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Intra-abdominal infections among adult intestinal and multivisceral transplant recipients in the 2-year post-operative period.

BACKGROUND: Intestinal and multivisceral transplantations are treatment options for patients with intestinal failure. Transplantation is often complicated by abdominal and/or bloodstream infections in the post-operative period. METHODS: A retrospective chart review of all adults who underwent intestinal or multivisceral transplantation at our institution from 2003 to 2015 was performed. Data were collected for 2 years post transplant. RESULTS: A total of 106 intestinal or multivisceral transplants were performed in 103 patients. The median age at the time of transplant was 44 (IQR: 34-52) wi

New and Emerging Antibiotics for Complicated Intra-Abdominal Infections.

The purpose of this review is to evaluate the efficacy and safety of ceftazidime/avibactam and ceftolozane/tazobactam in patients with complicated intra-abdominal infections (cIAI), and review eravacycline and other agents in the pipeline for management of cIAI. The increasing incidence of multidrug resistant strains of bacteria has led to the need for additional antibiotics with activity against these organisms. There are 2 newly approved antibiotics, ceftazidime/avibactam and ceftolazane/tazobactam for treatment of cIAI. Both agents have been shown to exert activity against resistant bacteri

Mechanical plus oral bowel preparation with paromomycin and metronidazole reduces infectious complications in elective colorectal surgery: a matched case-control study.

PURPOSE: Infectious complications are as high as 30% in elective colorectal surgery. In recent years, several studies have discussed the topic of preoperative bowel decontamination prior to colorectal surgery in order to reduce postoperative infectious complications and have found significant effects of oral antibiotic administration with a large variety of drugs used. No study has evaluated the combination of oral paromomycin and metronidazole in this context. METHODS: We performed a prospective single-center study with a matched-pair retrospective cohort to evaluate postoperative infectious

Fasciolosis.

Fasciolosis is a zoonosis affecting ruminants, caused by the liver flukes Fasciola (F.) hepatica, and F. gigantica, which infect at least 2.4 million people worldwide. This disease may occur in cluster or family infections or after travel in high-risk areas such as the Nile Delta in Egypt, Iran, Turkey, South-East Asia, Mexico, the Caribbean and the Andean Altiplano. In Europe, fasciolosis occurs more frequently in Portugal, Spain and France, although autochthonous infections have also been reported from Ireland and Germany. Infectious metacercariae are ingested with contaminated water or raw

Donor morbidity after living donation for liver transplantation.

BACKGROUND & AIMS: Reports of complications among adult right hepatic lobe donors have been limited to single centers. The rate and severity of complications in living donors were investigated in the 9-center Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL). METHODS: A retrospective observational study design was used. Participants included all potential living donors evaluated between 1998 and 2003. Complication severity was graded using the Clavien scoring system. RESULTS: Of 405 donors accepted for donation, 393 underwent donation, and 12 procedures were aborted. The

[Antibiotic sensitivity of aerobic gram-negative bacilli isolated from severe infections in 1992: results of a French multicenter study. Groupe d'Etude d'Infections à bacilles à Gram Négatif (GEIGN)].

OBJECTIVES: Antibiotic susceptibility of 649 gram-negative bacilli involved in severe infections and isolated in 18 teaching hospitals from … a (4%). Most of the strains were isolated from blood culture (72.3%), respiratory tract (11.4%) and intraabdominal infections (8.6%). Most of the enterobacteria isolates were susceptible to imipenem, aztreonam, amikacin and ciprofloxacin (percentages of susceptibility were respectively 99.3, 98, 98.3 and 96.3); in most of cases clavulanic acid did not entirely restore sens …

Results of the North American trial of piperacillin/tazobactam compared with clindamycin and gentamicin in the treatment of severe intra-abdominal infections. Investigators of the Piperacillin/Tazobactam Intra-abdominal Infection Study Group.

A total of 192 men and 139 women aged 15 to 89 years with diagnosed intra-abdominal infection were randomised in a 2:1 ratio to treatment with either intravenous piperacillin/tazobactam (3 g/375 mg every six hours) or clindamycin (600 mg every six hours) plus gentamicin (2.5 mg to 5.0 mg/kg every eight to 12 hours) in a multicentre trial. Of 147 evaluable patients with microbiologically confirmed infections, 104 were treated with piperacillin/tazobactam and 43 with clindamycin plus gentamicin. The diagnoses of perforated appendicitis (n = 79), other peritonitis (n = 32), cholecystitis/cholangi

Infected urocolpos and generalized peritonitis secondary to labia minora adhesions.

INTRODUCTION: Labia minora adhesions (LMA) are a common finding in young girls. Usually, this condition is asymptomatic and spontaneously disappears during adolescence. We report on a case revealed by infected urocolpos and peritonitis and whose treatment finally required surgical reduction labioplasty. CASE REPORT: A 9-year-old girl presented with a 2-day history of abdominal pain and fever. Urinary continence had never been obtained, with diurnal leaks. Physical examination showed signs of peritoneal irritation and a subtotal vulvar obstruction due to LMA. At surgery, after LMA lysis, a lar

Septic monoarthritis and osteomyelitis in an elderly man following Klebsiella pneumoniae genitourinary infection: case report.

INTRODUCTION: Klebsiella pneumoniae septic arthritis and osteomyelitis, albeit uncommon in adults, are important sites of disseminated infection. Many case reports have shown K. pneumoniae as a cause of nosocomial transmitted septic arthritis in neonates and children. We report a rare case of an elderly patient with K. pneumoniae genitourinary infection spreading to the liver and other extra hepatic sites like the prostate and peripheral joint. CLINICAL PICTURE: The patient presented with a short history of general malaise, fever and urinary symptoms, associated with an acute monoarthritis of

Prophylaxis with whole gut irrigation and antimicrobials in colorectal surgery. A prospective, randomized double-blind clinical trial.

In a prospective, randomized double-blind trial, the efficacy of whole gut irrigation as preoperative bowel preparation for elective colorectal surgery was evaluated alone and in combination with two antimicrobial agents in 148 patients. The antimicrobial regimens were metronidazole alone or metronidazole and ampicillin administered systemically preoperatively and continued for 3 days. Whole gut irrigation was completed without any discomfort in 87 percent of the patients. In 3 percent, the irrigation was stopped and the patients were excluded from the study. Abdominal wound infection develope

Imipenem/cilastatin in the treatment of serious bacterial infections.

Imipenem (N-formimidoyl thienamycin) is a new carbapenem beta-lactam antibiotic with a broad antibacterial spectrum. Forty-five patients were treated with either 500 or 1,000 mg of imipenem/cilastatin four times daily, the duration varying according to clinical response. The diagnoses were urinary tract infection, 10 patients; septicemia, six; intraabdominal sepsis, six; pneumonia, six (two cases of Legionnaires' disease); skin and soft tissue infection, four; and other diagnoses, 13. Of the 32 clinically assessable patients, 17 were cured, nine improved, three died, and three were withdrawn f

Inbred mouse strains differ in resistance to lethal Coccidioides immitis infection.

Inbred strains of mice were infected intraperitoneally with Coccidioides immitis, and the mean lethal dose was determined after 28 days. DBA/2N mice had a mean lethal dose of greater than 10(5) arthroconidia, whereas BALB/cAnN, C57BL/6N, and C57L/J mice had a mean lethal dose of less than or equal to 10(3). Since both BALB/c and DBA/2 mice are the H-2d haplotype, resistance is not primarily determined by the major histocompatibility locus. Resistance was the dominant phenotype. The pattern of C. immitis-resistant strains does not correspond to the strain distribution of the lsh gene or to the

Outpatient laparoscopic supracervical hysterectomy with assistance of the lap loop.

STUDY OBJECTIVE: To elucidate the safety and patient satisfaction with laparoscopic supracervical hysterectomy (LSH) performed in an outpatient setting. DESIGN: Prospective case study (Canadian Task Force classification II-2). SETTING: Public hospital. PATIENTS: Forty-three women. INTERVENTION: Outpatient LSH performed by lap-loop. MEASUREMENTS AND MAIN RESULTS: The procedure was recommened by 41 out of 43 patients. Three patients (7%) were admitted to the hospital due to complications after the surgery. One patient was admitted because of a vasovagal reaction after anesthesia; she recove

Appendicitis in children with a ventriculoperitoneal shunt.

The presentation of an acute abdomen in children with a ventriculoperitoneal shunt requires skillful diagnostic workup. Apart from complications caused by the shunt, primary abdominal pathological conditions must be taken into consideration, particularly in the older child. A series of 6 children with a ventriculoperitoneal shunt had to be treated surgically for appendicitis. Their medical records were analyzed retrospectively. Despite difficulties with the initial diagnosis, the time from admission to final diagnosis and operation was relatively short. An accurate history, careful evaluation

Effect of reinforced duct-mucosa anastomosis technique on clinically relevant postoperative pancreatic fistula: A retrospective cohort study and complimentary meta-analysis.

BACKGROUNDS/AIMS: To evaluate the effect of reinforced duct-mucosa anastomosis (REDMA) technique on clinically relevant postoperative pancreatic fistula (CR-POPF) in patients undergoing pancreaticoduodenectomy (PD). METHODS: The STROCSS guideline and the PRISMA statement standards were followed to conduct a retrospective cohort study and a complementary meta-analysis, respectively. All consecutive adult patients who underwent REDMA, a composite reconstruction technique incorporating mesh reinforcement, glue fixation, and pancreatic duct stenting simultaneously, during PD for pancreatic ductal

Treatment options for traumatic pseudoaneurysms of the paravisceral abdominal aorta.

Penetrating gunshot wounds (GSWs) to the abdominal aorta are frequently lethal. Alternative management options for treatment of traumatic pseudoaneurysms of the abdominal aorta are illustrated by three patient case histories. Patient A sustained two GSWs to the abdomen (midepigastrium, right subcostal region). He was hypotensive in the field. Emergent laparotomy was undertaken with suture ligature of a celiac injury and distal pancreatectomy/splenectomy for a pancreatic injury. Postoperative abdominal CT for an intraabdominal infection with leukocytosis revealed a 4 cm traumatic pseudoaneurysm

Non-stented pancreaticogastrostomy after pylorus-preserving pancreaticoduodenectomy.

BACKGROUND: We hypothesized that neutralization of the gastric acidity by alkaline pancreatic secretion via a non-stented pancreaticogastrostomy after pylorus-preserving pancreaticoduodenectomy (non-stented PPPD-PG) might provide protection against marginal or stress ulcer. Surgical risk of non-stented pancreaticogastrostomy was also assessed to clarify the importance of stenting in pancreatic anastomosis. METHODS: From January 1997 to December 2000, 54 patients with resectable periampullary lesions were included for non-stented PPPD-PG. Gastric pH and amylase levels were measured on the post

Postoperative infectious complications are associated with diminished overall survival of patients undergoing resection for colorectal liver metastases.

INTRODUCTION: Postoperative infectious complications (PIC) remain one of the most common complications after surgery. The influence of PIC o … ng regression models. RESULTS: Of 270 patients, eighty-four (31%) patients developed PIC including intraabdominal infections (n = 51, 61%), cholangitis (n = 5, 6%), pneumonia (n = 12, 14%), wound infections (n = 28, 33%), urinary tract infections (n = 5, 6%), or central line-associated bloodstream infections (n = 4, 5%). PIC were associated with a significantly diminished …

Acute portal vein thrombosis in a 59-year-old male with JAK2 V617F mutation.

Portal vein thrombosis is an uncommon finding that typically arises in the context of cirrhosis. In the acute setting, it may present with abdominal pain, portal hypertension, ascites, gastrointestinal bleeding, or mesenteric ischemia. Local risk factors that predispose its formation include: cirrhosis, hepatocellular carcinoma, pancreatitis, and intraabdominal infection. Systemic factors, including hypercoagulable states and sepsis, also pose an increased risk. JAK2 V617F positive myeloproliferative disorders are associated with systemic prothrombotic states and are a less frequently identifi

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… Local factors, such as cirrhosis and intraabdominal infections carry an increased risk of developing PVT. Reduced portal flow and abdominal inflammation leads to endothelial activation and release of prothrombotic factors [2] . … Abnormalities on CBC suggestive of PVT include leukocytosis in the setting of intraabdominal infection, erythrocytosis in PCV, or thrombocytosis in ET [3] . Chronic PVT is generally asymptomatic when detected and is more commonly an incidental finding on radiological imaging. …

Antibiotic irrigation and the formation of intraabdominal adhesions.

The efficacy of antibiotic peritoneal lavage in the prevention of postoperative infection is controversial. The role of intraperitoneally administered cefazolin and tetracycline in the formation of adhesions was studied in the rodent model. Thirty-two rats were divided into 3 groups. Group 1 underwent midline laparotomy with instillation of 10 ml of normal saline solution. Group 2 and Group 3 underwent the same procedure with instillation of 0.2 percent saline solutions of cefazolin or tetracycline, respectively. Animals were sacrificed after 2 weeks. Intraabdominal adhesions were graded and s