• Invasive Infection and Outcomes in a Humanitarian Surgical Burn Program in Haiti

      Murphy, RA; Nisenbaum, L; Labar, AS; Sheridan, RL; Ronat, JB; Dilworth, K; Pena, J; Kilborn, E; Teicher, C (SpringerLink - We regret that this article is behind a paywall., 2016-02-25)
      Compare to high-income settings, survival in burn units in low-income settings is lower with invasive infections one leading cause of death. Médecins Sans Frontières is involved in the treatment of large burns in adults and children in Haiti.
    • Multidrug-Resistant Surgical Site Infections in a Humanitarian Surgery Project

      Murphy, RA; Okoli, O; Essien, I; Teicher, C; Elder, G; Pena, J; Ronat, JB; Bernabé, KJ (Cambridge University Press, 2016-08-11)
      The epidemiology of surgical site infections (SSIs) in surgical programmes in sub-Saharan Africa is inadequately described. We reviewed deep and organ-space SSIs occurring within a trauma project that had a high-quality microbiology partnership and active follow-up. Included patients underwent orthopaedic surgery in Teme Hospital (Port Harcourt, Nigeria) for trauma and subsequently developed a SSI requiring debridement and microbiological sampling. Data were collected from structured chart reviews and programmatic databases for 103 patients with suspected SSI [79% male, median age 30 years, interquartile range (IQR) 24-37]. SSIs were commonly detected post-discharge with 58% presenting >28 days after surgery. The most common pathogens were: Staphylococcus aureus (34%), Pseudomonas aeruginosa (16%) and Enterobacter cloacae (11%). Thirty-three (32%) of infections were caused by a multidrug-resistant (MDR) pathogen, including 15 patients with methicillin-resistant S. aureus. Antibiotics were initiated empirically for 43% of patients and after culture and sensitivity report in 32%. The median number of additional surgeries performed in patients with SSI was 5 (IQR 2-6), one patient died (1%), and amputation was performed or recommended in three patients. Our findings suggest the need for active long-term monitoring of SSIs, particularly those associated with MDR organisms, resulting in increased costs for readmission surgery and treatment with late-generation antibiotics.
    • Regional Anesthesia for Painful Injuries after Disasters (RAPID): Study Protocol For A Randomized Controlled Trial

      Levine, AC; Teicher, C; Aluisio, AR; Wiskel, T; Valles, P; Trelles, M; Glavis-Bloom, J; Grais, RF (BioMed Central, 2016-11-14)
      Lower extremity trauma during earthquakes accounts for the largest burden of disaster-related injuries. Insufficient pain management is common in resource-limited disaster settings, and regional anesthesia (RA) may reduce pain in injured patients beyond current standards of care. To date, no controlled trials have been conducted to evaluate the use of RA for pain management in a disaster setting.
    • The short musculoskeletal functional assessment (SMFA) score amongst surgical patients with reconstructive lower limb injuries in war wounded civilians

      Teicher, C; Foote, N L; Al Ani, A M K; Alras, M S; Alqassab, S I; Baron, E; Ahmed, K; Herard, P; Fakhri, R M (Elsevier, 2014-10-24)
      The MSF programme in Jordan provides specialized reconstructive surgical care to war-wounded civilians in the region. The short musculoskeletal functional assessment score (SMFA) provides a method for quantitatively assessing functional status following orthopaedic trauma. In June 2010 the Amman team established SMFA as the standard for measuring patients' functional status. The objective of this retrospective study is to evaluate whether the SMFA scores can be useful for patients with chronic war injuries.