Surgical site infection in critically ill patients with secondary and tertiary peritonitis: epidemiology, microbiology and influence in outcomes

BACKGROUND: Surgical site infection (SSI) remains a significant problem in the postoperative period that can negatively affect clinical outcomes. Microbiology findings are typically similar to other nosocomial infections, with differences dependent on microbiology selection due to antibiotic pressure or the resident flora. However, this is poorly understood in the critical care setting. We therefore aimed to assess the incidence, epidemiology and microbiology of SSI and its association with outcomes in patients with severe peritonitis in the intensive care unit (ICU). METHODS: We prospectively studied 305 consecutive patients admitted to our surgical ICU from 2010 to 2014 with a diagnosis of secondary or tertiary peritonitis. We collected the following data: SSI diagnosis, demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiology Score (SAPS) II score, type of surgery, microbiology, antibiotic treatment and outcomes. Microbiological sampling was done by means of swabs. RESULTS: We identified 269 episodes of SSI in 162 patients (53.1 %) aged 64.4 ± 14.3 years, of which 200 episodes occurred in men (64.6 %). The mean APACHE II and SAPS II scores were 19.7 ± 7.8 and 36.5 ± 16.1 respectively. The mean ICU and hospital stays were 19.8 ± 24.8 and 21.7 ± 30 days respectively. Pseudomonas spp. (n = 52, 19.3 %), Escherichia coli (n = 55, 20.4 %) and Candida spp. (n = 46, 17.1 %) were the most frequently isolated microorganisms, but gram-positive cocci (n = 80, 29.7 %) were also frequent. Microorganisms isolated from SSIs were associated with a higher incidence of antibiotic resistance (64.9 %) in ICU patients, but not with higher in-hospital mortality. However, patients who suffered from SSI had longer ICU admissions (odds ratio = 1.024, 95 % confidence interval 1.010–1.039, P = 0.001). CONCLUSIONS: The incidence of SSI in secondary or tertiary peritonitis requiring ICU admission is very high. Physicians may consider antibiotic-resistant pathogens, gram-positive cocci and fungi when choosing empiric antibiotic treatment for SSI, although more studies are needed to confirm our results due to the inherent limitations of the microbiological sampling with swabs performed in our research. The presence of SSI may be associated with prolonged ICU stays, but without any influence on overall mortality

Diferencias en el uso de las estrategias de afrontamiento, el catastrofismo y el estado de ánimo en función del tiempo de evolución del dolor crónico

Introduction: preliminary study on the psychological variables and coping strategies in chronic pain related to duration. This study describes chronic pain as a stressor complex that the person using a coping strategies to adapt continuously. Method: the primary objective of this research observes differences in psychological variables and the use of pain coping strategies depending on the time of evolution. The assessment instruments are McGill Pain Questionnaire (MPQ), "Strategies for Coping with Chronic Pain" (CADR), Hopital Anxiety and Depression Scale (HAD), Catastro-phism Scale CSQ (CSQ-C). Participants of this study are patients with chronic pain and are treated in to specialized unit. The results show that duration and patient's age are associated with the use of a passive strategy, the "catharsis". The perception of pain has a positive relationship with catastrophizing, passive strategies, anxiety and depression. Results: results obtained by comparing the average of the two groups, one with 1 to 5 years of evolution, and another 13 to 33 years, show that the group of shorter duration makes greater use of the coping strategy of catharsis and it has scored higher on catastrophizing compared to another group. Conclusion: we observe the relationship between pain and psychological variables of this study and changes that may occur in different stages of duration of pain.Introducción: este estudio describe el dolor crónico como un estresor complejo al que la persona debe adaptarse continuamente usando diferentes estrategias. Método: el objetivo de esta investigación es observar las diferencias que existen en las variables psicológicas y el uso de las estrategias de afrontamiento del dolor en función del tiempo de evolución. Los instrumentos de evaluación son: "Cuestionario del Dolor McGill" (MPQ), "Estrategias de Afrontamiento del Dolor Crónico" (CADR), "Escala Hospitalaria de Ansiedad y Depresión" (HAD), "Escala de Catastrofismo del CSQ" (CSQ-C). Los 60 participantes del estudio son pacientes de una unidad de tratamiento especializada en el ámbito hospitalario. De estos se crearon dos grupos, uno de menor tiempo de evolución (de 1 a 5 años) y el otro de mayor tiempo de evolución (de más de 13 años). Resultados: los resultados muestran que tanto el tiempo de evolución como la edad del paciente se asocian con el uso de una estrategia pasiva, la "catarsis" y la evaluación del dolor tiene una relación positiva con el catastrofismo, las estrategias pasivas, la ansiedad y la depresión. Mediante el análisis de la comparación de medias de los dos grupos se confirma que el grupo de menor tiempo de evolución hace mayor uso de la estrategia de afrontamiento "catarsis" y además presenta puntuaciones más altas en "catastrofismo" en comparación con los componentes del otro grupo. Conclusión: se observa la relación entre del dolor y las variables psicológicas del estudio como también los cambios que pueden aparecer en diferentes etapas de la evolución del dolor

Validation of a HPLC method for simultaneous determination of main organic acids in fruits and juices.

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A new extraction approach to correct the effect of apparent increase in the secoiridoid content after filtration of virgin olive oil

In the current study, a new approach has been developed for correcting the effect that moisture reduction after virgin olive oil (VOO) filtration exerts on the apparent increase of the secoiridoid content by using an internal standard during extraction. Firstly, two main Spanish varieties (Picual and Hojiblanca) were submitted to industrial filtration of VOOs. Afterwards, the moisture content was determined in unfiltered and filtered VOOs, and liquid–liquid extraction of phenolic compounds was performed using different internal standards. The resulting extracts were analyzed by HPLC-ESI-TOF/MS, in order to gain maximum information concerning the phenolic profiles of the samples under study. The reduction effect of filtration on the moisture content, phenolic alcohols, and flavones was confirmed at the industrialscale. Oleuropein was chosen as internal standardand, for the first time, the apparent increase of secoiridoids in filtered VOO was corrected, using a correction coefficient (Cc) calculated from the variation of internal standard area in filtered and unfiltered VOO during extraction. This approach gave the real concentration of secoiridoids in filtered VOO, and clarified the effect of the filtration step on the phenolic fraction. This finding is of great importance for future studies that seek to quantify phenolic compounds in VOOs

Quantification of phenolic compounds by capillary zone electrophoresis in extracts of four commercial types of mate herb before and after acid hydrolysis.

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Optimizing the extraction of anthocyanins from the skin and phenolic compounds from the seed of jabuticaba fruits (Myrciaria jabuticaba (Vell.) O. Berg) with ternary mixture experimental designs

Total phenolic compounds (TPC) extraction from the seed and total monomeric anthocyanins (TMA) extraction from the skin of "Sabara" jabuticaba were optimized with simplex lattice designs for solvent mixing, and the extraction time was optimized by univariate design. The optimum conditions for the extraction method were ethanol: water (60: 40 v/v) solvent for TPC (seed) and methanol: water: acetic acid (80:20:0.5 v/v/v) solvent for TMA (skin). For both compound groups, the optimum extraction time was 30 min. The TMA yield for the skin of the "Sabara" variety was 1172.16 mg cyanidin-3-glycoside equivalents per 100 g freeze-dried sample, and for TPC in the seed, it was 86.50 mg gallic acid equivalents per 1 g freeze-dried sample. Both optimized extraction protocols proved to be extremely fast, simple, inexpensive and to have excellent extraction performance. The optimized protocols were compared with two other methods described in the literature and they were also applied to study the TMA contents in skin and the TPC contents in seed of five other varieties of jabuticaba, harvested in 2014 and 201530715061514CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQ145652/2014-