Surgical infections
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Surgical infections · Jan 2003
Reclassification of urinary tract infections in critically ill trauma patients: a time-dependent analysis.
Successful treatment of urinary tract infections (UTIs) in the trauma ICU requires early recognition and timely, appropriate antibiotic therapy. We evaluated the incidence and microbiology of UTIs stratified by days post-admission and risk factors. ⋯ Escherichia coli was the most common pathogen in all nosocomial infection categories. Increased age, gender, and obesity, in addition to catheter-days, were significant risk factors for UTI in trauma patients. Specific risk factors may predispose patients to pathogens that are not ordinarily covered by usually-chosen antibiotic therapy.
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Surgical infections · Jan 2003
Appendicitis: selective use of abdominal CT reduces negative appendectomy rate.
Recent literature supports the use of CT for all patients with right lower quadrant pain to improve diagnostic accuracy and reduce hospital cost. Our current practice at a large teaching hospital is to use CT only for patients whose diagnosis remains in question after a thorough history, physical examination, and focused laboratory assessment. In consideration of a more liberal use of CT for right lower quadrant pain, we reviewed our experience with selective CT and the effect this has had on our practice, paying particular attention to perforation rate and negative appendectomy rate. ⋯ Selective use of CT scan in patients presenting with right lower quadrant pain is helpful in reducing the incidence of nontherapeutic appendectomy.
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Surgical infections · Jan 2003
Candidemia: the impact of antifungal prophylaxis in a surgical intensive care unit.
Candidemia is fourfold more common in 1990 compared to 1980. In addition, a shift to non-albicans species has occurred in some institutions. Antifungal prophylaxis (AP) is effective in high-risk patients including critically ill surgical patients, but its use has been attributed to a resultant shift to non-albicans candida species. We hypothesized that the use of fluconazole prophylaxis would lead to a decreased incidence of candidemia but a possible increased incidence of resistant species of Candida, especially Candida glabrata (CG). ⋯ Unfortunately, the mortality of candidemia remains high in SICU patients (52%). In the SICU, risk factors for candidemia and mortality are common. However, antifungal prophylaxis has significantly decreased the annual incidence of candidemia without a statistically significant shift to non-albicans pathogens.
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Surgical infections · Jan 2003
Comparative StudyMonotherapy versus multi-drug therapy for the treatment of perforated appendicitis in children.
Children with perforated appendicitis often have a prolonged hospital course complicated by surgical site or intra-abdominal infections. Treatment with multiple intravenous (IV) antibiotics after appendectomy has been the standard of care for these patients. We have recently adopted a protocol using piperacillin-tazobactam (PT) as a single agent in lieu of the standard multi-drug regimen (MD). We hypothesized that PT would be as effective as MD in reducing postoperative complications and would result in decreased resource utilization. ⋯ Children with perforated appendicitis can be managed effectively with a single broad-spectrum antibiotic after appendectomy. Monotherapy is not only more efficacious than multi-drug therapy, but may be more cost effective. The use of monotherapy for children with perforated appendicitis after adequate source control should be considered the treatment of choice.
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Surgical infections · Jan 2003
Does prior transfusion worsen outcomes from infection in surgical patients?
Controversy continues to exist regarding the immunomodulatory effects of cellular blood transfusions in the fields of oncology, transplantation, and infectious diseases. Numerous studies have correlated transfusion with hospital-acquired infection, but the impact of transfusion on infection-related mortality has not been addressed. The objective of this study was to determine the effect of transfusion on outcomes among infected surgical patients. ⋯ The transfusion of packed red blood cells or platelets prior to infection is associated with more severe disease among surgical patients, but once corrected for treatment selection bias does not appear to worsen outcomes from infection.