Firearm-Related Fractures: Epidemiology and Infection Rate / Fraturas causadas por armas de fogo: Epidemiologia e taxa de infecção

Abstract Objective To investigate the incidence of infection in patients with gunshot-related fractures, and to correlate this finding with the occurrence of surgical debridement in the emergency room. Methods A retrospective, observational, descriptive study that included all cases of fractures caused by firearms between January 2010 and December 2014; 245 fractures in 223 patients were included. Results There was surgical-site infection in 8.5% of the fractures, and the mean number of debridements required to control the infectious process was of 1.273 ± 0.608. A correlation was identified between the surgical treatment chosen and the affected body segment (p< 0.001). The surgical treatment in the emergency room had a correlation with the occurrence of infection (p< 0.001; Chi-squared test). Conclusion Patients with gunshot injuries treated non-operatively presented less severe and stable lesions; thus, the incidence of complications in this group was found to be lower. On the other hand, those patients with complex lesions underwent debridement and external fixation. Therefore, a greater number of infectious complications in patients submitted to external fixation was found, as expected.

Resumo Objetivo Investigar a incidência de infecção em pacientes com fraturas por arma de fogo, e correlacionar esse achado com a ocorrência de desbridamento cirúrgico na sala de emergência. Métodos Estudo retrospectivo, observacional e descritivo, que incluiu todos os casos de fraturas causadas por armas de fogo entre janeiro de 2010 e dezembro de 2014; foram incluídas 245 fraturas em 223 pacientes. Resultados Houve infecção do local cirúrgico em 8,5% das fraturas, e a média de desbridamentos necessários para controlar o processo infeccioso foi de 1,273 ± 0,608. Foi identificada correlação entre o tratamento cirúrgico escolhido e o segmento corporal afetado (p< 0,001). O tratamento cirúrgico na sala de emergência teve correlação com a ocorrência de infecção (p< 0,001; teste do qui-quadrado). Conclusão Pacientes com ferimentos à bala tratados de forma não operatória apresentaram lesões menos graves e estáveis; portanto, a incidência de complicações nesse grupo foi menor. Por outro lado, os pacientes com lesões complexas foram aqueles submetidos a desbridamento e fixação externa. Portanto, como esperado, foi encontrado um maior número de complicações infecciosas em pacientes submetidos à fixação externa.

Prevalencia y perfil de susceptibilidad antimicrobiana en bacterias aisladas de úlceras crónicas infectadas en adultos / Prevalence and susceptibility pattern of bacteria isolated from infected chronic wounds in adult patients

Resumen Introducción: Las úlceras crónicas son un problema de salud pública, agravándose por infecciones bacterianas causadas principalmente por agentes resistentes. Objetivo: Estudiar prevalencia y perfil de susceptibilidad en bacterias aisladas de úlceras crónicas en pacientes adultos. Pacientes y Métodos: Pacientes atendidos en la Fundación Instituto Nacional de Heridas entre mayo y julio de 2014, con úlceras crónicas en extremidades inferiores con signos inflamatorios clínicos. Las muestras fueron cultivadas en aerobiosis y anaerobiosis y para la identificación bacteriana se empleó el sistema de galerías API (Biomerieux). La susceptibilidad in vitro se evaluó según el método de Kirby Bauer. Resultados: Se reclutaron 73 pacientes, entre quienes 46 presentaron úlceras infectadas, diagnosticándose 33 úlceras venosas con predominio de infección polimicrobiana y 10 úlceras de pie diabético con predominio de infección monomicrobiana (p ≤ 0,05). Se aislaron 68 cepas de los 46 pacientes con úlcera infectada. Las enterobacterias predominaron en infección monomicrobiana (p ≤ 0,05) y los demás grupos bacterianos fueron levemente más frecuentes en infección polimicrobiana. La especie prevalente fue Staphylococcus aureus (24%) seguida de Pseudomonas aeruginosa (18%). Cincuenta cepas (77%) presentaron resistencia a uno o más antibacterianos. Destacamos resistencia de S. aureus a ciprofloxacina (50%) y cefoxitina (37,5%) identificándose así resistencia a meticilina en la comunidad (SARM-AC), siendo todas sensibles a cotrimoxazol. Las enterobacterias presentaron resistencia a sensibilidad a amikacina (95,5%), P. aeruginosa evidenció resistencia a ciprofloxacina (33,3%) con alta sensibilidad a gentamicina (91,7%) y amikacina (83,3%), mientras Acinetobacter spp presentó resistencia a ciprofloxacina y ceftazidima en 60%, con 100% de sensibilidad a imipenem. Streptococcus β hemolítico presentó 50% de resistencia a clindamicina y penicilina. Conclusión: Estos datos entregan información epidemiológica de infecciones de úlceras crónicas, representando un apoyo al diagnóstico, tratamiento y manejo de esta patología.

Background: Chronic wounds are considered a public health problem that may be complicated by bacterial infections, mainly caused by resistant strains. Aim: To study the bacteria prevalence and antimicrobial susceptibility in samples from adult patients with chronic wounds. Methods: Patients treated at National Institute of Wounds Foundation between May and July 2014, with chronic ulcers in lower extremities with clinical inflammatory signs were recluted. Samples were cultured in aerobic and anaerobic atmosphere and species identification was performed by API (Biomerieux) galleries. The in vitro susceptibility was evaluated according to the Kirby Bauer method. Results: From 73 patients, 46 had infected wounds most of them were venous ulcers (33) with prevalence in polymicrobial infections and 10 with foot-diabetes ulcers with prevalence in monomicrobial infections (p ≤ 0.05). Sixty-eight strains were isolated and Enterobacteriaceae were predominant in monomicrobial infection (p ≤ 0.05) and the other groups were slightly higher in polymicrobial infection. The main species were Staphylococcus aureus (24%) followed by P. aeruginosa (18%). Fifty strains (77%) were resistant or multi-resistance. We emphasize resistance of S. aureus to ciprofloxacin (50%) and cefoxitin (37.5%), thus identifying resistance to methicillin in the community (CA-SAMR), all of which are sensitive to cotrimoxazole. Enterobacteria showed sensitivity to amikacin (95.5%), P. aeruginosa showed resistance to ciprofloxacin (33.3%) with high sensitivity to gentamicin (91.7%) and amikacin (83.3%), while Acinetobacter spp showed resistance to ciprofloxacin and ceftazidime in 60%, with 100% sensitivity to imipenem. 50% Streptococcus β hemolytic showed resistance to clindamycin and penicillin. Conclusion: These data provide epidemiological information on chronic wound infections, representing support for diagnosis, treatment and management of this pathology.

Incidencia y factores de riesgo para bacteriemia en pacientes pediátricos con quemaduras en un Centro de Atención Especializado en México / Incidence and risk factors for bacteremia on pediatric patients with burns in a specialized care center in Mexico

Background: Bacteremia events are frequent cause of mortality in burn patients and may originate from infected wounds, by bacterial translocation of endogenous microorganisms, from invasive devices or contaminated intravenous solutions. Objective: To quantify the incidence of bacteremia in pediatric patients with burns and to identify risk factors. Material and Methods: A prospective cohort study was performed in pediatric patients with burns of Hospital Civil de Guadalajara "Dr. Juan I. Menchaca". Bacteremia was diagnosed by blood cultures in patients with clinical manifestations of sepsis. Risk factors were investigated by multivariate analysis with Cox regression. Results: Were included in the cohort 260 patients, median age 3 years. The incidence of bacteremia was 9.6 events per 1,000 days patient. The most frequently isolated bacteria were Enterobacteriaceae (41.9%), Staphylococcus aureus (22.6%) and Pseudomonas aeruginosa (22.6%). Factors associated with bacteremia were: bums ≥ 20% TBSA (HR 11.06; 95% CI 4.8-25.4), deep second degree bums or higher (HR 6.9; 95% CI 2.0-23.3) and have had two or less debridement (HR 26.4; 95% CI 8.0-87.7). Conclusions: Patients with more extensive and deep burns with fewer debridement are at increased risk of bacteremia.

Introducción: Los eventos de bacteriemia son causa frecuente de mortalidad en pacientes con quemaduras y pueden originarse en heridas infectadas, por translocación bacteriana de microorganismos endógenos, por dispositivos invasores o por soluciones intravenosas contaminadas. Objetivo: Cuantificar la incidencia de bacteriemia en pacientes pediátricos con quemaduras e identificar los factores de riesgo. Material y Métodos: Estudio de cohorte prospectivo, en población pediátrica con quemaduras del Hospital Civil de Guadalajara "Dr. Juan I. Menchaca". En pacientes con manifestaciones clínicas de sepsis se diagnosticó bacteriemia mediante cultivos de sangre. Se indagaron factores de riesgo con análisis multivariado con regresión de Cox. Resultados: Se incluyeron en la cohorte 260 pacientes, mediana de edad 3 años. La incidencia de bacteriemia fue de 9,6 eventos por 1.000 días paciente. Las bacterias más frecuentes aisladas fueron enterobacterias (41,9%), Staphylococcus aureus (22,6%) y Pseudomonas aeruginosa (22,6%). Los factores asociados a bacteriemia fueron: quemaduras ≥ 20% de superficie corporal quemada (HR 11,06; IC 95% 4,8-25,4), quemaduras de segundo grado profundo o mayores (HR 6,9; IC 95% 2,0-23,3) y haber tenido dos o menos desbridamientos (HR 26,4; IC 95% 8,0-87,7). Conclusiones: Pacientes con quemaduras más extensas y profundas, con menor número de desbridamientos presentan mayor riesgo de bacteriemia.

Calidad de vida de persona con heridas complejas en Cartagena, Colombia / The quality of life for people suffering from complex wounds in Cartagena, Colombia

Objetivo Estimar la Calidad de Vida Relacionada con Salud-CVRS- de personas con heridas complejas que reciben cuidados en una Institución Prestadora de Servicios de Salud Extramural en Cartagena, durante mayo-junio de 2010. Materiales y métodos Estudio cuantitativo, descriptivo, cuya población y muestra fueron 93 personas adultas que reciben cuidados en el programa de heridas complejas de una Institución Prestadora de Servicios de Salud Extramural de la ciudad de Cartagena. Se aplicó un cuestionario sobre características socio demográfico, una guía de observación sobre las características de las heridas y el "Índice Multicultural de Calidad de Vida". Para el análisis estadístico se empleó el software SPSS 12. Resultados El promedio de edad fue de 59,3 años; predominó género femenino, 61,3 %; estado civil casado, 43,0 %; ocupación hogar, 38,7 %; escolaridad primaria, 38,7 %; y estratos socio-económicos 2 y 3, 68,8 %. El 93,5 % de los participantes tienen afiliación a la seguridad social en salud. Las heridas complejas se caracterizaron por presentar mayor porcentaje en la fase proliferativa de la cicatrización, 80,6 %; medir de seis a diez centímetros, 63,4 %; no reportar infecciones, 85 %; no presentar amputación, 90,3 %; ni dolor relacionado con la herida, 52,7 % y presentar limitación física relacionada con la herida, 66,7 %. Conclusiones Las personas perciben su CVRS como mala, resaltando con baja puntuación las dimensiones de plenitud personal, funcionamiento ocupacional y bienestar físico y psicológico.

Objective Estimating the health-related quality of life (HRQOL) of people suffering complex wounds who were receiving care in an extramural health service provider institution in Cartagena during May-June 2010. Materials and methods This was a quantitative, descriptive study where the population/sample consisted of 93 adults receiving care in an extramural health service provider institution's complex wounds program in the city of Cartagena. A questionnaire regarding socio-demographic characteristics, an observational guide on the characteristics of injuries and the Multicultural Quality of Life Index were used. SPSS 12.0 software was used for the statistical analysis. Results Mean age was 59.3 years, females predominated (61.3 %), 43.0 % were married, 38.7 % were housewives, 38.7 % had finished primary education, 68.8 % came from socioeconomic levels 2 and 3 and 93.5 % of the participants had health social security affiliation. Complex wounds were characterised by a greater percentage being in the proliferative phase of healing (80.6 %), measuring six to ten inches (63.4 %) no infection being reported (85%), no amputation (90.3 %) or wound-related pain (52.7 %) and presenting physical limitations related to the wound (66.7 %). Conclusions People perceived their HRQOL as poor, their low scores highlighting low personal fulfillment, occupational functioning and physical and psychological wellbeing.

Prospective analysis of nosocomial infections in a Burn Care Unit, Turkey.

Background & objectives: Prevention of infection in burned patients poses a great challenge as infection is the most common cause of mortality after burn injury. An analysis of burned patients, admitted and treated between January 2004 and December 2005 in a nine-bed burn unit in Turkey, was performed prospectively to identify the common pathogens and incidence of nosocomial infection in these patients. Methods: Of the 182 burn cases admitted to Burn Care Unit during the study period, 169 met the inclusion criteria. Information related to nosocomial infection (NI) was collected. Samples were collected for culture and microorganisms isolated were tested for antimicrobial sensitivity. Results: Of the 169 burn patients, 127 acquired 166 nosocomial infection (NI) (15.7% pneumonia, 56.0% burn wound infection, 8.4% urinary tract infection and 19.9% blood stream infection) with an overall NI rate of 18.2 per 1000 patient-days. The mean age (38 ± 21 yr), the mean length of hospitalization (45.06 ± 11.67 days) and the total burned surface area (TBSA) (34.58 ± 18.46%) of the patients with NI were higher than those of the patients with non NI (23 ± 17 yr), (16.38 ± 11.14 days) and (12.44± 8.69%) (P=0.03, P=0.001, P=0.01) respectively. By multiple logistic regression analysis, TBSA co-morbidities, broad spectrum antibiotic usage and invasive devices usage were significantly related to acquisition of NI. Pseudomonas aeruginosa (57%), Acinetobacter baumannii (21%) and Staphylococcus aureus (14%) were the most common resistant organisms isolated. Interpretation & conclusion: Our findings emphasize the need for careful disinfection and more strict infection control procedures in areas that serve immunosupressed individuals, such as burn patients.

Reparación primaria versus colostomía en lesiones del colon / Primary repair vs. colostomy in colon injuries

Introducción: El colon es el segundo órgano más frecuentemente lesionado en las heridas por trauma penetrante de abdomen. En México, las lesiones por arma blanca o de fuego van en aumento. Nuestro objetivo fue evaluar el principal manejo para las lesiones traumáticas de colon. Material y métodos: Estudio retrospectivo y aleatorizado de 178 pacientes con trauma abdominal y lesiones de colon, en un lapso de cinco años (enero de 2003 a junio de 2008) en el Hospital General de Balbuena. Se comparó el uso del cierre primario y cirugía derivativa con colostomía. Se analizó sexo, grupo de edad, tipo de herida, grado de lesión y mortalidad. Resultados: De 178 pacientes, 156 fueron hombres (87.6 %) y 22 mujeres (12.4 %). El grupo de edad con mayor afección fue el de 21 a 30 años; 74 pacientes (41.6 %) presentaron heridas por instrumento punzocortante y 104 pacientes (58.4 %) heridas por arma de fuego. El principal manejo fue mediante cierre primario: 92 casos (51.7 %) versus 86 (48.3 %) para cirugía derivativa; sin embargo, en las heridas por arma de fuego el principal manejo fue la colostomía (67 casos). La mortalidad fue de 17 casos (9.55 %) debido a causas diversas como lesiones a múltiples órganos de manera asociada. Conclusiones: En las lesiones colónicas debe individualizarse el tratamiento, según la etiopatogenia, grado de lesión y lesiones asociadas.

BACKGROUND: Colon trauma is frequent and its prevalence is difficult to establish because of the different factors that intervene in its origin. In Mexico, traumatic colon injuries, albeit stab wounds or gunshot wounds, are on the rise. Our objective was to evaluate the most appropriate management for traumatic colon injuries. METHODS: We conducted a retrospective study of 178 case files of patients with abdominal trauma and colon lesions during a 5-year period from January 2003 to June 2008 from the General Hospital of Balbuena, Mexico City. The study compared the use of primary closure vs. colostomy, analyzing variables such as sex, age, type of wound, severity of lesion and mortality. RESULTS: There were a total of 178 patients; 156 were male (87.6%) and 22 were female (12.4%). The most affected age group was between 21 and 30 years; 74 patients (41.6%) had stab wounds and 104 patients (58.4%) had gunshot wounds. Management consisted mainly of primary closure in 92 cases (51.7%) vs. colostomy in 86 patients (48.3%). However, 64% of gunshot wounds were treated with colostomy. Reported mortality was 9.55% and this was due to different factors such as multiple organ injury. CONCLUSIONS: Treatment of traumatic colon injury should be case specific, taking into account the mechanism of the lesion, its severity and associated injuries.

Cierre primario en trauma de colon / Primary closure in colon trauma

Objetivo: Informar si la evolución > 6 horas, grado de contaminación y lesión, sitio anatómico lesionado, PATI (penetrating abdominal trauma index) > 25 y presencia de otras lesiones en trauma de colon, se asocian a mayor morbimortalidad en pacientes con lesión colónica a quienes se les realizó cierre primario. Material y métodos: Estudio prospectivo, observacional, longitudinal, descriptivo, en el Hospital Central “Dr. Ignacio Morones Prieto”, San Luis Potosí. Se incluyeron pacientes con trauma abdominal sometidos a cirugía que presentaron lesión colónica. Análisis estadístico básico con χ2. Resultados: 481 pacientes fueron intervenidos por trauma abdominal; 77 (16.1 %) tuvieron lesión colónica, de los cuales 90 % (n = 69) se intervino en las primeras seis horas; 91 % fue lesión penetrante. El colon transverso fue el más lesionado (38 %, n = 29); las lesiones grado I y II representaron 75.3 % (n = 58). Se efectuó cierre primario en 76.66 % (n = 46), resección con anastomosis en 8.3 % (n = 5) y colostomía en 15 % (n = 9). Hubo lesiones asociadas en 76.6 % (n = 59) y contaminación en 85.7 % (n = 66); 82.8 % (58) tuvo PATI < 25; complicaciones asociadas al procedimiento operatorio, 28.57 % (n = 22); reintervenciones, 10 % (n = 8); estancia hospitalaria promedio, 11.4 días; mortalidad no relacionada a lesión de colon, 3.8 % (n = 3). Conclusiones: El cierre primario es un procedimiento seguro para el tratamiento de lesiones colónicas. Los pacientes con cierre primario presentaron menor morbilidad (p < 0.009). Los pacientes con cirugía en las primeras seis horas (p < 0.006) y estabilidad hemodinámica (p < 0.014) tuvieron menor riesgo de complicación.

BACKGROUND: Primary repair of colon injuries is an accepted therapeutic option; however, controversy persists regarding its safety. Our objective was to report the evolution and presence of complications in patients with colon injury who underwent primary closure and to determine if the time interval (>6 h), degree of injury, contamination, anatomic site injured, PATI (Penetrating Abdominal Trauma Index) >25, and the presence of other injuries in colon trauma are associated with increased morbidity and mortality. METHODS: This was a prospective, observational, longitudinal and descriptive study conducted at the Central Hospital "Dr. Ignacio Morones Prieto," San Luis Potosí, Mexico, from January 1, 2003 to December 31, 2007. We included patients with abdominal trauma with colon injury subjected to surgical treatment. chi(2) was used for basic statistical analysis. RESULTS: There were 481 patients with abdominal trauma who underwent surgery; 77(16.1%) had colon injury. Ninety percent (n = 69) were treated in the first 6 h; 91% (n = 70) were due to penetrating injuries, and gunshot wound accounted for 48% (n = 37). Transverse colon was the most frequently injured (38%) (n = 29). Grade I and II injuries accounted for 75.3% (n = 58). Procedures included primary repair (76.66 %) (n = 46); resection with anastomosis (8.3%) (n = 5); and colostomy (15%) (n = 9). Associated injuries were present in 76.6% (n = 59). There was some degree of contamination in 85.7% (n = 66); 82.8% (58) had PATI <25. Complications associated with the surgical procedure were observed in 28.57% (n = 22). Reoperation was necessary in 10% (n = 8). Average hospital stay was 11.4 days. Mortality was 3.8% (n = 3); none of these were related to colon injury. CONCLUSIONS: Primary repair is a safe procedure for treatment of colon injuries. Patients with primary repair had lower morbidity (p <0.009). Surgery during the first 6 h (p <0.006) and in hemodynamically stable patients (p <0.014) had a lower risk of complications.

Early post-operative complications after thyroidectomy for benign goiters

To find frequency of early complications after thyroid surgery for benign thyroid conditions. Quasi-experimental study. Combined Military Hospital [CMH] Lahore, from March 2005 to Sep 2007.Early complications after thyroid surgery for benign thyroid conditions were studied. One hundred patients with FNAC confirmed benign goiter or follicular growth admitted for elective thyroidectomies were included in the study. Data was collected in the pre-designed proforma and entered in SPSS-10 version. Descriptive statistics was used to calculate frequency of each complication in the early post-thyroidectomy period. The frequency of complications after thyroidectomy was 27%. Out of them 8 patients [8%] developed subcutaneous haematoma, 5 patients [5%] wound infection, 4 patients [4%] tension haematoma, 4 patients [4%] hypocalcaemia, 3 patients [3%] respiratory obstruction and 3 patients [3%] developed recurrent laryngeal nerve paralysis. Surgery for benign thyroid enlargement but may be associated with significant numbers of post operative complications including wound haematoma, wound infection and hypocalcaemia

Infections in traumatised patients: a growing medico-surgical concern.

Accidents and trauma are a leading global cause of mortality in young adults. Infections are one of the most important causes of death in traumatized patients. This is because of factors related to host and those due to trauma itself. Trauma jeopardizes the host's tissue integrity and immune effector mechanisms. Severely traumatized patients admitted to the ICUs are prone to get nosocomial infections due to open wounds and indwelling life saving devices. Massive blood loss also impairs the distribution of polymorphs, complement and antibiotics to the damaged tissues. Finally, diagnosis of infections in traumatized patients poses a challenge to clinicians due to various factors.

Common pathogens isolated in diabetic foot infection in Bir Hospital.

AIM: Foot ulcers are a frequent complication of patients suffering with diabetes mellitus, accounting for up to 20% of diabetes-related hospital admission . Secondary infection of these ulcers is by far the leading cause of amputation of feet and legs and the polymicrobial nature of diabetic foot infection has been well documented in the literature. The present study sought to reveal the bacterial etiology of diabetic foot ulcer in patients presenting to Bir Hospital. METHOD: A 1 year retrospective study was carried out to analyse the bacterial isolates of all patients admitted with diabetic foot infection presented with Wagner grade 2 -5 ulcers. Bacteriological diagnosis and antibiotic sensitivity profiles were carried out and analysed using standard procedures. RESULTS: Diabetic polyneuropathy was found to be common in (51.1%) and gram positive bacteria were isolated more often than gram-negative ones in the patients screened. The most frequent bacterial isolate were Staphylococcus aureus (38.4%), Pseudomonas aeruginosa (17.5%), and Proteus (14%). Imipenem was the most effective agent against gram-negative organisms. Vancomycin was found to be most effective against gram-positive organisms. CONCLUSION: Staph aureus and Pseudomonas aeruginosa were the most common causes of diabetic foot infections in Bir Hospital. Theses wounds require use of combined antimicrobial therapy for initial management, repeated dressing and wound debridements were done.

The optimal time for early excision in major burn injury.

INTRODUCTION: Early excision and grafting (E&G) drastically changed burn care in America by reducing morbidity, mortality and hospital length of stay (LOS). The present study was intended to determine whether an optimal time window exists between resuscitation and wound sepsis for the first E&G in a patient with a large burn. MATERIAL AND METHOD: The authors conducted a retrospective study of patients admitted between January 1994 and December 2000 with > or = 40% TBSA burns and at least 1 E&G procedure. Patients were grouped according to the day of their first operation. Patients allowed to heal indeterminate burns prior to excision and grafting of deep partial or full thickness burns were grouped as > or = d7 and were excluded from the present study. The authors correlated the time of first excision with infection, mortality and LOS. RESULTS: Seventy-five patients were identified and 12 patients allowed to heal indeterminate burn prior to excision and grafting of deep partial or full thickness burns were excluded. Sixty-three remaining patients included 51 males and 12 females. Mean burn size was 49% of total body surface area (TBSA) (44% deep partial or full thickness) and the mean age was 36 years. There were 61 flame (2 combined with electrical injuries), 1 scald and 1 chemical burn. Twelve died (19%) and 52 patients developed 121 infections. Whereas there was no statistical difference in mortality for patients operated on different days (p > 0.2), 60% of patients operated within the first 48 hours after injury died; this was not significant due to a small patient number CONCLUSIONS: The present data suggest that patients who undergo early excision and grafting within seven days following a major burn > or = 40% TBSA have equivalent infection or mortality rates regardless of when the first operation occurs between post burn day(PBD) 2 and PBD 7 (p > 0.2).

Nosocomial infections in an intensive care unit in a private hospital

The nosocomial infection rate in the intensive care unit (ICU) of a private hospital was assessed during an 18-month survey. From 629 admissions to the ICU, 139 hospital-acquired infections were identified. The rate was 22.1 compared to the overall nosocomial infection rate of 15.3 for the entire hospital. In the ICU, the main infections occurred in the respiratory tract, 41 (29.5), followed by surgical wounds, 35 (25.2), urinary tract, 28 (20.1) and the blood stream, 24 (17.3). From 165 bacterial isolates, 80 of isolates were gram-negative rods, with P aeruginosa, 48 (36.6), being the predominant gram-negative isolate followed by Klebsiella pneumoniae, 27 (20.6), and Enterobacter sp, 22 (16.8). The main gram-positive isolates were S aureus, 23 (41.8), coagulase-negative Staphylococci, 17 (30.9), and Enterococci, 11 (20.0). Of the 23 S aureus strains, 15 (65.2) were methicillin-resistant (MRSA), (8 MRSA were from surgical wounds, 5 from the respiratory tract and 2 from infected urine). Only 2 of the 17 (11.8) coagulase-negative staphylococci were methicillin-resistant, and both were isolated from wounds. Resistance to ampicillin and augmentin (amoxicillin-clavulanic acid) was high, 81.9 and 55.4, respectively. Gentamicin, aztreonam, piperacillin and piperacillin-tazobactam showed resistance rates of less than 15. Infection control measures aimed at reducing nosocomial infections at the hospital are often frustrated by apathy of hospital administrators who apparently are insensitive to the high nosocomial infection rate. Effort by the infection control team through seminars, lectures and newsletters have begun to show improvements in attitude and awareness of staff to infection control and preventative measures within the institution.

Aplicación de adhesivo plaquetario autólogo: mejora cicatrización en pacientes quemados / Application of the autologous platelet gel: improvement healing in burned patients

Recientes avances en la biología de la cicatrización demostraron que las plaquetas y macrófagos son las células reguladoras predominantes en este proceso. Ambas células liberan numerosos factores de crecimiento en la herida. Se estableció un protocolo prospectivo para el uso de plaquetas autólogas tópicas en pacientes quemados de menos de ocho horas de evolución, con lesiones homogéneas y pareadas para agrupar parejas idénticas en cada paciente, es decir, Unidad Caso sometida a estudio con Gel y Unidad Control con curación tradicional. El análisis estadístico se realizó con el test de rangos signados bilateral de Wilcoxon. El estudio reunió 24 unidades cutáneas quemadas cuyo agente fue fuego (58 por ciento) y agua caliente (42 por ciento). La evolución demostró una tendencia a la cicatrización más acelerada en las Unidades Caso respecto a las Unidades Control hasta el día 15 de observación. Estos resultados fueron significativos. Sólo hubo tres casos de infección local presentados en los Controles. En cuanto a los procedimientos locales, un 25 por ciento del subgrupo Caso requirió Escarectomía Tangencial mientras un 50 por ciento lo necesitó en el subgrupo Control: en Unidad Caso se injertó una superficie total de 0,6 por ciento y en Unidad Control ésta aumentó a un 30 por ciento. El incremento en la concentración de factores de crecimiento local lleva a mejorar el balance fisiológico de la herida y, como resultado, a acelerar la cicatrización. En este sentido, la aplicación tópica de Adhesivo Plaquetario Autólogo puede acortar el tiempo de cierre, mejorar el resultado clínico de la cicatriz y estimular la reparación en condiciones patológicas

Gastrointestinal injuries

Gastrointestinal injuries are the most important among abdominal injuries. These injuries could be the result of blunt trauma, penetrating wound, or iatrogenic 292 gastrointestinal injuries were recorded in our work 13 were iatrogenic, 55 due to blunt trauma and 224 were due to penetrating injuries. These injuries were dealt with according to general surgical rules, any part of the gastrointestinal tract could be injured, no part was immune except the thoracic esophagus which was well protected by the thoracic cage. All patients were subjected to history. clinical examination, diagnostic peritoneal lavage. X-ray and sonogram when possible. Wound infection was 32. burst abdomen 8 D.V.T 12. chest infection 18 minor leak 13. severe leak 8. septicaemia 4 bleeding 3. trauma high risk area 3. pulmonary embolism 3 and mvocardial infarction 2. All gastrointestinal injuries could be treated with favorable outcome except duodenal injuries which were in deep need for meticulous handling and perfect drainage

¿Es útil la vigilancia epidemiológica de la herida quirúrgica para disminuir la incidencia de infección? / Is the epidemiological suveillance useful in surgical wounds in order to decrease the incidence of infection?

Objetivo. Observar el efecto de la vigilancia epidemiológica de infección de la herida quirúrgica en una unidad de cirugía general. Sede. Unidad 305 del Hospital General de México. México, D.F. Diseño. Estudio prospectivo, longitudinal, comparativo de dos grupos de pacientes; formaron el grupo 1 los operados durante el año 1995 y el grupo 2 los operados en 1996. Se registraron los casos procedentes de herida limpia, limpia contaminada, contaminada y sucia. Resultados. El grupo 1 lo conformaron 700 pacientes operados de cirugía electiva y el 2 estuvo compuesto por 667 pacientes. En el primer grupo la cifra total de infecciones fue de 28/700 = 4.0 por ciento, en cirugía limpia 16/413 = 3.87 por ciento; limpia contaminada 5/197 = 2.54 por ciento, en el grupo 2 el número fue de 9/667 = 1.34 por ciento, cirugía limpia 7/401 = 1.74 por ciento y limpia contaminada 2/212 = 0.94 por ciento; en la prueba exacta de Fisher hubo reducción con validez estadística en cifra total con valor de 0.001 y no significativas en herida limpia (0.08) y limpia contaminada (0.26). En el grupo 2 se registró cambio en las bacterias causales al disminuir el guarismo de casos infectados por gérmenes procedentes de flora fecal. Conclusión. En el segundo grupo la vigilancia epidemiológica ejerció efecto de reducción de la cifra global de infección de herida quirúrgica y se observó cambio en la flora bacteriana

Monitoring effectiveness of controlling hospital acquired infections by prevalence surveys.

OBJECTIVE: To determine the effectiveness of control measures for hospital acquired infection (HAI) by prevalence studies. SETTING: National Hospital of Sri Lanka in Colombo (NHSL). STUDY DESIGN AND METHOD: Two prevalence surveys were undertaken, in October 1994 and in July 1997, after implementing infection control measures. The numbers of patients in the two studies were 2563 and 2865. The subjects were assessed for hospital acquired infection through information obtained from case notes and by discussion with ward nursing and medical staff. The changes in infection control activities during this 3-year period included increasing the number of infection control nurses, educational programs to health care workers at all levels, improvements in disposal of clinical waste, implementing published guidelines for use of antibiotics, cannula-site management and urinary catheter care. RESULTS: The prevalence of HAI in the hospital decreased significantly (p < 0.0001) from 13.5% in 1994 to 8.7% in 1997. A significant decrease (p < 0.0001) in infection rates was observed in medical wards, but the decrease in surgical wards and the burns unit did not reach statistical significance. The intensive care units showed a weakly significant increase (p < 0.05) of infection rate attributable to the large number of war injured who needed intensive care. The most significant reduction in rates of infection was seen in wound infection (p < 0.001), respiratory infections (p < 0.01) and in cannula site infections (p < 0.001). CONCLUSION: Implementation of infection control policies can have a significant impact on the prevalence of HAI, and their effectiveness could be measured by repeated prevalence surveys.

Fijación de injertos dermoepidérmicos: comparación de dos tipos de sutura / Dermoepidermic flaps fixation: comparison between 2 types of sutures

Se comparan los resultados obtenidos en 94 pacientes portadores de quemaduras tipo B injertadas, en quienes se utilizó como sutura quirúrgica para fijar los injertos dermoepidérmicos, corchetes Precise Ds 15-25, 3M en 40 pacientes y seda 4-0 en 54 pacientes. Se concluye que el uso de los corchetes abrevia significativamente el tiempo quirúrgico, permitiendo una fijación hemostática y rápida entre dos injertos, disminuyendo la pérdida de éstos por movilización o infección en un 50 por ciento al compararla con la sutura de seda. Por lo anterior recomendamos el uso de esta técnica quirúrgica

Avaliacao da incidencia de infeccoes na sala de sutura do Hospital de Pronto Socorro / Evaluation of the infections incidency in the suture room of the Hospital de Pronto Socorro

Este trabalho teve por objetivo avaliar a incidencia de infeccao nas feridas suturadas no Hospital de Pronto Socorro(HPS), no periodo compreendido entre maio e julho de 1989. Para tanto, foi realizado um estudo prospectivo com uma amostragem de cento e cinquenta e seis(156) lesoes, considerando as variaveis dia, turno, topografia e tamanho da lesao. Encontrou-se um indice de seis virgula quatro por cento(6,4%) de lesoes infectadas no quinto (5) dia da evolucao. Comparando-se com dados da literatura, conclui-se que o indice de infeccao das feridas suturadas no HPS e baixo, considerando-se as condicoes de urgencia em que sao realizadas, Enfatiza-se que nao foram encontrados na literatura indices de infeccao nas salas de urgencia