Management Of Surgical Infections Research Articles

Infectious mass debulking in lead-associated endocarditis with a percutaneous aspiration system.

Debulking of infective mass to reduce the burden if infective material is a fundamental principle in the surgical management of infection. The aim of this study was to investigate the validity of this principle in patients undergoing transvenous lead extraction in the context of bloodstream infection (BSI). We performed an observational single-centre study on patients that underwent transvenous lead extraction due to a BSI, with or without lead-associated vegetations, in combination with a percutaneous aspiration system during the study period 2015-22. One hundred thirty-seven patients were included in the final analysis. In patients with an active BSI at the time of intervention, the use of a percutaneous aspiration system had a significant impact on survival (log-rank: P = 0.0082), while for patients with a suppressed BSI at the time of intervention, the use of a percutaneous aspiration system had no significant impact on survival (log-rank: P = 0.25). A reduction of the infective burden by percutaneous debulking of lead vegetations might improve survival in patients with an active BSI.

Progress on the diagnosis and management of surgical infection: Dialogue with the world

Progress on the diagnosis and management of surgical infection: Dialogue with the world

Ultrasound in the Modern Management of the Diabetic Foot Syndrome: A Multipurpose Versatile Toolkit.

Ultrasound (US) is a noninvasive and versatile technology that in recent years found acceptance in almost all the medical specialties, with diagnostic and interventional applications. In the diabetic foot syndrome (DFS), US found specific indications mainly in the screening, quantification, and follow-up of the vascular component of the pathology, but also in the study of the deformities and structural modifications induced by neuropathy and in the diagnosis and surgical management of infections, especially those that induce anatomical changes, like abscesses and fasciitis. This review will summarize all these application of US, giving special attention to the vascular aspects, and on the predominant role that US gained in recent times to guide the indication to revascularization, on the new standardized approach to the study of the arterial tree of the limb and the foot, the so-called duplex ultrasound arterial mapping, which significantly increased the utilization of US to plan the revascularizations in this complex pathology. Outside the vascular fields, the diagnosis of neuropathy and infection and the intraoperative use of US in the surgical management of abscesses and fasciitis will be discussed, leaving the last part to the new and interesting applications of US in the management of DFU, a field that is still in evolution, offering new possibilities to the health care professionals involved in the management of these chronic wounds. The variety of applications both in diagnostic and operative fields makes US a rather versatile technology-a toolkit-that should have a special place among those at reach of the specialists of DFS care.

Treating Surgical Infections in Low- and Middle-Income Countries: Source Control, Then What?

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 management of surgical infections in low- and middle-income countries.

Team Approach: The Management of Infection After Total Knee Replacement.

* Diagnosis and management of infection after total knee arthroplasty are challenging. They require a multidisciplinary team approach, much like the management of musculoskeletal tumors.* Patients presenting with suspected infection after total knee arthroplasty require diagnostic confirmation, medical optimization, comprehensive surgical care that may include measures to cover the soft tissues, administration of long-term antibiotics, and extended rehabilitation to improve outcome.* Surgeons should work closely with infectious disease specialists or microbiologists at every step to minimize the perioperative risks of reinfection, should decide on the most appropriate surgical modality and antibiotic regime, and should monitor the response to therapy.* The current evidence on the best surgical management of infection after total knee arthroplasty (debridement and retention of prostheses compared with 1-stage exchange or 2-stage exchange arthroplasty) is lacking. Randomized, prospective studies that are under way may provide this much-needed information.

Infectious Complications in Patients With Left Ventricular Assist Device: Etiology and Outcomes in the Continuous-Flow Era

Continuous-flow left ventricular assist devices (LVAD) are increasingly being used in patients with end-stage heart failure and have largely replaced older generation pulsatile devices. While significant rates of infection have been reported in patients with pulsatile device support, incidence and outcomes of this complication for the continuous-flow device patients remain unknown. Between June 2005 and August 2009, 81 patients were implanted with continuous-flow LVADs at Washington University School of Medicine either as bridge to transplantation or as destination therapy. Outcomes of this study included incidence of postimplantation infection, types of infection, microbiologic profile, and association of postimplantation infections with clinical endpoints. Forty-two patients (51.9%) had at least one type of infection on continuous-flow LVAD support with a mean follow-up period of 9.2 ± 9.2 months. Patients who had an infection on LVAD support had a significantly prolonged hospital stay (37.9 ± 32.0 versus 20.7 ± 23.0 days, p = 0.008) and a trend toward increased mortality (33.1% versus 18.7% at 2 years, respectively, log rank p = 0.102) compared with patients who did not. Subgroup analysis revealed that postimplantation sepsis was significantly associated with increased mortality in the continuous-flow LVAD cohort (61.9% versus 18.0% at 2 years, respectively, in septic and nonseptic patients, log rank p = 0.001). The majority of the sepsis cases occurred before hospital discharge, whereas most of the device related infections occurred after discharge. Resistant Staphylococcus and Pseudomonas species were the most common pathogens leading to device- and nondevice-related local infections. Development of driveline or pocket infection had no effect on survival in patients with continuous-flow assist device support (p = 0.193). Even though better clinical outcomes have been achieved with the newer generation continuous-flow devices, infection complications-in particular sepsis-are still a major risk for patients with continuous-flow LVAD implantation. Prevention strategies with aggressive medical and surgical management of infections may increase survival and decrease morbidity among continuous-flow LVAD patients.

Modern management of the septic trauma patient

The principles of management of the septic trauma patient are similar, though in some ways more challenging, than the septic patient without trauma. These principles include confirmation that new or progressive organ failure is secondary to infection, identification of the site of infection, the administration of appropriate antibiotics, and surgical management of infection, if required.

Antibiotic-impregnated Calcium Sulfate Use in Combat-related Open Fractures

This article presents our experience with the use of antibiotic-impregnated calcium sulfate in the management of comminuted open fractures with a bony defect caused by combat-related blast injuries and high-energy wounds. Calcium sulfate was used 19 times in 15 patients (17 fractures) as a bone graft substitute and a carrier for antibiotics. The anatomic sites of the graft were as follows: 6 calcanei, 1 midfoot, 1 metatarsal, 5 tibiae, 3 femorae, and 1 humerus. The average number of procedures prior to grafting was 6.2 (range, 2-10; median, 6) with grafting performed at an average 28 days after injury (range, 9-194 days; median, 14 days). Average radiographic follow-up of 12 fractures not requiring repeat grafting or amputation was 8.5 months (range 1-19 months; median, 7 months), and all of these fractures demonstrated clinical and radiographic evidence of fracture healing and consolidation. Four patients subsequently underwent 5 transtibial amputations: 2 for persistent infection, 1 when the patient changed his mind against limb salvage acutely, and 2 for severe neurogenic pain. Including the 2 amputations for persistent infection, 4 patients (22.2%) required further surgical management of infection. Three patients (17.6%) subsequently developed heterotopic ossification at the graft site, which required surgical excision. Antibiotic-impregnated calcium sulfate is effective in treating severe, contaminated open fractures by reducing infection and assisting with fracture union.

Role of source control in the surgical infection

Source control includes all the physical inter-ventious to treat surgical infection. The main procedures are drainage of abscesses, debridement of nonviable or infected tissue and definitive management of the anatomic abnormality which is responsible for ongoing microbial contamination. The new concept of damage control surgery expedites the wide use of percutaneous drainage of abcess and abdominal open surgery. Second-look laparotomy is another damage control procedure for the eradication of surgical infection. Surgical infection could hardly be controled without effective source control measures. Source control plays a key role in the management of surgical infection. Key words: Surgical infection; Debridement; Drainage; Damage control

Clinical Issues in the Management of Surgical Infections, with an Emphasis on Antibiotic Management of Infections Caused by Multi-Drug-Resistant Pathogens

Clinical Issues in the Management of Surgical Infections, with an Emphasis on Antibiotic Management of Infections Caused by Multi-Drug-Resistant Pathogens

Clinical Issues in the Management of Surgical Infections, with an Emphasis on Antibiotic Management of Infections Caused by Multi-Drug-Resistant Pathogens

Clinical Issues in the Management of Surgical Infections, with an Emphasis on Antibiotic Management of Infections Caused by Multi-Drug-Resistant Pathogens

Source Control − A Guide to the Management of Surgical Infections.

Source Control − A Guide to the Management of Surgical Infections.

In vivo release of vancomycin from biodegradable beads.

The current delivery system of antibiotics for the treatment of osteomyelitis uses polymethylmethacrylate (PMMA) beads as a local drug-release agent. The nonbiodegradable nature of the PMMA, however, necessitates a second operation to remove the beads. This article explores the alternative of using biodegradable polymers as antibiotic beads for a long-term drug release in vivo. To manufacture an antibiotic bead, lactide-glycolide copolymers were mixed with vancomycin. The mixture was compressed and sintered at 55 degrees C to form beads 8 mm in diameter. An in vivo animal model was proposed to characterize the elution rate of antibiotic over a 55-day period. Biodegradable beads released high concentrations of antibiotic (well above the breakpoint sensitivity concentration) in vivo for the period of time needed to treat bone infection; that is, 4-6 weeks. A bacterial inhibition test was also carried out to determine the relative activity of the released antibiotics. The diameter of the sample inhibition zone ranged from 8 to 18 mm, which is equivalent to 9.1 to 100% of relative activity. In addition, the antibiotic concentration of systemic blood was found to be very low. Antibiotic-impregnated biodegradable beads may have a potential role in the prevention and management of surgical infections.

3.脳外科感染症の外科治療 : 脳膿瘍を中心に(LS 8 脳外科感染症治療)

3.脳外科感染症の外科治療 : 脳膿瘍を中心に(LS 8 脳外科感染症治療)

The Role of the Plastic Surgeon in the Management of Surgical Infection

The Role of the Plastic Surgeon in the Management of Surgical Infection

Surgical infections: Prevention and treatment—1965 to 1995

During the 30 year period from 1965-1995, significant advances have been made in the prevention, diagnosis, and management of surgical infections. To a great degree these advances have been provided by surgeons who developed a primary interest in this area. The Surgical Infection Society (SIS) was established in 1980 for surgeons and other physicians and scientists in order to better coordinate efforts in education and research concerning the infected surgical patient. The most significant of these advances were initially the accurate microbiologic definition of the human endogenous microflora in health and disease. Improvements in the techniques utilized to isolate and identity anaerobic microorganisms were of paramount importance. These lead to improvements in the choice of antibiotic agents for prophylaxis and treatment which resulted in improved clinical results. Most recently, emphasis has been placed on the perioperative identification of the high-risk patient who is more likely to develop infection in the postoperative period. By separating high-risk from low-risk patients in each operative procedure, rather than assuming their risk based on the traditional classification of surgical procedure, a more rationale plan of prospective alterations of treatment can be offered.

VASCULAR DISEASE OF THE LOWER EXTREMITIES IN DIABETES MELLITUS

Vascular disease, neuropathy, and infection act synergistically to cause diabetic foot ulceration. Appropriate care is hindered by misconceptions about microvascular disease. Recent advances and success with extreme distal revascularization combined with surgical management of infection have greatly improved salvage of the diabetic foot. Success is enhanced by a multidisciplinary team approach.

Principles and Management of Surgical Infections

The dawn of the antibiotic era a half century ago raised hope for the elimination of infections in medical and surgical practice. Yes, countless lives have been saved, and much suffering has been reduced, but only one infection has been eliminated from the world (smallpox, as a result of a massive immunization program). There is no doubt, however, that today's physicians are practicing a style of medicine and surgery nearly unrecognizable from that of their predecessors. Aside from changes resulting from such "high-tech" advances as laser, stereotactic, and transplant surgery, much of the credit for surgical wonders we now take for granted must go to improved understanding of the host immune response, enhanced ability to diagnose and treat diseases, and availability of numerous potent antimicrobial agents. We are at the threshold of monoclonal antibody treatment of sepsis and a number of vaccines previously undreamed of. "... much of the credit for

Antibiotic beads in the management of surgical infections

Polymethyl methacrylate antibiotic beads have been used successfully in the treatment of surgical infections. Presented are their mechanism of action, their use in experimental and clinical settings, and their complications.

Management of Surgical Infections

This book dealing with surgical infections is limited in its depth and scope, dealing with gastrointestinal infections, vascular graft infections, endocarditis, mediastinal infections, and nosocomial infections. There are introductory chapters on hospital epidemiology, host defenses, and clinical microbiology. In a book with this title we might have expected to see many chapters on infections that surgeons must manage. There is one chapter that seems to be misplaced: Anaerobes and Intra-Abdominal Infections: A Skeptic's Viewpoint. After reviewing the limited evidence that Bacteroides fragilis may not be a pathogen in experimental and clinical studies, the author concluded, Additional evidence is necessary before the risk and cost of anaerobic-directed antibiotic therapy can be justified. The positive blood culture for B fragilis in the patient with intra-abdominal infection should properly be viewed as an indication for laparotomy and not as an indication for additional unproven antibiotic treatment. The author seems to ignore an extensive