Surgical infections
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Surgical infections · Apr 2007
Review Case ReportsKlebsiella pneumoniae necrotizing fasciitis and septic arthritis: an appearance in the Western hemisphere.
Necrotizing fasciitis caused by Klebsiella pneumoniae is rare, with 11 documented cases in the literature, all occurring in Asia and the Middle East. These reports have become more frequent in recent years in association with the emergence of the highly virulent K1 capsular serotype of Klebsiella. We report a case of Klebsiella necrotizing fasciitis and con-current septic arthritis in the Western hemisphere. ⋯ Although K. pneumoniae is common, monomicrobial necrotizing fasciitis and septic arthritis caused by this pathogen has not been reported previously outside Asia, where it is rare. The appearance of this infection in the Western hemisphere may reflect geographic spread of the aggressive K1 phenotype. Physicians treating patients with symptoms and signs of necrotizing fasciitis or septic arthritis, particularly in the setting of underlying chronic illness or recent travel to Asia, should consider K. pneumoniae as a potential cause and treat accordingly.
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Surgical infections · Aug 2006
ReviewSurgical Infection Society guideline: prophylactic antibiotic use in open fractures: an evidence-based guideline.
Prolonged courses of broad-spectrum antibiotics are often cited as the standard of care for prevention of infective complications of open fractures. The origins of these recommendations are obscure, however, and multi-drug-resistant systemic infections attributable to antibiotic overuse are common life-threatening problems in current intensive care unit practice. ⋯ The data support the conclusion that a short course of first-generation cephalosporins, begun as soon as possible after injury, significantly lowers the risk of infection when used in combination with prompt, modern orthopedic fracture wound management. There is insufficient evidence to support other common management practices, such as prolonged courses or repeated short courses of antibiotics, the use of antibiotic coverage extending to gram-negative bacilli or clostridial species, or the use of local antibiotic therapies such as beads. Large, randomized, blinded trials are needed to prove or disprove the value of these traditional approaches. Such trials should be performed in patients with high-grade fractures who (1) are well-stratified according to the degree of local injury and (2) undergo standardized fracture and wound management. Trials also must be powered to study the effects of extended antibiotic coverage on nosocomial infections. Antibiotic regimens confirmed to improve local fracture outcomes in such studies could then be used rationally, balancing the risks of local fracture-related infections and of multi-drug-resistant systemic infections to achieve optimal global outcomes.
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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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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.
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Patients with cancer suffer alterations of their metabolic state and nutritional depletion. This review was designed to evaluate the effect of different nutritional regimens on surgical outcomes. ⋯ Enteral immunonutrition should represent the first choice to nourish surgical subjects.