Treatment Failure Rates of Second-Generation Endometrial Ablation Devices in Premenopausal Women with BMI≥35 Kg/m2

Abstract Background Acute otitis media(AOM) is the most common indication for antibiotics in children. The primary pathogens that cause AOM have changed since the introduction of the pneumococcal conjugate vaccine(PCV). The clinical failure rate of amoxicillin for treatment of AOM post-PCV is unknown.We aimed to determine the clinical failure rate of amoxicillin for the treatment of uncomplicated AOM in children. Organisms identified on culture and amoxicillin treatment failure from nasopharyngeal specimens of children age 6-35 months with uncomplicated acute otitis media at Denver Health, Denver, CO from April 2019-March 2020. Methods Children age 6-35 months seen at Denver Health, Denver, CO with uncomplicated AOM and prescribed amoxicillin were prospectively enrolled. An interim analysis of patients enrolled from April 2019-March 2020 was completed. Patients completed surveys that included the AOM-SOS©(UPMC, Pittsburgh, PA) at enrollment, days 5, 14, and 30 and had chart abstraction completed. Treatment failure was defined as: (1) requiring a new antibiotic within 14 days; (2) AOM-SOS© score on day 5 or 14 not improved by a relative reduction of ≥ 55% from baseline. Recurrence was defined as requiring a new antibiotic within 15-30 days. Nasopharyngeal swabs were obtained and bacterial culture was completed. Results In total,110 patients were enrolled. Rates of treatment failure defined by AOM-SOS© were 28.4%(37; 95%CI:25.5-33.6%) at 5 days and 15.5%(27; 95%CI:17.5-24.5%) at 14 days. However, only 4.5%(5; 95%CI:2.0-4.5%) required a new antibiotic. Recurrence occurred in 5.5% (6, 95%CI:2.5-5.5%) of patients. Of patients who had not received antibiotics before enrollment(82), culture yielded no organism in 17.0%, one organism in 42.7%, and multiple organisms in 40.0% (Table). M.catarrhalis was the most frequently identified organism (53.7% of children). Of H.influenzae isolates 52.9% (9/17) produced beta-lactamase, resulting in no treatment failures or recurrences requiring a new antibiotic. Failure rates were similar between organisms. Conclusion Despite the change in otopathogen prevalence post-PCV, preliminary data suggest that while early subjective treatment failure was common, the 14 day treatment failure and 30 day recurrence rates was low when measured by need for a new antibiotic. Failure was low even among patients with organisms that would not be expected to be treated successfully with amoxicillin, such as those with beta-lactamase producing H.influenzae and M.catarrhalis. Disclosures Samuel Dominguez, MD, PhD, BioFire (Consultant, Research Grant or Support)

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Bayesian Network Meta-Analysis of the Effectiveness of Various Interventions for Nontraumatic Osteonecrosis of the Femoral Head

BioMed Research International ◽

10.1155/2018/2790163 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

Ji Wang ◽

Jing Wang ◽

Kai Zhang ◽

Yanfang Wang ◽

Xuanwen Bao

Keyword(s):

Femoral Head ◽

Treatment Failure ◽

Bayesian Network ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Failure Rates ◽

Randomized Controlled ◽

Harris Score ◽

Fibular Grafting

Objective. To assess the effectiveness of various therapeutic hip preservation strategies on patients with nontraumatic osteonecrosis of the femoral head (ONFH). Design. This is a systematic review of previous literature and in-depth Bayesian network meta-analysis of randomized controlled trials (RCTs) to compare the clinical effect of various operation methods and one physical intervention (extracorporeal shockwave). Data Sources. Electronic literature, for studies published up to December 2017, was collected from PubMed, Medline, and the Cochrane Library. Study Selection. We selected RCTs on patients with ONFH. Treatment methods included extracorporeal shockwave (ESW), core decompression (CD), multiple drilling decompression (DD), vascularized fibular grafting (VFG), free-vascularized fibular grafting (FVFG), inverted femoral head grafting (IFHG), vascular iliac pedicle bone grafting (VIPBG), osteotomy, and tantalum implantation (TI). Outcome. The primary outcome was Harris score; the secondary outcome was Harris hip score (HHS), including total hip arthroplasty requirement (THA) and progression to collapse. Results. A total of 14 randomized controlled trials were investigated. ESW had the highest improvement on Harris score (probability best 52%), followed by VFG (probability was 38%). In the meanwhile, VFG also proved to be superior in reducing the failure rates of treatment (probability lowest 59%), followed by ESW (probability lowest 24%). In femoral necrosis stage-II, VFG achieved the highest probability in preventing treatment failures (52%) and showed better performance in reducing treatment failure rates than CD. Conclusion. ESW therapy (ESWT) is the most effective intervention to improve HHS, and VFG shows superior effect on reducing treatment failure rates.

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Endometrial Ablation Versus Hysterectomy

50 Studies Every Obstetrician-Gynecologist Should Know ◽

10.1093/med/9780190947088.003.0040 ◽

2021 ◽

pp. 218-223

Author(s):

Christine Helou ◽

Mandy Yunker

Keyword(s):

Significant Proportion ◽

Premenopausal Women ◽

Relevant Information ◽

Endometrial Ablation ◽

Patient Specific ◽

Patient Counseling ◽

Case Scenario ◽

Treatment Plans ◽

Small Sample Sizes ◽

Surgical Treatments

This article reviews study methodology, results, limitations, and utility of the Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding (STOP-DUB). Criticisms and limitations of the study are proposed. Relevant information from other studies or guidelines are reviewed. The key findings from this study are then applied to a clinical case scenario. The results of this study, particularly those related to reoperation, were in line with other studies. While follow-up of enrolled patients was lengthy, the study was limited by slow recruitment leading to small sample sizes. Generalizability of this study is limited by the lack of randomized with regards to surgical technique and hysterectomy route, as well as use of resectoscopic ablation techniques. Both endometrial ablation and hysterectomy were found to be effective treatments for premenopausal women with DUB. Hysterectomy was more effective at treating bleeding symptoms but was associated with more adverse events and higher rates of infection. A small but significant proportion of women initially treated with ablation subsequently underwent reoperation with either repeat ablation or hysterectomy. The information from this study when used in context with similar studies is useful in guiding patient counseling for treatment of premenopausal DUB; however, treatment plans should ultimately be individualized based on patient-specific factors to maximize the likelihood of success with initial treatment.

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Randomized controlled trials in second-generation endometrial ablation

Modern Management of Abnormal Uterine Bleeding ◽

10.3109/9780203091524-30 ◽

2008 ◽

pp. 213-223

Keyword(s):

Randomized Controlled Trials ◽

Second Generation ◽

Endometrial Ablation ◽

Controlled Trials ◽

Randomized Controlled

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Comparison of Ceftriaxone and Antipseudomonal β-Lactam Antibiotics Utilized for Potential AmpC β-Lactamase-Producing Organisms

Hospital Pharmacy ◽

10.1177/0018578720931463 ◽

2020 ◽

pp. 001857872093146

Author(s):

David M. Peters ◽

Jessica B. Winter ◽

Christopher A. Droege ◽

Neil E. Ernst ◽

Siyun Liao

Keyword(s):

Treatment Failure ◽

Therapeutic Option ◽

Primary Objective ◽

Definitive Treatment ◽

Failure Rates ◽

Production Methods ◽

Optimal Dosing ◽

Definitive Therapy ◽

Enterobacteriaceae Infections ◽

Tract Infections

Background: Induction of antibiotic resistance is associated with increased morbidity and mortality in AmpC β-lactamase producing Enterobacteriaceae. The use of ceftriaxone is controversial for treatment of these organisms due to concerns for inducible resistance. This study was designed to compare treatment failure rates between ceftriaxone and antipseudomonal β-lactam antibiotics when used as definitive therapy for organisms most commonly associated with chromosomal AmpC β-lactamase production. Methods: A retrospective, single-center cohort study was performed enrolling patients hospitalized with monomicrobial Enterobacter, Citrobacter, or Serratia spp. infections. The primary objective compared proportion of treatment failure between groups. All patients received either ceftriaxone or an antipseudomonal β-lactam alone within 24 hours of culture finalization, and with a duration of at least 72 hours for definitive treatment. Treatment failure was defined as either clinical failure (abnormal white blood cell count or temperature on day 7 or 14 post-antibiotics) or microbiologic failure (regrowth of the same organism at same site within 14 or 21 days). Results: Of 192 total patients, treatment failure was observed in 24/71 patients (34%) receiving ceftriaxone and in 42/121 patients (35%) receiving antipseudomonal β-lactam ( P = .98). No difference was observed between clinical or microbiologic failure rates between groups. The ceftriaxone group had significantly more patients undergoing treatment for urinary tract infections (51% vs 17%, P < .001), but treatment failure rates remained similar between groups when comparing infections of all other sources. Conclusion: Ceftriaxone has comparable treatment failure rates to antipseudomonal β-lactams for susceptible Enterobacteriaceae infections and may be considered as a therapeutic option. Further, prospective research is needed to validate optimal dosing and application in all sites of infection.

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