1
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Lange SM, Sharpe EE, Hertzfeldt DN, Schroeder DR, Sviggum HP. Effect of penicillin allergy on prophylactic antibiotic administration in the parturient undergoing cesarean delivery. Acta Anaesthesiol Scand 2021; 65:329-334. [PMID: 33147356 DOI: 10.1111/aas.13730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/07/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Administering antibiotics is often difficult in patients with specific medication allergies. This investigation aimed to determine if a penicillin or cephalosporin allergy increased the risk for not receiving correct timing of prophylactic antibiotics at cesarean delivery. We hypothesized that patients with a penicillin or cephalosporin allergy would be less likely to receive antibiotics prior to incision for cesarean delivery. METHODS All women undergoing cesarean delivery at Mayo Clinic Hospital, from 1 March 2008, to 28 February 2018 were retrospectively identified by electronic medical record query. Patients were grouped based on allergy status to penicillin/cephalosporins. Data recorded included the type and time of antibiotic given in relation to surgical incision. The primary outcome of this study was administration of antibiotics within 60 minutes prior to surgical incision. Characteristics potentially associated with the primary outcome were assessed using logistic regression. RESULTS Of the 818 patients with a penicillin or cephalosporin allergy, 75 (9.2%) did not receive prophylactic antibiotic within 60 minutes prior to skin incision. Conversely, 326 (6.9%) of the 4744 patients without a penicillin or cephalosporin allergy did not receive their prophylactic antibiotic within 60 minutes prior to skin incision (P = .019). Patients undergoing an emergent cesarean delivery were also at an increased risk of not receiving their prophylactic antibiotic within 60 minutes prior to skin incision (P < .001). CONCLUSION Patients with a penicillin or cephalosporin allergy were less likely to receive prophylactic antibiotics within the recommended 60 minutes prior to surgical incision. Clear plans and communication are important for ensuring proper antibiotic administration at cesarean delivery to prevent surgical site infection.
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Affiliation(s)
- Samantha M. Lange
- Department of Anesthesiology and Perioperative Medicine Mayo Clinic Rochester MN USA
| | - Emily E. Sharpe
- Department of Anesthesiology and Perioperative Medicine Mayo Clinic Rochester MN USA
| | - Dana N. Hertzfeldt
- Department of Anesthesiology and Perioperative Medicine Mayo Clinic Rochester MN USA
| | | | - Hans P. Sviggum
- Department of Anesthesiology and Perioperative Medicine Mayo Clinic Rochester MN USA
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2
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Toccafondi G, Di Marzo F, Sartelli M, Sujan M, Smyth M, Bowie P, Cardi M, Cardi M. Will the COVID-19 pandemic transform infection prevention and control in surgery? Seeking leverage points for organizational learning. Int J Qual Health Care 2021; 33:51-55. [PMID: 33432983 PMCID: PMC7802066 DOI: 10.1093/intqhc/mzaa137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/08/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In response to the coronavirus disease of 2019 (COVID-19) pandemic, healthcare systems worldwide have stepped up their infection prevention and control efforts in order to reduce the spread of the infection. Behaviours, such as hand hygiene, screening and cohorting of patients, and the appropriate use of antibiotics have long been recommended in surgery, but their implementation has often been patchy. METHODS The current crisis presents an opportunity to learn about how to improve infection prevention and control and surveillance (IPCS) behaviours. The improvements made were mainly informal, quick and stemming from the frontline rather than originating from formal organizational structures. The adaptations made and the expertise acquired have the potential for triggering deeper learning and to create enduring improvements in the routine identification and management of infections relating to surgery. RESULTS This paper aims to illustrate how adopting a human factors and ergonomics perspective can provide insights into how clinical work systems have been adapted and reconfigured in order to keep patients and staff safe. CONCLUSION For achieving sustainable change in IPCS practices in surgery during COVID-19 and beyond we need to enhance organizational learning potentials.
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Affiliation(s)
- Giulio Toccafondi
- Cinical risk Management and Patient Safety Center, Via Pietro Dazzi 1, 50141, Firenze; Italy
| | - Francesco Di Marzo
- UOC Chirurgia Generale, Ospedale Valtiberina, Sansepolcro, Usl Toscana Sud‐Est, Viale Galileo Galilei, 101, 52037 Sansepolcro AR, Italy
| | - Massimo Sartelli
- UOC Chirurgia Generale, Dipartimento chirurgia maggiore oncologica Ospedale di Macerata, – Asur 9 Via Santa Lucia, 2, 62100 Macerata MC, Italy
| | - Mark Sujan
- Human Factors Everywhere Ltd., UK and Warwick Medical School, University of Warwick Coventry, CV4 7AL, UK
| | - Molly Smyth
- Chartered Institute of Ergonomics and Human Factors, The Courtyard, Wootton Park, Wootton Wawen, Warwickshire B95 6HJ, UK
| | - Paul Bowie
- NHS Education for Scotland, UK, Westport 102, Edinburgh Westport 102, West Port, Edinburgh, EH3, 9DN, UK
| | - Martina Cardi
- Associate Architect of Bryden Wood, UK 100 Gray’s Inn Road, London, UK
| | - Maurizio Cardi
- Università “La Sapienza”, Dipartimento di Chirurgia Pietro Valdoni, Viale del Policlinico, 155 00161, Roma, Italy
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3
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Tapia B, Garrido E, Cebrian JL, Castillo JLD, Alsina E, Gilsanz F. New techniques and recommendations in the management of free flap surgery for head and neck defects in cancer patients. Minerva Anestesiol 2020; 86:861-871. [PMID: 32486605 DOI: 10.23736/s0375-9393.20.13997-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Free flap surgery is the gold standard surgical treatment for head and neck defects in cancer patients. Outcomes have improved considerably, probably due to recent advances in surgical techniques. In this article, we review improvements in the parameters traditionally used to optimize hematocrit levels and body temperature and to prevent vasoconstriction, and describe the use of cardiac output-guided fluid management, a technique that has proved useful in other procedures. Finally, we review other parameters used in free flap surgery, such as clotting/platelet management and nutritional optimization.
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Affiliation(s)
- Blanca Tapia
- Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain -
| | - Elena Garrido
- Department of Anesthesia an Intensive Care, Wexner Medical Center, Columbus, OH, USA
| | - Jose L Cebrian
- Department of Oral and Maxillofacial Surgery, La Paz University Hospital, Madrid, Spain
| | - Jose L Del Castillo
- Department of Oral and Maxillofacial Surgery, La Paz University Hospital, Madrid, Spain
| | - Estibaliz Alsina
- Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain
| | - Fernando Gilsanz
- Department of Anesthesia and Intensive Care, La Paz University Hospital, Madrid, Spain
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Impact of Antimicrobial Stewardship Interventions on Appropriateness of Surgical Antibiotic Prophylaxis: How to Improve. Antibiotics (Basel) 2020; 9:antibiotics9040168. [PMID: 32283597 PMCID: PMC7235845 DOI: 10.3390/antibiotics9040168] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/03/2020] [Accepted: 04/05/2020] [Indexed: 12/18/2022] Open
Abstract
Surgical site infections (SSIs) are the most common healthcare-associated infections. The appropriate use of Surgical Antibiotic Prophylaxis (SAP) is a key component to reduce SSIs, while its inappropriate application is a major cause of some emerging infections and selects for antibiotic resistance. We describe an Antimicrobial Stewardship (AMS) intervention on SAP appropriateness. The prospective study was conducted in an Italian hospital, in 12 main surgical units, and was organized in three subsequent phases, as follows. Phase 0: Definition of hospital evidence-based guidelines and a new workflow to optimize the process of ordering, dispensing, administering and documenting the SAP. Phase 1: We analysed 2059 elective surgical cases from January to June 2018 for three SAP parameters of appropriateness: indication, choice and dose. Phase 2: In July 2018, an audit was performed to analyse the results; we reviewed 1781 elective surgical procedures from July to December 2018 looking for the same three SAP appropriateness parameters. The comparative analysis between phases 1 and 2 demonstrated that the correct indication, the correct dose and the overall compliance significantly improved (p-value 0.00128, p-value < 2.2·1016 and p-value < 5.6·1012 respectively). Our prospective study demonstrates a model of successful antimicrobial stewardship intervention that improves appropriateness on SAP.
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5
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Sartelli M, Pagani L, Iannazzo S, Moro ML, Viale P, Pan A, Ansaloni L, Coccolini F, D’Errico MM, Agreiter I, Amadio Nespola G, Barchiesi F, Benigni V, Binazzi R, Cappanera S, Chiodera A, Cola V, Corsi D, Cortese F, Crapis M, Cristini F, D’Arpino A, De Simone B, Di Bella S, Di Marzo F, Donati A, Elisei D, Fantoni M, Ferrari A, Foghetti D, Francisci D, Gattuso G, Giacometti A, Gesuelli GC, Marmorale C, Martini E, Meledandri M, Murri R, Padrini D, Palmieri D, Pauri P, Rebagliati C, Ricchizzi E, Sambri V, Schimizzi AM, Siquini W, Scoccia L, Scoppettuolo G, Sganga G, Storti N, Tavio M, Toccafondi G, Tumietto F, Viaggi B, Vivarelli M, Tranà C, Raso M, Labricciosa FM, Dhingra S, Catena F. A proposal for a comprehensive approach to infections across the surgical pathway. World J Emerg Surg 2020; 15:13. [PMID: 32070390 PMCID: PMC7029591 DOI: 10.1186/s13017-020-00295-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/10/2020] [Indexed: 02/08/2023] Open
Abstract
Despite evidence supporting the effectiveness of best practices in infection prevention and management, many healthcare workers fail to implement them and evidence-based practices tend to be underused in routine practice. Prevention and management of infections across the surgical pathway should always focus on collaboration among all healthcare workers sharing knowledge of best practices. To clarify key issues in the prevention and management of infections across the surgical pathway, a multidisciplinary task force of experts convened in Ancona, Italy, on May 31, 2019, for a national meeting. This document represents the executive summary of the final statements approved by the expert panel.
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Affiliation(s)
- Massimo Sartelli
- Department of Surgery, Macerata Hospital, ASUR Marche, Macerata, Italy
| | - Leonardo Pagani
- Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy
| | | | - Maria Luisa Moro
- Regional Agency for Health and Social Care, Emilia-Romagna Region–ASSR, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, “Alma Mater Studiorum”-University of Bologna, Bologna, Italy
| | - Angelo Pan
- Infectious Diseases, ASST di Cremona, Cremona, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Federico Coccolini
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Marcello Mario D’Errico
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Iris Agreiter
- Bone Marrow Transplant Unit, Denis Burkitt, St. James’s Hospital, Dublin, Ireland
| | | | - Francesco Barchiesi
- Infectious Diseases Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Valeria Benigni
- Clinical Administration, Senigallia Hospital, ASUR Marche, Senigallia, AN Italy
| | | | - Stefano Cappanera
- Infectious Diseases Clinic, Department of Medicine, “S. Maria” Hospital, Terni, University of Perugia, Perugia, Italy
| | | | - Valentina Cola
- Department of Hospital Pharmacy, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Daniela Corsi
- Department of Anesthesiology and Intensive Care Unit, Civitanova Marche Hospital, ASUR Marche, Civitanova Marche, MC Italy
| | - Francesco Cortese
- Emergency Surgery and Trauma Care Unit, San Filippo Neri Hospital, Rome, Italy
| | - Massimo Crapis
- Infectious Diseases Unit, Pordenone Hospital, Pordenone, Friuli-Venezia Giulia Italy
| | | | - Alessandro D’Arpino
- Hospital Pharmacy Unit, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Belinda De Simone
- Operative Unit of General Surgery, Azienda USL IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Di Bella
- Infectious Diseases Department, Trieste University Hospital, Trieste, Italy
| | | | - Abele Donati
- Department of Anesthesiology and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Daniele Elisei
- Department of Anesthesiology and Intensive Care Unit, Macerata Hospital, ASUR Marche, Macerata, Italy
| | - Massimo Fantoni
- Department of Infectious Diseases, Fondazione Policlinico A. Gemelli IRCCS, Istituto di Clinica delle Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy
| | - Anna Ferrari
- Department of Critical Care Medicine Unit, San Filippo Neri Hospital, Rome, Italy
| | - Domitilla Foghetti
- Department of Surgery, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | | | - Gianni Gattuso
- Infectious Diseases Unit, Carlo Poma Hospital, Mantua, Italy
| | - Andrea Giacometti
- Infectious Diseases Clinic, Department of Biological Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | | | - Cristina Marmorale
- Department of Surgery, Marche Polytechnic University of Marche Region, Ancona, Italy
| | - Enrica Martini
- Hospital Hygiene Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | | | - Rita Murri
- Department of Infectious Diseases, Fondazione Policlinico A. Gemelli IRCCS, Istituto di Clinica delle Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy
| | - Daniela Padrini
- Clinical Administration Santa Maria Annunziata Hospital, USL Toscana Centro, Florence, Italy
| | | | - Paola Pauri
- Unit of Microbiology and Virology, Senigallia Hospital, Senigallia, AN Italy
| | | | - Enrico Ricchizzi
- Regional Agency for Health and Social Care, Emilia-Romagna Region–ASSR, Bologna, Italy
| | - Vittorio Sambri
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
- Unit of Microbiology, The Great Romagna Area Hub Laboratory, Pievesestina, Cesena, Italy
| | | | - Walter Siquini
- Department of Surgery, Macerata Hospital, ASUR Marche, Macerata, Italy
| | - Loredana Scoccia
- Unit of Hospital Pharmacy, Macerata Hospital, ASUR Marche, Macerata, Italy
| | - Giancarlo Scoppettuolo
- Infectious Diseases Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriele Sganga
- Division of Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Marcello Tavio
- Infectious Diseases Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Giulio Toccafondi
- Clinical Risk Management and Patient Safety Center, Tuscany Region, Florence, Italy
| | - Fabio Tumietto
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, “Alma Mater Studiorum”-University of Bologna, Bologna, Italy
| | - Bruno Viaggi
- Department of Anesthesiology, Neuro Intensive Care Unit, Florence Careggi University Hospital, Florence, Italy
| | - Marco Vivarelli
- Unit of Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Cristian Tranà
- Department of Surgery, Macerata Hospital, ASUR Marche, Macerata, Italy
| | | | | | - Sameer Dhingra
- Faculty of Medical Sciences, School of Pharmacy, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Fausto Catena
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
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6
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Karaali C, Emiroğlu M, Çalık B, Sert I, Kebapci E, Kaya T, Budak GG, Akbulut G, Aydın C. Evaluation of Antibiotic Prophylaxis and Discharge Prescriptions in the General Surgery Department. Cureus 2019; 11:e4793. [PMID: 31497412 PMCID: PMC6726339 DOI: 10.7759/cureus.4793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction Although there are international guidelines for surgical antibiotic prophylaxis (SP), the use of inappropriate SP is still a common problem. Most studies investigated SP applications in clean and clean-contaminated cases. However, antibiotics in the discharge prescriptions of these cases have not been adequately investigated. In this study, we aimed to examine the antibiotics in SP applications and discharged prescriptions together and to find out the causes of inappropriate use. Materials and methods We retrospectively evaluated the data of patients admitted to our general surgery wards between 2014 and 2015. Patients with clean or clean-contaminated wound category operations were included. The patients were evaluated in terms of convenience of SP (choice of antibiotics, compliance with an indication for SP, timing of the first dose, SP>24 hours, and discharge prescription). In addition, to interpret the results, a questionnaire has been performed for the surgeons in the same clinics. Results A total of 1205 patients with clean and clean-contaminated wound class operation were enrolled in this study. The total accuracy rate of SP was 7.1%. SP application with the correct indication and timing of the first dose was compatible with guidelines: 55.6% and 81.9%, respectively. SP was applied >24 hours at 60.2% and antibiotic prescribing carried out after discharge at 80.6% of patients. According to questionnaire results, the use of SP over 24 hours and the prescription of antibiotics during discharge were: drain usage, hyperthermia, leukocytosis, surgeons feeling of comfort, avoidance of patients, and their relatives' reactions. Conclusion The total accuracy rate of SP rate was low in the present study and in surgeons prescribing the SP after discharge. In light of the present study, we suggest that discharge prescriptions should also be reviewed in clinics who have a high inappropriate surgical antibiotic prophylaxis rate.
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Affiliation(s)
- Cem Karaali
- General Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, TUR
| | - Mustafa Emiroğlu
- General Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, TUR
| | - Bülent Çalık
- General Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, TUR
| | - Ismaıl Sert
- General Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, TUR
| | - Eyup Kebapci
- General Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, TUR
| | - Tayfun Kaya
- General Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, TUR
| | | | - Gökhan Akbulut
- General Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, TUR
| | - Cengiz Aydın
- General Surgery, University of Health Sciences Tepecik Training and Research Hospital, Izmir, TUR
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7
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Menichetti F, Falcone M, Lopalco P, Tascini C, Pan A, Busani L, Viaggi B, Rossolini GM, Arena F, Novelli A, De Rosa F, Iannazzo S, Cohen J. The GISA call to action for the appropriate use of antimicrobials and the control of antimicrobial resistance in Italy. Int J Antimicrob Agents 2018; 52:127-134. [PMID: 29802887 DOI: 10.1016/j.ijantimicag.2018.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/17/2018] [Accepted: 05/12/2018] [Indexed: 12/21/2022]
Abstract
The spread of antibiotic resistance is one of the leading public health problems in Italy. A European Centre for Disease Prevention and Control country visit recently confirmed the major challenges and made important suggestions. In response, the Ministry of Health published the National Plan for Antimicrobial Resistance Containment, and a group of experts belonging to the Italian Group of Antimicrobial Stewardship (GISA) convened to develop a summary of practical recommendations. The GISA document is intended for use by practising physicians; it aims to increase the rational use of antimicrobials in the treatment of infections, and to change the culture of infection control of antibiotic-resistant bacteria, through the translation of theoretical knowledge into priority actions. This document has been endorsed by several national scientific societies, and reflects the particular challenges that are faced in Italy. Nevertheless, it is considered that the general principles and approaches discussed are relevant, particularly to other developed economies.
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Affiliation(s)
- Francesco Menichetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Marco Falcone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Pierluigi Lopalco
- Hygiene and Epidemiology Section, Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Carlo Tascini
- Department of Infectious Diseases, Cotugno Hospital, Naples, Italy
| | - Angelo Pan
- Infectious Diseases, Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Luca Busani
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Bruno Viaggi
- NeuroAnesthesia and Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Fabio Arena
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Andrea Novelli
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | | | - Stefania Iannazzo
- Department of Prevention and Innovation, General Direction, Italian Ministry of Health, Rome, Italy
| | - Jonathan Cohen
- Department of Medicine, Brighton & Sussex Medical School, Brighton, UK
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8
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Cai MY, Martin Carreras-Presas F, Zhou PH. Endoscopic full-thickness resection for gastrointestinal submucosal tumors. Dig Endosc 2018; 30 Suppl 1:17-24. [PMID: 29658639 DOI: 10.1111/den.13003] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/11/2017] [Indexed: 02/06/2023]
Abstract
Endoscopic full-thickness resection (EFTR) is a "changing-concept" endoscopic resection technique, which safely allows resecting deep submucosal tumors (SMTs) in the gastrointestinal (GI) wall. It's a highly promising endoscopic procedure that allows full-thickness excision of a small piece of the complete GI wall by using only a flexible endoscope. EFTR is a meeting point between surgery and endoscopy and probably the onset of many prospective combined minimally invasive therapeutic techniques that science will explore. In this review, use of the EFTR technique for gastrointestinal SMTs is highlighted, focusing on some technical aspects, indications, contraindications and outcomes.
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Affiliation(s)
- Ming-Yan Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, Shanghai, China
| | | | - Ping-Hong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, Shanghai, China
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9
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[Multidrug-resistant bacteria in Germany. The impact of sources outside healthcare facilities]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 59:113-23. [PMID: 26446586 DOI: 10.1007/s00103-015-2261-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Currently, there is an ongoing discussion about the question whether the emergence of multidrug-resistant microorganisms (MDRO) among humans is due to transfer of these bacteria from animals. OBJECTIVES This review summarizes data on the occurrence of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase (ESBL) producing enterobacteria in animals and humans, and describes knowledge about transmission pathways. MATERIAL AND METHODS After a scientific literature analysis, relevant articles were identified by screening of titles and abstracts, amended by publications of infection control authorities and the respective reference lists. RESULTS MDRO are both transmitted in the nosocomial setting and are increasingly detected as sources of infection outside healthcare facilities. CONCLUSIONS Due to new transmission pathways of MDRO an inter-disciplinary approach towards prevention is necessary, involving medical, pharmaceutical and veterinary expertise.
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10
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Sartelli M, Duane TM, Catena F, Tessier JM, Coccolini F, Kao LS, De Simone B, Labricciosa FM, May AK, Ansaloni L, Mazuski JE. Antimicrobial Stewardship: A Call to Action for Surgeons. Surg Infect (Larchmt) 2016; 17:625-631. [PMID: 27828764 DOI: 10.1089/sur.2016.187] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Despite current antimicrobial stewardship programs (ASPs) being advocated by infectious disease specialists and discussed by national and international policy makers, ASPs coverage remains limited to only certain hospitals as well as specific service lines within hospitals. The ASPs incorporate a variety of strategies to optimize antimicrobial agent use in the hospital, yet the exact set of interventions essential to ASP success remains unknown. Promotion of ASPs across clinical practice is crucial to their success to ensure standardization of antimicrobial agent use within an institution. To effectively accomplish this standardization, providers who actively engage in antimicrobial agent prescribing should participate in the establishment and support of these programs. Hence, surgeons need to play a major role in these collaborations. Surgeons must be aware that judicious antibiotic utilization is an integral part of any stewardship program and necessary to maximize clinical cure and minimize emergence of antimicrobial resistance. The battle against antibiotic resistance should be fought by all healthcare professionals. If surgeons around the world participate in this global fight and demonstrate awareness of the major problem of antimicrobial resistance, they will be pivotal leaders. If surgeons fail to actively engage and use antibiotics judiciously, they will find themselves deprived of the autonomy to treat their patients.
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Affiliation(s)
| | - Therese M Duane
- 2 Department of Surgery, John Peter Smith Health Network , Fort Worth, Texas
| | - Fausto Catena
- 3 Department of Emergency Surgery, Maggiore Hospital , Parma, Italy
| | - Jeffrey M Tessier
- 4 Department of Infectious Diseases, John Peter Smith Health Network , Fort Worth, Texas
| | | | - Lillian S Kao
- 6 Department of Surgery, McGovern Medical School, University of Texas Health Science Center , Houston, Texas
| | | | - Francesco M Labricciosa
- 7 Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health , UNIVPM, Ancona, Italy
| | - Addison K May
- 8 Department of Surgery, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Luca Ansaloni
- 5 Department of Surgery, Papa XXIII Hospital , Bergamo, Italy
| | - John E Mazuski
- 9 Department of Surgery, Section of Acute and Critical Care Surgery, Washington University School of Medicine , St. Louis, Missouri
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12
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Kaya S, Aktas S, Senbayrak S, Tekin R, Oztoprak N, Aksoy F, Firat P, Yenice S, Oncul A, Gunduz A, Solak S, Kadanali A, Cakar SE, Caglayan D, Yilmaz H, Bozkurt I, Elmaslar T, Tartar AS, Aynioglu A, Kocyigit NF, Koksal I. An Evaluation of Surgical Prophylaxis Procedures in Turkey: A Multi-Center Point Prevalence Study. Eurasian J Med 2016; 48:24-8. [PMID: 27026760 DOI: 10.5152/eurasianjmed.2015.15222] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate compliance with guidelines in surgical prophylaxis (SP) procedures in Turkey. MATERIALS AND METHODS A point prevalence study involving 4 university, 5 education and research and 7 public hospitals was performed assessing compliance with guidelines for antibiotic use in SP. Compliance was based on the "Clinical Practice Guidelines for Antimicrobial Surgery (CPGAS) 2013" guideline. RESULTS Sixteen centers were included in the study, with 166 operations performed at these being evaluated. Parenteral antibiotic for SP was applied in 161 (96.9%) of these. Type of antibiotic was inappropriate in 66 (40.9%) cases and duration of use in 47 (29.1%). The main antibiotics used inappropriately in SP were ceftriaxone, glycopeptides and aminoglycosides. No significant difference was observed between secondary and tertiary hospitals in terms of inappropriate selection. Duration of prophylaxis was also incompatible with guideline recommendations in approximately half of surgical procedures performed in both secondary and tertiary hospitals, however statistical significance was observed between institutions in favor of tertiary hospitals. CONCLUSION Antibiotics are to a considerable extent used in a manner incompatible with guidelines even in tertiary hospitals in Turkey. It must not be forgotten that several pre-, intra- and postoperative factors can be involved in the development of surgical site infections (SSI), and antibiotics are not the only option available for preventing these. A significant improvement can be achieved in prophylaxis with close observation, educational activities, collaboration with the surgical team and increasing compliance with guidelines. All health institutions must establish and apply their own SP consensus accompanied by the guidelines in order to achieve success in SP.
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Affiliation(s)
- Selcuk Kaya
- Department of Infectious Diseases and Microbiology, Karadeniz Technical University School of Medicine, Trabzon; Hospital Infections Prevention and Control Committee, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Seyhan Aktas
- Hospital Infections Prevention and Control Committee, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Seniha Senbayrak
- Clinic of Infectious Diseases and Clinical Microbiology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Recep Tekin
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine Diyarbakır, Turkey
| | - Nefise Oztoprak
- Clinic of Infectious Diseases and Clinical Microbiology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Firdevs Aksoy
- Clinic of Infectious Diseases and Clinical Microbiology, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Pinar Firat
- Clinic of Infectious Diseases and Clinical Microbiology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Sevinc Yenice
- Infection Control Committee, Zonguldak Obstetrics and Pediatric Diseases Hospital, Zonguldak, Turkey
| | - Ahsen Oncul
- Clinic of Infectious Diseases and Clinical Microbiology, Şişli Etfal Training and Research Hospital, İstanbul, Turkey
| | - Alper Gunduz
- Clinic of Infectious Diseases and Clinical Microbiology, Şişli Etfal Training and Research Hospital, İstanbul, Turkey
| | - Semiha Solak
- Clinic of Infectious Diseases and Clinical Microbiology, Yıldırım Beyazıt University, Yenimahalle Training and Research Hospital, Ankara, Turkey
| | - Ayten Kadanali
- Clinic of Infectious Diseases and Clinical Microbiology, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Sule Eren Cakar
- Clinic of Infectious Diseases and Clinical Microbiology, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Derya Caglayan
- Clinic of Infectious Diseases and Clinical Microbiology, İzmir M. Enver Şenerdem Torbalı Public Hospital, İzmir, Turkey
| | - Hava Yilmaz
- Clinic of Infectious Diseases and Clinical Microbiology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Ilkay Bozkurt
- Clinic of Infectious Diseases and Clinical Microbiology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Tulin Elmaslar
- Clinic of Infectious Diseases and Clinical Microbiology, Ardahan State Hospital, Ardahan, Turkey
| | - Ayse Sagmak Tartar
- Clinic of Infectious Diseases and Clinical Microbiology, Cizre State Hospital, Cizre, Turkey
| | - Aynur Aynioglu
- Clinic of Infectious Diseases and Clinical Microbiology, İzmir Kemalpaşa Public Hospital, İzmir, Turkey
| | - Nilgun Fidan Kocyigit
- Clinic of Infectious Diseases and Clinical Microbiology, Zonguldak Atatürk Public Hospital, Zonguldak, Turkey
| | - Iftihar Koksal
- Department of Infectious Diseases and Microbiology, Karadeniz Technical University School of Medicine, Trabzon; Hospital Infections Prevention and Control Committee, Karadeniz Technical University School of Medicine, Trabzon, Turkey
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