scholarly journals Prevention and Management of Infectious Complications of Retrograde Intrarenal Surgery

2021 ◽  
Vol 8 ◽  
Author(s):  
Johnathan A. Khusid ◽  
John C. Hordines ◽  
Areeba S. Sadiq ◽  
William M. Atallah ◽  
Mantu Gupta
Keyword(s):  
Risk Mitigation ◽  
Infectious Complications ◽  
Stone Disease ◽  
Carbonate Apatite ◽  
Retrograde Intrarenal Surgery ◽  
Operative Morbidity ◽  
Empiric Antibiotic ◽  
Potential Benefits ◽  
Empiric Antibiotic Treatment ◽  
Obstructive Pyelonephritis

Kidney stone disease (KSD) is a commonly encountered ailment in urologic practice. Urinary tract infection (UTI) is commonly associated with KSD, both as an etiology (e.g., struvite and carbonate apatite stones), and as a complication (i.e., obstructive pyelonephritis and post-operative UTI). Indeed, a significant portion of the economic burden of KSD is skewed toward stones associated with infection. UTI is the most common post-operative complication related to stone intervention with progression to urosepsis as a rare but serious consequence. Risk for infection is influenced by a variety of factors including co-morbid conditions, anatomic abnormalities, prior surgical procedures, and local anti-microbial susceptibility. Understanding these risks and the proper steps to mitigate them is an essential component in reducing post-operative morbidity and mortality. Retrograde intrarenal surgery is routinely used for the treatment of KSD. The objective of this review article is to examine the current literature and guidelines for the prevention and management of stone-related infectious complications associated with retrograde intrarenal surgery. Special attention will be given to the incidence, etiology, and antibiotic prophylaxis choice in the management of stone-related infections. Intraoperative risk mitigation techniques will be discussed in conjunction with the management of post-operative infections. Antibiotic stewardship and the potential benefits of reduced empiric antibiotic treatment will also be discussed.

scholarly journals Risk factors of infectious complications after retrograde intrarenal surgery: a retrospective clinical analysis

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052095683
Author(s):  
Hua Zhang ◽  
Tao Jiang ◽  
Rui Gao ◽  
Qin Chen ◽  
Weiwen Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Operative Time ◽  
Small Diameter ◽  
Modern Society ◽  
Clinical Analysis ◽  
Infectious Complications ◽  
Stone Disease ◽  
Lithotomy Position ◽  
Retrograde Intrarenal Surgery ◽  
Stone Size

Objective Stone disease is one of the most common afflictions in modern society. Complications following retrograde intrarenal surgery (RIRS) vary considerably, and small-diameter ureteral access sheaths are reportedly significantly associated with rates of infectious complications following RIRS. This study aimed to explore additional risk factors for infectious complications after RIRS. Methods This study retrospectively analyzed 602 patients who underwent RIRS between December 2016 and October 2019 at the First Affiliated Hospital of Fujian Medical University. All flexible ureteroscopic lithotripsy processes were conducted with patients under general anesthesia in the low lithotomy position. Postoperative systemic inflammatory response syndrome (SIRS) was diagnosed; statistical analyses comprised two-way analysis of variance (ANOVA) and one-way multivariate ANOVA. Results The incidence of infectious complications after RIRS was 7.14%. Operative time was an independent risk factor that increased the risk of infection. Stone size >2 cm was observed in 153 (27.37%) patients in the SIRS group and 29 patients (67.44%) in the non-SIRS group. Conclusions Findings in the literature suggest that early antibiotic treatment and active fluid therapy might lower the rate of infectious complications after RIRS. Our results indicate that extended operative time and increased stone size may be risk factors for infectious complications after RIRS.

Prevention and Treatment of Peritoneal Dialysis-Associated Peritonitis in Pediatric Patients

2005 ◽  
Vol 25 (3_suppl) ◽  
pp. 117-119 ◽  
Author(s):  
Günter Klaus
Keyword(s):  
Peritoneal Dialysis ◽  
First Generation ◽  
Treatment Guidelines ◽  
Generation Cephalosporin ◽  
Infectious Complications ◽  
Relative Increase ◽  
Coagulase Negative Staphylococci ◽  
Frequent Use ◽  
Empiric Antibiotic ◽  
Empiric Antibiotic Treatment

Peritoneal dialysis (PD) is the preferred dialysis modality in children and adolescents aged less than 15 years. Peritoneal dialysis-associated peritonitis remains a major cause of morbidity and reason for dropout from the PD program, although the incidence of peritonitis seems to have decreased during the past few years. Improved patient care, more frequent use of automated peritoneal dialysis (APD), use of PD catheters with downward facing exit sites, and Staphylococcus aureus prophylaxis account for this decline in infectious complications. With respect to the isolated micro-organism in PD-associated peritonitis, a predominance of gram-positive germs is found in children. Recent registry data suggest a decrease in coagulase-negative staphylococci, with a relative increase in gram-negative peritonitis episodes. The empiric antibiotic treatment regimen using a first-generation cephalosporin or a glycopeptide in combination with a third-generation cephalosporin in a risk-stratified manner was suggested in the pediatric peritonitis treatment guidelines. This regimen is currently being evaluated in the International Pediatric Peritonitis Registry.

Empiric Antibiotic Treatment Reduces Mortality in Severe Sepsis and Septic Shock From the First Hour

2014 ◽  
Vol 42 (8) ◽  
pp. 1749-1755 ◽  
Author(s):  
Ricard Ferrer ◽  
Ignacio Martin-Loeches ◽  
Gary Phillips ◽  
Tiffany M. Osborn ◽  
Sean Townsend ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Antibiotic Treatment ◽  
Empiric Antibiotic ◽  
Empiric Antibiotic Treatment ◽  
Sepsis And Septic Shock

scholarly journals Primary Cutaneous Cryptococcosis in an Immunocompetent 6-Year-Old Female

2018 ◽  
Vol 2 (4) ◽  
pp. 240-242
Author(s):  
Mitchell Hobbs ◽  
Joy King ◽  
Rana El Feghaly ◽  
Robert Brodell
Keyword(s):  
Cryptococcus Neoformans ◽  
Skin Lesions ◽  
Immunocompetent Patient ◽  
Immunocompromised Patients ◽  
Oral Fluconazole ◽  
Healthy Female ◽  
Empiric Antibiotic ◽  
Empiric Antibiotic Treatment ◽  
Cutaneous Cryptococcosis ◽  
Superficial Culture

A 6-year-old otherwise healthy female presented to the ED with a right eyebrow lesion for one month.  Previous I&D attempts and empiric antibiotic treatment had failed to improve the lesion.  Following dermatology referral, superficial culture resulted with growth of Cryptococcus neoformans after which completion of oral fluconazole treatment resolved the lesion.  Though Cryptococcus neoformans infections commonly plague immunocompromised patients, primary cutaneous cryptococcosis in the immunocompetent patient is a rare but documented infection with a paucity of reported pediatric cases, and frontline physicians should be aware of such a diagnosis in the setting of persistent skin lesions without response to more commonly utilized therapies.

scholarly journals Adherence to International Empiric Antibiotic Treatment Guidelines in a Tertiary Teaching Hospital in Mexico City

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Marco Antonio Rodríguez-Cervera ◽  
Paulo Francisco Castañeda-Mendez ◽  
Luis Soto-Ramírez ◽  
Lorena Cabrera-Ruiz
Keyword(s):  
Mexico City ◽  
Antibiotic Treatment ◽  
Teaching Hospital ◽  
Treatment Guidelines ◽  
Tertiary Teaching ◽  
Empiric Antibiotic ◽  
Tertiary Teaching Hospital ◽  
Empiric Antibiotic Treatment

599 MEDIASTINITIS SECONDARY TO ESOPHAGEAL PERFORATION: IT’S TOO LATE?

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Emanuele Russo ◽  
Mario Sorice ◽  
Luigi Busiello ◽  
Aniello Della Morte ◽  
Emilia Polimeno ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Esophageal Perforation ◽  
Multiple Organ ◽  
Oesophageal Perforation ◽  
Invasive Treatment ◽  
Emergency Thoracotomy ◽  
Risk Of Death ◽  
Single Center Experience ◽  
Empiric Antibiotic ◽  
Empiric Antibiotic Treatment

Abstract   Mediastinitis secondary to esophageal perforation is a rare, progressive, and destructive disease that may often lead to an imminent risk of death. We describe a single center experience showing how early diagnosis and prompt intervention can reduce mortality and complications. Methods From February 2016 to December 2019, 15 consecutive patients were referred to the Emergency Unit of The AORN Cardarelli (Naples) with clinical and radiological (CT scan) diagnosis of acute mediastinitis secondary to oesophageal perforation (post endoscopy or after foreign body ingestion) and furthermore, referred to the Thoracic Surgery Unit, they underwent to early surgical treatment (cervicotomy and\or thoracotomy and chest drainage. Results For early detected case (occurred within 24 hours) an emergency thoracotomy/cervicotomy was performed with surgical repair. For late detected (referred from other hospitals) a Surgical esclusion (abdominal plus cervical) and toilette thoracotomy was performed in emergency. Reconstruction occurred in 5 cases with a median of 46 days after firts care. All patient were admitted to ICU unit and susbsequentily to the thoracic surgery ward. 30 days mortality occurred in two cases. Median hospital staying was 28 days, in six cases a redo surgery was necessary. Empiric antibiotic treatment was started before operation and reviewed under Infectivologist. Conclusion Mediastinitis secondary to esophageal perforation has a fulminating course with a potential risk of sepsis, pericarditis, and multiple organ failure. A prompt identification and an invasive treatment is the best and most successful option to reduce mortality and improve patient’s recovery.

Fever in the Young Infant

2020 ◽  
pp. 75-81
Author(s):  
Paul Ishimine
Keyword(s):  
Bacterial Infections ◽  
Young Infant ◽  
Diagnostic Testing ◽  
Screening Tests ◽  
Empiric Antibiotic ◽  
Bacterial Gastroenteritis ◽  
Empiric Antibiotic Treatment ◽  
Serious Bacterial Infections ◽  
Tract Infections ◽  
Urine Testing

Fever is the most common complaint of children who present to the emergency department. Approximately 12% of febrile neonates (aged 0–28 days) and young infants (aged 29—56 days) have serious bacterial infections (bacteremia, meningitis, urinary tract infections, pneumonia, bacterial gastroenteritis, and osteomyelitis). The evaluation and management of the febrile neonate and febrile young infant can be confusing. All febrile neonates require diagnostic testing, treatment with antibiotics, and hospital admission. The workup of the febrile young infant is more controversial. These patients should undergo blood and urine testing, but the need for lumbar puncture is controversial, as is the need for empiric antibiotic treatment. The disposition of these patients will depend on the results of these screening tests.

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