1,063 results on '"abdominal infection"'
Search Results
52. The application of endoscopic loop ligation in defect repair following endoscopic full-thickness resection of gastric submucosal tumors originating from the muscularis propria layer
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Mei-Dong Xu, Guo-Xiang Wang, Yan-Li Xiang, Hong-Gang Wang, Yangde Miao, and Guang Yu
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Male ,Abdominal pain ,medicine.medical_specialty ,Defect repair ,Endoscopic Mucosal Resection ,business.industry ,Abdominal Infection ,Stomach ,Gastroenterology ,Length of Stay ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Gastric Mucosa ,Stomach Neoplasms ,Fundus (uterus) ,Gastroscopy ,medicine ,Humans ,Clinical efficacy ,Full thickness resection ,medicine.symptom ,Ligation ,business ,Retrospective Studies - Abstract
OBJECTIVE We sought to investigate the clinical efficacy and safety of a novel endoscopic closure technique in repairing gastric wall defects after endoscopic full-thickness resection (EFTR) of gastric submucosal tumors (SMTs) originating from the muscularis propria layer. METHODS From December 2016 to December 2019, patients with gastric submucosal tumors were enrolled and clinicopathological data were collected. All SMTs were resected by EFTR and gastric wall defects were closed using a novel endoscopic closure technique. The feasibility, efficacy, and safety were evaluated. RESULTS A total of 21 patients with gastric SMTs were included in this study. Among the included SMTs, 15 tumors were located in the fundus of the stomach, and 6 were located in the upper body of the stomach. The average size of the lesions was 2.3 cm (range: 1.9-2.5 cm). All patients underwent EFTR and the gastric wall defect was closed by endoscopic closure. The average endoscopic closure time was 9 min (range: 7-15 min) and the average hospitalization stay length was five days (range: 4-6 days). One patient developed abdominal pain on the first day after the procedure and their body temperature increased; he received treatments such as anti-infection, antacid, and gastrointestinal decompression and was cured and discharged after 4 days. No instance of delayed bleeding, postoperative gastrointestinal fistula, or abdominal infection occurred. No case was transferred to surgery. The postoperative pathology profile included 18 stromal tumors and 3 leiomyomas. During the follow-up period (6-24 months), no case of residual or recurrence was recorded. CONCLUSION The described endoscopic loop ligation technique is feasible, effective, and safe for repairing gastric wall defects after EFTR for gastric submucosal tumors originating from the muscularis propria layer.
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- 2021
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53. ISOLATION AND ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF MICROORGANISMS CAUSING INTRA-ABDOMINAL INFECTIONS AT TERTIARY CARE HOSPITAL OF NORTHERN INDIA
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Harit Kumar, Ritu Garg, Parminder Singh, and Rinku
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Pharmacology ,Isolation (health care) ,business.industry ,Abdominal Infection ,Pharmaceutical Science ,Medicine ,Antimicrobial susceptibility ,Pharmacology (medical) ,Tertiary care hospital ,business ,Microbiology - Abstract
Objective: The objective of the study is to find out the resistance pattern of pathogenic organisms isolated from intra-abdominal infection (IAI). Methods: A total of 500 samples were collected from suspected IAIs of patients reporting to the hospital and cultured. Identification of the isolates was done using standard identification protocol. Antimicrobial susceptibility was performed by Kirby-Bauer disc diffusion method and interpretation was done using Central Laboratory Standard Institute guidelines. Results: Out of 500 samples, 170 were culture positive and 330 showed no growth. Gram-negative organisms (n=127) outnumbered the Gram-positive organisms (n=23). Among the Gram-negative organisms, Escherichia coli (n=67) was the most commonly isolated bacilli followed by Klebsiella sp. (n=32), Pseudomonas sp. (n=25), Acinetobacter baumannii (n=18), and Klebsiella oxytoca (n=05). Among Gram-positive organisms Staphylococcus aureus (n=17) and Enterococcus spp (n=06) isolates of were grown in culture. Among Gram-negative bacilli, Imipenem followed by Gentamicin was the most effective drug but in Acinetobacter spp. The second most effective drug was Tigecycline. Among Gram-positive isolates, Linezolid was the most effective drug. Conclusion: Prompt starting of empirical antimicrobials based on the local susceptibility pattern, followed by modification of treatment in accordance with the antimicrobial susceptibility report can significantly reduce the morbidity and the mortality associated with IAIs.
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- 2021
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54. C-reactive protein but not procalcitonin may predict antibiotic response and outcome in infections following major abdominal surgery
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A Frangiosa, C Antropoli, M De Palma, Ciro Esposito, Alessandro Perrella, Antonio Giuliani, Fulvio Calise, Giovanni Vennarecci, Maurizio Castriconi, and Carlo Molino
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medicine.medical_specialty ,medicine.medical_treatment ,Peritonitis ,Abdominal surgery ,Gastroenterology ,Procalcitonin ,Sepsis ,Antimicrobialstewardship ,Internal medicine ,medicine ,Humans ,Receptors, Immunologic ,Inflammation ,biology ,business.industry ,Abdominal Infection ,C-reactive protein ,CRE ,Surgical infection ,medicine.disease ,Surgery ,Anti-Bacterial Agents ,C-Reactive Protein ,biology.protein ,Intraabdominal Infections ,Original Article ,Hepatectomy ,Segmental resection ,business ,Infection ,CRP ,Biomarkers - Abstract
We aimed to evaluate the usefulness of C-reactive protein (CRP) and procalcitonin (PCT) as markers of infection, sepsis and as predictors of antibiotic response after non-emergency major abdominal surgery. We enrolled, from June 2015 to June 2019, all patients who underwent surgery due to abdominal infection (peritoneal abscess, peritonitis) or having sepsis episode after surgical procedures (i.e. hepatectomy, bowel perforation, pancreaticoduodenectomy (PD), segmental resection of the duodenum (SRD) or biliary reconstruction in a Tertiary Care Hospital. Serum CRP (cut-off value < 5 mg/L) and PCT (cut-off value < 0.1mcg/L) were measured in the day when fever was present or within 24 h after abdominal surgery. Both markers were assessed every 48 h to follow-up antibiotic response and disease evolution up to disease resolution. We enrolled a total of 260 patients underwent non-emergency major abdominal surgery and being infected or developing infection after surgical procedure with one or more microbes (55% mixed Gram-negative infection including Klebsiella KPC, 35% Gram-positive infection, 10% with Candida infection), 58% of patients had ICU admission for at least 96 h, 42% of patients had fast track ICU (48 h). In our group of patients, we found that PCT had a trend to increase after surgical procedure; particularly, those undergoing liver surgery had higher PCT than those underwent different abdominal surgery (U Mann-Whitney p < 0.05). CRP rapidly increase after surgery in those developing infection and showed a statistical significant decrease within 48 h in those subject being responsive to antibiotic treatment and having a clinical response within 10 days independently form the pathogens (bacterial or fungal). Further we found that those having CRP higher than 250 mg/L had a reduced percentage of success treatment at 10 days compared to those < 250 mg/mL (U Mann-Whitney p < 0.05). PCT did not show any variation according to treatment response. CRP in our cohort seems to be a useful marker to predict antibiotic response in those undergoing non-emergency abdominal surgery, while PCT seem to be increased in those having major liver surgery, probably due to hepatic production of cytokines.
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- 2021
55. Risk Factors for Enterococcal Intra-Abdominal Infections and Outcomes in Intensive Care Unit Patients
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Jiabin Xuan, Xingzheng Luo, Hengrui Zhao, Zhenhua Zeng, Shumin Cai, Zhongqing Chen, Xiaohua Guo, Lulan Li, and Qiaobing Huang
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Microbiology (medical) ,medicine.medical_specialty ,Critical Care ,business.industry ,Abdominal Infection ,Intensive care unit ,Anti-Bacterial Agents ,law.invention ,Intensive Care Units ,Infectious Diseases ,Risk Factors ,law ,Emergency medicine ,medicine ,Humans ,Intraabdominal Infections ,Surgery ,business ,Enterococcus ,Gram-Positive Bacterial Infections ,Retrospective Studies - Abstract
Background: To investigate the risk factors for enterococcal intra-abdominal infections (EIAIs) and the association between EIAIs and outcomes in intensive care unit (ICU) patients. Methods: We rev...
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- 2021
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56. Clinical Efficacy and Safety of Cefoperazone–Sulbactam in Treatment of Intra-Abdominal Infections: A Systematic Review and Meta-Analysis
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Shen-Peng Chang, Chien-Ming Chao, Chih-Cheng Lai, Li-Chin Lu, and Shao-Huan Lan
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Microbiology (medical) ,medicine.medical_specialty ,medicine.drug_class ,business.industry ,Abdominal Infection ,Antibiotics ,Cefoperazone ,Anti-Bacterial Agents ,Treatment Outcome ,Infectious Diseases ,Sulbactam ,Meta-analysis ,Internal medicine ,medicine ,Humans ,Intraabdominal Infections ,Drug Therapy, Combination ,Surgery ,Clinical efficacy ,business ,Adverse effect ,Cefoperazone+Sulbactam ,Intra-Abdominal Infection - Abstract
Background: In this systematic review and meta-analysis, we aimed to assess the clinical efficacy and safety of cefoperazone–sulbactam against alternative antibiotics in the treatment of intra-abdo...
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- 2021
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57. Pneumoperitoneum Secondary to Necrotic Intra-abdominal Lymph Node.
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Cairl NS and Sharp VL
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Pneumoperitoneum is often treated as a surgical emergency as the most common etiology is perforated hollow viscus. Here, we present the case of a man in his 70s who presented to the emergency department with fever and abdominal pain. On physical exam, he was diffusely tender in the bilateral lower quadrants with guarding. Imaging demonstrated moderate volume pneumoperitoneum. On review of his imaging, the pneumoperitoneum was centered around a 7 cm necrotic lymph node. Repeat CT scan with positive oral (PO) and rectal contrast demonstrated no extraluminal contrast extravasation, but air bubbles were seen extending from the necrotic lymph node into the lower abdominal cavity. He underwent CT-guided drain placement and was started on antibiotics, and improved without surgical intervention. In stable patients presenting with pneumoperitoneum and known intra-abdominal lymphadenopathy, perforated viscus should be ruled out prior to surgical intervention, and necrotic intra-abdominal lymph node should be considered as a differential diagnosis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Cairl et al.)
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- 2023
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58. Tigecycline resistance caused by rpsJ evolution in a 59-year-old male patient infected with KPC-producing Klebsiella pneumoniae during tigecycline treatment.
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He, Fang, Shi, Qiucheng, Fu, Ying, Xu, Juan, Yu, Yunsong, and Du, Xiaoxing
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ANTIBIOTICS , *KLEBSIELLA pneumoniae , *DRUG resistance in bacteria , *NOSOCOMIAL infections , *BIOINFORMATICS , *GENETIC mutation - Abstract
Abstract Carbapenem resistant Klebsiella pneumoniae (CRKP) nosocomial infection increased rapidly in recent years. By far, the anti-infection drugs for CRKP infection are limited. Tigecycline is one of the last resort treatments for CRKP infections. In this study, curative effect of tigecycline therapy was monitored in a 59-year-old male patient infected with KPC-producing K. pneumoniae. Consecutive clonal consistent K. pneumoniae isolates were cultured during tigecycline treatment. Whole genome sequencing of the isolates was performed, and bioinformatics analysis was further performed. Five isolates, four of which were susceptible and one resistant were collected. All of the isolates belong to Sequence Type 11 (ST11), and harbouring 11 gene sequences relevant to antibiotic resistance including bla KPC-2. One amino acid substitution V57L in rpsJ was identified in the tigecycline resistant isolates. Subsequent transformation experiment confirmed the contribution of the rpsJ variant (V57L) to reduced tigecycline susceptibility. To our knowledge, this study is the first report to provide direct in vivo evidence that evolution in the rpsJ gene can lead to tigecycline resistance in patients infected with KPC-producing K. pneumoniae during tigecycline treatment. This finding serves as a therapeutic warning as the rpsJ gene is on the chromosome of CRKP strains. Under selective pressure from tigecycline, the rpsJ mutation may occur and lead to tigecycline resistant. Highlights • Curative effect of tigecycline therapy was monitored in a 59-year-old male patient infected with KPC-producing K. pneumoniae. • This study provides direct in vivo evidence that evolution in the rpsJ gene can lead to tigecycline resistance. • This finding serves as a therapeutic warning that the rpsJ mutation may occur under selective pressure from tigecycline. [ABSTRACT FROM AUTHOR]
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- 2018
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59. Epidemiology and Risk Factors for Isolation of Multi-Drug-Resistant Organisms in Patients with Complicated Intra-Abdominal Infections.
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Labricciosa, Francesco M., Sartelli, Massimo, Abbo, Lilian M., Barbadoro, Pamela, Ansaloni, Luca, Coccolini, Federico, and Catena, Fausto
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ANTI-infective agents , *INTRA-abdominal infections , *OPERATIVE surgery , *PANCREATITIS , *PANCREATITIS treatment , *PATIENTS , *THERAPEUTICS , *ANTIBIOTICS , *BACTERIA , *BACTERIAL diseases , *CROSS infection , *DRUG resistance in microorganisms , *RETROSPECTIVE studies , *PHARMACODYNAMICS - Abstract
Background: Patients with complicated intra-abdominal infections (cIAIs) caused by multi-drug-resistant organisms (MDROs) have been identified as being at increased risk for adverse outcomes. Prompt identification and stratification of these patients is essential in the clinical management, allowing the physician timely optimization of empiric antimicrobial therapy while awaiting results of intra-operative cultures to streamline antibiotic treatment.Methods: The study is a secondary analysis from two prospective multi-center color surveillance studies. It included all consecutively hospitalized adult patients undergoing surgical procedures, interventional drainage, or conservative treatment with cIAIs, with positive cultures performer on intra-operative samples of peritoneal fluid or purulent exudate/discrete abscesses. Patients with pancreatitis and primary peritonitis were excluded. A case-control approach has been used to evaluate the factors associated with the isolation of a MDRO in enrolled patients.Results: Among 1986 patients included in the study, a total of 3534 micro-organisms were isolated from intra-peritoneal fluid samples; in 46.5% of cultures, two or more pathogens were identified. The MDROs represented 9.8% of the total of isolated micro-organisms. The overall incidence rate of MDROs was 13.9%. The MDROs were more frequently isolated in patients with health-care-associated cIAIs (25.4%). Multi-nomial logistic regression analysis of risk factors demonstrated that statistically significant risk factors independently associated with the occurrence of MDROs were previous antimicrobial therapy administered within seven days before operation, presence of severe cardiovascular disease, white blood cell count <4000/mL or >12,000/mL, cIAI acquired in a healthcare setting, and inadequate source control.Conclusions: The study showed that knowledge of five easily recognizable variables-assessable on hospital admission or as soon as the surgical intervention is concluded-might guide the surgeon to identify patients with cIAIs caused by MDROs, and therefore to choose the most adequate empiric antimicrobial therapy for them. [ABSTRACT FROM AUTHOR]- Published
- 2018
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60. Detection of Abdominal Abscesses After Colorectal Surgery: Ultrasonography, Computed Tomography and Gallium Scan
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Lin, Wan-Yu, Chai, Jyh-Wen, Chao, Te-Hsin, and Hayat, M. A., editor
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- 2009
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61. Pylephlebitis — a rare complication of a fish bone migration mimicking metastatic pancreatic cancer: A case report
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António Ribeiro Mendes, Nuno J França, Sofia Bezerra, Firmo Mineiro, Cristina Duarte, and Germano Capela
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medicine.medical_specialty ,Pylephlebitis ,business.industry ,Abdominal Infection ,General Medicine ,Pancreatic cancer ,Abdominal infection ,medicine.disease ,Gastroenterology ,Portal vein thrombosis ,Internal medicine ,Metastatic pancreatic cancer ,Case report ,medicine ,Fish bone ,Complication ,business - Abstract
BACKGROUND Pylephlebitis is a rare condition, poorly recognized by clinicians and with few references. In this case, the clinical appearance resembled the clinical course of a pancreatic cancer and was originated by the ingestion of a fish bone, making the case more interesting and rare. CASE SUMMARY A 79-year-old female presented to the emergency department with fever, loss of appetite and jaundice. Tenderness in the right upper quadrant was present. Inflammation marker were high. A computed tomography (CT) scan revealed gallstones and aspects compatible with acute pancreatitis. The patient was admitted to surgery ward and has her condition aggravated. A magnetic resonance revealed multifocal liver lesions. Later, a cholangiopancreatography and an endoscopic ultrasound (US) were able to diagnose the condition. Specific treatment was implemented and the patient made a complete recovery. CONCLUSION In conclusion, this case report demonstrates for the first time the diagnosis of an unusual case of pylephlebitis complicated by the migration of a fish bone, mimicking metastatic pancreatic cancer. Clinical presentation and traditional imaging studies, such as transabdominal US and CT, remain the standard for diagnosing this condition.
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- 2021
62. Hepatic portal venous gas: A case report and analysis of 131 patients using PUBMED and MEDLINE database
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Chun Liu, Jin-Ping Liu, Qing Lan, Chang-Long Li, Wen-Lai Zhou, Wen-Bin Li, Changhui Wu, Jie-Yu Zhao, and Xiang-De Zheng
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medicine.medical_specialty ,business.industry ,Fistula ,Mortality rate ,Abdominal Infection ,Perforation (oil well) ,030208 emergency & critical care medicine ,General Medicine ,Diverticulitis ,medicine.disease ,Gastroenterology ,Appendicitis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Emergency Medicine ,medicine ,Etiology ,business ,Survival rate - Abstract
Objective Hepatic portal pneumatosis has a high mortality rate, and whether surgical intervention is necessary remains controversial. This experiment retrospectively analyzed the etiology, treatment methods and prognosis of adult patients with hepatoportal pneumocele to provide a theoretical basis for the treatment of this disease. Methods We analyzed the clinical symptoms and post-treatment of a 43-year-old male patient with HPVG admitted to hospital. We retrieved adult non-iatrogenic HPVG cases with complete clinical data in PUBMED, and MEDLINE and other databases were retrieved for analysis, and summarized the pathogenesis, clinical symptoms, pathogenesis, pathogenesis and prognosis of different treatment schemes were summarized. Results The main etiology of HPVG are intestinal ischemia (27%), severe enteritis/intestinal perforation/intestinal fistula (16%), intestinal obstruction (7%), abdominal infection (7%), gastric diseases (11%), appendicitis and its complications (5%), acute hemorrhage or necrotizing pancreatitis (5%), Crohn's disease and its complications (4%), trauma (traffic accidents, falls) (2%), diverticulitis and perforation (6%), nephrogenic diseases (4%), spontaneous pneumohepatic portal vein (2%), other reasons (4%). And after analysis, we found that the survival rate of patients treated by surgery was 40.5% and the mortality rate was 19.1%, the difference between the two was significant. Conclusions Etiology should be actively explored and surgical treatment is necessary.
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- 2021
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63. Infectious Enteritis
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Maconi, Giovanni, Tarantino, Luciano, Porro, Gabriele Bianchi, Baert, A. L., editor, Knauth, M., editor, Sartor, K., editor, Maconi, Giovanni, editor, and Porro, Gabriele Bianchi, editor
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- 2007
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64. Abdominal actinomycosis 'imitator' of colon cancer
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Katanić Nataša, Bojović K., Milošević I., Lavadinović L., Aritonović J., Odalović A., and Malinić J.
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actinomycosis ,abdominal infection ,Medicine - Abstract
We present a single case of abdominal actinomycosis occurring in a 52-year-old female with a two months history of illness before presentation. Abdominal actinomycosis is a rare, chronic, granulomatous infection characterized by the release of 'sulphur granules'. Actinomyces species should always be part of the differential diagnosis of patients presenting with a history of surgical or invasive procedures, presenting with an abdominal mass. Diagnosis is often difficult. In less than 10% of cases, the diagnosis is made preoperatively. Definitive diagnosis is often based on histochemical, macroscopic, and microscopic examination of tissue specimens. The disease should be treated with high doses of intravenous penicillin for 2-6 weeks followed by oral therapy for at least 6-12 months.
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- 2014
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65. IN INTRA-ABDOMINAL INFECTIONS AND PERITONITIS
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S. P. Mikhno, A. V. Kotov, and V. I. Desyaterik
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medicine.medical_specialty ,business.industry ,Internal medicine ,Abdominal Infection ,medicine ,Peritonitis ,business ,medicine.disease ,Gastroenterology - Abstract
Summary. Purpose of the reserche. To study changes in microflora and sensitivity of isolated strains to antibiotics using bacteriological research methods for intra-abdominal infections and peritonitis to determine their resistance when planning antibiotic therapy. Results and discussion. The paper presents data from a retrospective analysis of the results of studies of microflora and its resistance in intra-abdominal infections (IAI) and peritonitis for 2 periods: I period — from january 2007 to december 2008, II period — from january 2018 to december 2019. The difference between period II and I was in the increase in the number of individual pathogenic strains of microorganisms. Thus, the number of Klebsiella spp. increased from 13.8 % to 23.8 %, which in absolute number of their total number amounted to a 73.5 %, ranking second in the overall structure among pathogens sown in IAI and peritonitis. The number of strains of Staphylococcus spp., Enterobacter spp., Acinetobacter spp. has also increased by 2.4–5.8 % respectively. Among the strains Klebsiella spp., E. coli and Staphylococcus spp. the number of poly- and multi-polyresistant forms has increased. Thus, the number of such forms among Klebsiella spp. increased from 19.2 to 44.5 %, Staphylococcus spp. — from 43.8 to 67.1 % and E. coli from 18.2 to 23.5 %, respectively. Conclusions. Over the past 10 years, with IAI and peritonitis, the most significant changes were revealed on the part of pathogenic strains of Klebsiella spp., Staphylococcus spp. and Acinetobacter spp. Multidrug resistant strains were predominantly susceptible to carbapenems, semisynthetic ureidopenicillins, aminoglycosides, glycopeptides, oxazalidinones, phosphonoic acid derivatives. In the context of changes in the microbial landscape observed over the past decade, an increase in the number of poly- and multi-resistant forms of pathogenic microorganisms in IAI and peritonitis, the choice of antibiotics for rational therapy should be based solely on bacterioscopy and antibiograms.
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- 2021
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66. A New Device for Measuring Abdominal Wall Tension and Its Value in Screening Abdominal Infection
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Yaoli Wang, Dong Liu, Dongpo Jiang, Yong Guo, Hao Tang, Yang Li, Zhengguo Wang, Lian-Yang Zhang, Hua-Yu Zhang, and Peng Xiaoyu
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Evidence and Research [Medical Devices] ,Biomedical Engineering ,abdominal infection ,Medicine (miscellaneous) ,030209 endocrinology & metabolism ,Positive correlation ,law.invention ,Abdominal wall ,03 medical and health sciences ,0302 clinical medicine ,law ,Medicine ,New device ,abdominal compliance ,Original Research ,business.industry ,Critically ill ,Abdominal Infection ,abdominal wall tension ,Intensive care unit ,intra-abdominal hypertension ,medicine.anatomical_structure ,intra-abdominal pressure ,Anesthesia ,Clinical diagnosis ,Intra-Abdominal Hypertension ,business ,030217 neurology & neurosurgery - Abstract
Hao Tang, Dong Liu, Yong Guo, Huayu Zhang, Yang Li, Xiaoyu Peng, Yaoli Wang, Dongpo Jiang, Lianyang Zhang, Zhengguo Wang Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People’s Republic of ChinaCorrespondence: Zhengguo Wang; Lianyang Zhang Email hpzhangly@163.com; dpzhangly@163.comObjective: This study is the largest clinical study of noninvasive Abdominal wall tension (AWT) measurement with a tensiometer to date. It also initially applies a polynomial regression equation to analyze the correlation between AWT measurement and intravesical pressure (IVP) measurement and remarkably finds interesting changes between different IVP intervals and AWT.Methods: Critically ill patients who were treated in the intensive care unit (ICU) of Daping Hospital, Army Medical University, from August 30, 2018, to June 30, 2020, and met the inclusion criteria were prospectively included in this study. The patients were divided into an intra-abdominal hypertension group and a non-intra-abdominal hypertension group and an abdominal infection group and no abdominal infection group. AWT and IVP were measured at 9 points on the abdominal wall on the first day after admission to the ICU. The correlations between AWTs and IVP were analyzed, and the role of AWT in the diagnosis of complications of abdominal infection and the prediction of adverse prognosis were analyzed.Results: A total of 127 patients were included. The average AWT and IVP were 2.77± 0.38 N/mm and 12.31± 7.01 mmHg, respectively, on the first day of admission. There was a positive correlation between AWT and IVP (correlation coefficient r = 0.706, p < 0.05). The polynomial regression model was AWT= -1.616× 10− 3 IVP2 +8.323× 10− 2 IVP+2.094. The cutoff value of the sensitivity and specificity of AWT for the diagnosis of abdominal infection was 2.57 N/mm. Furthermore, AWT = 2.57 N/mm had the best diagnostic efficiency, which was better than that of IAH and lactate.Conclusion: There was a correlation between AWT and IVP. AWT measurement was helpful in the diagnosis of IAH and abdominal infection complications and can therefore serve as a new method for the clinical diagnosis of IVP and abdominal infection.Keywords: intra-abdominal hypertension, abdominal wall tension, intra-abdominal pressure, abdominal compliance, abdominal infection
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- 2021
67. Intra-Abdominal Infections by Carbapenemase-ProducingEnterobacteriaceaein a Surgical Unit: Counting Mortality, Stay, and Costs
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Ismael Mora-Guzmán, Elena Martín-Pérez, Ines Rubio-Perez, and Diego Domingo-Garcia
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Microbiology (medical) ,0303 health sciences ,medicine.medical_specialty ,Carbapenemase-Producing Enterobacteriaceae ,biology ,030306 microbiology ,business.industry ,Abdominal Infection ,Public health ,Carbapenem-resistant enterobacteriaceae ,biology.organism_classification ,Enterobacteriaceae ,03 medical and health sciences ,fluids and secretions ,0302 clinical medicine ,Infectious Diseases ,Internal medicine ,embryonic structures ,medicine ,Antimicrobial stewardship ,Surgery ,030212 general & internal medicine ,business ,Surgical Infections ,Carbapenem resistance - Abstract
Background: Carbapenemase-producing Enterobacteriaceae (CPE)-related infections are a problem in public health at present, including intra-abdominal infections (IAI) and surgical populations. The a...
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- 2021
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68. Debridement and 'Peritoneal Toilet'
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Bohnen, John, Schein, Moshe, editor, and Marshall, John C., editor
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- 2003
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69. A randomized controlled trial comparing the efficacy of tigecycline versus meropenem in the treatment of postoperative complicated intra-abdominal infections
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Hao Wang, Shi-ning Qu, Chu-lin Huang, Hao Zhang, Zhen-Nan Yuan, Xue-zhong Xing, Hai-jun Wang, and Quan-hui Yang
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medicine.medical_specialty ,Tigecycline ,Meropenem ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Clinical endpoint ,medicine ,Humans ,Prospective Studies ,Adverse effect ,Advanced and Specialized Nursing ,business.industry ,Incidence (epidemiology) ,Abdominal Infection ,Intensive care unit ,Anti-Bacterial Agents ,Treatment Outcome ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Intraabdominal Infections ,business ,medicine.drug - Abstract
Background The efficacy and safety of tigecycline in the treatment of complicated intra-abdominal infections (cIAIs) is potentially controversial. Here we conducted the non-inferiority study to assess the efficacy and safety of tigecycline versus meropenem in the treatment of postoperative cIAIs. Methods Data of abdominal tumor surgery patients with postoperative cIAIs admitted to intensive care unit (ICU) between October 2017 and December 2019 were collected. A prospective, randomized controlled trial was conducted in which 56 eligible patients with cIAIs randomly received intravenous tigecycline or meropenem for 3 to 14 days. Patients and clinicians were not blinded to the group allocation. Results The total of 56 patients were enrolled, which were divided into 2 groups, one group included 30 patients receiving meropenem and another group included 26 receiving tigecycline therapy. The 2 groups were similar at demographic and baseline clinical characteristics. Microorganisms were isolated from 46 of 56 patients (82.14%), with a total of 107 pathogens were cultured in two groups. The two groups had similar distribution of infecting microorganisms. The primary end point was the clinical response at the end-oftherapy (EOT) visit and upon discharge visit and comprehensive efficacy. The clinical success rates were 83.33%, 76.67% for meropenem versus 76.92%, 88.46% for tigecycline at the EOT visit and upon discharge visit (P>0.05), respectively. Comprehensive efficacy did not significantly differ between two groups either. There were no significant differences in 30-day and 60-day all-cause mortality between two groups (P>0.05). The univariable analysis identified that serum albumin at admission ICU, colorectal cancer on oncology type, postoperative abdominal bleeding were the risk factors for 60-day all-cause mortality. The multivariable analysis showed that postoperative abdominal bleeding were independent predictors of 60-day all-cause mortality. Gastrointestinal disorders and antibacterials-induced Fungal Infection were the most frequently reported adverse events (AEs). The incidence of AEs was similar between meropenem and tigecycline groups (P>0.05). Conclusions Taken together, the study demonstrated that tigecycline is as effective and safe as meropenem for postoperative cIAIs in abdominal tumors patients. Tigecycline is non-inferior to meropenem.
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- 2021
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70. Bilateral acute renal cortical necrosis after a dog bite: case report
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Maja Weisser, Sandra S Zingg, Simon A. Amacher, Martin Siegemund, Coralie Nkoulou, Raoul Sutter, Alexa Hollinger, Kirstine K. Søgaard, and Adrian Egli
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Adult ,medicine.medical_specialty ,Fulminant ,Dog bite ,Amputation, Surgical ,lcsh:Infectious and parasitic diseases ,Sepsis ,Immunocompromised Host ,03 medical and health sciences ,Dogs ,0302 clinical medicine ,Case report ,medicine ,Animals ,Humans ,Capnocytophaga canimorsus ,lcsh:RC109-216 ,Bites and Stings ,030212 general & internal medicine ,Disseminated intravascular coagulation ,biology ,Septic shock ,business.industry ,Abdominal Infection ,Disseminated Intravascular Coagulation ,medicine.disease ,biology.organism_classification ,Shock, Septic ,Anti-Bacterial Agents ,Surgery ,Acute kidney injury ,Transplantation ,Infectious Diseases ,Reverse rim sign ,Intraabdominal Infections ,Female ,Kidney Cortex Necrosis ,Gram-Negative Bacterial Infections ,business ,Capnocytophaga ,Switzerland ,030217 neurology & neurosurgery - Abstract
Background Capnocytophaga canimorsus is a Gram-negative capnophilic rod and part of dogs/cats’ normal oral flora. It can be transmitted by bites, scratches, or even by contact of saliva with injured skin. Asplenic patients and patients with alcohol abuse are at particular risk for fulminant C. canimorsus sepsis. However, also immunocompetent patients can have a severe or even fatal infection. This is the first case of a severe C. canimorsus infection in an immunocompromised host complicated by acute renal cortical necrosis with a “reverse rim sign” in contrast-enhanced computed tomography on hospital admission. Case presentation We report the case of a 44-year functionally asplenic patient after an allogeneic stem cell transplantation, who presented with septic shock after a minor dog bite injury 4 days prior. Because of abdominal complaints, epigastric pain with local peritonism, and radiological gallbladder wall thickening, an abdominal focus was suspected after the initial work-up. The patient underwent emergent open cholecystectomy, but the clinical suspicion of abdominal infection was not confirmed. Septic shock was further complicated by cardiomyopathy and disseminated intravascular coagulation. As a causative pathogen, C. canimorsus could be isolated. The clinical course was complicated by permanent hemodialysis and extensive acral necrosis requiring amputation of several fingers and both thighs. Conclusion We present a severe case of a C. canimorsus infection in a functionally asplenic patient after a minor dog bite. The clinical course was complicated by septic shock, disseminated intravascular coagulation, and the need for multiple amputations. In addition, the rare form of acute renal failure - bilateral acute renal cortical necrosis – was visible as “reverse rim sign” on computed tomography scan. This case is an example of the potential disastrous consequences when omitting pre-emptive antibiotic therapy in wounds inflicted by cats and dogs, particularly in asplenic patients.
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- 2021
71. Current spectrum of causative pathogens in sepsis: A prospective nationwide cohort study in Japan
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Naoshi Takeyama, Kiyotsugu Takuma, Shin Ichiro Shiraishi, Yutaka Umemura, Toshihiko Mayumi, Daizoh Saitoh, Seitato Fujishima, Masashi Ueyama, Takehiko Tarui, Akiyoshi Hagiwara, Kohji Okamoto, Yuichiro Sakamoto, Norio Yamashita, Toru Hifumi, Taka-aki Nakada, Hiroshi Ogura, Joji Kotani, Kazuma Yamakawa, Tomohiko Masuno, Shigeki Kushimoto, Yasuhiro Otomo, Hiroto Ikeda, Ryosuke Tsuruta, Toshikazu Abe, Yasukazu Shiino, Atsushi Shiraishi, Satoshi Gando, and Junichi Sasaki
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Adult ,Male ,0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Cardiovascular infection ,Epidemiology ,030106 microbiology ,Gram-Positive Bacteria ,Blood culture ,lcsh:Infectious and parasitic diseases ,Cohort Studies ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Internal medicine ,Intensive care ,Gram-Negative Bacteria ,medicine ,Humans ,lcsh:RC109-216 ,Prospective Studies ,030212 general & internal medicine ,medicine.diagnostic_test ,business.industry ,Abdominal Infection ,Bacterial Infections ,General Medicine ,Middle Aged ,medicine.disease ,Antimicrobial ,Anti-Bacterial Agents ,Intensive Care Units ,Infectious Diseases ,Cohort ,Female ,business ,Cohort study - Abstract
Background There is no one-size-fits-all empiric antimicrobial therapy for sepsis because the pathogens vary according to the site of infection and have changed over time. Therefore, updating knowledge on the spectrum of pathogens is necessary for the rapid administration of appropriate antimicrobials. Objective The aim of this study was to elucidate the current spectrum of pathogens and its variation by site of infection in sepsis. Methods This was a prospective nationwide cohort study of consecutive adult patients with sepsis in 59 intensive care units in Japan. The spectrum of pathogens was evaluated in all patients and in subgroups by site of infection. Regression analyses were conducted to evaluate the associations between the pathogens and mortality. Results The study cohort comprised 1184 patients. The most common pathogen was Escherichia coli (21.5%), followed by Klebsiella pneumoniae (9.0%). However, the pattern varied widely by site of infection; for example, gram-positive bacteria were the dominant pathogen in bone/soft tissue infection (55.7%) and cardiovascular infection (52.6%), but were rarely identified in urinary tract infection (6.4%). In contrast, gram-negative bacteria were the predominant pathogens in abdominal infection (38.4%) and urinary tract infection (72.0%). The highest mortality of 47.5% was observed in patients infected with methicillin-resistant Staphylococcus aureus, which was significantly associated with an increased risk of death (odds ratio 1.88, 95% confidence interval 1.22–2.91). Conclusions This study revealed the current spectrum of pathogens and its variation based on the site of infection, which is essential for empiric antimicrobial therapy against sepsis.
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- 2021
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72. Plasma mitochondrial DNA levels are associated with acute lung injury and mortality in septic patients
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Hongmin Zhang, Dawei Liu, Xiaoting Wang, Dongkai Li, and Jia-Yu Mao
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Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Lung injury ,Gastroenterology ,DNA, Mitochondrial ,Severity of Illness Index ,Procalcitonin ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Acute lung injury ,Humans ,Prospective Studies ,Interleukin 6 ,030304 developmental biology ,Aged ,Aged, 80 and over ,lcsh:RC705-779 ,0303 health sciences ,biology ,Plasma mtDNA level ,business.industry ,Abdominal Infection ,Incidence (epidemiology) ,Hazard ratio ,Odds ratio ,lcsh:Diseases of the respiratory system ,Middle Aged ,medicine.disease ,Survival Analysis ,ROC Curve ,biology.protein ,Female ,business ,Biomarkers ,Research Article - Abstract
Background Mitochondrial DNA (mtDNA) is a critical activator of inflammation. Circulating mtDNA released causes lung injury in experimental models. We hypothesized that elevated plasma mtDNA levels are associated with acute lung injury (ALI) in septic patients. Methods We enrolled 66 patients with sepsis admitted to the Department of Critical Care Medicine of Peking Union Medical College Hospital between January 2019 and October 2019. Respiratory, hemodynamic and bedside echocardiographic parameters were recorded. Plasma mtDNA, procalcitonin, interleukin 6, and interleukin 8 levels were examined. Results Plasma mtDNA levels within 24 h after admission were significantly increased in the group of septic patients with ALI [5.01 (3.38–6.64) vs 4.13 (3.20–5.07) log copies/µL, p 0.0172]. mtDNA levels were independently associated with mortality (hazard ratio, 3.2052; 95% CI 1.1608–8.8500; p 0.0253) and ALI risk (odds ratio 2.7506; 95% CI 1.1647–6.4959; p 0.0210). Patients with high mtDNA levels had worse outcomes, and post hoc tests showed significant differences in 28-day survival rates. Increased mtDNA levels were seen in patients with abdominal infection. Conclusions Increased plasma mtDNA levels within 24 h after admission were significantly associated with ALI incidence and mortality in septic patients.
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- 2021
73. Performance of nasal methicillin‐resistant Staphylococcus aureus screening for intra‐abdominal infections in critically ill adult patients
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Chanda Mullen, Bhavin Mistry, Michaelia Cucci, and Sean Bennett
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Male ,Methicillin-Resistant Staphylococcus aureus ,0301 basic medicine ,medicine.medical_specialty ,Critical Illness ,030106 microbiology ,030204 cardiovascular system & hematology ,medicine.disease_cause ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Internal medicine ,medicine ,Humans ,Mass Screening ,Pharmacology (medical) ,Aged ,Retrospective Studies ,business.industry ,Critically ill ,Abdominal Infection ,Middle Aged ,Staphylococcal Infections ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,Intensive care unit ,Methicillin-resistant Staphylococcus aureus ,Staphylococcus aureus ,Intraabdominal Infections ,Population study ,Female ,Diagnosis code ,Nasal Cavity ,business ,Cohort study - Abstract
Study objective Intra-abdominal infections (IAIs) are a common reason for intensive care unit (ICU) admissions, and methicillin-resistant Staphylococcus aureus (MRSA) is an uncommon pathogen in IAIs. Although more data are available in the setting of non-abdominal sources, there are limited data on the performance of nasal MRSA screening for MRSA IAIs. The primary objective of this study was to evaluate the performance of nasal MRSA screening for MRSA IAIs in critically ill adult patients. Design This was a multicenter, retrospective, cohort study. Setting A 14-hospital healthcare system between January 1, 2014, and August 31, 2019. Patients Adult patients admitted to an ICU for at least 24 h with a diagnosis code for an IAI, a nasal MRSA surveillance screen within 30 days, and an intra-abdominal culture were eligible for inclusion. Intervention The primary outcome was to evaluate the performance of nasal MRSA screening for MRSA IAIs by calculating the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Measurements and main results Out of 863 patients randomly screened, a total of 192 patients were included. The study population had a mean age of 60 (SD ±15) years, and 101 (53%) patients were male. Six (3.1%) patients were positive for an MRSA IAI, of which four (66.7%) demonstrated a positive nasal MRSA screen. A total of 186 (96.8%) patients were negative for a MRSA IAI, of which 19 (10.2%) were nasal MRSA-positive and 167 (89.8%) were nasal MRSA-negative. Nasal MRSA screening demonstrated the following performance: accuracy 89.1% (95% CI: 83.8%-93.1%), sensitivity 66.7% (95% CI: 22.3%-95.7%), specificity 89.8% (95% CI: 84.5%-93.7%), PPV 17.4% (95% CI: 9.4%-30.0%), and NPV 98.8% (95% CI: 96.4%-99.6%). There were no significant differences in clinical outcomes, including renal replacement-free days, ICU and hospital length of stay, and in-hospital mortality. Conclusions Among critically ill adult patients with IAIs, a negative nasal MRSA screen within 30 days may help to empirically exclude MRSA as a causative pathogen.
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- 2021
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74. Tigecycline Use in Surgical Intensive Care Unit for the Treatment of Complicated Intra-Abdominal Infections: A Real-World Study
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Xiang Si, Xiangdong Guan, Yao Nie, Fei Pei, and Luhao Wang
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medicine.medical_specialty ,APACHE II ,business.industry ,Abdominal Infection ,Mortality rate ,Incidence (epidemiology) ,Surgical intensive care unit ,Tigecycline ,Single Center ,Internal medicine ,medicine ,Observational study ,business ,medicine.drug - Abstract
OBJECTIVES: To describe real-world use of tigecycline in cIAIs patients. METHODS: A retrospective, observational study enrolled cIAIs patients hospitalized in The First Affiliated Hospital, Sun Yat-sen University from January 1, 2013 to June 30, 2017 was conducted. Patients’ data were collected and matched based on age, gender, and Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score according to receiving first-line, later-line, or no tigecycline during hospitalization. RESULTS: Data were collected for 52 patients. 82.6% were male. Mean age was 57.8 years and APACHE II score was 14.8. The incidence of both extended-spectrum beta-lactamase producing and carbapenem-resistant pathogens was high on initial culture; however, few patients received first-line tigecycline. No significant difference in mortality rate was identified among first-line, later-line and no tigecycline users. Of surviving patients, shorter hospital length of stay was observed for patients receiving first- vs later-line or no tigecycline, respectively. ICU length-of-stay was shorter in patients receiving first- vs later-line or no tigecycline. CONCLUSIONS: First-line tigecycline use was rare in our surgical intensive care unit. Resistant organisms were commonly cultured from initial specimens. Although these results are limited by small patient numbers and single center, our results suggest that early tigecycline use may have significant benefits with similar mortality. Further research is warranted to demonstrate the values of early tigecycline use in cIAIs patients.
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- 2021
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75. Dental Management of a Patient with a Left Temporal Brain Abscess: A Case Report
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Martin Tisdall, Kathryn Harley, and Aliya Hasan
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medicine.medical_specialty ,business.industry ,Cerebral Abscesses ,Abdominal Infection ,Pulmonary disease ,030206 dentistry ,medicine.disease ,Surgery ,Odontogenic ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,business ,General Dentistry ,Brain abscess ,030217 neurology & neurosurgery - Abstract
Cerebral abscesses of odontogenic origin are uncommon. Cerebral abscesses are often caused by cardiac and pulmonary disease or infections such as skin or abdominal infections. However, there have been some reported incidences of cerebral abscesses caused by odontogenic infection. This paper aims to discuss a case report whereby an odontogenic infection was the most probable cause of a cerebral abscess in a paediatric patient. CPD/Clinical Relevance: To discuss the importance of oral disease as a potential causative factor for cerebral infection.
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- 2021
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76. Microbiomic Analysis of Intra-Abdominal Infections by Using Denaturing High-Performance Liquid Chromatography: A Prospective Observational Study.
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Koch, Christian, Amati, Anca L., Hecker, Andreas, Höxter, Marcel, Hirschburger, Marcus, Matejec, Reginald, Padberg, Winfried, Weigand, Marcus A., Lichtenstern, Christoph, Domann, Eugen, and Höxter, Marcel
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INTRA-abdominal infections , *HIGH performance liquid chromatography , *ANTI-infective agents , *METHYLOBACTERIUM , *ENTEROCOCCUS , *ANTIBIOTICS , *BIOCHEMISTRY , *PHENOMENOLOGY , *MICROBIOLOGICAL techniques , *DIAGNOSIS , *SEPSIS - Abstract
Background: Intra-abdominal infections represent a subgroup of septic syndromes with high death rates and the need for prompt and appropriate antimicrobial therapy. Conventional culture-based microbial identification has notable shortcomings in the diagnostics of polymicrobial infections. Modern culture-independent molecular methods may represent a new diagnostic approach. The current study aimed to compare the results obtained from the denaturing high-performance liquid chromatography WAVE® system as a culture-independent diagnostic tool with those obtained from standard culture-based microbiologic testing in the clinical setting of severe intra-abdominal sepsis.Patients and Methods: The study included 42 samples of pathologic intra-abdominal fluids, collected from 37 patients with intra-abdominal sepsis. Micro-organisms grown in culture and detected by the WAVE system were compared. Further, we recorded clinical data including baseline characteristics and the use of antibiotic agents.Results: In 38.1% of the analyzed samples, the classic, culture-based methods showed no bacterial growth on agar plates, in comparison with the microbiomic analysis in which the proportion of samples with negative signal was 31%. In about 40% of the patients, both methods detected one microbiologic agent, whereas in approximately one quarter of the samples, two or more agents were identified. The detection rate of certain bacteria such as Enterobacteriacae or Enterococcus faecium was significantly higher using the microbiomic analysis. Bacteria such as Haemophilus, Lactobacillus, Clostridium, Methylobacterium, Collinsella aerofaciens, and Solobacterium moorei were detected exclusively using microbiomic analysis.Conclusion: The culture independent molecular WAVE system provided additional information, especially concerning unusual, fastidious bacteria in patients with intra-abdominal infections. Further, it has a higher detection rate for polymicrobial infection and delivers results much sooner than conventional microbiologic methods. [ABSTRACT FROM AUTHOR]- Published
- 2017
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77. Surgical Site Infections and Associated Operative Characteristics.
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Waltz, Paul K. and Zuckerbraun, Brian S.
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SURGICAL site , *OPERATIVE surgery , *BLOOD loss estimation , *BLOOD transfusion , *SKIN care products - Abstract
Surgical site infection (SSI) contributes significantly to surgical morbidity. Patient factors and operative factors contribute to the risk of development of SSI. This review focuses on understanding operative characteristics that are associated with an increased risk of SSI. Much attention has been given to protocol care to reduce SSI, such as hair removal, skin preparation, and pre-operative antibiotic agents. Even with this, the appropriate antibiotic and re-dosing regimens often remain a challenge. Other operative factors such as blood loss/transfusion, emergency/urgent cases, duration of the operation, type of anesthesia, and resident involvement are also potentially modifiable to reduce the risk of SSI. Data are reviewed to highlight the increased risk associated with such factors. Strategies to reduce risk, such as operative care bundles, have significant promise to reduce the incidence of SSI for any given procedure. [ABSTRACT FROM AUTHOR]
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- 2017
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78. Age and Its Impact on Outcomes with Intra-Abdominal Infection.
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Farmer, Drew, Tessier, Jeffrey M., Sanders, James M., Sawyer, Robert G., Rotstein, Ori D., Dellinger, E.P., Lipsett, Pamela A., Cuschieri, Joseph, Miller, Preston, Cook, Charles H., Guidry, Christopher A., Askari, Reza, Moore, Billy J., and Duane, Therese M.
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INTRA-abdominal infections , *AGING , *ETIOLOGY of diseases , *SURGICAL site , *INFECTION , *PATIENTS , *ANTIBIOTICS , *AGE distribution , *CLINICAL trials , *RETROSPECTIVE studies , *SURGICAL site infections , *MEDICAL drainage , *THERAPEUTICS - Abstract
Background: Age has been shown to play a significant role in the etiology of complicated intra-abdominal infections (cIAIs), but the correlation between age and outcomes after therapy was not investigated in the Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial.Patients and Methods: Data were obtained by post hoc analysis of the STOP-IT trial database. Patients were stratified by age <65 or ≥65 years. Primary outcomes were surgical site infection (SSI), recurrent IAI (recIAI), and death. Multivariable analysis was performed to identify independent predictors of outcomes.Results: There were 398 subjects <65 and 120 ≥ 65 years. Overall baseline characteristics of the two groups were similar. The site of infection was similar between groups except: Colon or rectum (48.3% vs. 29.9%, p = 0.0002) and biliary tree (16.7% vs. 9.1%, p = 0.02), which were more common in the older group, whereas small intestine (6.7% vs. 16.3%, p = 0.008) and appendix (4.2% vs.17.1%, p = 0.0004) were more common in the younger group. Among the primary outcomes, only death was significantly different between the age groups and was more prevalent in the ≥65 years group (4 [3.3%] vs. 1 [0.3%], p = 0.01). Surgical site infection (9.2% vs. 7.3%, p = 0.50), recIAI (15.8% vs. 14.4%, p = 0.69), and a composite outcome (26.7% vs. 20.4%, p = 0.14) were statistically similar between the age groups, and this remained true when controlling for other co-variables. Multivariable analyses did not reveal age as an independent predictor of the composite or individual outcomes.Conclusion: Patients with a more advanced age demonstrated variable sources of infection relative to the younger cohort, yet received similar treatments. Patient age was not an independent predictor of the undesired cIAI outcomes. These findings suggest that advanced age itself does not play a significant role in predicting these adverse outcomes for cIAIs and does not necessitate an altered treatment tactic. [ABSTRACT FROM AUTHOR]- Published
- 2017
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79. Analysis of prognostic factors in patients with emergency sepsis.
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Ning XL and Shao M
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Background: Emergency sepsis is a common and serious infectious disease, and its prognosis is influenced by a number of factors., Aim: To analyse the factors influencing the prognosis of patients with emergency sepsis in order to provide a basis for individualised patient treatment and care. By retrospectively analysing the clinical data collected, we conducted a comprehensive analysis of factors such as age, gender, underlying disease, etiology and site of infection, inflammatory indicators, multi-organ failure, cardiovascular function, therapeutic measures, immune status and severity of infection., Methods: Data collection: Clinical data were collected from patients diagnosed with acute sepsis, including basic information, laboratory findings, medical history and treatment options. Variable selection: Variables associated with prognosis were selected, including age, gender, underlying disease, etiology and site of infection, inflammatory indicators, multi-organ failure, cardiovascular function, treatment measures, immune status and severity of infection. Data analysis: The data collected are analysed using appropriate statistical methods such as multiple regression analysis and survival analysis. The impact of each factor on prognosis was assessed according to prognostic indicators, such as survival, length of stay and complication rates., Results: Descriptive statistics: Descriptive statistics were performed on the data collected from the patients, including their basic characteristics and clinical presentation., Conclusion: Type 2 diabetes mellitus were independent factors affecting the prognosis of patients with sepsis., Competing Interests: Conflict-of-interest statement: All the authors declare that they have no conflict of interest., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)
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- 2023
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80. Pylephlebitis: a rare complication of an intra-abdominal infection
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Katherine Wong, David S. Weisman, and Kelly-Ann Patrice
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pylephlebitis ,portal vein thrombosis ,abdominal infection ,sepsis ,diverticulitis ,appendicitis ,bacteroides ,Internal medicine ,RC31-1245 - Abstract
Pylephlebitis is defined as an inflamed thrombosis of the portal vein. It is a rare complication of an intra-abdominal infection, and the diagnosis is often missed due to its nonspecific clinical presentation. Symptoms may include abdominal pain, fever, chills, fatigue, nausea, and vomiting. It is important to consider this differential when a patient presents with signs of abdominal sepsis since it has a high mortality rate and is often diagnosed postmortem. Pylephlebitis can be diagnosed via abdominal ultrasound or CT demonstrating a thrombus in the portal vein, and it must be treated early and aggressively with broad-spectrum antibiotics. We are presenting a case of pylephlebitis as well as discussing the diagnosis and treatment of this potentially lethal condition.
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- 2013
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81. Recurrent Appendicitis Caused by a Retained Appendiceal Tip: A Case Report.
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Boardman, Timothy J. and Musisca, Nicholas J.
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APPENDICITIS , *COMPUTED tomography , *ABDOMINAL pain , *SEPSIS , *APPENDECTOMY , *DIFFERENTIAL diagnosis - Abstract
Background: Acute appendicitis is one of the most common surgical emergencies, and it is treated definitively with appendectomy. Recurrent appendicitis is a rare entity, being reported after approximately 1 in 50,000 appendectomies. It is typically caused by inflammation of the appendiceal stump. Inflammation of a retained appendiceal tip is a unique entity that can also cause recurrent appendicitis and presents similarly to primary appendicitis.Case Report: We present a case of a 50-year-old man who had undergone laparoscopic appendectomy 1 year earlier and who subsequently presented with a chief complaint of right lower quadrant abdominal pain. The diagnosis of recurrent appendicitis caused by a retained appendiceal tip was made after a computed tomography scan. The patient underwent successful laparoscopic removal of the retained appendiceal fragment. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The etiology of recurrent appendicitis is separate from the stump appendicitis that has been well described in the literature. Retained tip appendicitis poses a diagnostic dilemma because it is uncommon and, if missed, can lead to complications, such as perforation and severe sepsis. Recurrent appendicitis must be in the differential diagnosis for patients who are post-appendectomy and who present with right lower quadrant abdominal pain. [ABSTRACT FROM AUTHOR]- Published
- 2019
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82. Short and long-term mortality in severe sepsis/septic Shock in a setting with low antibiotic resistance centers
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Negar Mohtadi, Parviz Saleh, and Zeinolabedin Khodaie
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medicine.medical_specialty ,APACHE II ,medicine.diagnostic_test ,Septic shock ,business.industry ,Abdominal Infection ,medicine.medical_treatment ,Immunosuppression ,medicine.disease ,Sepsis ,Internal medicine ,medicine ,SOFA score ,Blood culture ,Risk factor ,business - Abstract
Background: Sepsis, which is a common inflammatory response to severe infection, is one of the major causes of mortality in hospitalized patients. Sepsis, severe sepsis or sepsis syndrome, and eventually septic shock, may be seen in the development of infection. The aim of this study was to evaluate the short-term and long-term mortality in patients with severe sepsis and septic shock in centers with low antibiotic resistance. Methods: In this cross-sectional study, blood culture samples and peripheral blood samples were taken from all patients for para-clinical tests. The severity of severe sepsis and septic shock was assessed by the APACHE II and SOFA clinical criteria. Sepsis risk factors and primary causes of sepsis were recorded. Results: From 100 patients, 55% had severe sepsis and 45% had septic shock. SOFA24h and SOFA96h scores were significantly higher in patients with septic shock. The most common primary cause of sepsis was related to abdominal infections with a frequency of 42%. The frequency of confirmed positive blood culture was 53%. The most commonly isolated pathogen was E.coli with a frequency of 66%. Short-term mortality was 29% and long-term mortality was 28.2%. Conclusion: The main risk factors affecting the mortality of patients were age-related septic shock, cardiovascular disease; hypertension, immunosuppression, and SOFA score.
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- 2020
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83. The Potential Prognostic Performance of Neutrophil CD64 and Monocyte HLA-DR in Patients with Complicated Intra-abdominal Infections
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Dimitrov Evgeni, Enchev Emil, Minkov Georgi, Halacheva Krasimira, and Yovtchev Yovcho
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medicine.anatomical_structure ,business.industry ,Abdominal Infection ,Monocyte ,Immunology ,Neutrophil cd64 ,HLA-DR ,medicine ,Immunology and Allergy ,In patient ,business - Abstract
Background: Complicated intra-abdominal infections are still associated with a high risk of an unfavorable outcome. Despite the equal treatment, the mortality rates in some patients’ populations remain significant, especially when the impaired immune response is present. Aim: The object of this research is to analyze the impact of pro-inflammatory neutrophil CD64 and anti-inflammatory monocyte HLA-DR on the final outcome. Methods: We have searched in the PubMed database, the literature relating the prognostic value of two biomarkers - nCD64 and mHLA-DR in patients with complicated intra-abdominal infections and/or sepsis. Results: Eighteen original studies with 2960 patients fulfilled our inclusion criteria. The data about nCD64 that we found was contradictory, whereas low mHLA-DR expression showed good prognostic value. Conclusion : Our review showed heterogeneous data about nCD64 survival prediction. Further investigations with surgical patients exclusively are needed to evaluate its prognostic value in cIAIs. However, we observed a good prognostic performance of low mHLA-DR expression. After a validation in larger multicentre studies, mHLA-DR could be used as promising prognostic biomarker in cIAIs.
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- 2020
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84. Abdominal Drainage in the Prevention and Management of Major Intra-Abdominal Complications after Total Gastrectomy for Gastric Carcinoma
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Oh Jeong, Seong Yeob Ryu, Soo Young Lim, Mi Ran Jung, and Ji Hoon Kang
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Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Anastomosis ,03 medical and health sciences ,0302 clinical medicine ,Gastrectomy ,medicine ,Stage (cooking) ,business.industry ,Abdominal Infection ,Incidence (epidemiology) ,Gastroenterology ,medicine.disease ,Comorbidity ,Surgery ,Oncology ,030220 oncology & carcinogenesis ,Drainage ,030211 gastroenterology & hepatology ,Lymphadenectomy ,Original Article ,Morbidity ,business ,Body mass index - Abstract
Purpose The role of prophylactic abdominal drainage in total gastrectomy is not well-established. This study aimed to evaluate the efficacy of abdominal drainage in the prevention and management of major intra-abdominal complications after total gastrectomy for gastric carcinoma. Materials and methods We retrospectively reviewed the data of 499 patients who underwent total gastrectomy for gastric carcinoma in a high-volume institution. The patients were divided into drainage and non-drainage groups and compared for the development and management of major intra-abdominal complications, including anastomotic leak, abdominal bleeding, abdominal infection, and pancreatic fistulas. Results The drainage group included 388 patients and the non-drainage group included 111 patients. The 2 groups showed no significant differences in clinicopathological characteristics or operative procedures, except for more frequent D2 lymphadenectomies in the drainage group. After surgery, the overall morbidity (drainage group vs. non-drainage group: 24.7% vs. 28.8%, P=0.385) and incidence of major intra-abdominal complications (6.4% vs. 6.3%, P=0.959) did not significantly differ between the two groups. The non-drainage group showed no significant increase in the incidence rate of major intra-abdominal complications in the subgroups divided by age, sex, comorbidity, operative approach, body mass index, extent of lymphadenectomy, and pathological stage. Abdominal drainage had no significant impact on early diagnosis, secondary intervention or reoperation, or recovery from major intra-abdominal complications. Conclusions Prophylactic abdominal drainage showed little demonstrable benefit in the prevention and management of major intra-abdominal complications of total gastrectomy for gastric carcinoma.
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- 2020
85. Temporary Abdominal Closure Is Associated with Increased Risk for Fungal Intra-Abdominal Infections in Trauma Patients
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Obeid N. Ilahi, Javier Enrique Rincon, Grant V. Bochicchio, Ricardo A. Fonseca, Jennifer M. Leonard, Kelly Bochicchio, Qiao Zhang, Rohit R. Rasane, Jose A. Aldana, Maya J. Sorini, and Christina Xinyue Zhang
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Microbiology (medical) ,Laparotomy ,medicine.medical_specialty ,Time Factors ,business.industry ,Abdominal Infection ,Suture Techniques ,Abdominal Injuries ,Surgery ,Injury Severity Score ,Postoperative Complications ,Treatment Outcome ,Infectious Diseases ,Increased risk ,Mycoses ,medicine ,Humans ,Intraabdominal Infections ,Closure (psychology) ,business ,Intra-Abdominal Infection ,Retrospective Studies - Abstract
Background: Fungal infections are associated with increased morbidity and death. Few studies have examined risk factors associated with post-operative fungal intra-abdominal infections (FIAIs) in t...
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- 2020
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86. Management of intra-abdominal-infections: 2017 World Society of Emergency Surgery guidelines summary focused on remote areas and low-income nations
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Elena Bonati, Yoram Kluger, Fausto Catena, Andrew W. Kirkpatrick, Francesco M. Labricciosa, Alain Chichom-Mefire, Vladimir Khokha, Federico Coccolini, Luca Ansaloni, Fikri M. Abu-Zidan, George C. Velmahos, Salomone Di Saverio, Ernest E. Moore, Gustavo Pereira Fraga, Marco Ceresoli, Raul Coimbra, Ionut Negoi, Massimo Sartelli, Helmut Alfredo Segovia Lohse, Giuffrida Mario, Ronald V. Maier, Zaza Demetrashvili, Carlos A. Ordoñez, Dieter G. Weber, Ari Leppäniemi, Walter L. Biffl, Boris Sakakushev, Imtaz Wani, Gennaro Perrone, Perrone, G, Sartelli, M, Giuffrida, M, Chichom-Mefire, A, Labricciosa, F, Abu-Zidan, F, Ansaloni, L, Biffl, W, Ceresoli, M, Coccolini, F, Coimbra, R, Demetrashvili, Z, Di Saverio, S, Fraga, G, Khokha, V, Kirkpatrick, A, Kluger, Y, Leppaniemi, A, Maier, R, Moore, E, Negoi, I, Ordonez, C, Sakakushev, B, Lohse, H, Velmahos, G, Wani, I, Weber, D, Bonati, E, Catena, F, and HUS Abdominal Center
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0301 basic medicine ,Microbiology (medical) ,Low income ,Standardization ,030106 microbiology ,MEDLINE ,Global Health ,Acute cholecystiti ,Antimicrobial resistance ,Diagnostic tools ,Remote area ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,Intra-abdominal infection ,0302 clinical medicine ,Anti-Infective Agents ,Emergency surgery ,Intra-abdominal infections ,Health care ,Acute appendicitis ,Acute cholecystitis ,Acute diverticulitis ,Remote areas ,Humans ,Medicine ,lcsh:RC109-216 ,030212 general & internal medicine ,Ultrasonography ,business.industry ,Abdominal Infection ,General Medicine ,3126 Surgery, anesthesiology, intensive care, radiology ,medicine.disease ,Triage ,3. Good health ,Infectious Diseases ,Acute diverticuliti ,Income ,Intraabdominal Infections ,Acute appendiciti ,Medical emergency ,business - Abstract
Background: Most remote areas have restricted access to healthcare services and are too small andremote to sustain specialist services. In 2017, the World Society of Emergency Surgery (WSES) published guidelines for the management of intra-abdominal infections. Many hospitals, especially those in remote areas, continue to face logistical barriers, leading to an overall poorer adherence to international guidelines. Methods: The aim of this paper is to report and amend the 2017 WSES guidelines for the management of intra-abdominal infections, extending these recommendations for remote areas and low-income countries. A literature search of the PubMed/MEDLINE databases was conducted covering the period up until June 2020. Results: The critical shortages of healthcare workers and material resources in remote areas require the use of a robust triage system. A combination of abdominal signs and symptoms with early warning signs may be used to screen patients needing immediate acute care surgery. A tailored diagnostic step-up approach based on the hospital's resources is recommended. Ultrasound and plain X-ray may be useful diagnostic tools in remote areas. The source of infection should be totally controlled as soon as possible. Conclusions: The cornerstones of effective treatment for intra-abdominal infections in remote areas include early diagnosis, prompt resuscitation, early source control, and appropriate antimicrobial therapy. Standardization in applying the guidelines is mandatory to adequately manage intra-abdominal infections. (c) 2020 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
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- 2020
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87. Accuracy of differences in blood and peritoneal glucose to differentiate between septic and non-septic peritonitis in horses
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Bruna dos Santos, Marcos Jun Watanabe, Carolina Soares Esper, Márcio Garcia Ribeiro, Simony Trevizan Guerra, Henry David Mogollón García, Rodrigo Rosa Giampietro, Juliana de Moura Alonso, Celso Antonio Rodrigues, Gustavo dos Santos Rosa, José Carlos de Figueiredo Pantoja, Regina Kiomi Takahira, Carlos Alberto Hussni, Ana Liz Garcia Alves, and Universidade Estadual Paulista (Unesp)
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Blood Glucose ,Male ,medicine.medical_specialty ,040301 veterinary sciences ,Peritonitis ,Septic peritonitis ,Gastroenterology ,0403 veterinary science ,03 medical and health sciences ,Glucose concentration ,Nucleated cell ,Internal medicine ,medicine ,Animals ,Ascitic Fluid ,Horses ,Positive test ,030304 developmental biology ,0303 health sciences ,General Veterinary ,business.industry ,Abdominal Infection ,Peritoneal fluid ,Bacterial Infections ,04 agricultural and veterinary sciences ,Abdominal infection ,medicine.disease ,Clinical Practice ,Glucose ,Specificity ,Female ,Horse Diseases ,business - Abstract
Made available in DSpace on 2020-12-12T02:13:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-10-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Difference in blood and peritoneal glucose (DBPG) is used in clinical practice to support a diagnosis of septic peritonitis in horses. It is inexpensive, easy and rapid to perform. The aim of this study was to evaluate the accuracy of the DBPG to differentiate between septic and non-septic peritonitis in horses. Blood and peritoneal fluids were harvested from suspected animals. Plasma and peritoneal glucose levels, total nucleated cell count, direct microscopic and microbiological examinations of the peritoneal fluid were evaluated. Using DBPG levels, the animals were classified into two groups: difference ≥ 50 mg/dL (positive test) and difference < 50 mg/dL (negative test). Positive microbiological examination and/or presence of bacteria in direct microscopic examination was used as a gold standard to detect septic peritonitis. The accuracy parameters analysed were: sensitivity, specificity, and positive/negative predictive values, for which the results were respectively: 0.23, 0.91, 0.60 and 0.67. Due to poor accuracy, other cut-off margins and peritoneal glucose concentrations were evaluated. The test was considered most accurate when the DBPG was zero with sensitivity, specificity, and positive/negative predictive values of 0.85, 0.82, 0.73, 0.90 respectively. Peritoneal glucose concentrations alone were not a reliable feature to detect peritonitis. DBPG ≥50 mg/dL, widely used for the diagnosis of septic peritonitis, does not have a good accuracy and the DBPG = 0 has a better accuracy for detecting the disease. Department of Veterinary Surgery and Animal Reproduction School of Veterinary Medicine and Animal Science Univ. Estadual Paulista (Unesp) Department of Animal Production and Preventive Veterinary Medicine School of Veterinary Medicine and Animal Science Univ. Estadual Paulista (Unesp) Department of Internal Medicine Botucatu Medical School Univ. Estadual Paulista (Unesp) Department of Veterinary Clinics School of Veterinary Medicine and Animal Science Univ. Estadual Paulista (Unesp) Department of Veterinary Surgery and Animal Reproduction School of Veterinary Medicine and Animal Science Univ. Estadual Paulista (Unesp) Department of Animal Production and Preventive Veterinary Medicine School of Veterinary Medicine and Animal Science Univ. Estadual Paulista (Unesp) Department of Internal Medicine Botucatu Medical School Univ. Estadual Paulista (Unesp) Department of Veterinary Clinics School of Veterinary Medicine and Animal Science Univ. Estadual Paulista (Unesp) FAPESP: 2016/08712-8 e 2018/ 16013-8
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- 2020
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88. Prognostic factors in older patients admitted in ICU with diagnosis of abdominal sepsis (sepsis-3 criteria)
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Savino Spadaro, Alberto Fogagnolo, Carlo Alberto Volta, Francesca Remelli, Amedeo Zurlo, and Stefano Volpato
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quickSOFA ,Aging ,medicine.medical_specialty ,elderly, abdominal sepsis, intensive care, quickSOFA ,business.industry ,Mortality rate ,Abdominal Infection ,medicine.disease ,elderly ,Intensive care unit ,NO ,law.invention ,Sepsis ,Abdominal sepsis ,law ,Intensive care ,Internal medicine ,abdominal sepsis ,medicine ,SOFA score ,Observational study ,Geriatrics and Gerontology ,business ,intensive care - Abstract
Background & aims. In septic older patients, hospitalization in Intensive Care Unit (ICU) is often associated with unfavourable outcomes. The aim of this study was to estimate the prevalence of geriatric age in patients admitted to ICU for abdominal sepsis and to investigate predictors of mortality, including quickSOFA, a recent prognostic index proposed for septic patients. Methods. Prospective observational study on patients admitted to ICU of St. Anna Hospital (Ferrara) between January and July 2016 with the following inclusion criteria: 1) adults (18 years); 2) abdominal infection treated with surgically techniques; 3) admission to ICU. Demographic, clinical data and survival at 30 and 90-day were collected for each patient. Results. Thirty patients were enrolled, and the majority of geriatric patients (80% ≥ 65 years and 53% ≥ 75 years). The 30 and 90-day mortality was 17 and 37%, respectively. Almost all deaths occurred in older age (mortality rate of 42%). SOFA (Sepsis Related Organ Failure Assessment) score was the prognostic index most frequently associated with exitus at 30 (AUC = 0.702) and 90 days (AUC = 0.730). quickSOFA was only related to early mortality (AUC = 0.640). Conclusions. Our data confirm the high geriatric prevalence among patients admitted to ICU for abdominal sepsis, underlining the advanced age as a negative prognostic factor. SOFA score appears a reliable prognostic indicator of mortality, also in older population, while quickSOFA proved effective only for short-term mortality.
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- 2020
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89. Eravacycline for the treatment of complicated intra‐abdominal infections
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Hongmei Wang, Namphi Nguyen, and Christopher Cruz
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chemistry.chemical_compound ,medicine.medical_specialty ,Antibiotic resistance ,chemistry ,business.industry ,Abdominal Infection ,Internal medicine ,medicine ,General Medicine ,Eravacycline ,business - Published
- 2020
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90. Association between postoperative fluid balance and mortality and morbidity in critically ill patients with complicated intra-abdominal infections: a retrospective study
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Joohyun Sim, Jae Young Kwak, and Yun Tae Jung
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medicine.medical_specialty ,business.industry ,Pleural effusion ,Abdominal Infection ,critically ill ,Retrospective cohort study ,complicated intra-abdominal infection ,Critical Care and Intensive Care Medicine ,Critical Care Nursing ,medicine.disease ,Intensive care unit ,law.invention ,law ,Anesthesia ,Anesthesiology ,Propensity score matching ,Medicine ,Original Article ,Surgery ,business ,Survival rate ,fluid overload ,Abdominal surgery - Abstract
BACKGROUND Postoperative fluid overload may increase the risk of developing pulmonary complications and other adverse outcomes. We evaluated the impact of excessive fluid administration on postoperative outcomes in critically ill patients. METHODS We reviewed the medical records of 320 patients admitted to intensive care unit (ICU) after emergency abdominal surgery for complicated intra-abdominal infection (cIAI) between January 2013 and December 2018. The fluid balance data of the patients were reviewed for a maximum of 7 days. The patients were grouped based on average daily fluid balance with a cutoff value of 20 ml/kg/day. Propensity score matching was performed to reduce the underlying differences between the groups. RESULTS Patients with an average daily fluid balance of ≥20 ml/kg/day were associated with higher rates of 30-day mortality (11.8% vs. 2.4%; P=0.036) than those with lower fluid balance (
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- 2020
91. Managing non-IBD fistulising disease
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Samuel O Adegbola, Ailsa Hart, N. Iqbal, Janindra Warusavitarne, Kapil Sahnan, Phil Tozer, Charlene Twum-Barima, Lillian Reza, and Phillip Lung
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Anal fistula ,Anorectal abscess ,medicine.medical_specialty ,Hepatology ,business.industry ,Fistula ,General surgery ,Abdominal Infection ,Gastroenterology ,Diverticulitis ,medicine.disease ,Inflammatory bowel disease ,03 medical and health sciences ,0302 clinical medicine ,Rectovaginal fistula ,medicine ,030211 gastroenterology & hepatology ,030212 general & internal medicine ,Abscess ,business ,Colorectal - Abstract
As well as inflammatory bowel disease, there are a number of other conditions which either predispose to or cause perianal disease. For the most part, these are relatively simple and can be managed by a local specialist but there are cases where more nuanced approach is needed and where tertiary referral maybe more appropriate. In particular, rarer forms of perianal disease such as complex cryptoglandular fistula, rectovaginal fistula (RVF) and those associated with ileoanal pouches are associated with high levels of morbidity, risk and treatment failure. Experience in patient selection, multiple reparative techniques and identifying rare causes are crucial, and where evidence is lacking, this experience is the surgeon’s only weapon. The Association of Coloproctology of Great Britain and Ireland have recently released an updated position statement on anal fistula, once again recognising its complexity and often a lack of high-level evidence for treatment.1 A greater proportion of men suffer from anorectal abscess than women and these occur at a mean age of 40 in both sexes.2–4 Known risk factors associated with developing an abscess include inflammatory bowel disease (IBD), smoking and HIV.5 The most commonly reported symptoms are pain and discharge, causing social embarrassment and loss of quality of life (QoL).6–9 It is thought that approximately 90% of abscesses occur due to cryptoglandular suppuration, with infection of the intersphincteric anal glands which lubricate the passage of stool.10 11 The remaining ~10% of cases are caused by Crohn’s disease (CD), abdominal infections tracking caudally (eg, diverticulitis), penetrative causes (eg, animal bones or by anal digitation),12 perforated cancers (eg, rectal or anal) or post radiotherapy, penetrating ulcers,13 tuberculosis (TB),14 actinomycosis15 or from a complication of local surgical procedures (eg, haemorrhoidectomy, episiotomy) or medical treatment (with nicorandil, which causes perianal or peristomal ulceration …
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- 2020
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92. Abdominal rebleeding after transcatheter arterial embolization for ruptured pseudoaneurysms associated with severe acute pancreatitis: a retrospective study
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Jian Xu, Min Ai, Dazhi Gao, and GuangMing Lu
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medicine.medical_specialty ,Percutaneous ,Urology ,Fistula ,severe acute pancreatitis ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Pseudoaneurysm ,0302 clinical medicine ,intestinal fistula ,Medicine ,cardiovascular diseases ,Original Paper ,medicine.diagnostic_test ,business.industry ,Arterial Embolization ,Abdominal Infection ,Mortality rate ,Gastroenterology ,anatomical position ,Obstetrics and Gynecology ,pseudoaneurysm ,medicine.disease ,Endoscopy ,Surgery ,cardiovascular system ,Acute pancreatitis ,030211 gastroenterology & hepatology ,business ,rebleeding - Abstract
Introduction Patients are at risk of abdominal rebleeding after transcatheter arterial embolization (TAE) for pancreatitis-related pseudoaneurysm, which increases the mortality rate. Aim This study was performed to evaluate the effects of an intestinal fistula (IF) and the anatomical location of the pseudoaneurysm on abdominal rebleeding after TAE of a ruptured pseudoaneurysm associated with severe acute pancreatitis (SAP). Material and methods From February 2013 to November 2019, 24 patients with SAP-related pseudoaneurysm rupture and hemorrhage in our hospital underwent TAE. All patients' epidemiological data and related medical histories were collected and statistically analyzed. We classified the pseudoaneurysms as type I, II, and III according to their anatomical locations and as type A (without an IF) and type B (with an IF). Results The interventions for abdominal infection in patients with type I pseudoaneurysms were percutaneous drainage in 6 patients, endoscopic necrotic tissue removal in 5, and surgical necrotic tissue removal or enterostomy in none, with a rebleeding rate of 33.3% (3/9 patients). The interventions for abdominal infection in patients with type II pseudoaneurysms were percutaneous drainage in 7 patients, endoscopy in three, and surgery in one, with a rebleeding rate of 20.0% (2/10 patients). The interventions for abdominal infection in patients with type III pseudoaneurysms were percutaneous drainage in 3 patients, endoscopy in 1, and surgery in 2, with a rebleeding rate of 80.0% (4/5 patients). There was no statistically significant difference in the types of interventions for abdominal infection among patients with type I, II, and III pseudoaneurysms (p = 0.355) or in the rate of abdominal rebleeding after TAE for type III pseudoaneurysms (p = 0.111). The interventions for abdominal infection in patients with type A pseudoaneurysms were percutaneous drainage in 13 patients, endoscopy in 6, and surgery in 1, with a rebleeding rate of 22.2% (4/18 patients) and mortality rate of 11.1% (2/18 patients). The interventions for abdominal infection in patients with type B pseudoaneurysms were percutaneous drainage in 3 patients, endoscopy in 3, and surgery in 2, with a rebleeding rate of 83.3% (5/6 patients) and mortality rate of 66.7% (4/6 patients). There was no significant difference in the types of interventions for abdominal infection in patients with and without IF (p = 0.215); however, the rebleeding rate and mortality rate were significantly higher in patients with IF (p = 0.015 and 0.018, respectively). Conclusions IF may increase the rate of abdominal rebleeding after TAE for ruptured SAP-related pseudoaneurysms, while the anatomical location of the pseudoaneurysm may not affect the rate of rebleeding after TAE.
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- 2020
93. Current status of laparoscopic radical hilar cholangiocarcinoma in Mainland China
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Yuhua Zhang, Youyao Xu, and Yizhen Chen
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Mainland China ,China ,medicine.medical_specialty ,Health (social science) ,medicine.medical_treatment ,Blood Loss, Surgical ,Anastomotic Leak ,Hepatic Duct, Common ,Negative margin ,Postoperative Hemorrhage ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,0302 clinical medicine ,Laparotomy ,medicine ,Humans ,Hospital Mortality ,Laparoscopy ,medicine.diagnostic_test ,business.industry ,Incidence ,Abdominal Infection ,Incidence (epidemiology) ,Anastomosis, Surgical ,Margins of Excision ,General Medicine ,Length of Stay ,medicine.disease ,Surgery ,Survival Rate ,Klatskin tumor ,Search terms ,Bile Duct Neoplasms ,030220 oncology & carcinogenesis ,Feasibility Studies ,030211 gastroenterology & hepatology ,business ,Follow-Up Studies ,Klatskin Tumor - Abstract
Our purpose was to explore the status of laparoscopic radical resection of hilar cholangiocarcinoma (LRRHcca) in Mainland China. Studies published before February 2020 were retrieved from CNKI database, Pubmed database and Wanfang database. Search terms included "hilar cholangiocarcinoma", "Klatskin tumor", "laparoscopy", "radical operation". Relevant articles regarding LRRHcca in Mainland China were also retrieved. 13 articles were included in this study, with a total of 189 cases. The operation time was 354 min (weighed average, WA), and the mean intraoperative blood loss was 324 mL (WA). The rate of negative margin (R0 rate) was 95.2%, and the number of lymph nodes received was 9.5 (WA). 2.6% of cases were converted to laparotomy. The incidence of postoperative complications was 21.2%, with 3.2% for those classified as Clavien-Dindo ≥ 3, 12.2% for bile leakage, 1.6% for postoperative abdominal hemorrhage, 1.6% for liver insufficiency, and 1.1% for abdominal infection. In-hospital mortality was 0.5%, with mean postoperative hospital stay of 15 days (WA), and the rate of reoperation was 1.1%. The mean postoperative follow-up time was 16 months (WA), and 1-year overall survival rate was 84.5%. In conclusions, laparoscopic radical hilar cholangiocarcinoma is safe and feasible in experienced hands after careful selection of HCCA cases.
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- 2020
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94. Effect of early enteral nutrition on outcomes of trauma patients requiring intensive care
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Peng-Fei Li, Yao-Li Wang, Jian Zhou, Ling Nan, Yu-Li Fang, and Dan Zhang
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Adult ,medicine.medical_specialty ,Time Factors ,Critical Care ,Wound infection ,medicine.medical_treatment ,law.invention ,03 medical and health sciences ,Enteral Nutrition ,0302 clinical medicine ,law ,Internal medicine ,Intensive care ,medicine ,Humans ,Orthopedics and Sports Medicine ,Mortality ,Aged ,lcsh:R5-920 ,030222 orthopedics ,Septic shock ,business.industry ,Abdominal Infection ,030208 emergency & critical care medicine ,Bowel resection ,Length of Stay ,Middle Aged ,medicine.disease ,Length of hospital stay ,Intensive care unit ,Treatment Outcome ,Parenteral nutrition ,Vomiting ,Wounds and Injuries ,Injury Severity Score ,Original Article ,Surgery ,medicine.symptom ,lcsh:Medicine (General) ,Trauma intensive care ,business - Abstract
Purpose: To investigate the effect of early enteral nutrition on outcomes of trauma patients in the intensive care unit (ICU). Methods: Clinical data of trauma patients in the ICU of Daping Hospital, China from January 2012 to December 2017 was retrospectively analyzed, including patient age, gender, injury mechanism, injury severity score (ISS), nutritional treatment, postoperative complications (wound infection, abdominal abscess, anastomotic rupture, pneumonia), mortality, and adverse events (nausea, vomiting, abdominal distention). Only adult trauma patients who developed bloodstream infection after surgery for damage control were included. Patients were divided into early enteral nutrition group (48 h). Data of all trauma patients were collected by the same investigator. Data were expressed as frequency (percentage), mean ± standard deviation (normal distribution), or median (Q1, Q3) (non-normal distribution) and analyzed by Chi-square test, Student's t-test, or rank-sum test accordingly. Multiple logistic regression analysis was further adopted to investigate the significant variables with enteral nutrition. Results: Altogether 876 patients were assessed and 110 were eligible for this study, including 93 males and 17 females, with the mean age of (50.0 ± 15.4) years. Traffic accidents (46 cases, 41.8%) and fall from height (31 cases, 28.2%) were the dominant injury mechanism. There were 68 cases in the early enteral nutrition group and 42 cases in the control group. Comparison of general variables between early enteral nutrition group and control group revealed significant difference regarding surgeries of enterectomy (1.5% vs. 19.0%, p = 0.01), ileum/transverse colon/sigmoid colostomy (4.4% vs. 16.3%, p = 0.01) and operation time (h) (3.2 (1.9, 6.1) vs. 4.2 (1.8, 8.8), p = 0.02). Other variables like ISS (p = 0.31), acute physiology and chronic health evaluation≥20 (p = 0.79), etc. had no obvious difference. Chi-square test showed a much better result in early enteral nutrition group than in control group regarding morality (0 vs. 11.9%, p = 0.03), length of hospital stay (days) (76.8 ± 41.4 vs. 81.4 ± 44.7, p = 0.01) and wound infection (10.3% vs. 26.2%, p = 0.03). Logistic regression analysis showed that the incidence of wound infection was related to the duration required to achieve the enteral nutrition standard (OR = 1.095, p = 0.002). Seventy-six patients (69.1%) achieved the nutritional goal within a week and 105 patients (95.5%) in the end. Trauma patients unable to reach the enteral nutrition target within one week were often combined with abdominal infection, peritonitis, bowel resection, intestinal necrosis, intestinal fistula, or septic shock. Conclusion: Early enteral nutrition for trauma patients in the ICU is correlated with less wound infection, lower mortality, and shorter hospital stay.
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- 2020
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95. Detection of early cytokine storm in patients with septic shock after abdominal surgery
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Aijie Yu, Cui Song, Dong Ge, Shan Liu, Liu Sibo, Rongli Yang, Yanyan Gao, Jiaojiao Chao, Chang Liu, and Yeye Han
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Nephrology ,medicine.medical_specialty ,abdominal infection ,sepsis ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Internal Medicine ,Medicine ,sequential organ failure assessment ,030304 developmental biology ,0303 health sciences ,vasopressor dependency index ,business.industry ,Septic shock ,Abdominal Infection ,Interleukin ,medicine.disease ,030220 oncology & carcinogenesis ,Anesthesia ,cytokine storm ,septic shock ,Original Article ,SOFA score ,business ,Cytokine storm ,Abdominal surgery - Abstract
Objectives: To explore the characteristics of cytokine storm in patients with septic shock after abdominal surgery, examine its relationship with clinical data, and determine intervention timings. Materials and Methods: We prospectively observed a cohort of patients with abdominal infection admitted to the surgical intensive care unit (ICU) after surgery (shock group). A control group of healthy individuals was used for comparison. Plasma samples and clinical data recorded at 0, 12, 24, 48, and 72 h after surgery were collected. Cytokines (tumor necrosis factor-α, interleukin [IL]-6, IL-8, IL-10, monocyte chemotactic protein [MCP]-1, IL-1 β, interferon-γ, IL-12p70, MCP-1α, IL-4, IL-2, and IL-13) were detected using the Luminex® technique. Results: Concentrations of most cytokines were significantly higher in the shock group. When a cytokine storm intensity curve was considered with the vasopressor dependency index and a Sequential Organ Failure Assessment (SOFA) score, time point of maximum cytokine storm intensity was earlier than that of the maximum vasopressor dependency index and SOFA score in the shock group. Conclusions: Cytokine storm occurred in patients with septic shock shortly after the abdominal surgery and may be a main mechanism leading to septic shock. Cytokine storm interventions should ideally be initiated within 24 h after surgery and be guided by cytokine storm biomarkers.
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- 2020
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96. Utility of World Society of Emergency Surgery Sepsis Severity Score in Predicting Outcomes of Intra-abdominal Infections
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Mark N Awori, Kinyua Isaiah Mwenda, and Daniel Ojuka
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medicine.medical_specialty ,business.industry ,Abdominal Infection ,Organ dysfunction ,medicine.disease ,Logistic regression ,Odds ,Sepsis ,Emergency surgery ,Emergency medicine ,medicine ,Surgery ,In patient ,medicine.symptom ,Prospective cohort study ,business - Abstract
Background: Intra-abdominal infections are classified as simple or complicated. Many tools have been studied to predict risk factors and outcomes of patients with intra-abdominal infections. None of these tools has been adopted for patient care at the Kenyatta National Hospital (KNH), Kenya. Objective: To determine the utility of the World Society of Emergency Surgery (WSES) Sepsis Severity Score in predicting short-term outcomes of patients managed for complicated intra-abdominal infections. Methods: We conducted a hospital-based prospective cohort study. Patients aged 18 years and above with complicated intra-abdominal infections were recruited. Data were obtained on demographics, condition at admission, time to source control, origin of infection, immune suppressants and complications. IBM SPSS version 21.0 was used to obtain means and standard deviations while logistic regression was used for associations. Results: A sepsis severity score of 6.5, best predicted mortality having a sensitivity of 80% and a specificity of 20.9% were obtained. For each unit increase in the WSES scores, the odds of mortality were 2.1, organ dysfunction 2.2, CCU admission 2.1. Conclusion: Our sepsis severity score has demonstrated good performance in our adult population, and also ability to predict adverse outcomes other than mortality in patients managed for intra-abdominal sepsis. Keywords: WSES, Sepsis, Sepsis severity score, Intra-abdominal infections
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- 2020
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97. Abdominal infectious complications associated with the dislocation of intraperitoneal part of drainage tube and poor drainage after major surgeries
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Wenping Wang, Xu Guo, Wei Yan, Siqi Liu, Nengwei Zhang, Buhe Amin, Dongbo Lian, Jia Wang, Jirun Peng, Qing Fan, Ming Song, Kai Li, Bao Zhang, Ziliang Han, Yifan Guo, Ke Gong, Guangzhong Xu, Jianlu Zhang, and Bin Zhu
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medicine.medical_specialty ,Peritonitis ,Physical examination ,Dermatology ,Abdominal wall ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Abdomen ,medicine ,Humans ,030212 general & internal medicine ,Drainage ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Abdominal Infection ,Abdominal Abscess ,Abdominal Cavity ,Original Articles ,medicine.disease ,Surgery ,medicine.anatomical_structure ,business ,Abdominal surgery - Abstract
Abdominal drainage, serving as a diagnostic and therapeutic tool, has been widely applied to prevent complications after major abdominal surgical procedures. However, dislocation of intraperitoneal portion of drainage tube and poor drainage after major surgery has never been detailed. In this retrospective study, we determined whether postoperative abdominal infectious complications are attributed to dislocation of intraperitoneal portion of drainage tube. Patients were recruited from the Department of General Surgery at Beijing Shijitan Hospital, Capital Medical University, between June 2015 and June 2018. All of the enrolled patients had undergone different major abdominal surgical procedures with abdominal drainage. According to different fixation methods of the drainage tube, the patients were categorised as follows: group 1 as conventional extra-abdominal fixation where the tubes were fixed on abdominal wall; group 2 as double fixation where the tubes were fixed by both extra-abdominal and intra-abdominal fixation. Among 60 patients (40 in group 1 and 20 in group 2) with suspected postoperative abdominal infection, abdominal computed tomography (CT) was performed to determine the presence of abnormality. Dislocation of drainage tubes, morbidity, treatment, and prognosis were compared between the two groups. None of the patients showed slip knot or drainage tube slipping from the abdomen based on physical examination and CT imaging. Drainage tube was fixed firmly on the abdominal wall. In group 1, 18 (45%) patients developed postoperative complications resulting from abdominal infection where severe dislocation of intraperitoneal portion of drainage tubes was confirmed by CT. Drainage tubes of six cases were significantly dislocated to the anterior abdominal wall from the target area; 7 upper abdominal drainage tubes dislocated to the lower abdomen; and 5 lower abdominal drainage tubes dislocated to the upper abdomen. Common complications included localised peritonitis (n = 4), abdominal abscess (n = 8), and anastomotic leakage (n = 6). Among them, 8 patients were cured by abdominal puncture catheter drainage; 5 underwent secondary operation and 5 were cured by conservative treatment. In group 2, no tube dislocation was identified by CT. Five patients (25%) developed complications, including localised peritonitis (n = 1), abdominal abscess (n = 1), and anastomotic leakage (n = 3). All the five patients were cured by conservative treatment. Postoperative abdominal infection complications can stem from dislocation of intraperitoneal portion of drainage tube and poor drainage after major abdominal surgery. Maintaining the intraperitoneal portion of drainage tube at the proper location, for example, by applying intraabdominal fixation, is paramount to decrease the incidence and severity of postoperative complications.
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98. Poor Outcome Could Be Predicted by Lower Monocyte Human Leukocyte Antigen-DR Expression in Patients with Complicated Intra-Abdominal Infections: A Review
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G. Minkov, Emil Enchev, Krasimira Halacheva, Yovcho Yovtchev, and Evgeni Dimitrov
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Microbiology (medical) ,medicine.medical_specialty ,Monocytes ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Human leukocyte antigen DR ,Internal medicine ,medicine ,HLA-DR ,Humans ,In patient ,030212 general & internal medicine ,Prospective cohort study ,0303 health sciences ,030306 microbiology ,business.industry ,Abdominal Infection ,Monocyte ,HLA-DR Antigens ,Prognosis ,medicine.disease ,Infectious Diseases ,medicine.anatomical_structure ,Intraabdominal Infections ,Biomarker (medicine) ,Surgery ,business ,Biomarkers - Abstract
Complicated intra-abdominal infections (cIAIs) are still associated with high morbidity and mortality levels. Early prognostic evaluation is a great challenge, and a serious amount of resources have been used to find the perfect mortality predictor. Monocyte human leukocyte antigen-DR (mHLA-DR) expression has been studied as a biomarker in patients with sepsis and other infections. Our aim was to evaluate the potential prognostic performance of mHLA-DR in patients with cIAIs. Methods: We performed an electronic search of Google Scholar and PubMed databases for articles published before January 2019. The search terms were "HLA-DR," "monocyte HLA-DR," "intra-abdominal infections," "sepsis," "outcome," and "mortality." Results: A total of 12 studies with 761 patients met our inclusion criteria. In 10 studies, poor outcome was predicted by lower mHLA-DR expression, and two studies showed no prognostic value. Conclusion: This review found association between lower mHLA-DR expression and mortality. We concluded that mHLA-DR could be a reliable and meaningful predictor of poor outcome in patients with cIAIs. Nevertheless, more large prospective studies with surgical patients exclusively are needed before using this biomarker in a clinical setting.
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99. Risk of Postoperative Infectious Complications From Medical Therapies in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
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Deborah Koh, Cindy C.Y. Law, Yueyang Bao, Vipul Jairath, and Neeraj Narula
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Integrins ,medicine.medical_specialty ,Infections ,Inflammatory bowel disease ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Adrenal Cortex Hormones ,Risk Factors ,Internal medicine ,Odds Ratio ,medicine ,Humans ,Immunologic Factors ,Immunology and Allergy ,Prospective Studies ,Mesalamine ,Perioperative Period ,Prospective cohort study ,Digestive System Surgical Procedures ,Retrospective Studies ,business.industry ,Abdominal Infection ,Confounding ,Gastroenterology ,Retrospective cohort study ,Odds ratio ,Inflammatory Bowel Diseases ,medicine.disease ,Confidence interval ,030220 oncology & carcinogenesis ,Meta-analysis ,Tumor Necrosis Factor Inhibitors ,030211 gastroenterology & hepatology ,business - Abstract
ObjectiveTo assess the impact of inflammatory bowel disease (IBD) medications on postoperative infection risk within 30 days of surgery.MethodsWe searched multiple electronic databases and reference lists of articles dating up to August 2018 for prospective and retrospective studies comparing postoperative infection risk in patients treated with an IBD medication perioperatively with the risk in patients who were not taking that medication. Outcomes were overall infectious complications and intra-abdominal infections within 30 days of surgery.ResultsSixty-three studies were included. Overall infectious complications were increased in patients who received anti–tumor necrosis factor (TNF) agents (odds ratio [OR] 1.26; 95% confidence interval [CI], 1.07-1.50) and corticosteroids (OR 1.34; 95% CI, 1.25-1.44) and decreased in those who received 5-aminosalicylic acid (OR 0.63; 95% CI, 0.46-0.87). No difference was observed in those treated with immunomodulators (OR 1.08; 95% CI, 0.94-1.25) or anti-integrin agents (OR 1.06; 95% CI, 0.67-1.69). Both corticosteroids and anti-TNF agents were associated with increased intra-abdominal infection risk (OR 1.63; 95% CI, 1.33-2.00 and OR 1.46; 95% CI, 1.08-1.97, respectively), whereas no impact was observed with 5-aminosalicylates, immunomodulators, or anti-integrin therapy. Twenty-two studies had low risk of bias while the remaining studies had very high risk.ConclusionsCorticosteroids and anti-TNF agents were associated with increased overall postoperative infection risk as well as intra-abdominal infection in IBD patients, whereas no increased risk was observed for immunomodulators or anti-integrin therapy. Although these results may result from residual confounding rather than from a true biological effect, prospective studies that control for potential confounding factors are required to generate higher-quality evidence.
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- 2020
- Full Text
- View/download PDF
100. Antibiotic Resistance in Community-Acquired Intra-Abdominal Infections: Diabetes Mellitus as a Risk Factor
- Author
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Sebastian Nuñez, Jimena Nuñez, Gisella Serruto, Verónica Lacal, María Teresa Verón, and Mariela Soledad Zárate
- Subjects
Male ,Microbiology (medical) ,medicine.medical_specialty ,Microbial Sensitivity Tests ,Diabetes Complications ,Empirical antibiotic therapy ,Antibiotic resistance ,Risk Factors ,Diabetes mellitus ,Internal medicine ,Drug Resistance, Bacterial ,Epidemiology ,medicine ,Humans ,Risk factor ,Intra-Abdominal Infection ,Retrospective Studies ,business.industry ,Abdominal Infection ,Middle Aged ,medicine.disease ,Anti-Bacterial Agents ,Antimicrobial drug ,Community-Acquired Infections ,Infectious Diseases ,Intraabdominal Infections ,Female ,Surgery ,business - Abstract
Background: Antimicrobial drug resistance in community-acquired (CA) infections is a growing problem. Knowing the local epidemiology is essential to design empirical antibiotic therapy. Therefore, ...
- Published
- 2020
- Full Text
- View/download PDF
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