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Matsubara Y, Kawanami S, Kinoshita G, Kurose S, Shinichiro Y, Morisaki K, Furuyama T, Yoshizumi T. Perioperative therapeutic antibiotics are beneficial to prevent exacerbation of limb-associated infection after bypass surgery in patients with critical limb-threatening ischemia and foot infection score of ≥1. Vascular 2024; 32:640-647. [PMID: 36719423 DOI: 10.1177/17085381231154608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Postoperative limb infection is associated with a poor prognosis and a low amputation-free survival rate after surgical revascularization in patients with critical limb-threatening ischemia. The Global Vascular Guidelines 2019 recommend antibiotic therapy for patients with deep space foot infection or wet gangrene; however, no study is cited as evidence for this recommendation. The present study was performed to offer new evidence supporting the use of perioperative therapeutic antibiotics in patients with critical limb-threatening ischemia (CLTI) undergoing surgical revascularization. METHODS This single-center retrospective study was performed in Kyushu University Hospital and involved patients with CLTI who underwent surgical revascularization from 2003 to 2021. Ampicillin/sulbactam and cefazolin were defined as preventive antibiotics, and other types were defined as therapeutic antibiotics. Postoperative limb-associated infection was defined as an increased foot infection (fI) score in the Wound, Ischemia, and foot Infection (WIfI) classification system after surgical revascularization. The association between perioperative antibiotic therapy and postoperative limb-associated infection was assessed. RESULTS Among 286 limbs of 263 patients with CLTI, 27 (9%) limbs developed postoperative limb-associated infection after surgical revascularization. The fI scores were significantly higher in the patients with than without postoperative limb-associated infection (1.0 ± 0.2 vs 0.4 ± 0.1, respectively; p = 0.0033), indicating that an fI score of ≥1 was a risk factor for postoperative limb-associated infection. Perioperative therapeutic antibiotics significantly reduced the incidence of postoperative limb-associated infection compared with preventive antibiotics (0.0% vs. 44.8%, respectively; p = 0.0028) in the patients with CLTI who had an fI score of ≥1 after bypass surgery, although perioperative therapeutic antibiotics were not effective for patients with an fI score of 0. CONCLUSION Perioperative therapeutic antibiotics for patients with an fI score of ≥1 are beneficial for reducing the incidence of postoperative limb-associated infection after surgical revascularization.
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Affiliation(s)
- Yutaka Matsubara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shogo Kawanami
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Go Kinoshita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shun Kurose
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Vascular Surgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Yoshino Shinichiro
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Vascular Surgery, Kyushu Medical Center, Fukuoka, Japan
| | - Koichi Morisaki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tadashi Furuyama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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2
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Park YY, Lee SH. Korean perspectives of surgical site infection surveillance: an interim analysis of SSI rates in abdominal surgery before and after SSI prevention bundle education. J Hosp Infect 2024; 146:199-205. [PMID: 37301231 DOI: 10.1016/j.jhin.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/13/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Y Y Park
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, South Korea
| | - S-H Lee
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, South Korea.
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3
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Tucker KJ, Ham Y, Holmer HK, McCracken CM, Sukerman E, Lewis JS, McGregor JC. Utility of beta-lactam allergy assessment in patients receiving vancomycin for surgical prophylaxis. SURGERY IN PRACTICE AND SCIENCE 2024; 16:100232. [PMID: 38915860 PMCID: PMC11195622 DOI: 10.1016/j.sipas.2023.100232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
Background Beta-lactam antibiotics are first-line agents for most patients receiving antimicrobial prophylaxis in surgical procedures. Despite evidence showing low cross-reactivity between penicillins and cephalosporins, patients with beta-lactam allergies commonly receive vancomycin as an alternative to avoid allergic reaction. Methods Adult patients receiving vancomycin for surgical prophylaxis with a reported beta-lactam allergy at our institution between August 2017 to July 2018 were retrospectively evaluated for potential eligibility for penicillin allergy testing and/or receipt of standard prophylaxis. Results Among 830 patients who received vancomycin for surgical prophylaxis, 196 reported beta-lactam allergy and were included in the analysis. Approximately 40 % of surgeries were orthopedic. Of patients receiving vancomycin as first-line therapy, 189 (96.4 %) were potentially eligible for beta-lactam prophylaxis. Conclusions Patients with beta-lactam allergies often qualify for receipt of a first-line antibiotic. An opportunity exists for improved allergy assessment as an antimicrobial stewardship intervention in surgical prophylaxis.
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Affiliation(s)
- Kendall J. Tucker
- Department of Pharmacy Practice, College of Pharmacy, Oregon State University, United States
| | - YoungYoon Ham
- Department of Pharmacy, Oregon Health & Science University, Portland, OR, United States
| | | | - Caitlin M. McCracken
- Department of Pharmacy Practice, College of Pharmacy, Oregon State University, United States
| | - Ellie Sukerman
- Division of Infectious Diseases, School of Medicine, Oregon Health & Science University, Portland Oregon, United States
| | - James S. Lewis
- Department of Pharmacy, Oregon Health & Science University, Portland, OR, United States
| | - Jessina C. McGregor
- Department of Pharmacy Practice, College of Pharmacy, Oregon State University, United States
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4
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Giamarellou H, Galani L, Karavasilis T, Ioannidis K, Karaiskos I. Antimicrobial Stewardship in the Hospital Setting: A Narrative Review. Antibiotics (Basel) 2023; 12:1557. [PMID: 37887258 PMCID: PMC10604258 DOI: 10.3390/antibiotics12101557] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
The increasing global threat of antibiotic resistance, which has resulted in countless fatalities due to untreatable infections, underscores the urgent need for a strategic action plan. The acknowledgment that humanity is perilously approaching the "End of the Miracle Drugs" due to the unjustifiable overuse and misuse of antibiotics has prompted a critical reassessment of their usage. In response, numerous relevant medical societies have initiated a concerted effort to combat resistance by implementing antibiotic stewardship programs within healthcare institutions, grounded in evidence-based guidelines and designed to guide antibiotic utilization. Crucial to this initiative is the establishment of multidisciplinary teams within each hospital, led by a dedicated Infectious Diseases physician. This team includes clinical pharmacists, clinical microbiologists, hospital epidemiologists, infection control experts, and specialized nurses who receive intensive training in the field. These teams have evidence-supported strategies aiming to mitigate resistance, such as conducting prospective audits and providing feedback, including the innovative 'Handshake Stewardship' approach, implementing formulary restrictions and preauthorization protocols, disseminating educational materials, promoting antibiotic de-escalation practices, employing rapid diagnostic techniques, and enhancing infection prevention and control measures. While initial outcomes have demonstrated success in reducing resistance rates, ongoing research is imperative to explore novel stewardship interventions.
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Affiliation(s)
- Helen Giamarellou
- 1st Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, 4 Erythrou Stavrou & Kifisias, Marousi, 15123 Athens, Greece; (L.G.); (T.K.); (I.K.)
| | - Lamprini Galani
- 1st Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, 4 Erythrou Stavrou & Kifisias, Marousi, 15123 Athens, Greece; (L.G.); (T.K.); (I.K.)
| | - Theodoros Karavasilis
- 1st Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, 4 Erythrou Stavrou & Kifisias, Marousi, 15123 Athens, Greece; (L.G.); (T.K.); (I.K.)
| | - Konstantinos Ioannidis
- Clinical Pharmacists, Hygeia General Hospital, 4 Erythrou Stavrou & Kifisias, Marousi, 15123 Athens, Greece;
| | - Ilias Karaiskos
- 1st Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, 4 Erythrou Stavrou & Kifisias, Marousi, 15123 Athens, Greece; (L.G.); (T.K.); (I.K.)
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5
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Lu H, Liu S, Wang A, Yang H, Liang X, Chen X, Li Q. Transmission and regulation insights into antibiotic resistance genes in straw-sludge composting system amended with calcium peroxide. BIORESOURCE TECHNOLOGY 2023; 386:129539. [PMID: 37488016 DOI: 10.1016/j.biortech.2023.129539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Abstract
This study developed a Fenton-like system by adding calcium peroxide (CaO2) to a composting system containing straw and sludge. The objective was to examine the influence of antibiotic resistance genes (ARGs) and the structure of the bacterial community. The findings indicated that the inclusion of CaO2 facilitated the reduction of ARGs. ARGs abundance in the test group (T) with CaO2 was 19.02% lower than that in the control check group (CK) without CaO2, and the abundance of ARGs in both groups after composting was lower than the initial abundance. Additionally, the structure of bacterial community in both groups underwent significant changes. Redundancy analysis (RDA) revealed that the CaO2-induced Fenton-like reaction predominantly affected temperature, pH, and the bacterial community by means of reactive oxygen species (ROS). In conclusion, the addition of CaO2 enhanced the removal of ARGs from sewage-sludge and improved compost quality in the composting.
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Affiliation(s)
- Heng Lu
- School of Chemistry and Chemical Engineering, Guangxi University, Nanning 530004, China
| | - Shuaipeng Liu
- School of Chemistry and Chemical Engineering, Guangxi University, Nanning 530004, China
| | - Ao Wang
- School of Chemistry and Chemical Engineering, Guangxi University, Nanning 530004, China
| | - Hongmei Yang
- School of Chemistry and Chemical Engineering, Guangxi University, Nanning 530004, China
| | - Xueling Liang
- School of Chemistry and Chemical Engineering, Guangxi University, Nanning 530004, China
| | - Xiaojing Chen
- School of Chemistry and Chemical Engineering, Guangxi University, Nanning 530004, China
| | - Qunliang Li
- School of Chemistry and Chemical Engineering, Guangxi University, Nanning 530004, China.
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6
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Sartelli M, Boermeester MA, Cainzos M, Coccolini F, de Jonge SW, Rasa K, Dellinger EP, McNamara DA, Fry DE, Cui Y, Delibegovic S, Demetrashvili Z, De Simone B, Gkiokas G, Hardcastle TC, Itani KMF, Isik A, Labricciosa FM, Lohsiriwat V, Marwah S, Pintar T, Rickard J, Shelat VG, Catena F, Barie PS. Six Long-Standing Questions about Antibiotic Prophylaxis in Surgery. Antibiotics (Basel) 2023; 12:antibiotics12050908. [PMID: 37237811 DOI: 10.3390/antibiotics12050908] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Surgical site infections (SSIs) are the most common adverse event occurring in surgical patients. Optimal prevention of SSIs requires the bundled integration of a variety of measures before, during, and after surgery. Surgical antibiotic prophylaxis (SAP) is an effective measure for preventing SSIs. It aims to counteract the inevitable introduction of bacteria that colonize skin or mucosa into the surgical site during the intervention. This document aims to guide surgeons in appropriate administration of SAP by addressing six key questions. The expert panel identifies a list of principles in response to these questions that every surgeon around the world should always respect in administering SAP.
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Affiliation(s)
| | - Marja A Boermeester
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 1105AZ Amsterdam, The Netherlands
| | - Miguel Cainzos
- Department of Surgery, Hospital Clínico Universitario, 15706 Santiago de Compostela, Spain
| | - Federico Coccolini
- Department of Emergency and Trauma Surgery, Pisa University Hospital, University of Pisa, 55126 Pisa, Italy
| | - Stijn W de Jonge
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 1105AZ Amsterdam, The Netherlands
| | - Kemal Rasa
- Department of Surgery, Anadolu Medical Center, 41200 Kocaeli, Turkey
| | | | - Deborah A McNamara
- Department of Colorectal Surgery, Beaumont Hospital, D09V2N0 Dublin, Ireland
| | - Donald E Fry
- Department of Surgery, Northwestern University, Chicago, IL 60208, USA
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin 300100, China
| | - Samir Delibegovic
- Department of Surgery, University Clinical Center of Tuzla, 75000 Tuzla, Bosnia and Herzegovina
| | - Zaza Demetrashvili
- Department General Surgery, Kipshidze Central University Hospital, Tbilisi 0162, Georgia
| | - Belinda De Simone
- Department of Emergency and Metabolic Minimally Invasive Surgery, Centre Hospitalier Intercommunal de Poissy/Saint Germain en Laye, 78300 Poissy CEDEX, France
| | - George Gkiokas
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Timothy C Hardcastle
- Department of Surgery, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, Mayville 4058, South Africa
| | - Kamal M F Itani
- Department of Surgery, VA Boston Health Care System, Boston University and Harvard Medical School, Boston, MA 02118, USA
| | - Arda Isik
- Division of General Surgery, School of Medicine, Istanbul Medeniyet University, 34700 Istanbul, Turkey
| | | | - Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Sanjay Marwah
- Department of Surgery, BDS Post-Graduate Institute of Medical Sciences, Rohtak 124001, India
| | - Tadeja Pintar
- Department of Abdominal Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Vishal G Shelat
- Department of Hepato-Pancreatic-Biliary Surgery, Tan Tok Seng Hospital, Singapore 308433, Singapore
| | - Fausto Catena
- Department of Surgery, "Bufalini" Hospital, 47023 Cesena, Italy
| | - Philip S Barie
- Department of Surgery, Weill Cornell Medicine, E. Northport, New York, NY 11731, USA
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7
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Vecchia M, Colaneri M, Sacchi P, Marvulli LN, Salvaderi A, Lanza J, Boschini S, Ragni F, Marone P, Cutti S, Muzzi A, Marena C, Calvi M, Scudeller L, Marone EM, Bruno R. Implementation of an antimicrobial stewardship program in the Vascular Surgery ward of a university tertiary care hospital in Pavia, Northern Italy. BMC Infect Dis 2023; 23:138. [PMID: 36882761 PMCID: PMC9993681 DOI: 10.1186/s12879-023-08061-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/07/2023] [Indexed: 03/09/2023] Open
Abstract
PURPOSE The commitment of multidisciplinary teams in antimicrobial stewardship programs (ASPs) is often inadequately considered, especially in surgical wards. We wanted to evaluate clinical, microbiological, and pharmacological outcomes before and after the implementation of an ASP in the Vascular Surgery ward of Fondazione IRCCS Policlinico San Matteo, a tertiary care hospital in Pavia, Italy. METHODS This was a quasi-experimental quality-improvement study. The antimicrobial stewardship activity was conducted twice a week for 12 months and consisted of both prospective audit and feedback of all the ongoing antimicrobial prescriptions by the infectious diseases' consultants and educational meetings for the healthcare workers of the Vascular Surgery ward. For comparison between the study periods, Student t test (Mann-Whitney test for skewed distributions) was used for quantitative variables (ANOVA or Kruskall-Wallis for > 2 groups respectively), and Pearson's chi-squared test (Fisher exact test where appropriate) for categorical variables. 2-tailed tests were used. P-value significance cut-off was 0.05. RESULTS During the 12-month intervention period, among a total number of 698 patients, 186 prescriptions were revised, mostly leading to de-escalating an ongoing antimicrobial therapy (39, 20.97%). A statistically significant reduction in isolates of carbapenem-resistant Pseudomonas aeruginosa (p-value 0.003) and the absence of Clostridioides difficile infections were reported. No statistically significant changes were observed in terms of length of stay and all-cause in-hospital mortality. A significant decrease in the administration of carbapenems (p-value 0.01), daptomycin (p-value < 0.01) and linezolid (p-value 0.43) was registered. A significant reduction in antimicrobial costs was also observed. CONCLUSIONS The implementation of a 12-month ASP brought significant clinical and economic results, highlighting the benefits of a multidisciplinary teamwork.
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Affiliation(s)
- Marco Vecchia
- Division of Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Marta Colaneri
- Division of Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Sacchi
- Division of Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lea Nadia Marvulli
- Division of Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Salvaderi
- Division of Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jessica Lanza
- Division of Vascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Boschini
- Division of Vascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Franco Ragni
- Division of Vascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Piero Marone
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Cutti
- Medical Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alba Muzzi
- Medical Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlo Marena
- Medical Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Monica Calvi
- Pharmacy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luigia Scudeller
- Head, Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Enrico Maria Marone
- Division of Vascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, Pavia, Italy
| | - Raffaele Bruno
- Division of Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, Pavia, Italy
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Barie PS, Kao LS, Moody M, Sawyer RG. Infection or Inflammation: Are Uncomplicated Acute Appendicitis, Acute Cholecystitis, and Acute Diverticulitis Infectious Diseases? Surg Infect (Larchmt) 2023; 24:99-111. [PMID: 36656157 DOI: 10.1089/sur.2022.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: It is recognized increasingly that common surgical infections of the peritoneal cavity may be treated with antibiotic agents alone, or source control surgery with short-course antimicrobial therapy. By extension, testable hypotheses have emerged that such infections may not actually be infectious diseases, but rather represent inflammation that can be treated successfully with neither surgery nor antibiotic agents. The aim of this review is to examine extant data to determine which of uncomplicated acute appendicitis (uAA), uncomplicated acute calculous cholecystitis (uACC), or uncomplicated mild acute diverticulitis (umAD) might be amenable to management using supportive therapy alone, consistent with the principles of antimicrobial stewardship. Methods: Review of pertinent English-language literature and expert opinion. Results: Only two small trials have examined whether uAA can be managed with observation and supportive therapy alone, one of which is underpowered and was stopped prematurely because of challenging patient recruitment. Data are insufficient to determine the safety and efficacy of non-antibiotic therapy of uAA. Uncomplicated acute calculous cholecystitis is not primarily an infectious disease; infection is a secondary phenomenon. Even when bactibilia is present, there is no high-quality evidence to suggest that mild disease should be treated with antibiotic agents. There is evidence to indicate that antibiotic prophylaxis is indicated for urgent/emergency cholecystectomy for uACC, but not in the post-operative period. Uncomplicated mild acute diverticulitis, generally Hinchey 1a or 1b in current nomenclature, does not benefit from antimicrobial agents based on multiple clinical studies. The implication is that umAD is inflammatory and not an infectious disease. Non-antimicrobial management is reasonable. Conclusions: Among the considered disease entities, the evidence is strongest that umAD is not an infectious disease and can be treated without antibiotic agents, intermediate regarding uACC, and lacking for uAA. A plausible hypothesis is that these inflammatory conditions are related to disruption of the normal microbiome, resulting in dysbiosis, which is defined as an imbalance of the natural microflora, especially of the gut, that is believed to contribute to a range of conditions of ill health. As for restorative pre- or probiotic therapy to reconstitute the microbiome, no recommendation can be made in terms of treatment, but it is not recommended for prevention of primary or recurrent disease.
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Affiliation(s)
- Philip S Barie
- Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Lillian S Kao
- Department of Surgery, UTHealth Houston John P. and Kathrine G. McGovern Medical School, Houston, Texas, USA
| | - Mikayla Moody
- Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| | - Robert G Sawyer
- Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
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Clinical Outcomes of Single Versus Double Anaerobic Coverage for Intra-abdominal Infections. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2022. [DOI: 10.1097/ipc.0000000000001175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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10
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Membrilla-Fernández E, Gómez-Zorrilla S, González-Castillo AM, Pelegrina-Manzano A, Guzmán-Ahumada J, Prim N, Echeverria-Esnal D, Grau-Cerrato S, Horcajada-Gallego JP, Badía JM, Sancho-Insenser JJ. Scientific evidence of the duration of antibiotic treatment in intra-abdominal infections with surgical focus control. Cir Esp 2022; 100:608-613. [PMID: 35760316 DOI: 10.1016/j.cireng.2022.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/22/2022] [Indexed: 06/15/2023]
Abstract
A non-systematic review of the published scientific evidence has been carried out on the duration of empirical antibiotic treatment in surgical intra-abdominal infections (IIA) with effective focus control. Given the progressive increase in antibiotic resistance, it is urgent to have strategies to reduce the pressure on the microbiota. The American guidelines made by Mazuski et al. of 20171, as the central axis in the recommendations of the duration of empirical antibiotic treatment in intra-abdominal infections with control of the focus and a bibliographic search of all the articles that contained the keywords in Pubmed and Google Scholar is added. 21 articles referring to the duration of empirical antibiotic treatment in intra-abdominal infection with control of the focus are collected. With the American guidelines and these articles, a proposal is prepared for the duration of empirical antibiotic treatment in patients without risk factors between 24 and 72 h. And in those who present risk factors, it should be individualized with active monitoring every 24 h of fever, paralytic ileus and leukocytosis (FIL), before an early detection of complications or the need for changes in antibiotic treatment. Short treatments are just as effective as those of longer durations and are associated with fewer adverse effects, therefore, daily adjusting and reassessing the duration of empirical antibiotic treatment is essential for better practice.
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Affiliation(s)
| | | | | | | | - Juan Guzmán-Ahumada
- Servicio de Cirugía General y Aparato Digestivo, Hospital del Mar de Barcelona, Spain
| | - Nuria Prim
- Servicio de Microbiología, Laboratorio de Referencia de Cataluña, Spain
| | | | | | | | - Josep María Badía
- Servicio de Cirugía General y Aparato Digestivo, Hospital de Granollers, Universitat Internacional de Catalunya, Spain
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11
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Schena CA, de’Angelis GL, Carra MC, Bianchi G, de’Angelis N. Antimicrobial Challenge in Acute Care Surgery. Antibiotics (Basel) 2022; 11:antibiotics11101315. [PMID: 36289973 PMCID: PMC9598495 DOI: 10.3390/antibiotics11101315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 12/07/2022] Open
Abstract
The burden of infections in acute care surgery (ACS) is huge. Surgical emergencies alone account for three million admissions per year in the United States (US) with estimated financial costs of USD 28 billion per year. Acute care facilities and ACS patients represent boost sanctuaries for the emergence, development and transmission of infections and multi-resistant organisms. According to the World Health Organization, healthcare-associated infections affected around 4 million cases in Europe and 1.7 million in the US alone in 2011 with 39,000 and 99,000 directly attributable deaths, respectively. In this scenario, antimicrobial resistance arose as a public-health emergency that worsens patients’ morbidity and mortality and increases healthcare costs. The optimal patient care requires the application of comprehensive evidence-based policies and strategies aiming at minimizing the impact of healthcare associated infections and antimicrobial resistance, while optimizing the treatment of intra-abdominal infections. The present review provides a snapshot of two hot topics, such as antimicrobial resistance and systemic inflammatory response, and three milestones of infection management, such as source control, infection prevention, and control and antimicrobial stewardship.
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Affiliation(s)
- Carlo Alberto Schena
- Unit of Digestive and HPB Surgery, CARE Department, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Gian Luigi de’Angelis
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
- Correspondence:
| | - Maria Clotilde Carra
- Rothschild Hospital, AP-HP, Université Paris Cité, U.F.R. of Odontology, 75006 Paris, France
| | - Giorgio Bianchi
- Unit of Digestive and HPB Surgery, CARE Department, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Nicola de’Angelis
- Unit of Digestive and HPB Surgery, CARE Department, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
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Vallicelli C, Minghetti M, Sartelli M, Coccolini F, Ansaloni L, Agnoletti V, Bravi F, Catena F. Antibiotic De-Escalation in Emergency General Surgery. Antibiotics (Basel) 2022; 11:antibiotics11091148. [PMID: 36139928 PMCID: PMC9495047 DOI: 10.3390/antibiotics11091148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background. Antibiotic treatment in emergency general surgery (EGS) is a major challenge for surgeons, and a multidisciplinary approach is necessary in order to improve outcomes. Intra-abdominal infections are at high risk of increased morbidity and mortality, and prolonged hospitalization. An increase in multi-drug resistance bacterial infections and a tendency to an antibiotic overuse has been described in surgical settings. In this clinical scenario, antibiotic de-escalation (ADE) is emerging as a strategy to improve the management of antibiotic therapy. The objective of this article is to summarize the available evidence, current strategies and unsolved problems for the optimization of ADE in EGS. Methods. A literature search was performed on PubMed and Cochrane using “de-escalation”, “antibiotic therapy” and “antibiotic treatment” as research terms. Results. There is no universally accepted definition for ADE. Current evidence shows that ADE is a feasible strategy in the EGS setting, with the ability to optimize antibiotic use, to reduce hospitalization and health care costs, without compromising clinical outcome. Many studies focus on Intensive Care Unit patients, and a call for further studies is required in the EGS community. Current guidelines already recommend ADE when surgery for uncomplicated appendicitis and cholecystitis reaches a complete source control. Conclusions. ADE in an effective and feasible strategy in EGS patients, in order to optimize antibiotic management without compromising clinical outcomes. A collaborative effort between surgeons, intensivists and infectious disease specialists is mandatory. There is a strong need for further studies selectively focusing in the EGS ward setting.
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Affiliation(s)
- Carlo Vallicelli
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, 47521 Cesena, Italy
- Correspondence:
| | - Margherita Minghetti
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, 47521 Cesena, Italy
| | | | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, 56124 Pisa, Italy
| | - Luca Ansaloni
- Department of General and Emergency Surgery, Policlinico San Matteo, 27100 Pavia, Italy
| | - Vanni Agnoletti
- Anesthesia, Intensive Care and Trauma Department, Bufalini Hospital, 47521 Cesena, Italy
| | - Francesca Bravi
- Healthcare Administration, Santa Maria delle Croci Hospital, 48121 Ravenna, Italy
| | - Fausto Catena
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, 47521 Cesena, Italy
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Membrilla-Fernández E, Gómez-Zorrilla S, González-Castillo AM, Pelegrina-Manzano A, Guzmán-Ahumada J, Prim N, Echeverria-Esnal D, Grau-Cerrato S, Horcajada-Gallego JP, Badía Pérez JM, Sancho-Insenser JJ. Evidencia científica de la duración del tratamiento antibiótico en las infecciones intraabdominales con control de foco quirúrgico. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Creedon M, Humphreys H, Connolly R, Gaughan L, Skally M, Caird J, Duddy J, O'Halloran P, Mandiwanza T, Burns K, Dinesh B, Smyth E, O'Connell K, Fitzpatrick F. Multidisciplinary neurosurgical rounds incorporating antimicrobial stewardship. Are they of benefit? BRAIN AND SPINE 2022; 2:100885. [PMID: 36248101 PMCID: PMC9560698 DOI: 10.1016/j.bas.2022.100885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/23/2022] [Accepted: 03/27/2022] [Indexed: 01/01/2023]
Abstract
Background In an era of increasing antimicrobial resistance, appropriate antimicrobials are essential to optimise patient outcomes. In 2017, antimicrobial use prevalence (AMU) on the two neurosurgical wards in our tertiary teaching hospital varied from 23% on ward A to 33% on ward B with 67% and 100% ‘appropriate’ prescriptions, respectively. In July 2018, a weekly antimicrobial stewardship multidisciplinary round led by a senior neurosurgery registrar commenced, attended by the antimicrobial stewardship team (AST). Research question This report evaluates whether a multi-disciplinary approach on neurosurgical prescribing was beneficial, specifically in reducing AMU. Materials and methods The following data was collected on AST rounds for 30 weeks in total from August 2018 to July 2019: number of patients on antimicrobials, appropriateness and stewardship actions. A questionnaire was distributed to neurosurgical doctors on two occasions to canvass opinions and attitudes on antimicrobial prescribing. Results 1716 prescriptions were reviewed (mean 57.2 per week). Of these 321 (18.7%) included antimicrobial prescriptions; 200 on ward A (19.8%), and 121 on ward B (17%), representing a decrease in AMU from 2017. The majority of antimicrobial prescriptions, 271 (84.4%) were deemed appropriate. Stewardship actions were taken in 215 (67%) prescriptions. Fifteen questionnaires were completed by neurosurgical doctors. The majority, 87%, stated the AST round was helpful overall. 93% indicated that informal training on the AST round was a source of education in antibiotic prescribing. Discussion and conclusion The weekly AST round provided a timely opportunity for multidisciplinary discussion, implementation of antimicrobial stewardship actions and opportunistic antimicrobial stewardship education. Surgeons need to be directly involved in antimicrobial stewardship to optimise patient outcomes and reduce antimicrobial resistance. A multidisciplinary antimicrobial stewardship (AST) ward round led by neurosurgery commenced in our hospital in 2018. Antimicrobial stewardship actions were taken in 67% of prescriptions, and antimicrobial use prevalence reduced in 2018 compared to 2017. A questionnaire distributed to neurosurgical doctors on the value of the AST round indicated that 87% of neurosurgical doctors found it helpful. We believe leadership and accountability were crucial to the success of the ward round, as neurosurgeons contributed directly to decision making.
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Bashar MA, Miot J, Shoul E, van Zyl RL. Impact of an antibiotic stewardship programme in a surgical setting. S Afr J Infect Dis 2021; 36:307. [PMID: 34917678 PMCID: PMC8661296 DOI: 10.4102/sajid.v36i1.307] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/06/2021] [Indexed: 12/20/2022] Open
Abstract
Background Antibiotics are miracles of science and critical for many surgical procedures. However, the emergence of multidrug resistant pathogens resulting from inappropriate antibiotic use is a threat to modern medicine. This study aimed to determine the appropriateness of antibiotic use, cost, consumption and impact of an antibiotic stewardship intervention round in a surgical ward setting. Methods Baseline antibiotic utilisation was determined with a retrospective cross-sectional study in two surgical wards in a tertiary academic hospital in South Africa where medical records of 264 patients who received antibiotics were reviewed. In the second stage of the study, records of 212 patients who received antibiotics were reviewed during a weekly antibiotic stewardship intervention round. The volume of antibiotics consumed was determined using defined daily doses (DDDs)/1000 patients' days, and the appropriateness of the antibiotic prescription for treatment was also determined using a quality-of-use algorithm. Results There was a reduction in the volume of antibiotic consumption from a total 739.30 DDDs/1000 to 564.93 DDDs/1000 patient days, with reduction in inappropriate antibiotic use from 35% to 26% from baseline to antibiotic stewardship programme stages, respectively. There was an overall increase in culture targeted therapy in both wards in the antibiotic stewardship programme stage. Conclusion The implementation of an antibiotic stewardship programme led to a reduction in antibiotic consumption and improvement in appropriate use of antibiotics.
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Affiliation(s)
- Muhammad A Bashar
- Pharmacology Division, Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Pharmacology and Therapeutics, College of Health Sciences, Federal University Birnin Kebbi, Birnin Kebb, Nigeria
| | - Jacqui Miot
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Evan Shoul
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Robyn L van Zyl
- Pharmacology Division, Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Gruber MM, Weber A, Jung J, Werner J, Draenert R. Impact and Sustainability of Antibiotic Stewardship on Antibiotic Prescribing in Visceral Surgery. Antibiotics (Basel) 2021; 10:antibiotics10121518. [PMID: 34943730 PMCID: PMC8698864 DOI: 10.3390/antibiotics10121518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Antibiotic stewardship (AS) ward rounds are a core element in clinical care for surgical patients. Therefore, we aimed to analyze the impact of surgical AS ward rounds on antibiotic prescribing, and the sustainability of the effect after the AS interventions are no longer provided. METHODS On four wards of the department of visceral surgery, we conducted two independent retrospective prescribing analyses (P1, P2) over three months each. During the study periods, the level of AS intervention differed for two of the four wards (ward rounds/no ward rounds). RESULTS AS ward rounds were associated with a decrease in overall antibiotic consumption (91.1 days of therapy (DOT)/100 patient days (PD) (P1), 70.4 DOT/100PD (P2)), and improved de-escalation rates of antibiotic therapy (W1/2: 25.7% (P1), 40.0% (P2), p = 0.030; W3: 15.4 (P1), 24.2 (P2), p = 0.081). On the ward where AS measures were no longer provided, overall antibiotic usage remained stable (71.3 DOT/100PD (P1), 74.4 DOT/100PD (P2)), showing the sustainability of AS measures. However, the application of last-resort compounds increased from 6.4 DOT/100PD to 12.1 DOT/100PD (oxazolidinones) and from 10.8 DOT/100PD to 13.2 DOT/100PD (carbapenems). CONCLUSIONS Antibiotic consumption can be reduced without negatively affecting patient outcomes. However, achieving lasting positive changes in antibiotic prescribing habits remains a challenge.
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Affiliation(s)
- Magdalena Monika Gruber
- Antibiotic Stewardship Team, University Hospital, LMU Munich, 81377 München, Germany; (M.M.G.); (A.W.); (J.J.)
- Hospital Pharmacy, University Hospital, LMU Munich, 81377 München, Germany
| | - Alexandra Weber
- Antibiotic Stewardship Team, University Hospital, LMU Munich, 81377 München, Germany; (M.M.G.); (A.W.); (J.J.)
- Hospital Pharmacy, University Hospital, LMU Munich, 81377 München, Germany
| | - Jette Jung
- Antibiotic Stewardship Team, University Hospital, LMU Munich, 81377 München, Germany; (M.M.G.); (A.W.); (J.J.)
- Max von Pettenkofer Institute, Faculty of Medicine, LMU Munich, 81377 München, Germany
| | - Jens Werner
- Department of General, Visceral und Transplantation Surgery, University Hospital, LMU Munich, 81377 München, Germany;
| | - Rika Draenert
- Antibiotic Stewardship Team, University Hospital, LMU Munich, 81377 München, Germany; (M.M.G.); (A.W.); (J.J.)
- Correspondence:
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Kotwani A, Kapur A, Singhal S, Wattal C. Is the education of human and animal healthcare professionals about antimicrobial resistance and stewardship adequate during their pre-service training? Indian J Med Microbiol 2021; 39:439-445. [PMID: 34511310 DOI: 10.1016/j.ijmmb.2021.08.458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This paper explores inclusion of topics on antimicrobial resistance (AMR) and antimicrobial stewardship (AMS) in pre-service human and animal healthcare professional curricula as mandated in the first strategic objective of National Action Plan on Antimicrobial Resistance. METHODS Online versions of pre-service medical [Bachelor of Medicine, Bachelor of Surgery (MBBS)], dental [Bachelor of dental sciences (BDS)], pharmacy [Bachelor of Pharmacy (B Pharm)], veterinary [Bachelor of veterinary science and animal husbandry (B.V.Sc. & A.H.)] and post graduate medical [Doctor of medicine (MD), Master of surgery (MS) and post graduate (PG) medical diploma courses] curricula and hardcopy of nursing (Bachelor of science (BSc) Nursing-Basic) curricula were assessed. Validated search terms were used for identifying individual learning topics, domains of learning and number of hours of learning related to AMS and AMR. Recent edition of commonly referred medical textbooks were manually checked for inclusion of chapters or separate sections on AMR and AMS. RESULTS Low coverage and poor depth with no mention of required duration of learning for AMR and AMS was observed across the majority of curricula. MS, BDS, B Pharm and BSc nursing curricula did not include AMR and AMS. Out of twenty-three textbooks assessed, only six textbooks included AMS. Gynecology, Obstetrics, Orthopedic and Surgery textbooks did not include separate section on AMR or AMS. CONCLUSIONS Our study documented inadequate inclusion of AMR and AMS in pre-service medical, dental, nursing, pharmacy and veterinary curricula and post graduate medical curriculum. Standardized education regarding AMR and AMS in multi-professional curricula by educational councils across sectors and updating of medical textbooks of all the subjects by authors/publishers for adequate emphasis on these topics is urgently needed for success of 'One health' in combating AMR.
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Affiliation(s)
- Anita Kotwani
- Department of Pharmacology, Vallabhbhai Patel Chest Institute, Delhi, India.
| | - Ajita Kapur
- Department of Pharmacology, Vallabhbhai Patel Chest Institute, Delhi, India.
| | - Shubha Singhal
- Department of Pharmacology, Maulana Azad Medical College, Delhi, India.
| | - Chand Wattal
- Institute of Clinical Microbiology & Immunology, Sir Ganga Ram Hospital, New Delhi, India.
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Jaung R, Nisbet S, Gosselink MP, Di Re A, Keane C, Lin A, Milne T, Su'a B, Rajaratnam S, Ctercteko G, Hsee L, Rowbotham D, Hill A, Bissett I. Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial. Clin Gastroenterol Hepatol 2021; 19:503-510.e1. [PMID: 32240832 DOI: 10.1016/j.cgh.2020.03.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/13/2020] [Accepted: 03/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Antibiotic treatment is the standard care for patients with uncomplicated acute diverticulitis. However, this practice is based on low-level evidence and has been challenged by findings from 2 randomized trials, which did not include a placebo group. We investigated the non-inferiority of placebo vs antibiotic treatment for the management of uncomplicated acute diverticulitis. METHODS In the selective treatment with antibiotics for non-complicated diverticulitis study, 180 patients hospitalized for uncomplicated acute diverticulitis (determined by computed tomography, Hinchey 1a grade) from New Zealand and Australia were randomly assigned to groups given antibiotics (n = 85) or placebo (n = 95) for 7 days. We collected demographic, clinical, and laboratory data and answers to questionnaires completed every 12 hrs for the first 48 hrs and then daily until hospital discharge. The primary endpoint was length of hospital stay; secondary endpoints included occurrence of adverse events, readmission to the hospital, procedural intervention, change in serum markers of inflammation, and patient-reported pain scores at 12 and 24 hrs. RESULTS There was no significant difference in median time of hospital stay between the antibiotic group (40.0 hrs; 95% CI, 24.4-57.6 hrs) and the placebo group (45.8 hrs; 95% CI, 26.5-60.2 hrs) (P = .2). There were no significant differences between groups in adverse events (12% for both groups; P = 1.0), readmission to the hospital within 1 week (1% for the placebo group vs 6% for the antibiotic group; P = .1), and readmission to the hospital within 30 days (11% for the placebo group vs 6% for the antibiotic group; P = .3). CONCLUSIONS Foregoing antibiotic treatment did not prolong length of hospital admission. This result provides strong evidence for omission of antibiotics for selected patients with uncomplicated acute diverticulitis. ACTRN 12615000249550.
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Affiliation(s)
- Rebekah Jaung
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Sherry Nisbet
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Martijn Pieter Gosselink
- Department of Colorectal Surgery, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Angelina Di Re
- Department of Colorectal Surgery, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Celia Keane
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Anthony Lin
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Tony Milne
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Bruce Su'a
- South Auckland Clinical School, University of Auckland, Auckland, New Zealand
| | - Siraj Rajaratnam
- Colorectal Unit, Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Grahame Ctercteko
- Department of Colorectal Surgery, Westmead Hospital, Western Sydney Local Health District, Sydney, Australia
| | - Li Hsee
- Acute Surgical Unit, Department of Surgery, Auckland District Health Board, Auckland, New Zealand
| | - David Rowbotham
- Department of Gastroenterology and Hepatology, Auckland City Hospital, Auckland, New Zealand South Auckland Clinical School, University of Auckland, Auckland, New Zealand
| | - Andrew Hill
- South Auckland Clinical School, University of Auckland, Auckland, New Zealand; Department of Surgery, Counties Manukau Health, Auckland New Zealand
| | - Ian Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand; Colorectal Unit, Department of Surgery, Auckland District Health Board, Auckland, New Zealand.
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Powell N, Stephens J, Rule R, Phillips R, Morphew M, Garry E, Askaroff N, Hiley D, Strachan C, Sheehan M, McDonald C. Potential to reduce antibiotic use in secondary care: Single-centre process audit of prescription duration using NICE guidance for common infections. Clin Med (Lond) 2021; 21:e39-e44. [PMID: 33479082 DOI: 10.7861/clinmed.2020-0141] [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] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Antibiotic use drives antibiotic resistance. Reducing antibiotic use through reducing antibiotic course lengths could contribute to the UK national ambition to reduce total antibiotic use. METHODS Medical notes were reviewed for patients who had received at least 5 days of antibiotic therapy; had been discharged in January 2019; and were from a 750-bed acute secondary care hospital in England. UK national guidelines were used to determine the excess antibiotic use in common medical infections: community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), pyelonephritis, cellulitis, infective exacerbation of chronic obstructive pulmonary disease (IECOPD) and cholangitis. RESULTS Four-hundred and twenty-three patients met the inclusion criteria. Of these, 307 (73%) patient notes were retrieved and reviewed. One-hundred and seventy-three patients met the study case definitions, of which, 137 met short course criteria.Potential antibiotic reductions (measured in defined daily doses) were identified for five of the six infections: 32% in CAP, 20% in HAP, 14% in IECOPD, 11% in cellulitis and 10% in pyelonephritis. These reductions were estimated to reduce total antibiotic use in medical specialties by 12.4%, which equates to 3.6% of the hospital's total antibiotic use. CONCLUSION Clinical application of the evidence-based guidance for shorter antibiotic course lengths appears to be a valid strategy for reducing total antibiotic consumption.
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Affiliation(s)
- Neil Powell
- Royal Cornwall Hospital Trust, Treliske, UK and honorary clinical school fellow, University of Plymouth, Plymouth, UK
| | | | - Rory Rule
- Royal Cornwall Hospital Trust, Treliske, UK
| | | | | | - Emma Garry
- Royal Cornwall Hospital Trust, Treliske, UK
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Robinson ED, Volles DF, Kramme K, Mathers AJ, Sawyer RG. Collaborative Antimicrobial Stewardship for Surgeons. Infect Dis Clin North Am 2020; 34:97-108. [PMID: 32008698 DOI: 10.1016/j.idc.2019.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Antimicrobial stewardship efforts that include surgeons rely on healthy and open communications between surgeons, infectious diseases specialists, and pharmacists. These efforts most frequently are related to surgical prophylaxis, the management of surgical infections, and surgical critical care. Policy should be based on best evidence and timely interactions to develop consensus on how to develop appropriate guidelines and protocols. Flexibility on all sides leads to increasingly strong relationships over time.
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Affiliation(s)
- Evan D Robinson
- Department of Medicine, Division of Infectious Diseases, University of Virginia, PO Box 801340, Charlottesville, VA 22908-1340, USA
| | - David F Volles
- Department of Pharmacy, University of Virginia, PO Box 800674, Charlottesville, VA 22908, USA
| | - Katherine Kramme
- Department of Surgery, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, USA
| | - Amy J Mathers
- Department of Medicine, Division of Infectious Diseases, University of Virginia, PO Box 801340, Charlottesville, VA 22908-1340, USA
| | - Robert G Sawyer
- Department of Surgery, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, USA.
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Heise JW, Kentrup H, Dietrich CG, Cosler A, Hübner D, Krumholz W. Laparoscopic Appendectomy: A Safe and Definitive Solution for Suspected Appendicitis. Visc Med 2020; 37:180-188. [PMID: 34250075 DOI: 10.1159/000510487] [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: 05/15/2020] [Accepted: 07/27/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction Since conservative antibiotic treatment in uncomplicated appendicitis might not solve the clinical problem definitively, it has to compete with the results of today's laparoscopic appendectomy. Methods In a county hospital, accommodating also a pediatric department, all cases of appendectomy for suspected appendicitis over 15 years were analyzed retrospectively for the following items: beginning of symptoms, time from admission to surgery, surgical technique as "open," "laparoscopic" or "converted," if perforated at operation and histological confirmation of acute inflammation. Surgical morbidity was detected in distinct categories. To evaluate changes over time, 3 time periods of 5 years each were defined. Results Resulting in a total of 1,956 cases there were 731 in group I, 633 in group II and 592 in group III within the 3 time periods, respectively. The median age was 17 years. The percentage of perforations was 16.8%. Those patients had - with 47 compared to 27 h - a significantly prolonged time from the beginning of symptoms to admission (p = 0.0001). The proportion of laparoscopic surgery rose from 83.3 (group I) to 98.3% (group III; p = 0.0001). The median postoperative hospital stay diminished from 4 to 3 days in nonperforated (p = 0.0001) and from 8 to 7 days in perforated cases (p = 0.0009). Surgical morbidity was reduced from 4.1% in the first to 1.7% in the third observation period (p = 0.0144). There were no surgical site infections during the last 5 years. Conclusions Timely laparoscopic appendectomy in case of suspected appendicitis can be offered with an extraordinary low morbidity. Taking into account the complete solution of the otherwise pending threat, compared to conservative antibiotic treatment, it is safe and definitive.
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Affiliation(s)
- Joachim Wilfried Heise
- Department of General, Visceral and Thyroid Surgery, Bethlehem Gesundheitszentrum Stolberg (Rhld.), Stolberg, Germany
| | - Heiner Kentrup
- Department of Pediatrics, Bethlehem Gesundheitszentrum Stolberg (Rhld.), Stolberg, Germany
| | | | - Ansgar Cosler
- Department of Gynecology and Obstetrics, Bethlehem Gesundheitszentrum Stolberg (Rhld.), Stolberg, Germany
| | - Dolores Hübner
- Department of Radiology and Pediatric Radiology, Bethlehem Gesundheitszentrum Stolberg (Rhld.), Stolberg, Germany
| | - Werner Krumholz
- Department of Anesthesiology, Bethlehem Gesundheitszentrum Stolberg (Rhld.), Stolberg, Germany
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Amadei SS, Notario V. A Significant Question in Cancer Risk and Therapy: Are Antibiotics Positive or Negative Effectors? Current Answers and Possible Alternatives. Antibiotics (Basel) 2020; 9:E580. [PMID: 32899961 PMCID: PMC7558931 DOI: 10.3390/antibiotics9090580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 12/12/2022] Open
Abstract
Cancer is predominantly considered as an environmental disease caused by genetic or epigenetic alterations induced by exposure to extrinsic (e.g., carcinogens, pollutants, radiation) or intrinsic (e.g., metabolic, immune or genetic deficiencies). Over-exposure to antibiotics, which is favored by unregulated access as well as inappropriate prescriptions by physicians, is known to have led to serious health problems such as the rise of antibiotic resistance, in particular in poorly developed countries. In this review, the attention is focused on evaluating the effects of antibiotic exposure on cancer risk and on the outcome of cancer therapeutic protocols, either directly acting as extrinsic promoters, or indirectly, through interactions with the human gut microbiota. The preponderant evidence derived from information reported over the last 10 years confirms that antibiotic exposure tends to increase cancer risk and, unfortunately, that it reduces the efficacy of various forms of cancer therapy (e.g., chemo-, radio-, and immunotherapy alone or in combination). Alternatives to the current patterns of antibiotic use, such as introducing new antibiotics, bacteriophages or enzybiotics, and implementing dysbiosis-reducing microbiota modulatory strategies in oncology, are discussed. The information is in the end considered from the perspective of the most recent findings on the tumor-specific and intracellular location of the tumor microbiota, and of the most recent theories proposed to explain cancer etiology on the notion of regression of the eukaryotic cells and systems to stages characterized for a lack of coordination among their components of prokaryotic origin, which is promoted by injuries caused by environmental insults.
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Affiliation(s)
| | - Vicente Notario
- Department of Radiation Medicine, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20057, USA;
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Ge Y, Tang J, Fu H, Fu Y. Terpinen‐4‐ol liposomes‐incorporated chitosan/polyethylene oxide electrospun nanofibrous film ameliorates the external microenvironment of healing cutaneous wounds. J Appl Polym Sci 2020. [DOI: 10.1002/app.49670] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Yan Ge
- School of Textile and Clothing, Nantong University Nantong Jiangsu China
- National & Local Joint Engineering Research Center of Technical Fiber Composites for Safety and Protection, Nantong University Nantong Jiangsu China
| | - Jiapeng Tang
- Institute of Special Environmental Medicine, Nantong University Nantong Jiangsu China
| | - Haihong Fu
- School of Textile and Clothing, Nantong University Nantong Jiangsu China
- National & Local Joint Engineering Research Center of Technical Fiber Composites for Safety and Protection, Nantong University Nantong Jiangsu China
| | - Yijun Fu
- School of Textile and Clothing, Nantong University Nantong Jiangsu China
- National & Local Joint Engineering Research Center of Technical Fiber Composites for Safety and Protection, Nantong University Nantong Jiangsu China
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Nnadozie UU, Umeokonkwo CD, Maduba CC, Igwe-Okomiso D, Onah CK, Madubueze UC, Anikwe CC, Versporten A, Pauwels I, Goossens H, Ogbuanya AUO, Oduyebo OO, Onwe EO. Antibiotic use among surgical inpatients at a tertiary health facility: a case for a standardized protocol for presumptive antimicrobial therapy in the developing world. Infect Prev Pract 2020; 2:100078. [PMID: 34368721 PMCID: PMC8336176 DOI: 10.1016/j.infpip.2020.100078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/17/2020] [Indexed: 11/28/2022] Open
Abstract
Background Indiscriminate antimicrobial use is one of the greatest contributors to antimicrobial resistance. A low level of asepsis in hospitals and inadequate laboratory support have been adduced as reasons for indiscriminate use of antimicrobials among surgical patients. At present, there are no guidelines for presumptive antibiotic use in Nigeria and sub-Saharan Africa. Aim Surgical inpatients at the study hospital were surveyed to determine the level of antimicrobial use and degree of compliance with prescription quality indicators. Methods A cross-sectional survey was conducted among all surgical inpatients in May 2019 using a standardized tool developed by the University of Antwerp to assess the point prevalence of antimicrobials. Inpatients who were admitted from 08:00 h on the day of the survey were included. Data on patients' demographics, indication for antimicrobial use, reason for antimicrobial use, stop/review date, adherence to guidelines and laboratory use were collected. The prevalence of antimicrobial use in the surgical department was estimated. Results Eighty-two inpatients were included in the survey. Of these, 97.6% were receiving at least one antimicrobial agent. Only 5.4% of the prescriptions were targeted, and 37.6% of prescriptions were for empirical treatment of infections. Approximately half (50.7%) of the patients were receiving presumptive antibiotics, and 6% were receiving prophylactic antibiotics. In total, 58.7% of prescriptions were administered parenterally, and 98.2% of patients had documentation of a stop/review date. Metronidazole (P=32.3%, T=29.2%), ceftriaxone (P=28.4%, T=19.8%) and ciprofloxacin (P=14.2%, T=14.6%) were the most common antimicrobials used. Conclusions There is a high rate of antimicrobial use among surgical inpatients, and the rate of indiscriminate antimicrobial prescribing among these patients needs to be reduced. This can be achieved by developing antimicrobial guidelines for presumptive antimicrobial therapy.
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Affiliation(s)
- U U Nnadozie
- Division of Plastic Surgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki Ebonyi State, Nigeria.,Department of Surgery, College of Health Sciences, Ebonyi State University Abakaliki, Ebonyi State, Nigeria
| | - C D Umeokonkwo
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - C C Maduba
- Division of Plastic Surgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki Ebonyi State, Nigeria
| | - D Igwe-Okomiso
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - C K Onah
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - U C Madubueze
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - C C Anikwe
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - A Versporten
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - I Pauwels
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - H Goossens
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - A U-O Ogbuanya
- Department of Surgery, College of Health Sciences, Ebonyi State University Abakaliki, Ebonyi State, Nigeria
| | - O O Oduyebo
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - E O Onwe
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
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Liu AC, Patel K, Vunikili RD, Johnson KW, Abdu F, Belman SK, Glicksberg BS, Tandale P, Fontanez R, Mathew OK, Kasarskis A, Mukherjee P, Subramanian L, Dudley JT, Shameer K. Sepsis in the era of data-driven medicine: personalizing risks, diagnoses, treatments and prognoses. Brief Bioinform 2020; 21:1182-1195. [PMID: 31190075 PMCID: PMC8179509 DOI: 10.1093/bib/bbz059] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/04/2019] [Accepted: 04/18/2019] [Indexed: 12/26/2022] Open
Abstract
Sepsis is a series of clinical syndromes caused by the immunological response to infection. The clinical evidence for sepsis could typically attribute to bacterial infection or bacterial endotoxins, but infections due to viruses, fungi or parasites could also lead to sepsis. Regardless of the etiology, rapid clinical deterioration, prolonged stay in intensive care units and high risk for mortality correlate with the incidence of sepsis. Despite its prevalence and morbidity, improvement in sepsis outcomes has remained limited. In this comprehensive review, we summarize the current landscape of risk estimation, diagnosis, treatment and prognosis strategies in the setting of sepsis and discuss future challenges. We argue that the advent of modern technologies such as in-depth molecular profiling, biomedical big data and machine intelligence methods will augment the treatment and prevention of sepsis. The volume, variety, veracity and velocity of heterogeneous data generated as part of healthcare delivery and recent advances in biotechnology-driven therapeutics and companion diagnostics may provide a new wave of approaches to identify the most at-risk sepsis patients and reduce the symptom burden in patients within shorter turnaround times. Developing novel therapies by leveraging modern drug discovery strategies including computational drug repositioning, cell and gene-therapy, clustered regularly interspaced short palindromic repeats -based genetic editing systems, immunotherapy, microbiome restoration, nanomaterial-based therapy and phage therapy may help to develop treatments to target sepsis. We also provide empirical evidence for potential new sepsis targets including FER and STARD3NL. Implementing data-driven methods that use real-time collection and analysis of clinical variables to trace, track and treat sepsis-related adverse outcomes will be key. Understanding the root and route of sepsis and its comorbid conditions that complicate treatment outcomes and lead to organ dysfunction may help to facilitate identification of most at-risk patients and prevent further deterioration. To conclude, leveraging the advances in precision medicine, biomedical data science and translational bioinformatics approaches may help to develop better strategies to diagnose and treat sepsis in the next decade.
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Affiliation(s)
- Andrew C Liu
- Department of Information Services, Northwell Health, New Hyde Park, NY, USA
- Donald and Barbara School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA
| | - Krishna Patel
- Department of Information Services, Northwell Health, New Hyde Park, NY, USA
- Donald and Barbara School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA
| | - Ramya Dhatri Vunikili
- Center for Research Informatics and Innovation, Northwell Health, New Hyde Park, NY, USA
- Courant Institute of Mathematical Sciences, New York University, New York, NY, USA
| | - Kipp W Johnson
- Department of Genetics and Genomic Sciences, Mount Sinai Health System, New York, NY, USA
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, NY, USA
| | - Fahad Abdu
- Center for Research Informatics and Innovation, Northwell Health, New Hyde Park, NY, USA
- Stonybrook University, 100 Nicolls Rd, Stony Brook, NY, USA
| | - Shivani Kamath Belman
- Center for Research Informatics and Innovation, Northwell Health, New Hyde Park, NY, USA
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Benjamin S Glicksberg
- Department of Genetics and Genomic Sciences, Mount Sinai Health System, New York, NY, USA
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, NY, USA
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Pratyush Tandale
- Center for Research Informatics and Innovation, Northwell Health, New Hyde Park, NY, USA
- School of Biotechnology and Bioinformatics, D Y Patil University, Navi Mumbai, India
| | - Roberto Fontanez
- Department of Information Services, Northwell Health, New Hyde Park, NY, USA
- Center for Research Informatics and Innovation, Northwell Health, New Hyde Park, NY, USA
| | | | - Andrew Kasarskis
- Department of Genetics and Genomic Sciences, Mount Sinai Health System, New York, NY, USA
| | | | | | - Joel T Dudley
- Department of Genetics and Genomic Sciences, Mount Sinai Health System, New York, NY, USA
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, NY, USA
| | - Khader Shameer
- Department of Information Services, Northwell Health, New Hyde Park, NY, USA
- Center for Research Informatics and Innovation, Northwell Health, New Hyde Park, NY, USA
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, NY, USA
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Manuel-Vázquez A, Palacios-Ortega F, García-Septiem J, Thuissard IJ, Sanz-Rosa D, Arias-Díaz J, Maríajover-Navalón J, Ramia JM. Antimicrobial Stewardship Programs Are Required in a Department of Surgery: "How" Is the Question A Quasi-Experimental Study: Results after Three Years. Surg Infect (Larchmt) 2020; 21:35-42. [PMID: 31347989 DOI: 10.1089/sur.2018.311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective: Our aim was to describe our antimicrobial stewardship program and the methodology based on the results in a surgical department. Methods: Our study was a quasi-experimental study conducted from January 1, 2009, through September 30, 2017. The site was the General and Digestive Surgery Department in a public primary referral center, the University Hospital of Getafe (Madrid, Spain). We implemented the antimicrobial stewardship program following a prospective audit and feedback model, with a surgeon incorporated into the manaagement group. We studied the deaths and 30-day re-admission rates, length of stay, prevalence of gram-negative bacilli, meropenem resistance, and days of treatment with meropenem. Results: After three years of the program, we recorded a significant decrease in Pseudomonas aeruginosa prevalence, a significant increase in Klebsiella pneumoniae prevalence, a decrease in meropenem resistance, and a reduction in meropenem days of treatment. Conclusions: Antimicrobial stewardship programs have a desirable effect on patients. In our experience, the program team should be led by a staff from the particular department. When human resources are limited, the sustainability, efficiency, and effectiveness of interventions are feasible only with adequate computer support. Finally, but no less important, the necessary feedback between the prescribers and the team must be based on an ad hoc method such as that provided by statistical control charts, a median chart in our study.
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Affiliation(s)
- Alba Manuel-Vázquez
- General and Digestive Surgery Department, University Hospital of Guadalajara, Guadalajara, Spain
| | | | - Javier García-Septiem
- General and Digestive Surgery Department, University Hospital of Getafe, Getafe, Madrid, Spain
| | - Israel John Thuissard
- School of Doctoral Studies and Research.Universidad Europea de Madrid, Madrid, Spain
| | - David Sanz-Rosa
- School of Doctoral Studies and Research.Universidad Europea de Madrid, Madrid, Spain
| | - Javier Arias-Díaz
- San Carlos Clinical Hospital, General and Digestive Surgery Department, Faculty of Medicine, Universidad Complutense, Madrid, Spain
| | - José Maríajover-Navalón
- General and Digestive Surgery Department, University Hospital of Getafe, Getafe, Madrid, Spain
| | - José Manuel Ramia
- General and Digestive Surgery Department, University Hospital of Guadalajara, Guadalajara, Spain
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Shen D, Wang D, Ning C, Lin C, Cao X, Liu Z, Ji L, Huang G. Prognostic factors of critical acute pancreatitis: A prospective cohort study. Dig Liver Dis 2019; 51:1580-1585. [PMID: 31079936 DOI: 10.1016/j.dld.2019.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/09/2019] [Accepted: 04/05/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with critical acute pancreatitis (CAP) have the highest risk of mortality. However, there have been no studies specifically designed to evaluate the prognostic factors of CAP. AIMS & METHODS This was a prospective observational cohort study involving patients with CAP. Three aspects including organ failure, (peri)pancreatic necrotic fluid cultures and surgical interventions were analyzed specifically to identify prognostic factors. RESULTS Of the 102 consecutive patients with CAP, 83 patients (81.4%) received step-up surgical treatment, the mortality of the step-up group was 25.3% (21/83). 19 patients (18.6%) underwent step-down surgical treatment, the mortality of the step-down group was 57.9% (11/19). Overall mortality in the whole cohort was 31.4% (32/102). Multivariate analysis of death predictors indicated that multiple organ failure (MOF) (OR = 5.3; 95% CI, 1.5-18.2; p = 0.008), long duration (≥5 days) of organ failure (OR = 6.4; 95% CI, 1.2-54.3; p = 0.029), multidrug-resistant organisms (MDROs) infection (OR = 4.6; 95% CI, 1.3-15.8; p = 0.013), OPN (OR = 3.7; 95% CI, 1.5-8.8; p = 0.004) and step-down surgical treatment (OR = 3.5; 95% CI, 1.2-10.1; p = 0.019) were significant factors. CONCLUSION Among patients with CAP, MOF, long duration (≥5 days) of organ failure, MDROs infection, OPN and step-down surgical treatment were identified as the predictors of mortality.
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Affiliation(s)
- Dingcheng Shen
- Department of Biliopancreatic Surgery, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Di Wang
- Department of Biliopancreatic Surgery, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Caihong Ning
- Department of Biliopancreatic Surgery, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Chiayen Lin
- Department of Biliopancreatic Surgery, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xintong Cao
- Department of Biliopancreatic Surgery, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiyong Liu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; Department of Intensive Care Unit, Xiangya Hospital, Central South University, Changsha, China
| | - Liandong Ji
- Department of Biliopancreatic Surgery, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Gengwen Huang
- Department of Biliopancreatic Surgery, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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28
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Manuel Vázquez A, Balibrea JM, Ramia JM. Antimicrobial stewardship programs and surgery: What is our role? Cir Esp 2019; 97:187-189. [PMID: 30217335 DOI: 10.1016/j.ciresp.2018.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Alba Manuel Vázquez
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Guadalajara, Guadalajara, España; Sección de Infección Quirúrgica, Asociación Española de Cirujanos, España.
| | | | - José Manuel Ramia
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Guadalajara, Guadalajara, España
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29
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Update on Prevention of Surgical Site Infections. CURRENT TRAUMA REPORTS 2019. [DOI: 10.1007/s40719-019-0157-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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30
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Johnston DN, Keshtkar F, Campbell W. The effect of re-audit and education on antibiotic prescribing practice at Causeway Hospital, Northern Ireland. Ir J Med Sci 2019; 188:1149-1153. [PMID: 30810949 DOI: 10.1007/s11845-019-01995-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/16/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Antimicrobial resistance is a growing global problem. There has been increasing emphasis on promoting antimicrobial stewardship. Accurate completion of antibiotic prescriptions, such as documentation of clinical indication and a stop/review date, helps promote antimicrobial stewardship. AIMS To investigate the impact of educational interventions on the completeness of antibiotic prescriptions at Causeway Hospital surgical unit. METHODS Inpatient drug prescription charts were audited to monitor the completeness of antibiotic prescriptions on the surgical unit. Two educational interventions were implemented, with a subsequent prospective re-audit carried out. RESULTS The completion of (1) "Stop date/Review date", (2) "What infection are you treating?", (3) "Cultures sent?", (4) "Printed name", (5) "Professional number", and (6) "Bleep number" fields within the inpatient drug charts increased noticeably in the re-audit. A paired t test, comparing all of the initial audit completion proportions with the re-audit completion proportions, demonstrated a statistically significant improvement (p < 0.05). CONCLUSIONS Educational interventions led to an improvement in the completeness of antibiotic prescriptions. This highlights the important role that continued audit and education play in the promotion of antimicrobial stewardship.
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Affiliation(s)
- David N Johnston
- Department of Surgery, Northern HSC Trust, Causeway Hospital, 4 Newbridge Road, Coleraine, BT52 1HS, Northern Ireland.
| | - Fatemeh Keshtkar
- Department of Surgery, Northern HSC Trust, Causeway Hospital, 4 Newbridge Road, Coleraine, BT52 1HS, Northern Ireland
| | - William Campbell
- Department of Surgery, Northern HSC Trust, Causeway Hospital, 4 Newbridge Road, Coleraine, BT52 1HS, Northern Ireland
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Tagashira Y, Yamane N, Miyahara S, Orihara A, Uehara Y, Hiramatsu K, Honda H. Misuse of Discharge Antimicrobial Prescription in the Emergency Department: An Observational Study at a Tertiary Care Center. Open Forum Infect Dis 2019; 6:ofz016. [PMID: 30793008 PMCID: PMC6368844 DOI: 10.1093/ofid/ofz016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/09/2019] [Indexed: 11/25/2022] Open
Abstract
We conducted a restrospective cohort study of patients discharged from the emergency department at a tertiary care center with an antimicrobial prescription. More than half of the prescribed antimicrobials were misused and frequently inappropriate for various infectious diseases. In this study, we analyzed the physician-related and environment-related factors predicting misuse.
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Affiliation(s)
- Yasuaki Tagashira
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Japan.,Department of Infection Control Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Naofumi Yamane
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Japan
| | - Satoshi Miyahara
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Japan
| | - Azusa Orihara
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Japan
| | - Yuki Uehara
- Department of Infection Control Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Keiichi Hiramatsu
- Department of Infection Control Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hitoshi Honda
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Japan
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Goff DA, File TM. The risk of prescribing antibiotics “just-in-case” there is infection. SEMINARS IN COLON AND RECTAL SURGERY 2018. [DOI: 10.1053/j.scrs.2017.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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33
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[Perception of surgeons on the use of antimicrobial stewardships programs]. J Healthc Qual Res 2018; 33:213-218. [PMID: 31610977 DOI: 10.1016/j.jhqr.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/14/2018] [Accepted: 04/06/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The misuse and overuse of antimicrobials can contribute to an increase in antimicrobial resistance, increasing the risk of infections caused by drug-resistant bacteria. Most common surgical pathologies are infectious (either primary or as a complication), often being over-treated. Exploring the perception of surgeons on the use of implementing Antimicrobial stewardship programs (ASPs) is relevant in order to adapt the program to local context. OBJECTIVE To determine the perception of surgeons on the management of infections and antibiotic (AB) prescription in a General Surgery Department (GSD). METHODS A cross-sectional and descriptive study was conducted using an anonymous questionnaire that was distributed to assess the aspects related to AB management. RESULTS A total of 42 questionnaires were completed, with a 65% response rate. The large majority (75%) considered that antimicrobial resistance was an important problem. The main situations considered with medium/high margin of improvement were: time from taking the specimen to receiving the results (70%), use of a wide spectrum AB, and excessive duration (88% and 89%), dose adjustment according to renal function (81%), unnecessary prolongation of intravenous AB treatment (87%) and excessive duration of it (89%), preference for intravenous AB administration until discharge of the patient (73%). There were also difficulties in ASP implementation, as well as established and solid AB patterns (84%) and the heterogeneity of the GSD (84%). CONCLUSIONS Organisational aspects of the GSD constitute one of the problems to implement the ASPs. A specific multidisciplinary team has been constituted to address different training aspects. This will also serve as a forum of discussion of certain complex patients with difficulties in antibiotic management.
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Pollmann AS, Bailey JG, Davis PJB, Johnson PM. Antibiotic use among older adults on an acute care general surgery service. Can J Surg 2017; 60:388-393. [PMID: 28930045 DOI: 10.1503/cjs.004317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Antibiotics play an important role in the treatment of many surgical diseases that affect older adults, and the potential for inappropriate use of these drugs is high. Our objective was to describe antibiotic use among older adults admitted to an acute care surgery service at a tertiary care teaching hospital. METHODS Detailed data regarding diagnosis, comorbidities, surgery and antibiotic use were retrospectively collected for patients 70 years and older admitted to an acute care surgery service. We evaluated antibiotic use (perioperative prophylaxis and treatment) for appropriateness based on published guidelines. RESULTS During the study period 453 patients were admitted to the acute care surgery service, and 229 underwent surgery. The most common diagnoses were small bowel obstruction (27.2%) and acute cholecystitis (11.0%). In total 251 nonelective abdominal operations were performed, and perioperative antibiotic prophylaxis was appropriate in 49.5% of cases. The most common prophylaxis errors were incorrect timing (15.5%) and incorrect dose (12.4%). Overall 206 patients received treatment with antibiotics for their underlying disease process, and 44.2% received appropriate first-line drug therapy. The most common therapeutic errors were administration of second- or third-line antibiotics without indication (37.9%) and use of antibiotics when not indicated (12.1%). There was considerable variation in the duration of treatment for patients with the same diagnoses. CONCLUSION Inappropriate antibiotic use was common among older patients admitted to an acute care surgery service. Quality improvement initiatives are needed to ensure patients receive optimal care in this complex hospital environment.
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Affiliation(s)
- André S Pollmann
- From the Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS (Pollmann, Bailey, Davis, Johnson); and the Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS (Bailey, Davis, Johnson)
| | - Jon G Bailey
- From the Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS (Pollmann, Bailey, Davis, Johnson); and the Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS (Bailey, Davis, Johnson)
| | - Philip J B Davis
- From the Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS (Pollmann, Bailey, Davis, Johnson); and the Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS (Bailey, Davis, Johnson)
| | - Paul M Johnson
- From the Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS (Pollmann, Bailey, Davis, Johnson); and the Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS (Bailey, Davis, Johnson)
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May M, Vetterlein MW, Wagenlehner FM, Brookman-May SD, Gilfrich C, Fritsche HM, Spachmann PJ, Burger M, Schostak M, Lebentrau S. [What is the perception of the 10-point plan of the German Federal Ministry of Health against multidrug-resistant pathogens and measures of antibiotic stewardship? : An interdisciplinary analysis among German clinicians and development of a decision tool for urologists]. Urologe A 2017; 56:1302-1310. [PMID: 28593351 DOI: 10.1007/s00120-017-0425-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Due to increasing antibiotic resistances, relevant treatment problems are currently emerging in clinical practice. In March 2015, the German Federal Ministry of Health (BMG) published a 10-point plan designed to combat this development. Furthermore, the first German guideline on antibiotic stewardship (ABS) was implemented in 2013 and instructs physicians of different specialties about several treatment considerations. Evidence is scarce on how such concepts (10-point plan/BMG, ABS) are perceived among clinicians. MATERIALS AND METHODS Within the MR2 study (Multiinstitutional Reconnaissance of practice with MultiResistant bacteria - a survey focusing on German hospitals), a questionnaire including 4 + 35 items was sent to 18 German hospitals between August and October 2015, surveying internists, gynecologists, general surgeons, and urologists. Using multivariate logistic regression models (MLRM), the impact of medical specialty and further criteria on the endpoints (1) awareness of the 10-point plan/BMG and (2) knowledge of ABS measures were assessed. Fulfillment of endpoints was predefined when average or full knowledge was reported (reference: poor to no knowledge). RESULTS Overall response rate was 43% (456/1061) for fully evaluable questionnaires. Only 63.0 and 53.6% of urologists and nonurologists (internists, gynecologists, and general surgeons), respectively, attended training courses regarding multidrug-resistance or antibiotic prescribing in the 12 months prior to the study (P = 0.045). The endpoints average and full knowledge regarding 10-point plan/BMG and ABS measures were fulfilled in only 31.4 and 32.8%, respectively. In MLRM, clinicians with at least one previous training course (reference: no training course) were 2.5- and 3.8-fold more likely to meet respective endpoint criteria (all P < 0.001). Medical specialty (urologists vs. nonurologists) did not significantly impact the endpoints in both MLRM. CONCLUSIONS The 10-point plan/BMG and ABS programs should be implemented into clinical practice, but awareness and knowledge of both is insufficient. Thus, it stands to reason that the actual realization of such measures is inadequate and continuous training towards rational prescription of antibiotics is necessary, regardless of medical specialty.
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Affiliation(s)
- M May
- Urologische Klinik, St. Elisabeth Klinikum, St.-Elisabeth-Str. 23, 94315, Straubing, Deutschland.
| | - M W Vetterlein
- Urologische Universitätsklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - F M Wagenlehner
- Urologische Universitätsklinik, Justus-Liebig Universitätsklinikum, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | - S D Brookman-May
- Klinik für Urologie, LMU München, Marchioninistraße 15, 81377, München, Deutschland
| | - C Gilfrich
- Urologische Klinik, St. Elisabeth Klinikum, St.-Elisabeth-Str. 23, 94315, Straubing, Deutschland
| | - H-M Fritsche
- Urologische Universitätsklinik, Universität Regensburg, Landshuter Straße 65, 93053, Regensburg, Deutschland
| | - P J Spachmann
- Urologische Universitätsklinik, Universität Regensburg, Landshuter Straße 65, 93053, Regensburg, Deutschland
| | - M Burger
- Urologische Universitätsklinik, Universität Regensburg, Landshuter Straße 65, 93053, Regensburg, Deutschland
| | - M Schostak
- Urologische Universitätsklinik, Universitätsklinikum Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - S Lebentrau
- Urologische Klinik, Ruppiner Kliniken, Fehrbelliner Str. 38, 16816, Neuruppin, Deutschland
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