A5076340831- Surgical site infection prevention
- Orthopedic Infections and Treatments
- Bone fractures and treatments
- Trauma and Emergency Care Studies
- Sepsis Diagnosis and Treatment
- Antimicrobial Resistance in Staphylococcus
- Emergency and Acute Care Studies
- Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Hip and Femur Fractures
- Streptococcal Infections and Treatments
- Nosocomial Infections in ICU
- Cardiac Arrest and Resuscitation
- Pelvic and Acetabular Injuries
- Pneumonia and Respiratory Infections
- Bacterial Identification and Susceptibility Testing
- Trauma Management and Diagnosis
- Antibiotics Pharmacokinetics and Efficacy
- Pleural and Pulmonary Diseases
- Surgical Sutures and Adhesives
- Respiratory Support and Mechanisms
- Infectious Diseases and Tuberculosis
- Cardiac, Anesthesia and Surgical Outcomes
- Diabetes Management and Research
- Infective Endocarditis Diagnosis and Management
- Abdominal Trauma and Injuries
University of Maryland, Baltimore
2015-2024
Population Health Research Institute
2024
Hamilton Health Sciences
2024
McMaster University
2024
Wake Forest University
2022
Uttarakhand Seva Nidhi Paryavaran Shiksha Sansthan
2022
University of Maryland Medical Center
2003-2021
University of Maryland Medical System
2000-2019
John Wiley & Sons (United States)
2019
New York Proton Center
2016
Objectives: Our objectives were to determine whether persistent hyperglycemia was predictive of outcome in critically ill trauma patients. Methods: Prospective data collected daily on 942 consecutive patients admitted the ICU over a 2-year period. Patients stratified by serum glucose level from day 1 7 (low = 0–139 mg/dL, medium 140–219 and high >220 mg/dL) age, gender, ISS. further pattern control (all low, all moderate, high, improving, worsening, highly variable (HV). Outcome measured...
ABSTRACT Biofilm‐associated implant‐related bone and joint infections are clinically important due to the extensive morbidity, cost of care socioeconomic burden that they cause. Research in field biofilms has expanded past two decades, however, there is still an immense knowledge gap related many clinical challenges these biofilm‐associated infections. This subject was assigned Biofilm Workgroup during second International Consensus Meeting on Musculoskeletal Infection held Philadelphia USA...
Studies evaluating surgical-site infection have had conflicting results with respect to the use of alcohol solutions containing iodine povacrylex or chlorhexidine gluconate as skin antisepsis before surgery repair a fractured limb (i.e., an extremity fracture).
Objectives: There is a paucity of data evaluating whether hyperglycemia at admission associated with adverse outcome in trauma patients. Our objectives were to determine was predictive critically ill Methods: Prospective collected daily on 1,003 consecutive patients admitted the intensive care unit over 2-year period. Diabetics excluded. Patients stratified by serum glucose level (<200 mg/dL vs. ≥200 mg/dL) age, gender, Injury Severity Score, and other preexisting risk factors. Outcome...
There is an absence of prospective data evaluating the impact prehospital intubation in adult trauma patients. Our objectives were to determine outcome patients intubated field who did not have acutely lethal traumatic brain injury (death within 48 hours) compared with immediately on arrival hospital.Prospective collected 191 consecutive admitted center a Glasgow Coma Scale score < or = 8 and head Abbreviated Injury > 3 either at admission hospital. Patients died hours transfers excluded...
Abstract Antibiotic‐loaded bone cement (ALBC) is broadly used to treat orthopaedic infections based on the rationale that high‐dose local delivery essential eradicate biofilm‐associated bacteria. However, ALBC formulations are empirically drug susceptibility from routine laboratory testing, which known have limited clinical relevance for biofilms. There also dosing concerns with nonstandardized, surgeon‐directed, hand‐mixed formulations, unknown release kinetics. On basis of our knowledge in...
Despite the widespread use of systemic antibiotics to prevent infections in surgically treated patients with fracture, high rates surgical site infection persist.To examine effect intrawound vancomycin powder reducing deep infections.This open-label randomized clinical trial enrolled adult an operatively tibial plateau or pilon fracture who met criteria for a risk from January 1, 2015, through June 30, 2017, 12 months follow-up (final assessments completed April 2018) at 36 US trauma...
Evaluate the impact of a tight glucose control (TGC) protocol during first week admission in critically injured trauma patients.A prospective quasi-experimental interrupted time-series design was used to evaluate TGC [24-month preintervention phase (no TGC) vs. 24-month postintervention phase]. Patients were stratified by serum level on day 1 7 (low, 0-150 mg/dL; medium-high, 151-219 and high, >/=220 mg/dL), age, gender, injury severity. further pattern (all low, all medium improving,...
Although there have been reports in the surgical literature regarding negative effects of preoperative hyperglycemia on outcome, impact elevated serum glucose levels trauma patients is unknown. Our objectives were to determine whether was associated with a greater morbidity and mortality who underwent intervention upon admission. Prospective data collected 252 consecutive nondiabetic admitted for ≥3 days went directly OR from resuscitation area. Patients stratified by level (<200 vs. ≥200...
Necrotizing soft-tissue infections (NSTI) have high morbidity and mortality rates despite aggressive surgical debridement antibiotic therapy. AB103 is a peptide mimetic of the T-lymphocyte receptor, CD28. We hypothesized that will limit inflammatory responses to bacterial toxins decrease incidence organ failure. To establish safety in patients with NSTI evaluate potential effects on clinically meaningful parameters related disease. A prospective, randomized, placebo-controlled,...
Infection after fracture fixation is a major source of morbidity. Information regarding bacterial speciation and antibiotic resistance lacking. We attempted to determine the drug profiles associated with infections.Retrospective study.Level I trauma center.Two hundred eleven patients 214 infections underwent surgery for postoperative infection from December 2006 2010. Deep within 12 months were included.None.Incidence each species rate clinically relevant in Staphylococcus aureus,...
A number of clinical studies in the spine literature suggest that use local vancomycin powder may substantially reduce surgical site infections (SSIs). These are primarily retrospective and observational few focus on orthopaedic trauma patients. This study is a phase III, prospective, randomized, trial to assess efficacy locally administered prevention SSI after fracture surgery. The primary goal VANCO Study compare proportion deep 6 months fixation secondary objective species antibacterial...
There is a paucity of data evaluating serum albumin on admission as predictor outcome in adult trauma patients. Our objectives were to evaluate whether or not hypoalbuminemia adverse Prospective was collected daily 1023 patients over 2-year period. Patients stratified by level admission, age, gender, injury severity, and comorbid conditions. Outcome measured ICU hospital length stay, ventilator days, incidence infection, mortality. Student t test, chi2, multilinear regression analysis used...
Objective To determine whether the use of prophylactic recombinant human granulocyte colony-stimulating factor (filgrastim) reduces frequency nosocomial infections in patients with either acute traumatic brain injury or cerebral hemorrhage. Design Randomized, placebo-controlled, double-blind, multicenter phase II study. Setting Intensive care units seven medical centers. Patients hemorrhage who were intubated within 6 hrs admission and expected to be ventilated for >72 hrs. Interventions...
Our objectives were to determine whether persistent hyperglycemia when compared with normoglycemia was predictive of outcome in the later stages hospitalization critically injured trauma patients.A prospective study conducted on 896 consecutive patients admitted intensive care unit during a 2-year period. Patients stratified by serum glucose level day 1 28 (low = 0-139 mg/dL, medium high 140-219 and >220 mg/dL), age, gender, race, insulin dependent diabetes, obesity, Injury Severity Score...
BACKGROUND Central-line–associated bloodstream infection (CLABSI) rate is an important quality measure, but it suffers from subjectivity and interrater variability, decreasing national CLABSI rates may compromise its power to discriminate between hospitals. This study evaluates hospital-onset bacteremia (HOB, ie, any positive blood culture obtained 48 hours post admission) as a healthcare-associated infection–related outcome measure by assessing the association HOB comparing of each among...
OBJECTIVE: To determine whether intrawound vancomycin changes the bacteriology of surgical site infection pathogens and investigate emergence antibiotic-resistant pathogens. METHODS: Design: Secondary analysis phase III, prospective, randomized clinical trial. Setting: Thirty-six US trauma centers. Patient Selection Criteria: Patients who became infected after fixation tibial plateau or pilon fracture. Outcome Measures Comparisons: Pathogen types bacterial susceptibilities as determined from...
Admission systemic inflammatory response syndrome (SIRS) score has been previously reported to be an accurate predictor of infection and outcome in trauma. However, the data were limited first 7 days admission. Our objective this follow-up study was prospectively evaluate utility daily SIRS scores second third week admission as compared with prediction nosocomial high-risk trauma patients.Prospective collected on 1,277 consecutive patients admitted during a 28-month period intensive care...
To evaluate the impact of damage control laparotomy on long term morbidity and survival.Prospective data were collected 56 consecutive trauma patients over a 20-month period (May 2000-January 2002). Patients stratified by mechanism injury, age, Injury Severity Score, type temperature at admission, initial blood transfusion volume pH. Initial outcome included major complications, intensive care unit hospital length stay, mortality. Readmission including number admissions, surgical procedures,...
To evaluate the effect of an online training course containing video clips central venous catheter insertions on compliance with sterile practice.Prospective randomized controlled study.Admitting area a university-based high-volume trauma center.Surgical and emergency medicine residents rotating through services.An recommended practices during insertion was developed. The contained short from actual patient care demonstrating common noncompliant behaviors breaks regarding practices. A...
Background: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in trauma patients, with a high mortality rate. Blood transfusion has been identified as an independent risk factor for VAP critically ill patients. Prior studies are limited by retrospective design, lack of multivariable analyses, and scant data on timing transfusion. We examined relation between blood product Methods: Prospective observational cohort study 766 patients admitted to intensive care unit...
Objectives: To determine factors predictive of postoperative surgical site infection (SSI) after fracture fixation and create a prediction score for risk at time initial treatment. Design: Retrospective cohort study. Setting: Level I trauma center. Patients/Participants: Study group, 311 patients with deep SSI; control 608 patients. Intervention: We evaluated 27 theorized to be associated infection. Bivariate multiple logistic regression analyses were used build model. A composite reflecting...
Objectives: To determine if the use of intrawound vancomycin powder reduces surgical-site infection after open reduction and internal fixation bicondylar tibial plateau, pilon, calcaneus fractures. Design: Retrospective analysis. Setting: Level I trauma center. Patients: All fractures operatively treated from January 2011 to February 2015 were reviewed; 583 high-risk included, which 35 received topical powder. A previously published prospectively collected cohort 235 similar at our center...