Biology of surgical infection

Robson, Martin C.; Krizek, Thomas J.; Heggers, John P.

doi:10.1016/s0011-3840(73)80010-3

Cited by 91 publications

(34 citation statements)

References 162 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Methicillin-resistant S. aureus now is one of the leading organisms causing invasive infection in burns across the world, with burn units reporting rates of infection greater than 50% [9,10]. In addition to causing pneumonia, sepsis, and other sequelae related to invasive burn wound infection, staphylococci are a significant cause of graft loss when the burden of infective organisms exceeds 10 5 CFU [11].…”

Section: Gram-positive Bacteriamentioning

confidence: 99%

Infection in Burns

Norbury

Herndon

Tanksley

et al. 2016

Surgical Infections

269

158

View full text Add to dashboard Cite

Background: Developments in critical care and surgical approaches to treating burn wounds, together with newer antimicrobial treatments, have significantly reduced the morbidity and mortality rates associated with this injury. Methods: Review of the pertinent English-language literature. Results: Several resistant organisms have emerged as the maleficent cause of invasive infection in burn patients, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, Pseudomonas, Acinetobacter, non-albicans Candida spp., and Aspergillus. Advances in antimicrobial therapies and the release of new classes of antibiotics have certainly added to the armamentarium of therapeutic resources for the clinician. Conclusion: Strict infection control measures, constant wound surveillance with regular sampling of tissues for quantitative culture, and early excision and wound closure remain the principal adjuncts to control of invasive infections in burn patients.

show abstract

Section: Gram-positive Bacteriamentioning

confidence: 99%

Infection in Burns

Norbury

Herndon

Tanksley

et al. 2016

Surgical Infections

269

158

View full text Add to dashboard Cite

show abstract

“…graft loss when the colony count of the graft bed exceeds 10 5 colony-forming units (cfu)=g of tissue [18]. Burn centers around the world have studied the emerging incidence and prevalence of multiresistant S. aureus infections.…”

mentioning

confidence: 99%

Emerging Infections in Burns

Branski

Al-Mousawi

Rivero

et al. 2009

Surgical Infections

294

174

View full text Add to dashboard Cite

Background: Patients who suffer severe burns are at higher risk for local and systemic infections. In recent years, emerging resistant pathogens have forced burn care providers world wide to search for alternative forms of treatment. Multidrug-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter spp., and various fungal strains have been the major contributors to the increase in morbidity and mortality rates. Multi-drugresistant S. aureus remains the major cause of gram-positive burn wound infections world wide. Treatment strategies include rigorous isolation protocols and new types of antibiotics where necessary. Methods: We reviewed 398 severely burned patients (burns >40% total body surface area [TBSA]) admitted to our hospital between 2000 and 2006. Patients who did not contract multi-drug-resistant gram-negative organisms during their hospital course and received our standard antibiotic regimen-vancomycin and piperacillin= tazobactam-served as controls (piperacillin=tazobactam; n ¼ 280). The treatment group consisted of patients who, during their acute hospital stay, developed infections with multi-drug-resistant gram-negative pathogens and were treated with vancomycin and colistin for at least three days (colistin; n ¼ 118). Results: Gram-negative organisms continue to cause the most severe infections in burn patients. Colistin has reemerged as a highly effective antibiotic against multiresistant Pseudomonas and Acinetobacter infections of burns. Patients who required colistin therapy had a significantly larger average total and full-thickness burn than patients treated with piperacillin=tazobactam and vancomycin, and the mortality rate was significantly higher in the colistin group (p < 0.05). However, there was no significant difference between the colistin and piperacillin= tazobactam groups in the incidence of neurotoxicity, hepatic toxicity, or nephrotoxicity. The main fungal pathogens in burn patients are Candida spp., Aspergillus spp., and Fusarium spp. A definitive diagnosis is more difficult to obtain than in bacterial infections. Amphotericin B and voriconazole remain the two most important anti-fungal substances in our practice. Conclusions: Innovations in fluid management, ventilatory support, surgical care, and antimicrobial therapy have contributed to a significant reduction in morbidity and mortality rates in burn patients. Vancomycin and clindamycin are the two most important reserve antibiotics for methicillin-resistant Staphylococcus aureus infection. Oxazolidinones and streptogramins have showed high effectiveness against gram-positive infections. Colistin has re-emerged as a highly effective antibiotic against multiresistant Pseudomonas and Acinetobacter infections. Current challenges include Candida, Aspergillus, and molds. The development of new agents, prudent and appropriate use of antibiotics, and better infection control protocols are paramount in the ongoing battle against multi-resistant organisms.

show abstract

“…Topical antibiotic irrigation, which affects only surface bacteria, is of minimal benefit. 6 As in all clinical situations, a thorough history and physical examination are prerequisites for making the best decisions for patient care. In the continued on page 252 The degree to which sutures affect wound infection rates varies with the chemical composition and configuration of the suture material.…”

Section: Initial Wound Managementmentioning

confidence: 99%

Wound contamination

Georgiade¹

1983

Postgraduate Medicine

View full text Add to dashboard Cite

The history of a wound and its clinical appearance help the clinician make appropriate decisions on management. The level of contamination in the wound can be determined with the rapid biopsy fixation technique. Extensive wound debridement, high-pressure irrigation, and cautious use of antibiotics should reduce the bacterial count to a level that allows primary healing. The use of sutures of appropriate chemical and physical characteristics should minimize suture contribution to the development of wound infection. Coverage of the wound after closure protects it from external contaminants and allows for completion of epithelialization. Immobilization and, if possible, elevation of the wounded part decrease secondary edema formation.

show abstract

Biology of surgical infection

Cited by 91 publications

References 162 publications

Infection in Burns

Infection in Burns

Emerging Infections in Burns

Wound contamination

Contact Info

Product

Resources

About