Surgical infections
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Surgical infections · Jan 2002
Practice GuidelineThe Surgical Infection Society guidelines on antimicrobial therapy for intra-abdominal infections: an executive summary.
The Surgical Infection Society last published guidelines on antimicrobial therapy for intra-abdominal infections in 1992 (Bohnen JMA, et al., Arch Surg 1992;127:83-89). Since then, an appreciable body of literature has been published on this subject. Therefore, the Therapeutics Agents Committee of the Society undertook an effort to update the previous guidelines, primarily using data published over the past decade. ⋯ Topics discussed include the selection of patients needing therapeutic antimicrobials, duration of antimicrobial therapy, acceptable antimicrobial regimens, and identification and treatment of higher-risk patients. Guidelines for patient selection and specific antimicrobial regimens were based on relatively good evidence, but those regarding optimal duration of therapy and treatment of higher-risk patients relied mostly on expert opinion, since there was a paucity of high-quality studies on those issues. Relevant areas for future investigation include the safety, convenience, and cost-effectiveness of available antimicrobial regimens for lower-risk patients, and better means for identifying and treating higher-risk patients with intra-abdominal infections.
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Surgical infections · Jan 2002
Endothelium down-regulates Fas, TNF, and TRAIL-induced neutrophil apoptosis.
Neutrophil (PMN) apoptosis regulates PMN functional longevity and is integral to the resolution of inflammation. We have recently shown that PMN contact with an endothelial monolayer down-regulates spontaneous PMN apoptosis. We sought to explore endothelial-mediated down-regulation of PMN apoptosis following mediator-induced apoptosis. We tested the three known membrane-initiated, receptor-ligand apoptotic pathways: Fas, tumor necrosis factor-alpha (TNF), and TNF-related apoptosis inducing ligand (TRAIL). ⋯ Endothelial-mediated down-regulation of PMN apoptosis is conferred after 4 h of co-culture. In addition to spontaneous apoptosis, endothelial contact down-regulated the three known membrane-initiated PMN apoptotic pathways: Fas, TNF, and TRAIL. These data imply that endothelial-mediated down-regulation of PMN apoptosis may involve defects in each apoptotic pathway or a single defect in a distal transduction or effector event common to all three pathways. Alterations in the activity of caspase 3 did not appear to serve as a mechanism for endothelial-mediated down-regulation of PMN apoptosis.
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Surgical infections · Jan 2002
Comparative StudyEmergence of resistant microbes in critical care units is transient, despite an unrestricted formulary and multiple antibiotic trials.
Antimicrobial resistance is a growing problem in the intensive care setting. This study was designed to evaluate the trends in bacterial prevalence and changes in antibiotic resistance at a large university hospital over the past decade. Antimicrobial resistance data were compared among the surgical intensive care unit (SICU), medical intensive care unit (MICU), and burn unit (BNU). ⋯ Hospital-wide antibiotic resistance data may be misleading and may not reflect individual critical care units throughout the hospital. Bacterial flora, including resistant organisms, changed little over 10 years, despite an unrestricted formulary. The emergence of resistant and opportunistic organisms is related to antibiotic usage and can vary significantly over time. This suggests that a policy of administering limited duration, narrow spectrum antibiotics may reduce drug resistance.
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Surgical infections · Jan 2002
In vitro antimicrobial evaluation of Coated VICRYL* Plus Antibacterial Suture (coated polyglactin 910 with triclosan) using zone of inhibition assays.
In this study, coated polyglactin 910 suture with triclosan was evaluated for its ability to inhibit the growth of wild-type and methicillin-resistant Staphylococcus aureus and S. epidermidis using several in vitro models. ⋯ These data support the conclusion that coated polyglactin 910 suture with triclosan provides antimicrobial effect sufficient to prevent in vitro colonization by S. aureus and S. epidermidis.
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Surgical infections · Jan 2002
Case ReportsSystemic Apophysomyces elegans after trauma: case report and literature review.
We present a case of systemic fungal infection caused by Apophysomyces elegans in a 50-year-old patient who developed a progressive skin lesion after a motor vehicle crash. Histopathological and mycological examination of the surgical sample showed non-septated hyphae characteristic of mucoraceous fungi. ⋯ Autopsy findings suggested systemic involvement. The fungi recovered from culture had non-apophyseal and globose sporangi, and branched sporaniophores and was identified as Apophysomyces elegans.