Increasing rates of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections have also affected the microbial profile of breast abscesses.Objective: To update the decade-old bacteriologic description of breast abscesses to improve the choice of initial antibacterial drug therapy.Design: Retrospective case series.Setting: County hospital emergency department.Patients: Forty-four women (mean age, 41 years; age range, 20-63 years) with breast abscesses.Methods: All cultures from the breast abscesses of patients were reviewed.
Main Outcome Measures:The microbiologic features and sensitivities of breast abscesses.Results: Of 46 specimens only 28 showed bacterial yield (61%). Of these, 11 (39%) were polymicrobial, for an average of 1.4 isolates per specimen. The most common or-
Setting: Six teaching hospitals. Patients: A total of 177 adult patients undergoing elective open inguinal hernia repair were randomized to either standard skin preparation with 10% povidone-iodine or skin preparation followed by cyanoacrylate-based liquid microbial sealant. Interventions: Wound contamination was assessed during surgery by microbial sampling inside the wound at initiation of skin incision and prior to skin closure. Main Outcome Measures: The primary outcome measures were the safety and effectiveness of cyanoacrylate-based microbial sealant to reduce bacterial contamination during surgery. The secondary outcome measure was reduction of postoperative surgical site infections using microbial sealant. Results: Demographics were similar. Patients treated with sealant were more likely to have no bacterial cells found in the wound than control participants (47% vs 31%; P = .04). Three patients developed surgical site infections; all were in the control group (P =.25). Independent factors that reduced wound contamination were use of microbial sealant (odds ratio,0.45; confidence interval, 0.23-0.88; P=.02) and perioperative antibiotics (odds ratio,0.24; confidence interval, 0.10-0.58; P =.001). Conclusion: Cyanoacrylate-based microbial sealant may be an important tool to reduce wound contamination and potentially prevent surgical site infections.
At our facility, diphtheroids are generally considered non-pathogenic contaminants in skin and soft tissue infections. The finding of A. bernardiae in necrotizing fasciitis is unusual and clinically important but would have been missed using conventional methods. As the "gram-positive bacillus" comes to include an ever-increasing number of organisms, genetic sequencing will probably be required more regularly for species identification. Furthermore, given that these genera are similar, often mistaken as contaminants, and difficult to differentiate using standard assays, they may often be missed and are possibly a more-frequent cause of complicated skin and soft tissue infections than the literature would suggest.
Hypothesis: Local wound management using a simple wound-probing protocol (WPP) reduces surgical site infection (SSI) in contaminated wounds, with less postoperative pain, shorter hospital stay, and improved patient satisfaction.
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