Abstract:
BACKGROUND:Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection affecting as many as 27% of mechanically ventilated patients. Ventilator-associated pneumonia is an important source of morbidity and mortality in the surgical intensive care unit (SICU). The optimal diagnostic method for VAP has remained controversial and the role of therapeutic bronchoscopy in the clearance of pulmonary secretions with VAP, in essence source control, remains unknown. Our unit utilizes bronchoscopy inconsistently for these purposes and we chose to evaluate its effectiveness in our patient population with the hypothesis that bronchoscopic diagnosis and therapy results in lower mortality rates and faster clinical resolution. METHODS:We analyzed retrospectively all patients treated for VAP in a single SICU between September 2003 and December 2011. Patients were divided into groups based upon diagnostic method and receipt of therapeutic bronchoscopy, and were analyzed for differences in time to clinical resolution and mortality. RESULTS:A total of 360 patients were included in the study, including 493 episodes of VAP. The diagnostic bronchoscopy group had statistically higher APACHE II scores (p=0.02) and fewer days in hospital prior to diagnosis (p=0.02) when compared with the non-invasive diagnosis group. Diagnostic bronchoscopy was associated with shorter length of stay and shorter duration of antibiotics whereas receipt of a therapeutic bronchoscopy was associated with the opposite effects by multivariable analysis. CONCLUSION:Our hypothesis was disproved and our findings are similar to those found in recent publications. This study supports no definitive conclusions, but further consideration of the role of bronchoscopy is urged in both the diagnosis and treatment of VAP. In our population, bronchoscopy for diagnostic or therapeutic purposes in VAP was not associated with better outcomes. However, differences in baseline characteristics suggest a randomized trial may be needed to answer more completely this question.
journal_name
Surg Infect (Larchmt)journal_title
Surgical infectionsauthors
Guidry CA,Mallicote MU,Petroze RT,Hranjec T,Rosenberger LH,Davies SW,Sawyer RGdoi
10.1089/sur.2013.142subject
Has Abstractpub_date
2014-10-01 00:00:00pages
527-32issue
5eissn
1096-2964issn
1557-8674journal_volume
15pub_type
杂志文章abstract:BACKGROUND:Conceptually, appropriateness of antibiotic therapy includes choice of agent relative to susceptibility of pathogens as well as dosing, timing of onset, and duration of therapy, but is most commonly considered in terms of choice of antibiotic. It has been suggested that inappropriate antibiotic selection can...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2005.6.41
更新日期:2005-04-01 00:00:00
abstract:BACKGROUND:Nocardia farcinica is a gram-positive, partially acid-fast, methenamine silver-positive aerobic actinomycete. Nocardia spp. are opportunistic pathogens, and N. farcinica is the least common species of clinical importance. METHODS:Review of the recent literature and description of a immunocompetent patient w...
journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/sur.2011.012
更新日期:2012-06-01 00:00:00
abstract:BACKGROUND:Appendectomy for acute appendicitis is an effective, universally accepted procedure performed more than 300,000 times annually in the United States. It is generally believed that appendicitis progresses invariably from early inflammation to later gangrene and perforation, and that appendectomy is required fo...
journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/sur.2007.079
更新日期:2008-08-01 00:00:00
abstract:BACKGROUND:Most HIV-1 replication occurs in secondary lymphoid tissues, and evaluating these tissues is crucial to investigations of pathogenesis. Inguinal lymph nodes (LN) are obtained frequently for these studies as they are readily detectable in most individuals and provide abundant numbers of cells. Knowledge of th...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2013.218
更新日期:2014-08-01 00:00:00
abstract:BACKGROUND:Colorectal surgical procedures have a high rate of surgical site infection (SSI), and obesity has been implicated as a predictor of such infection. We hypothesized that abdominal wall thickness (AWT), as a metric of obesity, would predict postoperative superficial and deep incisional SSI after colorectal sur...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2012.109
更新日期:2013-08-01 00:00:00
abstract:BACKGROUND:The Donor Risk Index (DRI) is used to predict graft survival following liver transplantation, but has not been used to predict post-operative infections in graft recipients. We hypothesized that lower-quality grafts would result in more frequent infectious complications. METHODS:Using a prospectively collec...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2013.035
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:In recent years, there has been a worldwide increase in infections caused by microorganisms resistant to multiple antimicrobial agents. METHODS:In the past few decades, an increased prevalence of infections caused by antibiotic-resistant pathogens, including Enterococcus spp., carbapenem-resistant Pseudomon...
journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/sur.2013.262
更新日期:2015-06-01 00:00:00
abstract:BACKGROUND:It has been suggested that the damage observed in invasive amebiasis is related to interactions between polymorphonuclear leukocytes (PMN) and Entamoeba histolytica trophozoites. We analyzed the relation between infiltrating inflammatory cell populations and E. histolytica density in intestinal amebic lesion...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2008.011
更新日期:2009-04-01 00:00:00
abstract:BACKGROUND:The designation "gram-positive bacillus" includes a variety of pleomorphic microorganisms, including diphtheroids, coryneform species, coccobacilli, and other small rods. Despite differing greatly in their virulence, sources, and even genus, these microscopically similar organisms are often difficult to diff...
journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/sur.2008.085
更新日期:2010-02-01 00:00:00
abstract:BACKGROUND:Superficial surgical site infection (SSI) can be caused by bacterial invasion during surgery. We investigated whether bacteria are found at the wound margin during surgery and whether a wound protector (WP; Alexis® Wound Retractor; Applied Medical, Rancho Santa Margarita, CA) contributes to preventing invasi...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2009.072
更新日期:2010-12-01 00:00:00
abstract:BACKGROUND:Orbital hydatidosis is rare, accounting for only 1% of all hydatid cysts. Herein we report a case and review the sparse literature. METHODS:Case report and review of pertinent literature. RESULTS:A 74-year-old farmer presented with progressive proptosis and loss of vision of the left eye. Evaluation reveal...
journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/sur.2009.019
更新日期:2010-08-01 00:00:00
abstract:: Background: Sarcopenia is a syndrome that can have negative consequences after gastric cancer (GC) surgery. This study aims to determine the effect of sarcopenia on surgical site infection (SSI) that develops after open GC surgery. Patients and Met...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2020.211
更新日期:2020-11-11 00:00:00
abstract:BACKGROUND:Extraintestinal Enterobius vermicularis infections are rare but may occasionally affect the female genital tract. Although mostly asymptomatic or causing minor clinical problems, they may lead to severe infectious complications. METHODS:Case report and review of the pertinent English language literature. R...
journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/sur.2008.090
更新日期:2009-12-01 00:00:00
abstract:BACKGROUND:Guidelines advise that patients with ventilator-associated pneumonia (VAP) should respond clinically by Day 3 of antibiotics. White blood cell (WBC) count, maximum temperature (Tmax), and PaO2:FIO2 ratio are all said to respond significantly by Day 6. Resolution of abnormalities has not been evaluated in tra...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2011.128
更新日期:2013-02-01 00:00:00
abstract:BACKGROUND:The pathogenicity of Enterococcus in polymicrobial surgical infections is controversial. The objective of this analysis was two-fold. The impact of Enterococcus on clinical outcome was assessed in adults with complicated intra-abdominal (IAI), complicated skin and skin structure (CSSSI), or acute pelvic (PI)...
journal_title:Surgical infections
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1089/109629602762539553
更新日期:2002-01-01 00:00:00
abstract:BACKGROUND:Metal implants are used frequently in orthopedic procedures and the occurrence of subclinical low-virulence infection is difficult to diagnose. The objective of this study was to examine the hypothesis that peri-prosthetic subclinical infections may be diagnosed effectively in a murine model system using sci...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2014.186
更新日期:2015-06-01 00:00:00
abstract:BACKGROUND:Invasive mucormycosis or aspergillosis is a life-threatening infection. The disease typically occurs in immunocompromised patients (e.g., those with diabetes mellitus or burns) but is rarely serious in otherwise-healthy young trauma patients. METHODS:Case report and literature review. RESULTS:A previously-...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2010.065
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:The use of silver for the treatment of various maladies or to prevent the transmission of infection dates back to at least 4000 b.c.e. Medical applications are documented in the literature throughout the 17th and 18th centuries. The bactericidal activity of silver is well established. Silver nitrate was used...
journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/sur.2011.097
更新日期:2013-02-01 00:00:00
abstract:BACKGROUND:Clostridium perfringens myonecrosis following an elective surgical procedure in a previously healthy child is a rare incident. METHODS:Case report and literature review. RESULTS:A two-year old boy admitted for elective bilateral osteotomies of tibiae was detected to be febrile at day one post-operatively w...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2012.192
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:Suppurative kidney infections (SKIs) have potentially lethal implications and a high incidence of treatment-related morbidity and death. Until this point, there has been no study that has derived a prognostic model for adverse early outcomes in SKI. Therefore, our aim was to derive and validate a simple scor...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2010.057
更新日期:2011-04-01 00:00:00
abstract:: Background: Biliary tract infection (BTI) is a common complication in patients with biliary obstruction caused by various biliary tract disorders. To improve the management of patients with BTI, microbial profiles from bile cultures and antibiotic resistance patterns were ...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2019.041
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:Daptomycin is used increasingly to treat prosthetic joint infection (PJI). A possible side effect of this drug is eosinophilic pneumonia. We describe two patients with PJI treated with daptomycin who had this side effect with different clinical presentations. METHODS:Case reports and review of the literatur...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2013.200
更新日期:2014-12-01 00:00:00
abstract:: Background: Coronavirus 2019 (COVID-19) in the post-operative period is challenging. Its clinical manifestations may have similarities to other septic, thoracic, or gastrointestinal post-surgical complications. Additionally, the post-operative period may be a time of incre...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2020.169
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:Musculoskeletal trauma represents a large source of morbidity in low and middle human development index countries (LMHDICs). Open reduction and internal fixation (ORIF) of traumatic long bone fractures definitively manages these injuries and restores function when conducted safely and effectively. Surgical s...
journal_title:Surgical infections
pub_type: 杂志文章,meta分析,评审
doi:10.1089/sur.2017.273
更新日期:2018-04-01 00:00:00
abstract:BACKGROUND:The utility of hyperbaric oxygen therapy (HBOT) in the treatment of necrotizing soft tissue infections (NSTIs) has not been proved. Previous studies have been subject to substantial selection bias because HBOT is not available universally at all medical centers, and there is often considerable delay associat...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2012.135
更新日期:2014-06-01 00:00:00
abstract:: Background: Multi-drug resistance is considered a serious health threat particularly in the intensive care unit (ICU) setting. Studies evaluating multi-drug-resistant (MDR) pathogens in critically ill trauma patients are limited. The objectives were to describe the inciden...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2019.031
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:The approach to perioperative antibiotic prophylaxis, bowel preparation, and postoperative routines in elective colorectal resections has changed over the last two decades. The aim of this national survey was to document the current methods of perioperative management of those patients scheduled for elective...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2005.6.305
更新日期:2005-10-01 00:00:00
abstract::Multiple organ dysfunction syndrome (MODS) is caused by an overwhelming, uncontrolled systemic inflammatory response that is activated by a number of hostile stimuli including sepsis, hypovolemic shock, and severe trauma resulting in massive tissue injury. The indiscriminate activation of the inflammatory response due...
journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/109629600750018123
更新日期:2000-10-01 00:00:00
abstract:: Background: A skin-sparing approach for the treatment of necrotizing soft-tissue infections (NSTIs) removes necrotic tissue planes while leaving viable overlying skin. Subsequent closure of the spared skin may decrease the need for graft-based reconstruction, which is asso...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2019.263
更新日期:2020-05-01 00:00:00
abstract:BACKGROUND:The pathogenic organisms responsible for the manifestations of secondary peritonitis have been well characterized through almost 30 years of experimental and clinical studies. Enteric gram-negative organisms and anaerobes predominate, with Escherichia coli and Bacteroides fragilis, respectively, being the mo...
journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/109629601750469474
更新日期:2001-07-01 00:00:00