Surgical Infections, An Issue of Surgical Clinics (Volume 89-2) (The Clinics: Surgery, Volume 89-2)

Microbial pathogens; Host response; Antimicrobial agents; Adjunctive measures; Prevention of SSI; Skin/soft tissue infections; Intra-abdominal infections; Prosthetic graft infections; Hospital-acquired pneumonia; Catheter-associated BSI; Nosocomial UTI; C. difficile-associated disease; Preventing bacterial resistance; Systems approaches; Future directions. 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 Common microbial pathogens in surgical practice / Motaz Qadan and William G. Cheadle The stressed host response to infections: the disruptive signals and rhythms of systemic inflammation / Stephen F. Lowry Antimicrobial agents for surgical infections / Nilam P. Patel and Mark A. Malangoni Adjunctive measures for treating surgical infections and sepsis / Matthew C. Byrnes and Greg J. Beilman Prevention of surgical site infection / John P. Kirby and John E. Mazuski Prosthetic infection: lessons from treatment of the infected vascular graft / Gabriel Herscu and Samuel Eric Wilson Skin and soft tissue infections / Addison K. May Intra-abdominal infections / John E. Mazuski and Joseph S. Solomkin Hospital-acquired pneumonia: pathophysiology, diagnosis, and treatment / Alicia N. Kieninger and Pamela A. Lipsett Catheter-related bloodstream infection / Matthew R. Goede and Craig M. Coopersmith Nosocomial urinary tract infection / Michael F. Ksycki and Nicholas Namias Clostridium difficile colotis / Philip A. Eforn and John E. Mazuski Preventing bacterial resistance in surgical patients / Heather L. Evans and Robert G. Sawyer A systems approach to the prevention of surgical infections / Donald E. Fry Future diagnostic and therapeutic approaches in surgical infections / Barbara Haas and Avery B. Nathens.