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Dale W Bratzler - One of the best experts on this subject based on the ideXlab platform.
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clinical practice guidelines for antimicrobial prophylaxis in surgery
American Journal of Health-system Pharmacy, 2013Co-Authors: Dale W Bratzler, Patchen E Dellinger, Lena M. Napolitano, Keith M Olsen, Trish M Perl, Paul G Auwaerter, Maureen K Bolon, Douglas N Fish, Robert G. SawyerAbstract:These guidelines were developed jointly by the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), the Surgical Infection Society (SIS), and the Society for Healthcare Epidemiology of America (SHEA). This work represents an update to the
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indwelling urinary catheter use in the postoperative period analysis of the national Surgical Infection prevention project data
Archives of Surgery, 2008Co-Authors: Heidi L Wald, Dale W Bratzler, Andrew M KramerAbstract:Objectives To describe the frequency and duration of perioperative catheter use and to determine the relationship between catheter use and postoperative outcomes. Design Retrospective cohort study. Setting Two thousand nine hundred sixty-five acute care US hospitals. Patients Medicare inpatients (N = 35 904) undergoing major surgery (coronary artery bypass and other open-chest cardiac operations; vascular surgery; general abdominal colorectal surgery; or hip or knee total joint arthroplasty) in 2001. Main Outcome Measure Postoperative urinary tract Infection. Results Eighty-six percent of patients undergoing major operations had perioperative indwelling urinary catheters. Of these, 50% had catheters for longer than 2 days postoperatively. These patients were twice as likely to develop urinary tract Infections than patients with catheterization of 2 days or less. In multivariate analyses, a postoperative catheterization longer than 2 days was associated with an increased likelihood of in-hospital urinary tract Infection (hazard ratio, 1.21; 95% confidence interval [CI], 1.04-1.41) and 30-day mortality (parameter estimate, 0.54; 95% CI, 0.37-0.72) as well as a decreased likelihood of discharge to home (parameter estimate, − 0.57; 95% CI, − 0.64 to − 1.51). Conclusions Indwelling urinary catheters are routinely in place longer than 2 days postoperatively and may result in excess nosocomial Infections. The association with adverse outcomes makes postoperative catheter duration a reasonable target of Infection control and Surgical quality-improvement initiatives.
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the Surgical Infection prevention and Surgical care improvement projects promises and pitfalls
American Surgeon, 2006Co-Authors: Dale W BratzlerAbstract:Variations in outcomes for patients who have surgery are well known, and there is extensive evidence that failure to apply standards of care known to prevent adverse events results in patient harm. Infections and postoperative sepsis, cardiovascular complications, respiratory complications, and thromboembolic complications represent some of the most common adverse events that occur after surgery. Patients who experience postoperative complications have increased hospital length of stay, readmission rates, and mortality rates; in addition, costs of care are increased for patients, hospitals, and payers. In 2002, the Centers for Medicare and Medicaid Services, in collaboration with the Centers for Disease Control and Prevention, implemented the Surgical Infection Prevention Project to decrease the morbidity and mortality associated with postoperative Surgical site Infections. More recently, the Surgical Care Improvement Project, a national quality partnership of organizations committed to improving the safety of Surgical care has been implemented. Although the Surgical Care Project does not focus on the complete set of important Surgical quality issues, it does provide the incentive and infrastructure for national data collection and quality improvement activities for hospitals. There is now a strong national commitment to measure processes and outcomes of care for surgery in the United States.
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the Surgical Infection prevention and Surgical care improvement projects national initiatives to improve outcomes for patients having surgery
Clinical Infectious Diseases, 2006Co-Authors: Dale W Bratzler, David R HuntAbstract:Among the most common complications that occur after surgery are Surgical site Infections and postoperative sepsis, cardiovascular complications, respiratory complications (including postoperative pneumonia), and thromboembolic complications. Patients who experience postoperative complications have dramatically increased hospital length of stay, hospital costs, and mortality rates. The Centers for Medicare & Medicaid Services, in collaboration with the Centers for Disease Control and Prevention, has implemented the Surgical Infection Prevention Project to decrease the morbidity and mortality associated with postoperative Surgical site Infections. More recently, the Surgical Care Improvement Project, a national quality partnership of organizations committed to improving the safety of Surgical care, has been announced. This review will provide an update from the Surgical Infection Prevention Project and provide an introduction to the Surgical Care Improvement Project.
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use of antimicrobial prophylaxis for major surgery baseline results from the national Surgical Infection prevention project
Archives of Surgery, 2005Co-Authors: Dale W Bratzler, Patchen E Dellinger, Peter M Houck, Chesley L Richards, Lynn Steele, Claudia Wright, Karina CarrAbstract:Hypothesis Surgical site Infections (SSIs) are a major contributor to patient injury, mortality, and health care costs. Despite evidence of effectiveness of antimicrobials to prevent SSIs, previous studies have demonstrated inappropriate timing, selection, and excess duration of administration of antimicrobial prophylaxis. We herein describe the use of antimicrobial prophylaxis for Medicare patients undergoing major surgery. Design National retrospective cohort study with medical record review. Setting Two thousand nine hundred sixty-five acute-care US hospitals. Patients A systematic random sample of 34 133 Medicare inpatients undergoing coronary artery bypass grafting; other open-chest cardiac surgery (excluding transplantation); vascular surgery, including aneurysm repair, thromboendarterectomy, and vein bypass operations; general abdominal colorectal surgery; hip and knee total joint arthroplasty (excluding revision surgery); and abdominal and vaginal hysterectomy from January 1 through November 30, 2001. Main Outcome Measures The proportion of patients who had parenteral antimicrobial prophylaxis initiated within 1 hour before the Surgical incision; the proportion of patients who were given a prophylactic antimicrobial agent that was consistent with currently published guidelines; and the proportion of patients whose antimicrobial prophylaxis was discontinued within 24 hours after surgery. Results An antimicrobial dose was administered to 55.7% (95% confidence interval [CI], 54.8%-56.6%) of patients within 1 hour before incision. Antimicrobial agents consistent with published guidelines were administered to 92.6% (95% CI, 92.3%-92.8%) of the patients. Antimicrobial prophylaxis was discontinued within 24 hours of surgery end time for only 40.7% (95% CI, 40.2%-41.2%) of patients. Conclusion Substantial opportunities exist to improve the use of prophylactic antimicrobials for patients undergoing major surgery.
Robert G. Sawyer - One of the best experts on this subject based on the ideXlab platform.
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the Surgical Infection society revised guidelines on the management of intra abdominal Infection
Surgical Infections, 2017Co-Authors: John E Mazuski, Phillip K Chang, Patrick J Oneill, Kevin P Mollen, Jared M Huston, Evan P. Nadler, Robert G. Sawyer, Jeffrey M Tessier, Matthew R Rosengart, Jose J DiazAbstract:Abstract Background: Previous evidence-based guidelines on the management of intra-abdominal Infection (IAI) were published by the Surgical Infection Society (SIS) in 1992, 2002, and 2010. At the t...
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clinical practice guidelines for antimicrobial prophylaxis in surgery
American Journal of Health-system Pharmacy, 2013Co-Authors: Dale W Bratzler, Patchen E Dellinger, Lena M. Napolitano, Keith M Olsen, Trish M Perl, Paul G Auwaerter, Maureen K Bolon, Douglas N Fish, Robert G. SawyerAbstract:These guidelines were developed jointly by the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), the Surgical Infection Society (SIS), and the Society for Healthcare Epidemiology of America (SHEA). This work represents an update to the
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the Surgical care improvement project and prevention of post operative Infection including Surgical site Infection
Surgical Infections, 2011Co-Authors: Laura H Rosenberger, Amani D Politano, Robert G. SawyerAbstract:Abstract Background: In response to inconsistent compliance with Infection prevention measures, the Centers for Medicare & Medicaid Services collaborated with the U.S. Centers for Disease Control and Prevention on the Surgical Infection Prevention (SIP) project, introduced in 2002. Methods: Quality improvement measures were developed to standardize processes to increase compliance. In 2006, the Surgical Care Improvement Project (SCIP) developed out of the SIP project and its process measures. These initiatives, published in the Specifications Manual for National Inpatient Quality Measures, outline process and outcome measures. This continually evolving manual is intended to provide standard quality measures to unify documentation and track standards of care. Results: Seven of the SCIP initiatives apply to the peri-operative period: Prophylactic antibiotics should be received within 1 h prior to Surgical incision (1), be selected for activity against the most probable antimicrobial contaminants (2), and be...
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single institutional experience with the Surgical Infection prevention project in intra abdominal surgery
Surgical Infections, 2007Co-Authors: Traci L Hedrick, Timothy L. Pruett, Florence E Turrentine, Robert L Smith, Shannon T Mcelearney, Heather L Evans, Robert G. SawyerAbstract:Background: The incidence of Surgical site Infection (SSI) is becoming a key component of standard measures of quality of performance. We hypothesized that institutional implementation of a protocol targeting known risk factors would reduce the incidence of SSI associated with intra-abdominal surgery. Methods: Beginning in June 2004, a quality control initiative was implemented to prevent SSI in patients undergoing intra-abdominal Surgical procedures at an academic medical center. This protocol included administration of the proper prophylactic antibiotic 0–60 minutes before incision, continued antibiotic administration for ≤24 hours, and maintenance of intraoperative normothermia (≥36°C), along with good glycemic control (goal<200 mg/dL 48 h postoperatively) in diabetic patients. Baseline data collected during the initial four months of protocol development (379 patients) were compared with data collected during the last four months of the 11-month study period (390 patients). Results: Compliance with an...
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the Surgical Infection society guidelines on antimicrobial therapy for intra abdominal Infections evidence for the recommendations
Surgical Infections, 2002Co-Authors: John E Mazuski, Robert G. Sawyer, Joseph T. Dipiro, Avery B Nathens, Moshe Schein, Kenneth A Kudsk, Charles J YowlerAbstract:Revised guidelines for the use of antimicrobial therapy in patients with intra-abdominal Infections were recently developed by the Therapeutic Agents Committee of the Surgical Infection Society (Ma...
Patchen E Dellinger - One of the best experts on this subject based on the ideXlab platform.
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clinical practice guidelines for antimicrobial prophylaxis in surgery
American Journal of Health-system Pharmacy, 2013Co-Authors: Dale W Bratzler, Patchen E Dellinger, Lena M. Napolitano, Keith M Olsen, Trish M Perl, Paul G Auwaerter, Maureen K Bolon, Douglas N Fish, Robert G. SawyerAbstract:These guidelines were developed jointly by the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), the Surgical Infection Society (SIS), and the Society for Healthcare Epidemiology of America (SHEA). This work represents an update to the
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diagnosis and management of complicated intra abdominal Infection in adults and children guidelines by the Surgical Infection society and the infectious diseases society of america
Clinical Infectious Diseases, 2010Co-Authors: Joseph S Solomkin, Patrick J Oneill, Patchen E Dellinger, Ellen Jo Baron, Anthony W. Chow, John E Mazuski, Keith A Rodvold, John S. Bradley, Ellie J C Goldstein, Soumitra R EachempatiAbstract:Evidence-based guidelines for managing patients with intra-abdominal Infection were prepared by an Expert Panel of the Surgical Infection Society and the Infectious Diseases Society of America. These updated guidelines replace those previously published in 2002 and 2003. The guidelines are intended for treating patients who either have these Infections or may be at risk for them. New information, based on publications from the period 2003-2008, is incorporated into this guideline document. The panel has also added recommendations for managing intra-abdominal Infection in children, particularly where such management differs from that of adults; for appendicitis in patients of all ages; and for necrotizing enterocolitis in neonates.
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use of antimicrobial prophylaxis for major surgery baseline results from the national Surgical Infection prevention project
Archives of Surgery, 2005Co-Authors: Dale W Bratzler, Patchen E Dellinger, Peter M Houck, Chesley L Richards, Lynn Steele, Claudia Wright, Karina CarrAbstract:Hypothesis Surgical site Infections (SSIs) are a major contributor to patient injury, mortality, and health care costs. Despite evidence of effectiveness of antimicrobials to prevent SSIs, previous studies have demonstrated inappropriate timing, selection, and excess duration of administration of antimicrobial prophylaxis. We herein describe the use of antimicrobial prophylaxis for Medicare patients undergoing major surgery. Design National retrospective cohort study with medical record review. Setting Two thousand nine hundred sixty-five acute-care US hospitals. Patients A systematic random sample of 34 133 Medicare inpatients undergoing coronary artery bypass grafting; other open-chest cardiac surgery (excluding transplantation); vascular surgery, including aneurysm repair, thromboendarterectomy, and vein bypass operations; general abdominal colorectal surgery; hip and knee total joint arthroplasty (excluding revision surgery); and abdominal and vaginal hysterectomy from January 1 through November 30, 2001. Main Outcome Measures The proportion of patients who had parenteral antimicrobial prophylaxis initiated within 1 hour before the Surgical incision; the proportion of patients who were given a prophylactic antimicrobial agent that was consistent with currently published guidelines; and the proportion of patients whose antimicrobial prophylaxis was discontinued within 24 hours after surgery. Results An antimicrobial dose was administered to 55.7% (95% confidence interval [CI], 54.8%-56.6%) of patients within 1 hour before incision. Antimicrobial agents consistent with published guidelines were administered to 92.6% (95% CI, 92.3%-92.8%) of the patients. Antimicrobial prophylaxis was discontinued within 24 hours of surgery end time for only 40.7% (95% CI, 40.2%-41.2%) of patients. Conclusion Substantial opportunities exist to improve the use of prophylactic antimicrobials for patients undergoing major surgery.
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Surgical Infection society intra abdominal Infection study prospective evaluation of management techniques and outcome
Archives of Surgery, 1993Co-Authors: Nicolas V. Christou, Patchen E Dellinger, Paul J Waymack, Philip S. Barie, Harlan H StoneAbstract:• This prospective, open, consecutive, nonrandomized trial examined management techniques and outcome in severe peritonitis. A total of 239 patients with Surgical Infection in the abdomen and an APACHE (acute physiology and chronic health evaluation) II score greater than 10 were studied. Seventy-seven patients (32%) died. Reoperation had a 42% mortality rate (35 of 83 patients died) compared with a 27% mortality rate (42 of 156 died ) in patients who did not undergo reoperation. Forty-six patients underwent one reoperation; 15, two reoperations; 10, three reoperations; five, four reoperations; and seven, five reoperations, with mortality rates of 43%, 40%, 30%, 40%, and 57%, respectively. There was no significant difference in mortality between patients treated with a "closed-abdomen technique" (31% mortality) and those treated with variations of the "open-abdomen" technique (44% mortality). Logistic regression analysis showed that a high APACHE II score, low serum albumin level, and high New York Heart Association cardiac function status were significantly and independently associated with death. Low serum albumin level, youth, and high APACHE II score were significantly and independently associated with reoperation. ( Arch Surg . 1993;128:193-199)
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guidelines for clinical care anti infective agents for intra abdominal Infection a Surgical Infection society policy statement
Archives of Surgery, 1992Co-Authors: John M A Bohnen, Joseph S Solomkin, Patchen E Dellinger, Stephen H Bjornson, Carey P PageAbstract:• Several antibiotics have been marketed for therapeutic use in intra-abdominal Infection. Often, these agents do not provide a sufficient spectrum activity against both facultative and obligate anaerobic gram-negative organisms, or have certain toxic effects that would not otherwise support their use. Guidelines have been developed for selection of antibiotic therapy for intra-abdominal Infections and are presented as a statement of the Surgical Infection Society endorsed by the Executive Council. These guidelines are restricted to Infections derived from the gastrointestinal tract and deal with those microorganisms commonly seen in such Infections. The recommendations are based on in vitro activity against enteric bacteria, experience in animal models, and documented efficacy in clinical trials. Other concerns regarding pharmacokinetics, mechanisms of action, microbial resistance, and safety were also used in the formation of these guidelines. For community-acquired Infections of mild to moderate severity, single-agent therapy with cefoxitin, cefotetan, or cefmetazole or ticarcillin—clavulanic acid is recommended. For more severe Infections, single-agent therapy with carbapenems (imipenem/cilastatin) or combination therapy with either a third-generation cephalosporin, a monobactam (aztreonam), or an aminoglycoside plus clindamycin or metronidazole is recommended. Regimens with little or no activity against facultative gram-negative rods or anaerobic gram-negative rods are not considered acceptable. (Arch Surg . 1992;127:83-89)
Dietmar H. Wittmann - One of the best experts on this subject based on the ideXlab platform.
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Cefotaxime in the treatment of prophylaxis of Surgical Infections.
Journal of chemotherapy (Florence Italy), 1997Co-Authors: Dietmar H. Wittmann, R N Jones, J Malledant, G PriviteraAbstract:Cefotaxime has retained its broad-spectrum activity against the key pathogens in Surgical Infection, despite 15 years of widespread use. It has good activity against a wide range of Gram-positive and Gram-negative aerobes and most anaerobes, except Bacteroides fragilis but, combined with metronidazole, it offers clinically complete coverage of B. fragilis and Escherichia coli, the two most important species involved in intra-abdominal Infections. For mixed Infections involving B. fragilis, 500 mg metronidazole 12-hourly should be added to the cefotaxime regimen. Cefotaxime therapy is simple, generally inexpensive and has a relatively broad spectrum of activity compared to many other antimicrobials used for postoperative nosocomial pneumonia. Treatment with cefotaxime at 1 g or 2 g can be 12-hourly. Surgical prophylaxis with single-dose cefotaxime (1 g or 2 g) is as effective as with many other agents, with no documented selection of resistance. Clinical experience gained worldwide strongly supports the use of cefotaxime for the treatment of prophylaxis and Surgical Infections.
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The role of cefotaxime in the treatment of Surgical Infection
Diagnostic Microbiology and Infectious Disease, 1995Co-Authors: Dietmar H. WittmannAbstract:This study examines the role of cefotaxime in the treatment of both Gram-negative and Gram-positive Surgical Infections. A dose of 2 g of cefotaxime will sustain peripheral compartment concentrations of 2.6, 3.9, 1.6, and 0.7 micrograms/ml for 6, 8, 10 and 12 h, respectively. Therefore, the proportion of pathogens with a minimal inhibitory concentration (MIC) below the peripheral compartment cefotaxime concentrations was assessed as a measure of therapeutic potential. It was observed that bacterial elimination in Infections correlates well with such pharmacodynamic predictions. Therefore, treatment recommendations for Surgical Infections are based on the following pharmacodynamics. The times above the MIC in the tissue compartment for various pathogens (1988-1994) known to cause Surgical Infections were: Escherichia coli, 12 h; all pyogenic streptococci, 12 h; pneumococci, 12 h; Haemophilus spp., 12 h; Proteus mirabilis, 12 h; Klebsiella spp., 10.9 h; viridans streptococci, 10.6 h; oxacillin-susceptible, coagulase-negative staphylococci, 9.7 h; Providencia spp., 9.2 h; Clostridium perfringens, 8.6 h; Peptostreptococcus spp., 8 h; oxacillin-susceptible Staphylococcus aureus, 7.3 h; and all S. aureus, 6.8 h. From the examination of pharmacodynamic parameters, cefotaxime appears to be a viable choice for the therapy of Surgical Infections other than the Gram-negative anaerobes. For those Infections, metronidazole with cefotaxime would be preferred.
Moshe Schein - One of the best experts on this subject based on the ideXlab platform.
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Source Control for Surgical Infections
World Journal of Surgery, 2004Co-Authors: Moshe Schein, John MarshallAbstract:The concept of source control encompasses all of the physical interventions, Surgical and otherwise, that are used to treat Infection. Although source control is one of the most important aspects of the treatment of serious Infection, it has received relatively little attention. It is the topic of this overview, which draws heavily on a book we edited recently: Source Control: A Guide to the Management of Surgical Infection (Springer-Verlag, 2002). The first section focuses on general considerations: historical perspective, scientific basis, and Surgical principles of source control. The second section highlights specific considerations of source control in various situations.
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the Surgical Infection society guidelines on antimicrobial therapy for intra abdominal Infections evidence for the recommendations
Surgical Infections, 2002Co-Authors: John E Mazuski, Robert G. Sawyer, Joseph T. Dipiro, Avery B Nathens, Moshe Schein, Kenneth A Kudsk, Charles J YowlerAbstract:Revised guidelines for the use of antimicrobial therapy in patients with intra-abdominal Infections were recently developed by the Therapeutic Agents Committee of the Surgical Infection Society (Ma...
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the Surgical Infection society guidelines on antimicrobial therapy for intra abdominal Infections an executive summary
Surgical Infections, 2002Co-Authors: John E Mazuski, Robert G. Sawyer, Joseph T. Dipiro, Avery B Nathens, Moshe Schein, Kenneth A Kudsk, Charles J YowlerAbstract:The Surgical Infection Society last published guidelines on antimicrobial therapy for intra-abdominal Infections in 1992 (Bohnen JMA, et al., Arch Surg 1992;127:83-89). Since then, an appreciable body of literature has been published on this subject. Therefore, the Therapeutics Agents Committee of the Society undertook an effort to update the previous guidelines, primarily using data published over the past decade. An additional goal of the Committee was to characterize its recommendations according to contemporary principles of evidence-based medicine. To develop these guidelines, the Committee carried out a systematic search for all English language articles published between 1990 and 2000 related to antimicrobial therapy for intra-abdominal Infections. This literature was reviewed individually and collectively by the Committee, and categorized according to the type of study and its quality. Additional articles published prior to 1990 were also utilized when necessary. By a process of iterative consensu...