Abstract：
BACKGROUND:Sepsis from bloodstream infection (BSI) is an important cause of morbidity and mortality among surgical patients. Our hypothesis was that fever and leukocytosis during BSI would be associated with gram-negative pathogens and worse outcomes among hospitalized surgical patients. STUDY DESIGN:A prospectively collected dataset of all infections diagnosed on the adult general and trauma surgery services between December 1996 and December 2005 at the University of Virginia Hospital was reviewed. Fever was considered a temperature of > or = 38.5 degrees C, and leukocytosis was defined as a white blood cell count > or = 15,000/microL within 24 hours of treatment for infection. Logistic regression was used to identify predictors of fever and mortality. RESULTS:Over 9 years, 823 BSIs were analyzed. One hundred forty-eight BSIs resulted in death (18.0%), and 541 (65.7%) patients were febrile at diagnosis; mortality for these two groups were 12.9% and 27.7%, respectively (p < 0.0001). Febrile patients had a trend toward fewer gram-negative infections (27.0% versus 31.9%, p = 0.13), 403 had a leukocytosis at diagnosis and 420 did not; mortality for the two groups was 19.1% and 16.9%, respectively (p = NS). Higher maximum temperature was protective against mortality in the logistic regression analysis (odds ratio = 0.60 per C degrees, p < 0.0001). CONCLUSIONS:Among surgical patients with sepsis, fever during BSI was not associated with a gram-negative cause and correlated with survival, although increasing WBC had little effect. Mortality after BSI appears associated more with an initially blunted physiologic response than with a robust, proinflammatory response. In addition, a threshold for blood culture other than temperature > or = 38.5 degrees C should be considered.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Swenson BR,Hedrick TL,Popovsky K,Pruett TL,Sawyer RGdoi
10.1016/j.jamcollsurg.2007.01.033subject
Has Abstractpub_date
2007-05-01 00:00:00pages
815-21; discussion 822-3issue
5eissn
1072-7515issn
1879-1190pii
S1072-7515(07)00123-8journal_volume
204pub_type
杂志文章abstract：BACKGROUND:Pancreatic resection can be performed to ameliorate the sequelae of chronic pancreatitis in selected patients. The perceived risk of pancreatectomy may limit its use. Using a national database, this study compared mortality after pancreatic resections for chronic pancreatitis with those performed for neoplas...
journal_title：Journal of the American College of Surgeons
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abstract：BACKGROUND:The American College of Surgeons (ACS) has collected comprehensive data about surgical residents for the past 12 years and has published an annual report, the Longitudinal Study of Surgical Residents. In 1994, the ACS and the American Medical Association (AMA) agreed to collaborate in collecting data about s...
journal_title：Journal of the American College of Surgeons
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journal_title：Journal of the American College of Surgeons
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abstract：BACKGROUND:The purpose of this study was to develop a performance-based laparoscopic suturing curriculum using simulators and to test the effectiveness (transferability) of the curriculum. STUDY DESIGN:Surgical residents (PGY1 to PGY5, n = 17) proficient in basic skills, but with minimal laparoscopic suturing experien...
journal_title：Journal of the American College of Surgeons
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更新日期：2021-01-01 00:00:00
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journal_title：Journal of the American College of Surgeons
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doi：
更新日期：1994-06-01 00:00:00
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journal_title：Journal of the American College of Surgeons
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journal_title：Journal of the American College of Surgeons
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