Reduction of Surgical Site Infection After Trauma Laparotomy Through Use of a Specific Protocol for Antibiotic Prophylaxis.

Emergency laparotomy for abdominal trauma is associated with high rates of surgical site infection (SSI). A protocol for antimicrobial prophylaxis (AMP) for trauma laparotomy was implemented to determine whether SSI could be reduced by adhering to established principles of AMP. A protocol utilizing ertapenem administered immediately before initiation of trauma laparotomy was adopted.

Stem cell and niche regulation in human short bowel syndrome.

Loss of functional small bowel surface area following surgical resection for disorders such as Crohn's disease, intestinal ischemic injury, radiation enteritis, and in children, necrotizing enterocolitis, atresia, and gastroschisis, may result in short bowel syndrome, with attendant high morbidity, mortality, and health care costs in the United States. Following resection, the remaining small bowel epithelium mounts an adaptive response, resulting in increased crypt cell proliferation, increased villus height, increased crypt depth, and enhanced nutrient and electrolyte absorption. Although these morphologic and functional changes are well described in animal models, the adaptive response in humans is less well understood.

Direct Monitoring Reveals Initiation of Turbidity Currents From Extremely Dilute River Plumes.

Rivers (on land) and turbidity currents (in the ocean) are the most important sediment transport processes on Earth. Yet how rivers generate turbidity currents as they enter the coastal ocean remains poorly understood. The current paradigm, based on laboratory experiments, is that turbidity currents are triggered when river plumes exceed a threshold sediment concentration of ~1 kg/m.

Management of Destructive Colon Injuries after Damage Control Surgery.

After the World War II, fecal diversion became the standard of care for colon injuries, although medical, logistic, and technical advancements have challenged this approach. Damage control surgery serves to temporize immediately life-threatening conditions, and definitive management of destructive colon injuries is delayed until after appropriate resuscitation. The bowel can be left in discontinuity for up to 3 days before edema ensues, but the optimal repair window remains within 12 to 48 hours.

Risk Factors for Surgical Site Infection After Cholecystectomy.

Background: There are limited data on risk factors for surgical site infection (SSI) after open or laparoscopic cholecystectomy.

Methods: A retrospective cohort of commercially insured persons aged 18-64 years was assembled using (ICD-9-CM) procedure or Current Procedural Terminology, 4th edition codes for cholecystectomy from December 31, 2004 to December 31, 2010. Complex procedures and patients (eg, cancer, end-stage renal disease) and procedures with pre-existing infection were excluded.

Synthetic versus Biologic Mesh in Single-Stage Repair of Complex Abdominal Wall Defects in a Contaminated Field.

Background: Synthetic meshes have been used with varying rates of success in a contaminated setting, although their use is not widely accepted because of concerns for infection. A biologic mesh (BM) is assumed to be more resistant to infection than a synthetic mesh; however, sparse clinical data support this theory. The hypothesis for this study: Uncoated polypropylene synthetic mesh (USM) can be used to obtain a durable repair in the setting of a contaminated abdominal wall reconstruction (AWR) in a single-stage procedure with comparable infectious outcomes to a biologic mesh repair.

Inadequate Source Control and Inappropriate Antibiotics are Key Determinants of Mortality in Patients with Intra-Abdominal Sepsis and Associated Bacteremia.

Background: Patients with intra-abdominal sepsis and associated bacteremia have a high mortality rate. However, outcomes studies in this population are limited, in part because of the small numbers of such patients. The objective of this study was to describe characteristics of critically ill patients with secondary blood stream infection (BSI) of intra-abdominal origin and identify predictors of mortality.