An Analysis of Past Surgical Infection Society Award Recipients

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Abstract

Background: The Surgical Infection Society (SIS) through its foundation (FDTN) confers awards to individuals who demonstrate interest in researching infection in the surgical setting. We sought to characterize the research output from prior award recipients and determine the impact of these awards on the individual and the SIS.

Methods: The SIS website was queried for the names of all past award recipients. A MEDLINE search of the recipients was performed. Total number of publications and publications in the society’s journal, Surgical Infections (SI), were identified. Gender and leadership positions within SIS were determined. Meeting attendance and participation were assessed. Donations by scholarship recipient to the FDTN were evaluated.

Results: Between 1984 and 2012, 116 individuals received an SIS award or scholarship. Of these, 72% were male. There were 101 scholarships awarded, totaling nearly $3 million. Of the 19 new Junior Faculty Scholarships awarded, four were to consecutive recipients (CR). There were 11 clinical evaluative award scholarships awarded, three to CR. There were 100 Resident/Fellow scholarships awarded, and of these, 22 were awarded to CR. Past recipients had multiple publications (median total publications = 27; interquartile range (IQR): Nine to 62) and published multiple papers on the topic for which they received an award (median two; IQR: Zero to four). Recipients did not publish in SI (median SI publications = zero; IQR: Zero to one). There was no substantial difference in the number of publications by gender. Multiple awards (MA) were conferred to 26 (22%) individuals. Six (5.1%) assumed an executive position within SIS, two (1.7%) became SIS president. Those who received MA were more likely to serve as an officer than those who only received one award (15% vs. 2%, p = 0.02).

Conclusions: Scholarships have a large benefit for individual recipients; however, the benefit to the society remains harder to quantify.

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An Argument for the Use of Aminoglycosides in the Empiric Treatment of Ventilator-Associated Pneumonia

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Abstract

Background: Appropriate empiric antibiotic therapy for ventilator-associated pneumonia improves outcomes. Controversy exists regarding the inclusion of aminoglycosides in empiric therapeutic regimens.

Methods: The Ovid and Cochrane databases were searched for relevant literature regarding the use of aminoglycosides in combination therapy for ventilator-associated pneumonia. The data supporting the use of aminoglycosides in certain populations and strategies to limit toxicity are summarized.

Results: In patients at high risk of infection with antibiotic-resistant gram-negative bacilli and in those with severe illness, aminoglycosides improve clinical outcomes. In critically ill populations, short-duration therapy and high-dose extended-interval dosing of aminoglycosides can improve therapeutic efficacy while limiting nephrotoxicity.

Conclusions: In selected populations using appropriate dosing strategies, aminoglycosides should be considered for empiric treatment of ventilator-associated pneumonia.

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Use of Gentamicin as Empiric Coverage for Ventilator-Associated Pneumonia: The “Con” Perspective

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Abstract

Background: Gentamicin is used commonly as an empiric antibiotic prior to culture evidence in the treatment of ventilator-associated pneumonia (VAP) in surgical patients.

Methods: The published literature on the use of gentamicin for empiric therapy in VAP was reviewed and in combination with the author’s personal experience, an evaluation has been made about the indications for the use of this antibiotic in VAP.

Results: Empiric gentamicin use appears to benefit less than 1% of patients in the treatment of presumptive VAP. The problematic pharmacokinetics of gentamicin use in this patient population combined with potential toxicity from the drug can be observed to yield greater risks than benefits in this clinical situation when published evidence is reviewed.

Conclusion: There is no definitive evidence to support empiric use of gentamicin in the treatment of VAP when evaluated on a cost-effective basis.

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The Surgical Management of Complicated Clostridium Difficile Infection: Alternatives to Colectomy

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Abstract

Background: Clostridium difficile is the most common nosocomial infection in the United States. There is a subset of patients for whom medical therapy fails or who progress rapidly to the development of complicated disease, often marked by critical systemic illness. Patients with complicated Clostridium difficile infection (CDI) who progress or fail to improve benefit from surgery.

Results: This focused review highlights the importance of early surgical consultation for patients with complicated CDI, as well as emerging surgical therapy that does not involve resection of the colon but rather the creation of a loop ileostomy with colonic lavage, followed by antegrade vancomycin enemas into the colon during the post-operative period.

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Surgical Management of Clostridium difficile Infection: The Role of Colectomy

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Abstract

Management of Clostridium difficile infections is usually accomplished through appropriate antimicrobial therapy. However, in patients that do not respond to this therapy, rapid and potentially lethal progressive organ dysfunction care occurs. Although supportive care and continued antimicrobial therapy is important, surgical therapy is critical to eradication of the inflammatory process and reversal of the dysregulated immunity associated with severe C. difficile infections. In the following paper, the role of colectomy is reviewed

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Duration of Antimicrobial Therapy in Treating Complicated Intra-Abdominal Infections: A Comprehensive Review

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Abstract

Background: Surgeons managing intra-abdominal infections should always respect the basic principles of antibiotic treatment. An adequate duration of antimicrobial therapy is important to optimize empiric therapy and minimize selective pressures favoring antimicrobial resistance.

Methods: The optimal duration of antibiotic therapy for intra-abdominal infections (IAIs) has been debated in the last years. A literature research, based on PubMed database and limited to English language publications, was performed without restriction of time or type of manuscript.

Results: In stable patients a short course of antimicrobial therapy (3–5 d) after adequate source control, depending on fever and leukocytosis, may be a reasonable option. In critically ill patients with severe sepsis and septic shock, an individualized approach is always mandatory and patient’s inflammatory response should be monitored regularly. Procalcitonin may be helpful for guiding antibiotic treatment in critically ill surgical patients and in predicting treatment response.

Conclusions: General surgeons managing intra-abdominal infections should always respect the basic principles of antibiotic treatment. Duration of antimicrobial treatment is an important variable to evaluate in treating complicated intra-abdominal infections.

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The Use of Extended-Interval Aminoglycoside Dosing Strategies for the Treatment of Moderate-to-Severe Infections Encountered in Critically Ill Surgical Patients

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Abstract

Background: Extended-interval dosing strategies have been developed to exploit the concentration-dependent bactericidal activity and time-dependent host toxicity associated with aminoglycoside the therapy. The ability of published extended-interval dosing nomograms to achieve optimal pharmacodynamic endpoints may be limited in certain critically ill surgical patients.

Methods: Review of pertinent English language literature. Presentation of descriptive, graded recommendations for extended-interval aminoglycoside dosing in critically ill surgical patients.

Results: Aminoglycoside dosing considerations in critically ill surgical patients should attempt to maximize the bacterial and host pharmacodynamic attributes of these agents. Empirically, extended-interval aminoglycoside doses proposed by published nomograms are reasonable for most patients; however, because of clinically meaningful variations in aminoglycoside pharmacokinetics, routine use of published extended-interval aminoglycoside dosing nomograms to determine an appropriate dosage interval is discouraged in many critically ill surgical patients. Critically ill surgical patients receiving extended-interval aminoglycoside dosages should undergo individualized pharmacokinetic analysis to characterize efficiently and more effectively plasma concentration-to-bacterial minimum inhibitory concentration (MIC) relationships and determine an appropriate dosing interval, considering site and severity of infection, plasma clearance, and the apparent post-antibiotic effect.

Conclusions: The use of extended-interval aminoglycoside dosage regimens in critically ill surgical patients should be based on pharmacodynamic endpoints and patient-specific pharmacokinetic assessment.

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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

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Abstract

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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Treatment of Complicated Skin and Soft Tissue Infections

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Abstract

Background: Skin and soft tissue infections (SSTIs) may produce substantial morbidity and mortality rates, particularly those classified as complicated or necrotizing.

Objective: To weigh the strength of recommendations using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methodology and to provide evidence-based recommendations for diagnosis and management for SSTIs.

Data Sources: Computerized identification of published research and review of relevant articles.

Study Selection: All published reports on the management of complicated and necrotizing SSTIs were evaluated by an expert panel of members of the Surgical Infection Society according to published guidelines for evidence-based medicine. The quality of the evidence was judged by the GRADE methodology and criteria. Practice surveys, pharmacokinetic studies, and reviews or duplicative publications presenting primary data already considered were excluded from analysis.

Data Extraction: Information on demographics, study dates, microbiology findings, antibiotic type, surgical interventions, infection-related outcomes, and the methodologic quality of the studies was extracted. Results were submitted to the Therapeutic Agents Committee of the Surgical Infection Society for review prior to creation of the final consensus document.

Data Synthesis: Current surgical and antibiotic management of complicated SSTIs is based on a small number of studies that often have insufficient power to draw well-supported conclusions, with the exception of antimicrobial therapy for non-necrotizing soft tissue infections, for which ample data are available.

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The Surgical Infection Society Guidelines on Antimicrobial Therapy for Children with Appendicitis

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ABSTRACT

Background: The Surgical Infection Society published their most recent recommendations for antimicrobial therapy in patients with intra-abdominal infections in 2002. These guidelines outlined several important considerations for the treatment of such infections, including which patients require antimicrobial agents, the appropriate duration of treatment, which antimicrobial regimens are appropriate, and the risk factors and indications for intensified regimens. However, the applicability of these recommendations to the pediatric population is not entirely clear.

Methods: Systematic review of all literature regarding antimicrobial therapy in the most common intra-abdominal infection in children, appendicitis, with the goal of establishing guidelines for use.

Results: Children with uncomplicated (acute or gangrenous), but not perforated, appendicitis can be treated with prophylactic antimicrobial agents for 24 h or less. Children with perforated appendicitis can be treated after appendectomy in the same manner as adults with established intra-abdominal infections; i.e., with therapeutic antibiotics until no clinical evidence of infection exists. This is true after both laparoscopic and open operations. Whereas “triple” antibiotic therapy has been the gold standard in pediatric patients, monotherapy with broad-spectrum agents is equally effective and possibly more cost-effective. The nonoperative management of perforated appendicitis with interval appendectomy represents a unique problem, and guidelines for therapy are less well established.

Conclusions: The evidence supports using guidelines in the pediatric population similar to those suggested for the adult population for the management of acute appendicitis.

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