EP.FRI.537 Post-operative antibiotics for cutaneous abscess after incision and drainage: Variations in Clinical Practice or lack of guidelines

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Sarah Zhao ◽  
Ahmad Najdawi ◽  
Aggelios Laliotis ◽  
Rhys Thomas ◽  
Michael El Boghdady
Keyword(s):  
Clinical Practice ◽  
Treatment Protocol ◽  
University Teaching ◽  
Systemic Complications ◽  
Incision And Drainage ◽  
Evidence Based Treatment ◽  
Superficial Skin ◽  
Retrospective Data Collection ◽  
Local And Systemic Complications ◽  
Surgical Condition

Abstract Aims Acute cutaneous abscess is a common surgical condition which mostly require incision and drainage. Despite this, there is no standardised national or international guidance on the post-operative antibiotics prescription. Traditionally, antibiotics are not indicated unless complications and/or risk factors such as immunocompromisation, diabetes or cellulitis exist. We aimed to study the local practice of the post-operative antibiotics prescription for cutaneous abscesses in a University teaching hospital in London. Methods A retrospective data collection of emergency general surgical admissions for a period of six months from July to December 2020 was carried out. All patients with superficial skin abscess were included in this analysis. Scrotal, breast and limb abscesses were excluded. Patients’ demographics, Co-morbidities, local and systemic complications were studied. Results A total of 149 patients presented during this period. Mean age was 40 (54% were male). Most common site of abscess was perianal (24%), followed by pilonidal, axilla, back, gluteal, neck, abdominal wall and groin. At total of 108 (72.5%) were managed surgically with incision and drainage, 70 (65%) got antibiotics and only 23 (33%) had indications for it (i.e. diabetic, immunocompromised, sepsis, cellulitis, MRSA carriage) = (χ2[1] =22.03, p<.0001). Co-amoxiclav was the most common post-operative empirical antibiotic prescribed in 61% of the patients.  Conclusions This study has identified significant variation in clinical practice regarding post-operative antibiotic usage in superficial abscesses. Further research is required in cooperation with microbiologists to develop standardised evidence-based treatment protocol for management of such common surgical condition.  

EP.FRI.535 A clinical audit of post-operative antibiotics prescription in uncomplicated perianal abscesses

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Sarah Zhao ◽  
Ahmad Najdawi ◽  
Aggelios Laliotis ◽  
Rhys Thomas ◽  
Michael El Boghdady
Keyword(s):  
Clinical Audit ◽  
Perianal Abscess ◽  
University Teaching ◽  
National Standard ◽  
Surgical Patients ◽  
Surgical Drainage ◽  
Timely Manner ◽  
Systemic Complications ◽  
Incision And Drainage ◽  
Local And Systemic Complications

Abstract Aims Management of perianal abscesses continues to revolve around prompt surgical drainage. The Association of Coloproctology of Great Britain and Ireland (ACPGBI) guidelines state that all patients should have incision and drainage within 24 hours and antibiotics are not indicated in routine uncomplicated perianal abscesses. We aimed to study the antibiotics prescription after surgical drainage in a London university teaching hospital against the national standard.  Methods A single-centred retrospective analysis of all emergency surgical admissions for incision and drainage of perianal abscess was carried out for a 6 month period. Patients’ demographics, Co-morbidities, local and systemic complications and readmissions were studied.  Results A total of 36 patients, (mean age 43, 64% males) were included in this study, 21 received incision and drainage without antibiotics prescription, while 15 received empirical post-operative antibiotics. Indications for antibiotic therapy in this group included diabetes, immunocompromise, local complications (necrosis, cellulitis) and recurrence. There was no clear indication for antibiotics in 60% of patients who received them. 86% of patients had surgical drainage within 24 hours of presentation. One patient was readmitted for a second drainage 3 months later. Most common empirical agent used was co-amoxiclav (53%), followed by (33%) combination of co-amoxiclav and metronidazole.  Conclusion Although surgical drainage was generally carried out in timely manner according to guidance, there was excessive post-operative antibiotic prescriptions. Increase awareness of guidelines is required to improve antibiotic stewardship in these surgical patients in order to avoid unnecessary drugs’ prescription.

scholarly journals Magnetic Resonance Imaging for the Normal Mesostenium and Involvement of the Mesostenium in Acute Pancreatitis

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Xiao Xiao Chi ◽  
Xiao Ming Zhang ◽  
Tian Wu Chen ◽  
Wei Tang ◽  
Bo Xiao ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Acute Pancreatitis ◽  
Clinical Practice ◽  
Magnetic Resonance ◽  
Severity Index ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Systemic Complications ◽  
The Relationship ◽  
Local And Systemic Complications

The main point of this paper is to study MRI findings of the normal mesostenium and the involvement of the mesostenium in acute pancreatitis and to discuss the relationship between the involvement of the mesostenium and the severity of acute pancreatitis. In clinical practice, the mesenterical involvement in acute pancreatitis was often observed on MRI in daily works, which was little recorded in the reported studies. We conducted the current study to assess the mesenterical involvement in acute pancreatitis with MRI. We found that the mesenterical involvement of acute pancreatitis patients is common on MRI. The mesenterical involvement has a positive correlation with the MR severity index and the Acute Physiology and Chronic Healthy Evaluation II scoring system. It has been shown that MR can be used to visualize mesenterical involvement, which is a supplementary indicator in evaluating the severity of acute pancreatitis and local and systemic complications.

Evaluating and Managing Uncomplicated Skin and Soft Tissue Infections Associated With Community-Associated Methicillin-Resistant Staphylococcus aureus for Outpatients: A Review of the Literature

2012 ◽  
Vol 5 (2) ◽  
pp. 98-105
Author(s):  
Yvette Winstead
Keyword(s):  
Staphylococcus Aureus ◽  
Clinical Practice ◽  
Soft Tissue ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Treatment Protocol ◽  
Evidence Based ◽  
Soft Tissue Infections ◽  
Incision And Drainage ◽  
Control And Prevention

Purpose: The purpose of this literature review is to determine how clinicians evaluate and manage uncomplicated skin and soft tissue infections caused by Staphylococcus aureus. Data Source: The research topic is explored based on an electronic search for literature published between 2003 and 2008 in MEDLINE and PubMed. The following search terms were used to secure noteworthy academic studies: skin abscess incision and drainage, incision and drainage, skin and soft tissue abscesses, uncomplicated skin and soft tissue abscesses, and antibiotics for soft tissue infections. Conclusions: A clinical practice guideline based on evidence-based practice will provide clinicians with an appropriate treatment protocol for uncomplicated skin and soft tissue abscesses. An evidence-based clinical practice guideline has the potential to positively influence patient outcomes and eliminate the unnecessary use of antibiotics. Implications for Practice: The Centers for Disease Control and Prevention (CDC) guidelines for the management of skin and soft tissue infections should be adopted by all clinicians in an effort to standardize treatment. Furthermore, clinicians must stay informed about the epidemiological and treatment of emerging organisms in their patient populations.

Geriatric distal femur fracture: Are we underestimating the rate of local and systemic complications?

Injury ◽  
2016 ◽  
Vol 47 (8) ◽  
pp. 1732-1736 ◽  
Author(s):  
Gele B. Moloney ◽  
Tiffany Pan ◽  
Carola F. Van Eck ◽  
Devan Patel ◽  
Ivan Tarkin
Keyword(s):  
Distal Femur ◽  
Femur Fracture ◽  
Systemic Complications ◽  
Distal Femur Fracture ◽  
Local And Systemic Complications

Enterostomies for acute abdominal surgical condition in children: An experience in a developing country

2020 ◽  
pp. 1-4
Keyword(s):  
Damage Control ◽  
Intestinal Atresia ◽  
University Teaching ◽  
Salvage Procedure ◽  
State University ◽  
Female Ratio ◽  
Peritoneal Contamination ◽  
Surgical Conditions ◽  
Age Range ◽  
Surgical Condition

Background: Pediatric abdominal surgical condition that is complicated by gross peritoneal contamination may require enterostomy as a damage control or salvage procedure. Late presentations mostly seen in developing countries make creation of enterostomy a relatively common surgical procedure. The aim of this study was to evaluate the creation of enterostomy in children who presented with acute abdominal surgical conditions. Methods: This was a retrospective study of children that had enterostomy in the pediatric surgery unit of Enugu State University Teaching Hospital, Enugu, Nigeria. Medical records of pediatric patients that had enterostomy over a 10-year period were assessed. Results: There were 32 cases of enterostomies performed during the study period. There were 25 males (78.1%) and 7 females (21.9%) with a male to female ratio of 3.6:1. The age range of the patients was 3 weeks to 180 months, with a median age of 96 months. There were 1 neonate (3.1%), 10 infants (31.3%) and 21 children (65.6%) older than 1 year. The primary diagnoses were typhoid intestinal perforation in 21 patients (65.6%), intussusception 10 (31.3%) and intestinal atresia 1 (3.1%). Ileostomy was performed in 31 patients (96.9%) and jejunostomy in 1 patient (3.1%). Enterostomy was created at the time of initial laparotomy (damage control) in 21 patients (65.6%) while 11 patients (34.4%) had their enterostomy as a salvage procedure at the time of re-exploration. Peristomal skin complication was the most common complication recorded in our patients. Mortality was 12.5%. Conclusion: Enterostomy is lifesaving in the management of acute abdominal surgical condition when there is gross peritoneal contamination in severely ill children. Proper surgical technique and electrolyte derangements are important considerations when enterostomies are created.

Perception, attitude, and satisfaction of paediatric physicians and nurses towards clinical practice guidelines at a university teaching hospital

2018 ◽  
Vol 25 (4) ◽  
pp. 543-549
Author(s):  
Yasser Sami Amer ◽  
Abdulrahman Al Nemri ◽  
Mohamed Elfaki Osman ◽  
Elshazaly Saeed ◽  
Asaad Mohamed Assiri ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Teaching Hospital ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
University Teaching

Endovascular Treatment of Atherosclerotic Iliac Stenosis: Local and Systemic Complications of the Open Brachial Access

2016 ◽  
Vol 33 ◽  
pp. 45-54
Author(s):  
Bahaa Nasr ◽  
Bénédicte Albert ◽  
Charles-Henri David ◽  
Ahmed Khalifa ◽  
Layal El Aridi ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Systemic Complications ◽  
Local And Systemic Complications

CROHN’S DISEASE IN CHILDREN: THE CURRENT STATE OF THE PROBLEM

2021 ◽  
Vol 100 (6) ◽  
pp. 78-85
Author(s):  
A.S. Bekin ◽  
◽  
E.Yu. Dyakonova ◽  
A.N. Surkov ◽  
A.P. Fisenko ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Surgical Treatment ◽  
Crohn's Disease ◽  
Granulomatous Inflammation ◽  
Unknown Etiology ◽  
Systemic Complications ◽  
Current State ◽  
Conservative And Surgical Treatment ◽  
Scientific Ideas ◽  
Local And Systemic Complications

Crohn's disease (CD) is chronic recurrent bowel disease of unknown etiology, characterized by segmental transmural granulomatous inflammation, mainly with the development of local and systemic complications. Despite the active development of conservative therapy methods, the number of drug-resistant forms of CD and complications of the disease requiring surgical treatment continues to increase. The article reflects modern scientific ideas about the methods of diagnosis, conservative and surgical treatment of CD in children.

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