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A 49-year-old woman with tachycardia was referred to our institution. Transthoracic echocardiography revealed severe mitral regurgitation, and surgery was planned. While awaiting surgery, she developed a fever. Transthoracic echocardiography and transesophageal echocardiography revealed vegetation on the mitral valve leaflet. Blood cultures were positive for Streptococcus anginosus. She was diagnosed with infective endocarditis, and antibiotics were administered. She experienced sudden abdominal pain 26 days after hospitalization. Contrast-enhanced computed tomography scan revealed a mycotic superior mesenteric artery aneurysm with impending rupture without intestinal ischemia, and aneurysm resection was performed. Mitral valve replacement was performed on postoperative day 10, with uneventful postoperative healing.

Abstract Background Despite advances in surgical techniques and care, pancreatoduodenectomy (PD) continues to have high morbidity and mortality rates. Complications such as sepsis, hemorrhage, pulmonary issues, shock, and pancreatic fistula are common postoperative challenges. A key concern in PD outcomes is the high incidence of infectious complications, especially surgical site infections (SSI) and postoperative pancreatic fistula (POPF). Bacteriobilia, or bile contamination with microorganisms, significantly contributes to these infections, increasing the risk of early postoperative complications. The occurrence of SSI in patients who undergo hepatobiliary and pancreatic (HPB) surgeries such as PD is notably higher than that in patients who undergo other surgeries, with rates ranging from 20 to 55%. Recent research by D'Angelica et al. revealed that, compared to cefoxitin, piperacillin/tazobactam considerably lowers the rate of postoperative SSI. However, these findings do not indicate whether extending the duration of antibiotic treatment is beneficial for patients at high risk of bacterial biliary contamination. In scenarios with a high risk of SSI, the specific agents, doses and length of antibiotic therapy remain unexplored. The advantage of prolonged antibiotic prophylaxis following PD has not been established through prospective studies in PD patients following biliary drainage. Methods This is an intergroup FRENCH-ACHBT-SFAR multicenter, open-labelled randomized, controlled, superiority trial comparing 2 broad-spectrum antibiotic (piperacillin/tazobactam) treatment modalities to demonstrate the superiority of 5-day postoperative antibiotic therapy to antibiotic prophylaxis against the occurrence of surgical site infections (SSI) following pancreaticoduodenectomy in patients with preoperative biliary stents. The primary endpoint of this study is the overall SSI rate, defined according to the ACS NSQIP, as a composite of superficial SSI, deep incisional SSI, and organ/space SSI. In addition, we will analyze overall morbidity, antibiotic resistance profiles, the pathogenicity of bacteriological and fungal cocontamination, the impact of complications after bile drainage and neoadjuvant treatment on the bacteriological and fungal profile of biliculture and cost-effectiveness. Conclusion This FRENCH24-ANIS study aims to evaluate 5-day post-operative antibiotic therapy combined with antibiotic prophylaxis on the occurrence of surgical site infections (SSI) following pancreaticoduodenectomy in patients with preoperative biliary stents. Trial registration ClinicaTrials.gov number, NCT06123169 (Registration Date 08–11–2023); EudraCT number 2021–006991-18; EUCT Number: 2024–515181-14–00.

Introduction and purpose Acute appendicitis, a common surgical abdominal ailment, mostly affects individuals in their second or third decade of life, with an annual incidence of about 100 cases per 100,000 persons. This literature review aims to synthesize evidence from diverse sources, summarizing optimal practices for clinical implementation. Surgical intervention, achieving almost 100% cure rates, remains the gold standard, emphasizing challenges in patient qualification for non-surgical approachesNon-operative treatment, considered safe for uncomplicated cases, involves antibiotic therapy, with concerns about antibiotic resistance. Summarizing the current understanding of antibiotic therapy of appendicitis seeks to enhance its effective use, decrease adverse incidents in patients, and contribute to the overall safety of both patients and healthcare providers. Material and methods The following review of studies was based on articles obtained from the PubMed and Google Scholar databases. Key search terms included acute appendicitis, acute appendicitis conservative treatment, appendectomy, surgical abdominal diaseases, antibiothic therapy. Conclusions The literature review highlights the existing challenges in the management of acute appendicitis, acknowledging the efficacy of both methods. While surgical intervention with high cure rates, the increasing popularity of non-operative therapy encourages optimism for comprehensive research in the future. The need for large, randomized studies comparing long-term clinical effectiveness is emphasized, aiming to inform decision-making and optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Abstract Surgeons in their daily practice are at the forefront in preventing and managing infections. However, among surgeons, appropriate measures of infection prevention and management are often disregarded. The lack of awareness of infection and prevention measures has marginalized surgeons from this battle. Together, the Global Alliance for Infections in Surgery (GAIS), the World Society of Emergency Surgery (WSES), the Surgical Infection Society (SIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), the American Association for the Surgery of Trauma (AAST), and the Panamerican Trauma Society (PTS) have jointly completed an international declaration, highlighting the threat posed by antimicrobial resistance globally and the need for preventing and managing infections appropriately across the surgical pathway. The authors representing these surgical societies call all surgeons around the world to participate in this global cause by pledging support for this declaration for maintaining the effectiveness of current and future antibiotics.

Abstract Background Perforation of the pyriform sinus, included in hypopharyngeal injury, is a rare condition typically caused by iatrogenic factors. We present a case of an infant who developed deep cervical and mediastinal abscesses due to a traumatic pyriform sinus perforation caused by accidentally falling with a marker pen in the mouth. Case presentation An 11-month-old healthy male infant fell on a trampoline with a marker pen in his mouth. The patient developed swelling in the neck 3 h after the incident and was taken to a regional general hospital. Although a laryngoscopy showed no perforation in the oral cavity or posterior pharynx, a computed tomography (CT) scan revealed significant emphysema extending from the cervix to the mediastinum. The patient was transferred to our tertiary hospital and admitted to the intensive care unit, where he was mechanically ventilated, and antibiotic therapy was initiated. On day 3 of admission, a CT scan revealed deep abscesses in the cervical and upper posterior mediastinum with pneumomediastinum. Although his respiratory status stabilized and he was temporarily weaned, the fever recurred. Pharyngoesopagography revealed significant leakage of contrast from the left pyriform sinus to the mediastinum. Consequently, surgical drainage of the abscess was performed on day 10. Two low-pressure continuous suction drains were placed, one in the posterior mediastinum and the other close to the pyriform sinus. Pharyngoesophagography on postoperative day (POD) 7 demonstrated decreased contrast leakage into the posterior mediastinum. The patient was initiated on enteral nutrition through a nasogastric tube. The patient was discharged on POD 31 after the suction drains were replaced with open Penrose drains, and enteral nutrition via nasogastric tube was continued at home. The Penrose drains were removed on POD 54, and salivary leakage ceased on POD 111. Conclusions Although injuries to the oral cavity and posterior pharynx are more easily recognized, the existence of injury in the pyriform sinus can be challenging to evaluate. However, prompt and appropriate management, including intubation, antibiotic therapy, surgical drainage, and nutritional support, is critical in preventing life-threatening complications.

Abstract Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice.

Surgeons in their daily practice are at the forefront in preventing and managing infections. However, among surgeons, appropriate measures of infection prevention and management are often disregarded. The lack of awareness of infection and prevention measures has marginalized surgeons from this battle. Together, the Global Alliance for Infections in Surgery (GAIS), the World Society of Emergency Surgery (WSES), the Surgical Infection Society (SIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), the American Association for the Surgery of Trauma (AAST), and the Panamerican Trauma Society (PTS) have jointly completed an international declaration, highlighting the threat posed by antimicrobial resistance globally and the need for preventing and managing infections appropriately across the surgical pathway. The authors representing these surgical societies call all surgeons around the world to participate in this global cause by pledging support for this declaration for maintaining the effectiveness of current and future antibiotics. [ABSTRACT FROM AUTHOR]

The aim of the study. To provide an analysis of the development of purulent-inflammatory complications in gunshot wounds and mine-explosive trauma and to develop tactics for the treatment of infectious complications at the stage of specialized medical care. Materials and methods. An analysis of the treatment of 57 patients with purulent-inflammatory complications of the limbs after gunshot bullet wounds and mine-explosive trauma was conducted. Of them, 34 (59.6%) military personnel and 23 (40.4%) civilians were treated in the bone-purulent surgery department. 44 (77.1%) of the patients had a mine-explosive injury, and 13 (22.9%) had bullet wounds. Research results. It was revealed that the cause of infectious complications was severe trauma, and in some cases irrational both general and local treatment during the evacuation stages. The therapy was not aimed primarily at the elimination of signs of traumatic shock, anemia, and detoxification of the body. In most of the victims, the initial surgical treatment of wounds was performed poorly and insufficiently, repositioning and stable fixation of fractures was not performed. As a result of the treatment, 2 (3.5%) patients with severe mine-explosive injuries of the lower limbs, pelvis and spine died, 6 (10.5%) victims underwent limb amputation at the level of the middle third of the thigh. The rest of the patients from the first day of hospitalization received complex treatment aimed at eliminating the purulent-inflammatory process of the extremities. In 41 (71.9%) fractures were fixed with external fixation devices. After elimination of the inflammatory process, all patients were transferred to outpatient treatment in a military hospital or at their place of residence. Conclusion. Modern combat trauma of the limbs in the course of treatment is complicated by severe purulent-inflammatory processes in 35% of cases. According to the clinical course, gunshot wounds differ significantly from mine-explosive injuries. One of the formidable infectious complications is gunshot osteomyelitis, the course of which exhausts the body and leads to sepsis and death. Stabilization of fractures against the background of purulent-inflammatory processes should be performed with external fixation devices.

BackgroundExtensive spinal epidural abscess (SEA) is an exceptional and threatening condition that requires prompt recognition and proper management to avoid potentially disastrous complications. We aimed to find key elements of early diagnosis and rational treatments for extensive SEA.Case presentationA 70-year-old man complained of intense pain in the cervical-thoracic-lumbar spine that radiated to the lower extremity. Laboratory test results revealed a marked increase in all indicators of infection. The spinal magnetic resonance imaging (MRI) revealed a ventral SEA extending from C2 to L4. Owing to the patient's critical condition, laminectomy, drainage, and systemic antibiotic therapy were administered. And the multidrug-resistant Staphylococcus epidermidis was detected in the purulent material from this abscess.ResultsPostoperative MRI revealed diminished epidural abscess, and the clinical symptoms were dramatically and gradually relieved after two rounds of surgery and systemic antibiotic therapy involving the combination of ceftriaxone, linezolid, and rifampicin.ConclusionsA comprehensive emergency assessment based on neck or back pain, neurological dysfunctions, signs of systemic infection, and MRI are important for early diagnosis of extensive SEA. Further, the combination of laminectomy, drainage, and systemic antibiotic therapy may be a rational treatment choice for patients with SEA, especially for extensive abscess or progressive neurological dysfunction.

Introduction: Subdural empyema (SDE) is a rare but potentially life-threatening intracranial infection that is invariably fatal if left untreated. As clinical and radiologic features may be subtle or uncertain, early diagnosis may be a challenge but is crucial in reducing morbidity and mortality. SDE should always be suspected especially in a paediatric group with a history of fever, focal seizures, meningism and neurological deficit. The management of SDE has been debated in the literature for decades. Being one of the most serious neurosurgical emergencies, goals include surgical evacuation where both burr-hole drainage and craniotomy are primary surgical options, treatment of pus, and establishing the etiologic agent which subsequently guides antibiotic therapy for a favourable outcome. Case presentation: We present three cases of immunocompetent patients, 4 and 6-month-old infants with a 14-year-old adolescent presenting with SDE without underlying risk factors. Non-contrast computed tomography imaging was equivocal for SDE. All of them required surgery. The two infants underwent burr holes and subsequently a wide craniotomy with intravenous antibiotics therapy while the adolescent required craniectomy because of swollen brain. They all had a favourable outcome on long term follow up. Conclusion: Paediatric supratentorial SDE, although rapidly fatal if not identified promptly, can be effectively managed with early surgical drainage preferably craniotomy, eradication of the source, and sensitive IV broad-spectrum antibiotics. In this article, we discuss the clinical presentation, diagnostic tools, treatment options and outcomes for SDE with an emphasis on the challenges.

Abstract Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4–1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.

In orthopaedic trauma, fracture-related infections (FRI) are still dreadful challenges that can cause non-union, amputation and even death. Standardization of general treatment strategies for FRI is still lacking. Due to the complexity of FRI, a multidisciplinary approach addressing host status, state of the fracture and causative microorganism has been applied in the management of FRI. Surgical treatment, antibiotic therapy and host optimization for FRI were summarized and discussed. The goal of this review is to provide an overview and summary of current approaches of FRI management and to make suggestions on FRI prevention and treatment based on multidisciplinary principles. [ABSTRACT FROM AUTHOR]

Abstract Appropriate measures of infection prevention and management are integral to optimal clinical practice and standards of care. Among surgeons, these measures are often over-looked. However, surgeons are at the forefront in preventing and managing infections. Surgeons are responsible for many of the processes of healthcare that impact the risk for surgical site infections and play a key role in their prevention. Surgeons are also at the forefront in managing patients with infections, who often need prompt source control and appropriate antibiotic therapy, and are directly responsible for their outcome. In this context, the direct leadership of surgeons in infection prevention and management is of utmost importance. In order to disseminate worldwide this message, the editorial has been translated into 9 different languages (Arabic, Chinese, French, German, Italian, Portuguese, Spanish, Russian, and Turkish).

Background: Intracranial suppurations (ICSs) are purulent collections of infectious origin. Many therapeutic attitudes have been described. Management has not really been the subject of consensus. Purpose: Study the epidemiological, clinical, and paraclinical features of ICSs and assess the clinical, radiological and postoperative outcomes according to the different therapeutic modalities. Patients and methods: Our retrospective, descriptive study including 43 cases of ICSs treated in the Neurosurgery department of the UHC Habib Bourguiba and Traumatology and Major Burns Center of Ben Arous-Tunisia, over a period of 7 years from 2012 to 2018. All epidemiological, etiological, clinical, radiological, biological, therapeutic and evolutionary parameters were studied. Results: The mean patients’age was 32.35 years with a sex ratio of 4.37. Locoregional infections accounted for 60.46% of aetiologies. Clinical signs found were infectious syndrome in 79.07% and intracranial hypertension in 62.70%. Neuroimaging made diagnosis in 30 cases of abscess and 13 cases of empyema. Predilection site was supratentorial in 90% of abscess and in 92.30% of empyema. Streptococci were isolated in 75% of abscess and in 4 cases of empyema. All patients received broad-spectrum antibiotics. Abscess aspiration was performed in 20 cases and excision in 17 cases. Evacuation of empyema by trepanation was performed in 7 patients and through craniotomy in 7 cases. Outcomes were favorable in 23 cases of abscess and 11 cases of empyema. Conclusion: ICSs are a topical pathology in various countries where management is multidisciplinary. Outcomes are favorable in more than 80%, improved by early treatment. Clinico-radiological monitoring during follow-up remain essential.

Pilonidal disease, although relatively common, often is not appropriately recognized and treated. This inflammatory condition may be found in several areas on the body; this article reviews disease affecting the gluteal cleft, how to identify the condition, initial treatment, and when to consider surgical intervention for definitive care. [ABSTRACT FROM AUTHOR]

The work describes a new antibiotic from the oxazolidinone group – tedizolid. The results of the clinical studies have shown a high efficacy of tedizolid in complicated skin and soft tissue infections. The use of tedizolid phosphate was accompanied by high activity against antibiotic-resistant microflora in combination with good tolerability and low frequency of side effects.

Objective: The aim of this study was to evaluate the efficacy of 48-h antibiotic prophylaxis in the prevention of surgical site infections during simple dental extractions by conducting a clinical trial controlled by 7-day antibiotic therapy. Our hypothesis was that there was no difference between these two protocols in the prevention of surgical site infection. Method: ology: This was a 6-month randomised multicentre clinical trial conducted in three health facilities in the city of Yaoundé. The study included any patient aged 18 years or older who was scheduled for a simple dental extraction. The calculated sample size was 142 patients randomly divided into 2 groups. Group I consisted of patients who took 1 g of amoxicillin 1 h before surgery and then 1 g every 12 h for 48 h. Group 2 took amoxicillin only postoperatively at a rate of 1 g every 12 h for 7 days. The control was done at day and day 7. The primary endpoint was the occurrence of surgical site infection and the secondary endpoints were the occurrence of dry socket, oedema and pain. Results: No statistically significant difference was found at the 5% level between the two protocols regarding the occurrence of pain, postoperative oedema and surgical site infection with respective p-values of 0.834; 0.414; 0.175. In addition, a statistically significant difference was found for dry socket disease (p-value = 0.0149) showing a reduced risk in the 48-h group. Conclusion: It was found that there was no difference between these two protocols except for dry socket disease where the 48 h antibiotic prophylaxis protocol seems to be more effective. Furthermore, the question of the necessity of antibiotic prophylaxis for simple extractions remains, as only a randomised placebo-controlled clinical trial could provide answers.

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The potential risk of fluoroquinolones on the musculoskeletal tissue, and tendinous structures in particular, has been known since its introduction in the 1980s. Following reports of serious and persistent side effects in their national registry, the German medicines authority (BfArM) has requested the European Medicines Agency (EMA) to conclude a safety review focusing on long-lasting effects mainly affecting the musculoskeletal and nervous systems. This review, published in early 2019, led to restriction of the usage of fluoroquinolones due to the risk of disabling and potentially long-term side effects. Furthermore, there have been a number of meta-analyses published in the recent years, which brought more clarity to the extent of fluoroquinolones' possible side effects. With this case report followed by an overview of the latest evidence, we would like to highlight these latest efforts in the quest to prescribe fluoroquinolones cautiously and sensitize physicians to this topic.

Abstract Background Based on epidemiological and clinical data acute appendicitis can present either as uncomplicated (70–80%) or complicated (20–30%) disease. Recent studies have shown that antibiotic therapy is both safe and cost-effective for a CT-scan confirmed uncomplicated acute appendicitis. However, based on the study protocols to ensure patient safety, these randomised studies used mainly broad-spectrum intravenous antibiotics requiring additional hospital resources and prolonged hospital stay. As we now know that antibiotic therapy for uncomplicated acute appendicitis is feasible and safe, further studies evaluating optimisation of the antibiotic treatment regarding both antibiotic spectrum and shorter hospital stay are needed to evaluate antibiotics as the first-line treatment for uncomplicated acute appendicitis. Methods APPAC II trial is a multicentre, open-label, non-inferiority randomised controlled trial comparing per oral (p.o.) antibiotic monotherapy with intravenous (i.v.) antibiotic therapy followed by p.o. antibiotics in the treatment of CT-scan confirmed uncomplicated acute appendicitis. Adult patients with CT-scan diagnosed uncomplicated acute appendicitis will be enrolled in nine Finnish hospitals. The intended sample size is 552 patients. Primary endpoint is the success of the randomised treatment, defined as resolution of acute appendicitis resulting in discharge from the hospital without the need for surgical intervention and no recurrent appendicitis during one-year follow-up. Secondary endpoints include post-intervention complications, late recurrence of acute appendicitis after one year, duration of hospital stay, pain, quality of life, sick leave and treatment costs. Primary endpoint will be evaluated in two stages: point estimates with 95% confidence interval (CI) will be calculated for both groups and proportion difference between groups with 95% CI will be calculated and evaluated based on 6 percentage point non-inferiority margin. Discussion To our knowledge, APPAC II trial is the first randomised controlled trial comparing per oral antibiotic monotherapy with intravenous antibiotic therapy continued by per oral antibiotics in the treatment of uncomplicated acute appendicitis. The APPAC II trial aims to add clinical evidence on the debated role of antibiotics as the first-line treatment for a CT-confirmed uncomplicated acute appendicitis as well as to optimise the non-operative treatment for uncomplicated acute appendicitis. Trial registration Clinicaltrials.gov, NCT03236961, retrospectively registered on the 2nd of August 2017.

Abstract Despite evidence supporting the effectiveness of best practices of infection prevention and management, many surgeons worldwide fail to implement them. Evidence-based practices tend to be underused in routine practice. Surgeons with knowledge in surgical infections should provide feedback to prescribers and integrate best practices among surgeons and implement changes within their team. Identifying a local opinion leader to serve as a champion within the surgical department may be important. The “surgeon champion” can integrate best clinical practices of infection prevention and management, drive behavior change in their colleagues, and interact with both infection control teams in promoting antimicrobial stewardship.

Background: Megaprosthetic infections continue to be a leading mode of failure after limb salvage surgery. Though challenging, amputations can be avoided with proper management in majority of the cases. This study aims to describe the spectrum of mega-endoprosthetic infections at our institute and assess the treatment efficacy in these patients. Materials and Methods: All patients treated for endoprosthetic infection at our institute between 2010 and 2018 were retrospectively analyzed for overall survival of reconstruction method, site and type of megaprosthesis, adjuvant therapy, microbial isolates, surgical and medical management and outcomes. Results: Thirty-five patients (22 males: 13 females) were analyzed following treatment for endoprosthetic infection. Majority were around the knee joint [most commonly with proximal tibia (n = 14) followed by distal femur (n = 12) megaprosthesis]. Ten patients had undergone primary surgical procedure at our institute, while 25 patients presented with infection after megaprosthesis implantation. In the 28 culture-positive infections, the most common micro-organism was Staphylococcus spp. (18 patients: methicillin-sensitive Staphylococcus aureus = 9, coagulase-negative Staphylococcus = 5, methicillin-resistant Staphylococcus aureus = 1, Staphylococcus epidermidis = 3) and poly-microbial infection was present in three patients. Nine patients underwent successful debridement and wound wash with insertion of antibiotic impregnated cement beads in 5/9 cases. Twenty-one patients required a two-stage revision. Of these 30 patients, all but one has completely resolved infections. One patient with resurfaced late infection after re-implantation is on chronic suppressive antimicrobial therapy and close follow-up. Amputation because of uncontrolled infection was performed in three patients (one death post-operatively due to systemic complications of septicemia), while two patients opted for amputation as opposed to stage revisions. Median antimicrobial therapy duration was 6 weeks (1–12 weeks). Reconstructive surgery for soft tissue cover was required in seven patients. Conclusions: In patients with early or acute presentation without frank granulation or pus around the implant, debridement and insertion of antibiotic cement beads was adequate. Two-stage revisions with complete removal of the megaprosthesis showed best results in infections that could be controlled with antimicrobial therapy. More than one exchange of cement spacer was required for uncontrolled infections. Multidisciplinary approach in consultation with the infectious disease team is essential to determine choice of antibiotic cement for beads/spacer as well as appropriate adjuvant antimicrobial therapy to solve the challenging problem of endoprosthetic infections following bone tumor surgery. Adequate and healthy soft tissue cover of the implant should be achieved wherever indicated. [ABSTRACT FROM AUTHOR]

Abstract Iatrogenic colonoscopy perforation (ICP) is a severe complication that can occur during both diagnostic and therapeutic procedures. Although 45–60% of ICPs are diagnosed by the endoscopist while performing the colonoscopy, many ICPs are not immediately recognized but are instead suspected on the basis of clinical signs and symptoms that occur after the endoscopic procedure. There are three main therapeutic options for ICPs: endoscopic repair, conservative therapy, and surgery. The therapeutic approach must vary based on the setting of the diagnosis (intra- or post-colonoscopy), the type of ICP, the characteristics and general status of the patient, the operator’s level of experience, and surgical device availability. Although ICPs have been the focus of numerous publications, no guidelines have been created to standardize the management of ICPs. The aim of this article is to present the World Society of Emergency Surgery (WSES) guidelines for the management of ICP, which are intended to be used as a tool to promote global standards of care in case of ICP. These guidelines are not meant to substitute providers’ clinical judgment for individual patients, and they may need to be modified based on the medical team’s level of experience and the availability of local resources.

Abstract Introduction Appendectomy has long been the mainstay of intervention for acute appendicitis, aiming at preventing perforation, peritonitis, abscess formation and recurrence. With better understanding of the disease process, non-operative management (NOM) with antibiotics alone has been proved a feasible treatment for uncomplicated appendicitis. This article aimed at systematically reviewing the available literatures and discussing the question whether NOM should replace appendectomy as the standard first-line treatment for uncomplicated appendicitis. Method A search of the Embase, Pubmed and Cochrane Library was performed using the keywords ‘acute appendicitis’ and ‘antibiotic therapy’. Meta-analysis with inverse variance model for continuous variable and Mantel Haenzel Model for dichotomous variable was performed to evaluate the one year treatment efficacy, morbidities rate, sick leave duration and length of hospital stay associated with emergency appendectomy and NOM. Results Six randomized control trials were identified out of 1943 publications. NOM had a significant lower treatment efficacy rate at one year, 0.10 (95% CI 0.03–0.36, p

Literature review is devoted to immunosuppression in sepsis and possibilities of its correction.

Background: Parafalcine subdural empyema (SDE) is a rare entity consisting of pus accumulating below the longitudinal sinus, between the falx cerebri and the arachnoid layer covering the medial surface of the cerebral hemisphere. Its treatment strategy is controversial, but most clinicians have the general belief that appropriate treatment consists of prompt surgery combined with long-term antibiotic therapy. Nevertheless, six reports published in the 1980s provided evidence that antibiotic therapy alone is a safe and suitable option. The treatment strategies and outcomes of the 31 well-described cases previously published, in addition to our own, are discussed. Case Description: We report a 21-year-old female with a right-side parafalcine SDE who presented with fever, headache, generalized tonic-clonic seizures, and contralateral hemiparesis 3 weeks after undergoing sinonasal surgery. Despite clinical symptoms almost entirely abating after starting treatment with broad-spectrum antibiotics, magnetic resonance imaging performed during the 2nd and 3rd weeks showed progressive enlargement of the interhemispheric collection (from 4 cm3 to 30 cm3). We reflect on the treatment strategy chosen for this patient, who experienced a total recovery. Conclusion: A nonsurgical strategy for parafalcine SDE might be contemplated for patients with a good clinical condition and no major midline shift on neuroradiological studies, given their usual indolent course and the relative difficulty in reaching the interhemispheric fissure. Conversely, surgery should be contemplated when the collection significantly enlarges despite antibiotic therapy. When surgical drainage is added to antibiotics, broadrange 16S ribosomal DNA polymerase chain reaction of the empyema is recommended to identify the causative organism as pus cultures are usually sterile. [ABSTRACT FROM AUTHOR]

The paper focuses on the recommendations for chronic prostatitis treatment taking into the consideration the peculiarities of the pathogenesis and clinical picture of this disease. The paper demonstrates that the efficient chronic prostatitis treatment requires the new UPOINT prostatitis classification rather than traditional VIN NIDDK (1995) classification. The paper discusses the indications for various drug and non-drug interventions: antibiotics, alpha-blockers, M-cholinolytics, analgesics, antidepressants, phytodrugs, pelviс floor acupuncture and physiotherapy, psychotherapy.

The articLe discusses the indications and conditions for the use of fLuoroquinoLones (ciprofloxacin, LevofLoxacin, moxifLoxacin) in surgicaL infections of the skin and soft tissues in ambuLatory patients. Various aspects of the use of fLuoroquinoLones are described from the standpoint of rationaL antibiotic therapy, the current sensitivity status of microbiaL agents in Russia, high-quaLity comparative cLinicaL findings and in accordance with the nationaL guideLines.he articLe discusses the indications and conditions for the use of fLuoroquinoLones (ciprofloxacin, LevofLoxacin, moxifLoxacin) in surgicaL infections of the skin and soft tissues in ambuLatory patients. Various aspects of the use of fLuoroquinoLones are described from the standpoint of rationaL antibiotic therapy, the current sensitivity status of microbiaL agents in Russia, high-quaLity comparative cLinicaL findings and in accordance with the nationaL guideLines.

The intensive care unit (ICU) is a special place in the hospital, just like intensive care is a special branch of medicine. Therapy in such units should always be interdisciplinary. Nursing is a key component of therapy, which in many cases a plays major role in the process of improving the patient's general condition. Surgical patients constitute about half of ICU patients. Hospitalization in ICU per se poses a risk of complications, regardless of other events which may appear as a consequence of underlying pathology and its treatment. Accordingly, therapy of this group of patients poses a challenge for highly qualified personnel. Regardless of guidelines and literature publications it is worth remembering that each patient requires an individual approach towards diagnosis and treatment. [ABSTRACT FROM AUTHOR]