[Looking back 2018--focused on surgical infection].

Area of Science:

• Surgical Infections
• Critical Care Medicine
• Antibiotic Therapy

Background:

• Published clinical research in 2018 is reshaping established opinions on managing surgical infections.
• Areas impacted include acute appendicitis, antibiotic use, septic shock resuscitation, and nutritional support for critically ill patients.

Purpose of the Study:

• To review and synthesize recent clinical research findings impacting surgical infection management.
• To highlight shifts in clinical practice regarding antibiotic therapy, wound closure, and critical care interventions.

Main Methods:

• Review of clinical research published in 2018 focusing on surgical infections.
• Analysis of studies related to appendicitis management, antibiotic efficacy, septic shock, and nutritional support.

Main Results:

• Antibiotic therapy may be effective for uncomplicated appendicitis, potentially avoiding surgery.
• Delayed primary wound closure does not decrease superficial surgical site infections compared to primary closure for complicated appendicitis.
• Long-course antibiotics offer no clinical benefit in critically ill post-operative patients after adequate source control.
• Deresuscitation is linked to reduced mortality in critically ill patients.
• Hydrocortisone shows potential in septic shock management, warranting further investigation.
• Piperacillin-tazobactam cannot substitute carbapenems for ESBL-producing E. coli and K. pneumoniae bloodstream infections.
• Energy-dense enteral nutrition did not improve survival in mechanically ventilated patients.
• Early enteral nutrition did not reduce mortality but increased digestive complications compared to early parenteral nutrition in septic shock patients.

Conclusions:

• Selective antibiotic use and careful wound management are key in appendicitis.
• Optimizing antibiotic duration and exploring deresuscitation strategies are crucial in critical care.
• Nutritional strategies require further refinement for critically ill patients, particularly those with septic shock.