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Introduction: Bacterial infections are a leading cause of morbidity and mortality in patients receiving solid-organ transplants. Extended-spectrum beta-lactamases (ESBL) pathogens are the most important pathogenic bacteria infecting these patients. Aim: This study aims to evaluate for the incidence and characteristics of ESBL-positive organism, to look for the clinical outcomes in ESBL-positive infected cases, and to evaluate and draft the antibiotic policy in posttransplant patients during the first 28 days posttransplant. Materials and Methods: This is a retrospective data analysis of liver transplant recipients infected with ESBL culture-positive infections. All the culture sites such as blood, urine, and endotracheal tube aspirates were screened for the first ESBL infection they had and noted. This data were collected till day 28 posttransplant. The antibiotic susceptibility pattern and the most common organism were also noted. Results: A total of 484 patients was screened and 116 patients had ESBL-positive cultures. Out of these, 54 patients had infections and 62 patients were ESBL colonizers. The primary infection site was abdominal fluid (40.7%), with Klebsiella accounting for most of the ESBL infections. Colistin was the most sensitive antibiotic followed by tigecycline. The overall mortality was 11.4% and 31 out of 54 ESBL-infected patients died. Conclusions: Infections with ESBL-producing organism in liver transplant recipients has a high mortality and very limited therapeutic options. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective review of a prospective database.Objective: The aim of this study was to define the role of sagittal orientation of the construct at the upper instrumented levels in the development of proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) patients.Summary Of Background Data: PJK following ASD surgery remains challenging. The final alignment of the upper instrumented vertebral segments has been proposed as a risk factor for PJK, but has not been fully investigated.Methods: ASD patients with 2-year follow-up and long posterior fusion to the pelvis were analyzed. Radiographic measurements included pelvic incidence (PI), lumbar lordosis (LL), pelvic tilt (PT), sagittal vertical axis, and two upper-most instrumented vertebra (UIV) parameters: UIV slope (UIV vs. horizontal) and inclination of the proximal-end of the construct. UIV parameters were secondarily evaluated with regard to the compensatory impact of post-PJK increased PT (PREF). A comparison between PJK and non-PJK patients was performed, according to the UIV location (upper thoracic [UT] or thoracolumbar).Results: A total of 252 patients (mean age, 61.5 years, 83% females) were included. PJK incidence was 56% at 2-years. PJK patients had a greater change in LL and thoracic kyphosis than non-PJK patients. In the UT group, there was no difference in UIV slope for PJK versus non-PJK. However, PJK patients had a smaller inclination of the upper instrumented segments versus vertical (P < 0.001) and the PREF (P = 0.005). Similarly, in the LT group, PJK patients had a posterior inclination versus the vertical (P < 0.001) and the PREF (P = 0.041).Conclusion: Analysis revealed that a more posterior construct inclination was present in patients who developed PJK. These results support previous hypotheses suggesting that PJK may develop in response to excessive spinal realignment. Proper rod contouring, especially at the proximal end, may reduce the risk of PJK.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]