Abstract:
OBJECTIVE:This study determined the association between proximal gastrointestinal (GI) colonization and the development of intensive care unit (ICU)-acquired infection and multiple organ failure (MOF) in a population of critically ill surgical patients. SUMMARY BACKGROUND DATA:ICU-acquired infection in association with progressive organ system dysfunction is an important cause of morbidity and mortality in critical surgical illness. Oropharyngeal and gastric colonization with the characteristic infecting species is common, but its association with ICU morbidity is poorly defined. METHODS:A prospective cohort study of 41 surgical ICU patients was undertaken. Specimens of gastric and upper small bowel fluid were obtained for quantitative culture; the severity of organ dysfunction was quantitated by a numeric score. RESULTS:One or more episodes of ICU-acquired infection developed in 33 patients and involved at least one organism concomitantly cultured from the upper GI tract in all but 3. The most common organisms causing ICU-acquired infection--Candida, Streptococcus faecalis, Pseudomonas, and coagulase-negative Staphylococci--were also the most common species colonizing the proximal GI tract. Gut colonization correlated with the development of invasive infection within 1 week of culture for Pseudomonas (90% vs. 13% in noncolonized patients, p < 0.0001) or Staphylococcus epidermidis (80% vs. 6%, p < 0.0001); a weaker association was seen for colonization with Candida. Infections associated with GI colonization included pneumonia (16 patients), wound infection (12 patients), urinary tract infection (11 patients), recurrent (tertiary) peritonitis (11 patients), and bacteremia (10 patients). ICU mortality was greater for patients colonized with Pseudomonas (70% vs. 26%, p = 0.03); organ dysfunction was most marked in patients colonized with one or more of the following: Candida, Pseudomonas, or S. epidermidis. CONCLUSIONS:The upper GI tract is an important reservoir of the organisms causing ICU-acquired infection. Pathologic GI colonization is associated with the development of MOF in the critically ill surgical patient.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Marshall JC,Christou NV,Meakins JLdoi
10.1097/00000658-199308000-00001subject
Has Abstractpub_date
1993-08-01 00:00:00pages
111-9issue
2eissn
0003-4932issn
1528-1140journal_volume
218pub_type
杂志文章abstract::The concept of core competencies in graduate medical education was introduced by the Accreditation Council for Graduate Medical Education of the American Medical Association to semiquantitatively assess the professional performance of students, residents, practitioners, and faculty. Many aspects of the career of J. Ma...
journal_title:Annals of surgery
pub_type: 传,历史文章,杂志文章
doi:10.1097/SLA.0b013e318249ce3b
更新日期:2012-07-01 00:00:00
abstract:OBJECTIVE:On November 23, 1992, the first endovascular stent graft (ESG) repair of an aortic aneurysm was performed in North America. Following the treatment of this patient, we have continued to evaluate ESG over the past 10 years in the treatment of 817 patients. SUMMARY AND BACKGROUND DATA:Abdominal (AAA) or thorac...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/01.sla.0000090473.63393.e9
更新日期:2003-10-01 00:00:00
abstract::Fibrin deposition in response to bacterial peritonitis appears to predispose to residual infection in the peritoneal cavity. Our previous studies have demonstrated that intraperitoneal fibrinolysis using human recombinant tissue plasminogen activator (t-PA) prevented abscess formation in a rat intra-abdominal sepsis m...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199002000-00003
更新日期:1990-02-01 00:00:00
abstract:OBJECTIVE:To investigate the association of the genetic variants in excision repair cross-complementation group 2 (ERCC2) R156R and ERCC4 rs3136038 with survival duration for patients with esophageal cancer. BACKGROUND:ERCC2 and ERCC4 are important molecules participating nucleotide excision repair system. The clinica...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318216f374
更新日期:2011-05-01 00:00:00
abstract::The effects of two levels of protein intake on protein metabolism in six severely burned adult patients were studied (means of 70% BSA burned). A crossover experimental design enabled the authors to study each patient at the end of two three-day dietary regimens. All diets were isocaloric and provided approximately 25...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198302000-00007
更新日期:1983-02-01 00:00:00
abstract:OBJECTIVE:The authors present an accurate and comprehensive snapshot of appendicitis and the practice of appendectomy in the 1990s. METHODS:Appendectomies were performed on 4950 patients in 147 Department of Defense hospitals worldwide over a 12-month period ending January 31, 1993. RESULTS:The median age was 23 year...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/00000658-199703000-00003
更新日期:1997-03-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to determine the results of liver resection for patients with bilateral hepatic metastases from colorectal cancer. We aimed to assess the evolution of the technical approach over time and correlations with morbidity, mortality, and oncologic outcome. SUMMARY BACKGROUND DATA:Although...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181557e47
更新日期:2008-01-01 00:00:00
abstract::Seventeen patients with femoral arteriovenous bovine shunts (FAVBS) were evaluated to delineate the cardiovascular consequences of the procedure. The resting cardiac index (CI), as estimated by echocardiography, was increased in 8 patients (47%). Twelve of the 17 patients (71%) had more than a 20% reduction in CI afte...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197607000-00017
更新日期:1976-07-01 00:00:00
abstract:OBJECTIVE:To determine whether increasing distance between helicopter ambulance airbase and either home residence or referring facility is associated with an increased risk of injury-related mortality. BACKGROUND:A dramatic increase in the absolute number and utilization of Helicopter Emergency Medical Services transp...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31827ee6b0
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVES:We examined the influence of surgeon age and other factors on proficiency in laparoscopic or open hernia repair. SUMMARY BACKGROUND DATA:In a multicenter, randomized trial comparing open and laparoscopic herniorrhaphies, conducted in Veterans Administration hospitals (CSP 456), we reported significant diffe...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/01.sla.0000179644.02187.ea
更新日期:2005-09-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Computer-assisted robotic surgery allows complex resections and anastomotic reconstructions to be performed with nearly identical standards to open surgery. We applied this technology to a variety of pancreatic resections to assess the safety, feasibility, versatility, and reliability of this ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182a4e87c
更新日期:2013-10-01 00:00:00
abstract::The etiology and mechanisms by which severe trauma or sepsis induce hepatic failure are unknown. Previously we showed that Kupffer cells (KC), the fixed macrophages of the liver, induce a profound decrease in hepatocyte (HC) total-protein synthesis when exposed to endotoxin. Furthermore we demonstrated that endotoxin-...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199010000-00009
更新日期:1990-10-01 00:00:00
abstract:OBJECTIVE:Comparative analyses of survival and funding statistics in cancers with high mortality were performed to quantify discrepancies and identify areas for intervention. BACKGROUND:Discrepancies in research funding may contribute to stagnant survival rates in pancreatic ductal adenocarcinoma (PDAC). METHODS:The ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003042
更新日期:2020-02-01 00:00:00
abstract::To determine the significance of proteolysis and delayed freezing of tumor samples on estrogen receptor levels, values from 19 of 31 biopsy specimens were compared with that in remaining tumor at the completion of mastectomy. There was a 15-100% decrease in receptor content. Time-decay studies on selected postmastecto...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198105000-00003
更新日期:1981-05-01 00:00:00
abstract::Thrombotic complications of heparin administration were observed in eight patients during a two year period. At sites of subcutaneous heparin injection, six patients developed areas of the skin and subcutaneous necrosis. Systemic thrombotic events and thrombocytopenia were observed in two of these patients when they r...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197911000-00007
更新日期:1979-11-01 00:00:00
abstract::The significance of regional therapy against the intrahepatic recurrence for hepatocellular carcinoma (HCC) was evaluated. During the past 6 years, 101 patients who had radical operations for HCC (liver cirrhosis, 75%; chronic hepatitis, 22%) were followed. Forty-seven patients (47%) had recurrences; the liver was the...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198707000-00006
更新日期:1987-07-01 00:00:00
abstract:OBJECTIVE:The objective of this prospective, nonrandomized study was to evaluate the immediate and long-term results of first-line chemotherapy and possible surgery in locally advanced, presumably T4 squamous cell esophageal cancer. SUMMARY BACKGROUND DATA:Locally advanced esophageal cancer is rarely operable and has ...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/00000658-199712000-00008
更新日期:1997-12-01 00:00:00
abstract:OBJECTIVE:To determine whether bariatric surgery is associated with a lower risk of cancer. BACKGROUND:Obesity is strongly associated with many types of cancer. Few studies have examined the relationship between bariatric surgery and cancer risk. METHODS:We conducted a retrospective cohort study of patients undergoin...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000002525
更新日期:2019-01-01 00:00:00
abstract:OBJECTIVE:Based on development of stem cell technology, newborn tissue, even undergoing cryopreservation, possesses promising potential as a donor source in the field of organ transplantation. However, the precise regeneration processes remains unclear. This study was designed to investigate the regenerative potential ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000168089.64630.94
更新日期:2005-07-01 00:00:00
abstract::The obturator bypass graft operation can be performed in a moderately simplified manner by a technique that allows extension of indications for the procedure beyond situations in which sepsis is present in the groin. Long-term analysis of the results of the cases available for study indicates that the procedure may ve...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198303000-00015
更新日期:1983-03-01 00:00:00
abstract:OBJECTIVE:The goal of this scoping review was to summarize the literature on facilitators and barriers to surgical practice change. This information can inform research to implement best practices and evaluate new surgical innovations. BACKGROUND:In an era of accelerated innovations, surgeons face the difficult decisi...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004355
更新日期:2020-08-26 00:00:00
abstract:OBJECTIVE:To assess the distant metastatic potential of duodeno-pancreatic neuroendocrine tumors (DP-NETs) in patients with MEN1, according to functional status and size. SUMMARY BACKGROUND DATA:DP-NETs, with their numerous lesions and endocrine secretion-related symptoms, continue to be a medical challenge; unfortuna...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003162
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVE AND BACKGROUND:Our objective was to determine the fetal in vivo microRNA signature in hypoplastic lungs of human fetuses with severe isolated congenital diaphragmatic hernia (CDH) and changes in tracheal and amniotic fluid of fetuses undergoing fetoscopic endoluminal tracheal occlusion (FETO) to reverse sever...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001054
更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:Over the past 2 decades, there has been an increase in opioid use and subsequently, opioid deaths. The amount of opioid prescribed to surgical patients has also increased. The aim of this systematic review was to determine postdischarge opioid consumption in surgical patients compared with the amount of opio...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002591
更新日期:2018-06-01 00:00:00
abstract::Spectral analysis was used to examine 257 carotid arteries in 227 patients who had undergone carotid endarterectomy at 1, 3, 6, and 12 months after surgery and annually thereafter. Routine intraoperative completion angiography ensured that the operations were technically satisfactory. Postoperative restenoses were ide...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198407000-00013
更新日期:1984-07-01 00:00:00
abstract::Human lymphocyte antigen (HLA) class I and class II antigens and beta 2 microglobulin (B2M) were identified in peritoneal dialysate (PD) and serum from patients with end-stage renal disease (ESRD) using monoclonal antibodies in an enzyme-linked immunoassay. The HLA class I and class II antigens each exhibited approxim...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199106000-00009
更新日期:1991-06-01 00:00:00
abstract:OBJECTIVE:To develop a model for the identification of individuals at risk for carotid stenosis (CS) that could be useful in a clinical setting when trying to decide whether screening is worthwhile. BACKGROUND:Evidence that aggressive medical therapy and life style changes reduce the risk of stroke in individuals with...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31827b9761
更新日期:2013-06-01 00:00:00
abstract::The effects of pH on the tensile properties of eight commonly used 2-0 suture materials--plain catgut, Dexon, Vicryl, silk, Nurolon, Ethilon, Mersilene, and Prolene--were examined. The pH level ranged from 3.0 to 10.0. In general, absorbable suture materials were more sensitive to pH than non-absorbable suture materia...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198308000-00019
更新日期:1983-08-01 00:00:00
abstract:BACKGROUND/OBJECTIVE:The National Surgical Quality Improvement Program (NSQIP) has demonstrated quality improvement in the VA and pilot study of 14 academic institutions. The objective was to show that American College of Surgeons (ACS)-NSQIP helps all enrolled hospitals. METHODS:ACS-NSQIP data was used to evaluate im...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181b4148f
更新日期:2009-09-01 00:00:00
abstract:OBJECTIVE:Cetuximab, a monoclonal antibody targeting epidermal growth factor receptor (EGFR), has been proven to be efficient in metastatic colorectal cancer (mCRC); however, the therapeutic response is variable and markers predictive of response are urgently required. This study was conducted to determinate the predic...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181bc9d96
更新日期:2010-02-01 00:00:00