Surgical Infections, An Issue of Surgical Clinics

Cover......Page 1
Foreword......Page 2
Reference......Page 4
Preface......Page 5
References......Page 7
Common Microbial Pathogens in Surgical Practice......Page 8
Anatomic considerations of bacterial and fungal pathogens......Page 9
Staphylococcus......Page 10
Streptococcus......Page 14
Gram-Positive Bacilli......Page 15
Gram-Negative Bacilli......Page 16
Pseudomonads......Page 17
Acinetobacter spp......Page 18
Fungi......Page 19
Future implications......Page 20
References......Page 21
The stressed clinical phenotype......Page 24
Local inflammatory signals......Page 25
Signals for innate immune system activation......Page 26
Autonomic rhythms......Page 27
Modifiers of the Initial Injury Response......Page 28
Confounding Illness and Treatment......Page 29
Responses to subsequent insults......Page 30
Genetic Factors......Page 31
References......Page 32
Antimicrobial Agents for Surgical Infections......Page 40
Penicillins......Page 54
Aminoglycosides......Page 55
Antifungals......Page 56
Pharmacokinetic and pharmacodynamic considerations in the surgical patient......Page 57
Considerations in management of multidrug-resistant organisms......Page 58
References......Page 59
Adjunctive Measures for Treating Surgical Infections and Sepsis......Page 61
Activated protein C......Page 62
Vasopressor/inotropic medications......Page 64
Goals......Page 65
Intensive glucose management......Page 66
Fluid resuscitation......Page 67
Other adjunctive therapies of sepsis......Page 68
Protocol-directed management of severe sepsis......Page 69
Role of intensivists......Page 70
References......Page 71
Definitions......Page 76
Risk factors for developing SSI......Page 77
Microbiology......Page 78
Prevention of SSI: general measures......Page 82
Prevention of SSI: antimicrobial prophylaxis......Page 88
Prevention of SSI: special considerations regarding staphylococcal infections......Page 92
Management of SSI......Page 93
Summary......Page 94
References......Page 95
Pathogenesis......Page 101
Aorto-iliac graft infection......Page 104
Peripheral vascular graft infection......Page 106
Hemodialysis graft infection......Page 107
Prevention of graft infection......Page 108
References......Page 109
Terminology and definitions......Page 112
Nonnecrotizing skin and soft tissue infections......Page 113
Treatment of Nonnecrotizing Skin and Soft Tissue Infections......Page 115
Nonnecrotizing cellulitis......Page 116
Complicated skin and soft tissue infections......Page 117
Necrotizing skin and soft tissue infections......Page 118
Therapeutic Approach for Necrotizing Infections......Page 121
Surgical Therapy for Necrotizing Infections......Page 122
Antibiotic Therapy for Necrotizing Infections......Page 123
Antibiotic Therapy for Necrotizing Skin and Soft Tissue Infections Caused by Highly Virulent Pathogens......Page 124
References......Page 125
Intra-Abdominal Infections......Page 130
Microbiology......Page 132
Source Control for Appendicitis......Page 134
Source Control for Severe, Diffuse Peritonitis......Page 136
Antimicrobial therapy......Page 137
Clinical outcomes......Page 141
References......Page 142
Hospital-Acquired Pneumonia: Pathophysiology, Diagnosis, and Treatment......Page 147
Microbiology......Page 148
Gram-Negative Bacteria......Page 149
Patient Risk Modification......Page 150
Decontamination of Digestive Tract......Page 151
Endotracheal Tube and Ventilator Management......Page 152
Sedation and Ventilator Weaning......Page 153
Clinical Evaluation......Page 154
Bacteriologic Evaluation......Page 156
Empiric Therapy......Page 158
Duration of Therapy......Page 160
Outcomes......Page 161
References......Page 163
Epidemiology and risk factors......Page 170
Hand Hygiene......Page 171
Anatomic Site of Insertion......Page 172
Comprehensive Prevention Programs......Page 173
Antiseptic- or Antibiotic-Coated Catheters......Page 174
Diagnosis......Page 175
Treatment......Page 176
Summary......Page 177
References......Page 178
Microbiology and diagnosis......Page 182
Prevention......Page 184
Treatment......Page 185
References......Page 187
Pathogenesis......Page 189
Risk factors......Page 190
Diagnosis......Page 191
Antimicrobial Treatment with Metronidazole and Vancomycin......Page 193
Treatment of Recurrent C difficile Infections......Page 196
Fulminant C difficile colitis......Page 197
Surgical therapy......Page 198
References......Page 199
Impact of resistant organisms on surgical practice......Page 207
Intra-Abdominal Infections......Page 208
Surgical Site Infections......Page 209
Centers for Disease Control and Prevention Campaign to Prevent Antimicrobial Resistance in Health Care Settings......Page 210
Antibiotic Formulary Restriction......Page 213
Selective Reporting of Bacterial Susceptibilities: Helpful or Harmful?......Page 214
Antibiotic cycling......Page 215
Summary......Page 217
References......Page 218
A Systems Approach to the Prevention of Surgical Infections......Page 226
Surgical Site Infection......Page 227
Postoperative Pneumonia......Page 229
Urinary Tract Infection (UTI)......Page 230
Intravascular Device Bacteremia......Page 231
Clostridium difficile Enterocolitis......Page 232
Government initiatives......Page 233
A systems approach......Page 235
Information Technology......Page 236
Analysis of Adverse Outcomes......Page 238
References......Page 239
Future Diagnostic and Therapeutic Approaches in Surgical Infections......Page 243
Culture-Based Assays......Page 244
Other Uses for Molecular Diagnostic Strategies......Page 245
Specimen-Based Assays......Page 246
Novel approaches to therapeutics......Page 247
Infection prevention through vaccination......Page 248
Advances in understanding host-microbial interactions......Page 250
References......Page 251