most frequent complications of surgical patients. Most surgical site infections (SSI) are acquired intraoperatively and arise from the flora of the patient's skin, gastrointestinal tract, or mucous membranes. Although preoperative mechanical cleansing of the bowel is considered by many surgeons a cornerstone of modern elective colorectal surgery and, in association with antibiotic prophylaxis, a fundamental component of an intestinal antisepsis program, many surgeons do not perform preoperative mechanical preparation routinely. ⋯ The dogma that mechanical bowel preparation is necessary before elective colorectal surgery may need to be reconsidered. On the other hand, such preparation decreases operating time by improving bowel handling during construction of the anastomosis. Moreover, it is helpful when intestinal palpation will be necessary for identification of a lesion.
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Surgical infections · Jan 2006
ReviewRecommendations and reports about central venous catheter-related infection.
Central venous catheters (CVCs) are used to deliver a variety of therapies, as well as for measurement of hemodynamic parameters. The major associated complication is catheter-related blood stream infection (CRBSI). ⋯ Central venous catheters are used commonly to deliver a variety of therapies, such as large amounts of fluid or blood products during surgery or in intensive care units, chemotherapy, and parenteral nutrition, as well as for measurement of hemodynamic variables. The major complication associated with CVCs is CRBSI.
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Yeasts and molds now rank among the most common pathogens in intensive care units. Whereas the incidence of Candida infections peaked in the late 1970s, aspergillosis is still increasing. ⋯ The incidence of invasive fungal infection is increasing, but so too are the choices of agents for therapy. For reasons of efficacy and safety, therapy with an echinocandin or azole antifungal agent is supplanting the use of polyenes.
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A substantial proportion of patients become colonized with Candida spp. after surgery, but only a minority subsequently develop invasive candidiasis. However, clinical signs of severe infection manifest only late, presenting a challenge for diagnosis. Better knowledge of the pathogenesis of candidiasis and new compounds have improved the prognosis but also encouraged the emergence of non-albicans strains of Candida. ⋯ After surgery, empiric treatment must be restricted to patients in whom the dynamics of Candida colonization predict a very high risk of invasive candidiasis. Prophylaxis should be limited to the small group of patients in whom its efficacy is proven.