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BACKGROUND The successful treatment of intraabdominal infection requires a combination of anatomical source control and antibiotics. The appropriate duration of antimicrobial therapy remains unclear. METHODS We randomly assigned 518 patients with complicated intraabdominal infection and adequate source control to receive antibiotics until 2 days after the(More)
BACKGROUND This study aimed to evaluate if variation in management of blunt splenic injury (BSI) among Level I trauma centers is associated with different outcomes related to the use of splenic artery embolization (SAE). METHODS All adult patients admitted for BSI from 2008 to 2010 at 4 Level I trauma centers were reviewed. Use of SAE was determined, and(More)
BACKGROUND Obesity is a worldwide healthcare concern, but its impact on critical care (intensive care unit; ICU) outcomes is not well understood. The general hypothesis is that obesity worsens ICU outcomes, but published reports fail to demonstrate this effect consistently. We hypothesized that increasing BMI would be an independent predictor of higher(More)
Background: Patients have traditionally been considered candidates for sentinel node biopsy (SNBx) only at the time of wide local excision (WLE). We hypothesized that patients with prior WLE may also be staged accurately with SNBx. Methods: Seventy-six patients, including 18 patients from the University of Virginia and 58 from a multicenter study of SNBx(More)
BACKGROUND Contact isolation is commonly used to prevent transmission of resistant organisms. We hypothesized that contact isolation negatively impacts the amount of direct patient care. METHODS For 2 hours per day over a 5-week period, a single observer recorded provider/patient contact in adjacent isolated and nonisolated patient rooms on both the(More)
OBJECTIVE To demonstrate whether daily bathing with cloths impregnated with 2% chlorhexidine gluconate will decrease colonization of resistant bacteria and reduce the rates of health care-associated infections in critically injured patients. DESIGN Retrospective analysis of data collected 6 months before and after institution of a chlorhexidine bathing(More)
BACKGROUND Whereas animal models of sepsis demonstrate survival benefits for the pro-estrus state, human observational studies have failed to demonstrate a consistent survival advantage among female patients. Estrogen biosynthesis differs substantially in primate and non-primate animals, and estrogens have diverse immunologic actions. Estrogen(More)
Intra-abdominal infection continues to pose a significant threat to critically ill patients in the year 2000. A review of the current literature reveals that despite remarkable developments in critical care medicine and extensive study of patients with tertiary peritonitis, the associated mortality rate remains nearly 30%. Progress has been limited by the(More)
BACKGROUND It is well documented that tertiary peritonitis is associated with different microbiological flora and worse outcomes than secondary peritonitis. It is unknown, however, if these differences can be explained simply by the nosocomial nature of tertiary peritonitis and underlying severity of illness. METHODS We reviewed all episodes of(More)