Abstract:
BACKGROUND:Purpura fulminans (PF) is a rare but lethal complication of severe infection. Aggressive surgical debridement of irreversibly devitalized tissue improves survival frequently at the cost of disfigurement. The ethical dilemma of surrogate decision-making for these often incapacitated patients presents a unique challenge for acute care surgeons managing necrotizing soft tissue infections (NSTI). METHODS:Case presentation and scholarly discussion of substituted judgment. RESULTS:A previously healthy 72-y-old fisherman developed PF as a consequence of Neisseria meningiditis severe sepsis requiring bilateral partial finger amputations and bilateral below-knee amputations of the affected gangrenous extremities. Skin biopsy confirmed the clinical impression of disseminated intra-vascular coagulation (DIC). During his 55-d hospitalization, medical decisions were made by a surrogate because the patient's mental status failed to recover to his pre-morbid baseline. A literature review revealed a paucity of data on the accuracy of a health care agent's ability to represent a patient's preferences accurately in elective as well as emergency surgery. CONCLUSIONS:Patients with NSTI and the surgeons who care for them are often confronted with the need to make prompt decisions of radical debridement or amputation. These patients are frequently incapable of making these decisions because of the severity of systemic illness. In such cases, physicians must help patient surrogates or health care agents (when identified) navigate a complex process of acute interventions balancing known or inferred patient's wishes. We urge surgeons to become familiar with the concept of substituted judgment and the challenges of surrogate decision-making.
journal_name
Surg Infect (Larchmt)journal_title
Surgical infectionsauthors
Tanosaki M,Shimizu N,Lian CG,Jurchak M,Patel Vdoi
10.1089/sur.2013.223subject
Has Abstractpub_date
2014-12-01 00:00:00pages
853-6issue
6eissn
1096-2964issn
1557-8674journal_volume
15pub_type
杂志文章abstract:BACKGROUND:Mycobacterium tuberculosis infection rarely penetrates both skull and dura with temporalis muscle abscess formation. METHODS:Case report and review of the literature. RESULTS:A non-immunocompromised female patient with a right temporal mass underwent surgical resection. The tubercular abscess extended from...
journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/sur.2012.106
更新日期:2013-10-01 00:00:00
abstract:BACKGROUND:Neutrophil dysfunction has been documented after injury in animals and human beings. This review evaluates the relative effects of the hormonal and endotoxin response to injury on immune resistance. METHOD:Review of the pertinent English-language literature. RESULTS:In volunteers given total parenteral nut...
journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/sur.2012.161
更新日期:2012-10-01 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:There has not been an appraisal of outcomes of appendectomy for more than 10 years. More reliable diagnostic techniques and minimally invasive surgery are now in widespread use, yet the impact of these advances remains unknown. METHODS:A retrospective review was performed of 453 patients who underwent appen...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2011.104
更新日期:2012-06-01 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:Surgical site infection (SSI), the third most common type of nosocomial infection in Sweden, is a patient injury that should be prevented. Methods of reducing SSIs include, for instance, disinfecting the skin, maintaining body temperature, and ensuring an aseptic environment. Guidelines for most of these int...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2017.286
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:Surgical site infections (SSIs) are a significant healthcare quality issue, resulting in increased morbidity, disability, length of stay, resource utilization, and costs. Identification of high-risk patients may improve pre-operative counseling, inform resource utilization, and allow modifications in peri-op...
journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/sur.2017.058
更新日期:2017-05-01 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:Ceftaroline fosamil is a novel cephalosporin approved by the United States Food and Drug Administration (US FDA) for treatment of acute bacterial skin and skin structure infection, including those caused by methicillin-resistant Staphylococcus aureus (MRSA). We evaluated the activity of ceftaroline and compa...
journal_title:Surgical infections
pub_type: 杂志文章,多中心研究
doi:10.1089/sur.2015.209
更新日期:2016-08-01 00:00:00
abstract:BACKGROUND:Low plasma concentrations and genetic polymorphisms of mannan-binding lectin (MBL) have been associated with infectious disease complications during various conditions. The present study examined the nature and expression of MBL deficiency during a surgery-induced acute-phase response. METHODS:Blood was sam...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2006.7.443
更新日期:2006-10-01 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
abstract:: Background: Rates of infections with multi-drug-resistant organisms (MDROs) are increasing among critically ill patients. Among non-surgical patients, MDROs increase directly the risk of adverse secondary events including death. However, similar effects do not appear to oc...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2019.240
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:Previously, we developed an infection model by intraperitoneal (IP) injection of Klebsiella pneumoniae. The high early mortality rate prompted a study of the effect of gentamicin on the disease course. METHODS:Infection was induced in Balb/c mice by IP inoculation of 10(3) colony-forming units (cfu) of K. p...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2006.060
更新日期:2007-06-01 00:00:00
abstract:BACKGROUND:The World Health Organization has identified the rapidly growing prevalence of obesity as one of today's serious health problems. Various surgical interventions categorized collectively as bariatric surgery now play an ever-increasing important role as the only known effective treatment for severe obesity. L...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2012.023
更新日期:2013-10-01 00:00:00
abstract:BACKGROUND:Surgical care is delivered 24 h a day at most institutions. Alarmingly, some authors have found that certain operative start times are associated with greater morbidity and mortality rates. This effect has been noted in both the public and private sector. Although some of these differences may be related to ...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2015.150
更新日期:2016-10-01 00:00:00
abstract:BACKGROUND:Bacterial infections are a well-known complication of traumatic amputations. In cases involving contact with soil or water contaminated with manure, one also must be aware of infections with fungi, particularly Scedosporium spp. We report on an immunocompetent trauma patient with an infection caused by a rec...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2006.038
更新日期:2007-12-01 00:00:00
abstract::Surgical infections present a significant burden of disease globally. Management focuses on source control and appropriate antibiotic therapy. This remains a challenge in low- and middle-income settings, where access to surgical care and antibiotics is limited. This paper discusses the complex challenges facing the ma...
journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/sur.2018.125
更新日期:2019-04-01 00:00:00
abstract:BACKGROUND:We reported similar rates of ventilator-associated pneumonia (VAP) previously in trauma patients intubated either in a pre-hospital (PH) venue or the emergency department. A subset of PH intubations with continuous quality assessment was re-examined to identify the intubation factors associated with VAP. ME...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2010.074
更新日期:2011-10-01 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:The optimal duration of antimicrobial therapy for treatment of complicated intra-abdominal infections (cIAI) in critically ill surgical patients is unknown. Recent evidence suggests that a short (four-day) course of therapy may be effective, however data in severely critically ill patients are limited. PATI...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2017.011
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:Primary echinococcosis, and especially primary alveolar echinococcosis (AE) is rare among adrenal lesions. METHODS:We report a case of primary AE in a 28-year-old male with low backache and occasional upper limb pain lasting for six months, and review the pertinent but sparse literature on this disorder. R...
journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/sur.2012.037
更新日期:2013-08-01 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:Vancomycin is the mainstay of treatment for methicillin-resistant Staphylococcus aureus (MRSA) meningitis. However, successful outcomes with linezolid have not been reported in a large series of patients. We conducted a single-center retrospective cohort study to compare vancomycin with linezolid in the trea...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2012.091
更新日期:2013-08-01 00:00:00
abstract:BACKGROUND AND PURPOSE:Each year, as many as two million operations are complicated by surgical site infections in the United States, and surgical patients account for 30% of patients with sepsis. The purpose of this study was to determine recent trends in sepsis incidence, severity, and mortality rate after surgical p...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2008.046
更新日期:2009-02-01 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:To determine if there is a difference in periocular post-operative infection rates when utilizing new versus re-processed monopolar electrocautery tips. METHODS:Retrospective cohort study of 4,976 consecutive surgical cases involving 17,149 procedures. Post-operative infections were identified using chart r...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2014.055
更新日期:2015-06-01 00:00:00
abstract:BACKGROUND:Surgical site infections are the third most common healthcare-associated infection, often leading to prolonged hospital stay and excessive expenditures. Management of these infections has become more challenging due to rising rates of multi-drug-resistant organisms and few new antibiotic options. METHODS:Th...
journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:
更新日期:2005-01-01 00:00:00
abstract:BACKGROUND:An untreated hand infection can lead rapidly to tissue destruction and permanent disability. METHODS:Review of the pertinent English literature. RESULTS:Early diagnosis and timely, effective intervention is crucial to treatment. Anatomically, the hand consists of multiple potential spaces and tissue planes...
journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/sur.2004.5.210
更新日期:2004-07-01 00:00:00
abstract:: Background: We aimed to assess independent risk factors for inadequate initial antimicrobial treatment (IAT) in critically ill patients with ventilator-associated pneumonia (VAP) treated in intensive care units (ICU) and to determine whether IAT is associated with adverse ...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2020.306
更新日期:2021-01-13 00:00:00
abstract:BACKGROUND: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 intensiv...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/109629602760105808
更新日期:2002-07-01 00:00:00