Shannon T. McElearney

Wound Infection after Elective Colorectal Resection

Introduction:Surgical site infection (SSI) is a potentially morbid and costly complication following major colorectal resection. In recent years, there has been growing attention placed on the accurate identification and monitoring of such surgical complications and their costs, measured in terms of increased morbidity to patients and increased financial costs to society. We hypothesize that incisional SSIs following elective colorectal resection are more frequent than is generally reported in the literature, that they can be predicated by measurable perioperative factors, and that they carry substantial morbidity and cost. Methods:Over a 2-year period at a university hospital, data on all elective colorectal resections performed by a single surgeon were retrospectively collected. The outcome of interest was a diagnosis of incisional SSI as defined by the Center of Disease Control and Prevention. Variables associated with infection, as identified in the literature or by experts, were collected and analyzed for their association with incisional SSI development in this patient cohort. Multivariate analysis by stepwise logistic regression was then performed on those variables associated with incisional SSI by univariate analysis to determine their prognostic significance. The incidence of SSI in this study was compared with the rates of incisional SSI in this patient population reported in the literature, predicted by a nationally based system monitoring nosocomial infection, and described in a prospectively acquired intradepartmental surgical infection data base at our institution. Results:One hundred seventy-six patients undergoing elective colorectal resection were identified for evaluation. The mean patient age was 62 ± 1.2 years, and 54% were men. Preoperative diagnoses included colorectal cancer (57%), inflammatory bowel disease (20%), diverticulitis (10%), and benign polyp disease (5%). SSIs were identified in 45 patients (26%). Twenty-two (49%) SSIs were detected in the outpatient setting following discharge. Of all preoperative and perioperative variables measured, increasing patient body mass index and intraoperative hypotension independently predicted incisional SSI. Although we could not measure statistically increased length of hospital stay associated with SSI, a representative population of patients with SSI accumulated a mean of

Cost of Gram-negative resistance*

6200/patient of home health expenses related to wound care. Our rates of SSI were substantially higher than that reported generally in the literature, predicted by the National Nosocomial Infection System, or described by our own institutional surgical infection data base. Conclusions:The incidence of incisional SSI in patients undergoing elective colorectal resection in our cohort was substantially higher than generally reported in the literature, the NNIS or predicted by an institutional surgical infection complication registry. Although some of these differences may be attributable to patient population differences, we believe these discrepancies highlight the potential limitations of systematic outcomes measurement tools which are independent of the primary clinical care team. Accurate surgical complication documentation by the primary clinical team is critical to identify the true frequency and etiology of surgical complications such as incisional SSI, to rationally approach their reduction and decrease their associated costs to patients and the health care system.

Does the addition of glutamine to enteral feeds affect patient mortality

Objective: It is unclear that infections with Gram‐negative rods resistant to at least one major class of antibiotics (rGNR) have a greater effect on patient morbidity than infections caused by sensitive strains (sGNR). We wished to test the hypothesis that rGNR infections are associated with higher resource utilization. Design: Retrospective observational cohort study of prospectively collected data. Setting: University hospital surgical intensive care unit and ward. Patients: Surgical patients with at least one GNR infection. Measurements: We compared admissions treated for rGNR infection with those with sGNR infections. Primary outcomes were total hospital costs and hospital length of stay. Other outcomes included antibiotic treatment cost, in‐hospital death, and intensive care unit length of stay. After univariate analysis comparing outcomes after rGNR infection with those after sGNR infection, multivariate linear regression models for hospital cost and length of stay were created to account for potential confounders. Main Results: Cost data were available for 604 surgical admissions treated for at least one GNR infection (Centers for Disease Control and Prevention criteria), 137 (23%) of which were rGNR infections. Admissions with rGNR infections were associated with a higher severity of illness at the time of infection (Acute Physiology and Chronic Health Evaluation II score, 17.6 ± 0.6 vs. 13.9 ± 0.3), had higher median hospital costs (

Differences in Early-and Late-Onset Ventilator-Associated Pneumonia Between Surgical and Trauma Patients in a Combined Surgical or Trauma Intensive Care Unit

80,500 vs.

Duration of Antibiotic Therapy for Ventilator-Associated Pneumonia Caused by Non-Fermentative Gram-Negative Bacilli

29,604, p < .0001) and median antibiotic costs (

Does body mass index affect infection-related outcomes in the intensive care unit?

2,607 vs.

Outbreak of resistant Pseudomonas aeruginosa infections during a quarterly cycling antibiotic regimen.

758, p < .0001), and had longer median hospital length of stay (29 vs. 13 days, p < .0001) and median intensive care unit length of stay (13 days vs. 1 day, p < .0001). Infection with rGNR within the first 7 days of admission was independently predictive of increased hospital cost (incremental increase in median hospital cost estimated at

Reduction in Rates of Methicillin-Resistant Staphylococcus aureus Infection after Introduction of Quarterly Linezolid–Vancomycin Cycling in a Surgical Intensive Care Unit

11,075; 95% confidence interval,

Effect of the 80-hour work week on cases performed by general surgery residents.

3,282–

Choosing Antibiotics for Intra-Abdominal Infections: What Do We Mean by “High Risk”?

20,099). Conclusions: Early infection with rGNR is associated with a high economic burden, which is in part related to increased antibiotic utilization compared with infection with sensitive organisms. Efforts to control overuse of antibiotics should be pursued.