Total knee replacement surgery and surgical site infection: a prospective audit.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
Thomas W Austin
Publications and source records attributed to Thomas W Austin.
Methicillin-resistant/methicillin-sensitive Staphylococcus aureus bacteremia.
OBJECTIVE: To examine the differences between the clinical presentation, management and outcome of persons bacteremic with methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA), after controlling for age, sex and primary diagnosis. METHODS: A review of the clinical records and laboratory data of all MRSA and MSSA bacteremic patients. Fifty matched case-control pairs were further analyzed looking for differences between the 2 populations. The study was carried out in a 500-bed adult tertiary care institution in southwestern Ontario, Canada, between 1994 and 1999. RESULTS: On univariate analysis a) duration of hospitalization prior to bacteremia, b) concomitant polymicrobial bacteremia, c) time to appropriate treatment, were significantly greater in the MRSA infected population. Attributable mortality was also higher, 36%-20%, but this did not achieve significance (p=0.1). On multiple logistic regression analysis, a), b) and c) remained significantly different. CONCLUSION: In a 1:1 matched case-control study of Staphylococcus aureus bacteremia, those infected with MRSA became bacteremic later in their hospital stay, more often had a polymicrobial bacteremia and were appropriately treated later. Although mortality attributable to the MRSA bacteremia was greater, this difference did not achieve significance.
Bacteremia↗
MRSA prevalence in a teaching hospital in Western Saudi Arabia.
OBJECTIVE: To determine the prevalence of Methicillin Resistant Staphylococcus aureus (MRSA) colonization in our institution. METHODS: A 5-day period prevalence study of all adult and pediatric patients. Excluded areas were the adult intensive care unit (screened on admission and weekly thereafter), the outpatient hemodialysis population (screened monthly), and newborns. Our facility is a referral/teaching hospital for the National Guard population and their dependants in Western Saudi Arabia. A total of 240 patients were screened. Nasal sampling was carried out and isolation/identification of MRSA was performed using standard microbiological methods. RESULTS: The total number of patients sampled was 240 and of those 10 (4%) were colonized. The 10 positives were found in 4 patient care areas; adult male medicine 5, adult male oncology 3, adult female medicine one, adult high dependency unit one. These patients care areas had 69 patients (42 males and 27 females). Ten (14%) were colonized by MRSA; 9 males (21%) and one female (3%). Statistical analysis Chi Square for discontinuous variables, "F" test for continuous variables found that one), male gender (p=0.04), 2) the presence of a long term invasive device (p=0.04), 3), length of stay (p=0.004) were predictive of MRSA colonization. CONCLUSION: The overall prevalence of MRSA colonization in our hospital was low, however a sub-segment of the population identified as male, having long term invasive devices, and hospitalized more than 2 weeks, were frequently colonized. Any strategy, in our hospital, to control the spread of MRSA should include the testing of this population.
Adult↗
A prospective randomized trial of endoscopic versus conventional harvesting of the saphenous vein in coronary artery bypass surgery.
OBJECTIVES: Our objectives were (1) to determine whether minimally invasive endoscopic harvesting of the saphenous vein reduces morbidity due to postoperative wound infection and pain with improved cosmetic results and mobilization as compared with the conventional technique and (2) to compare the histologic properties of the saphenous veins harvested conventionally and endoscopically. METHODS: One hundred forty-four patients undergoing coronary artery bypass grafting were randomized to have vein harvesting performed by either the conventional (n = 72) or an endoscopic (n = 72) minimally invasive technique. RESULTS: Vein harvest time (open leg wound time) was significantly reduced in the endoscopic group (27.6 vs 64.4 minutes; P <.0001). The rate of leg wound infection was significantly reduced in the endoscopic group (4.3%) as compared with the conventional group (24.6%), a relative risk reduction of 83% (95% confidence interval: 36%-129%; P =.0006). The majority of infections (84.2%) occurred after hospital discharge. Postoperative leg pain, mobilization, and overall patient satisfaction were also significantly improved in the endoscopic group. Double blinded histologic assessment of harvested vein (n = 28) showed no evidence of any clinically important significant damage to the specimens in either group. CONCLUSIONS: In this prospective randomized trial, endoscopic harvesting of the saphenous vein significantly reduced postoperative leg wound complications, including infection, and improved patient satisfaction as compared with the conventional harvesting technique. There were no significant histologic differences between the conventional and endoscopically harvested saphenous veins.
Coronary Artery Bypass↗