Severe Trauma Is Not an Excuse for Prolonged Antibiotic Prophylaxis

Velmahos, George C.; Toutouzas, Konstantinos G.; Sarkisyan, Grant; Chan, Linda S.; Jindal, Anurag; Karaiskakis, Marios; Katkhouda, Namir; Berne, Thomas V.; Δημητριάδης, Δημήτριος

doi:10.1001/archsurg.137.5.537

Cited by 73 publications

(39 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Antibiotics with broad coverage that includes multidrug-resistant pathogens such as Acinetobacter are likely not needed at the time of injury. Administration of more than one antibiotic for more than 24 hours does not offer additional protection against sepsis, organ failure, and death, but rather increases the probability of antibiotic-resistant infections [55,56].…”

Section: Discussionmentioning

confidence: 99%

Multidrug-resistant Organisms in Military Wounds from Iraq and Afghanistan

Calhoun

Murray

Manring

2008

Clinical Orthopaedics &Amp; Related Research

160

136

View full text Add to dashboard Cite

Mortality from battlefield wounds has historically declined, thanks to better surgical management, faster transport of casualties, and improved antibiotics. Today, one of the major challenges facing U.S. military caregivers is the presence of multidrug-resistant organisms in orthopaedic extremity wounds. The most frequently identified resistant strains of bacteria are Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter calcoaceticus-baumannii complex. Overuse of broad-spectrum antibiotics may be an important factor in building resistant strains. Acinetobacter infections appear to hospital-acquired and not from an initial colonization of the injury. More research is required to give military physicians the tools they require to reduce the infection rate and defeat multidrug-resistant organisms.

show abstract

Section: Discussionmentioning

confidence: 99%

Multidrug-resistant Organisms in Military Wounds from Iraq and Afghanistan

Calhoun

Murray

Manring

2008

Clinical Orthopaedics &Amp; Related Research

160

136

View full text Add to dashboard Cite

show abstract

“…[20][21][22][23][24] However, unnecessary antibiotic exposure is associated with increased risk for subsequent infectious complications, colonization, and infection with resistant pathogens, and increased hospital costs. 21,[25][26][27][28][29][30][31] Th us, early identifi cation of patients with pneumonia is necessary to improve outcomes in this population.…”

Section: For Editorial Comment See Page 1448mentioning

confidence: 99%

A Pilot Study of the Noninvasive Assessment of the Lung Microbiota as a Potential Tool for the Early Diagnosis of Ventilator-Associated Pneumonia

May

Brady

Romano-Keeler

et al. 2015

Chest

View full text Add to dashboard Cite

BACKGROUND: Ventilator-associated pneumonia (VAP) remains a common complication in critically ill surgical patients, and its diagnosis remains problematic. Exhaled breath contains aerosolized droplets that refl ect the lung microbiota. We hypothesized that exhaled breath condensate fl uid (EBCF) in hygroscopic condenser humidifi er/heat and moisture exchanger (HCH/HME) fi lters would contain bacterial DNA that qualitatively and quantitatively correlate with pathogens isolated from quantitative BAL samples obtained for clinical suspicion of pneumonia.

show abstract

“…The indication is less clear previous to the insertion of a chest tube [168][169][170][171][172][173]. In any case, protracted administration is not indicated, provided that it does not confer additional protection and increases antibioticrelated complications, and in some instances the risk of nosocomial infections [174][175][176]. Randomized clinical trials and comparative nonrandomized studies have proven it [177][178][179][180][181].…”

Section: Other Considerations During the First Daymentioning

confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

View full text Add to dashboard Cite

Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Organization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year.Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), technique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30% of 125 trauma deaths with errors. These errors contributed to 48% of all preventable deaths.The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions [9,10].It is imperative for the general surgeon who takes care of trauma patients to know how to deal with these critical aspects, to reduce preventable morbidity and mortality. In the next segment, the situations in which the participation of the surgeon is crucial, during the initial phases of reanimation and stabilization of the critically traumatized patient will be discussed. Airway and ventilation managementAirway and respiratory management errors are the most common of those identified by several authors [9][10][11] The cardinal manifestation is a sudden or a rapidly progressing desaturation, frequently accompanied by tachycardia and arrhytmias, and occasionally by agitation. Hypertension announces the cardiovascular collapse, and bradicardia appears immediately after the total collapse [12]. The symptoms should not be attributed to agitation when it is present, and other possible causes must be ruled out before. Diagnosing the complication involves a directed physical examination, the analysis of the airway pressures and ventilator volumes, chest radiographs, and sometimes the measurement of arterial blood gases (ABG), and the urinary bladder pressure ( Table 1).The emergency conditions in which the access to the airways must be gained, the displacement to diagnosis areas or operating room and the agitation, often present, make the critical...

show abstract

Severe Trauma Is Not an Excuse for Prolonged Antibiotic Prophylaxis

Abstract: Hypothesis: For critically injured patients, a limited course of antibiotics is as effective as a prolonged course in preventing sepsis and organ failures.

Cited by 73 publications

References 24 publications

Multidrug-resistant Organisms in Military Wounds from Iraq and Afghanistan

Multidrug-resistant Organisms in Military Wounds from Iraq and Afghanistan

A Pilot Study of the Noninvasive Assessment of the Lung Microbiota as a Potential Tool for the Early Diagnosis of Ventilator-Associated Pneumonia

Critical Care Issues in the Early Management of Severe Trauma

Contact Info

Product

Resources

About