scholarly journals Oral Antimicrobial Therapy: Efficacy and Safety for Methicillin-ResistantStaphylococcus aureusInfections and Its Impact on the Length of Hospital Stay

2014 ◽  
Vol 46 (3) ◽  
pp. 172
Author(s):  
Young Kyung Yoon ◽  
Eu Suk Kim ◽  
Jian Hur ◽  
Shinwon Lee ◽  
Shin Woo Kim ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Antimicrobial Therapy ◽  
Length Of Hospital Stay ◽  
Efficacy And Safety ◽  
Therapy Efficacy

scholarly journals 109. Impact of Accelerate PhenoTM System on Time to De-escalation of Antimicrobial Therapy

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S69-S69
Author(s):  
Caroline Powers ◽  
Ryan P Moenster ◽  
Travis W Linneman
Keyword(s):  
Blood Culture ◽  
Hospital Stay ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Multivariate Regression ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
P Value ◽  
Gram Positive ◽  
Quasi Experimental

Abstract Background The Accelerate PhenoTM system yields identification (ID) and antimicrobial susceptibility testing (AST) within 7 hours of growth in blood culture. The objective of this study was to determine its impact on time to de-escalation of antimicrobial therapy. Methods This retrospective quasi-experimental, observational cohort study included patients hospitalized at the St. Louis VA who received intravenous antibiotics for a positive blood culture. Patients with blood cultures positive for polymicrobial growth or fungi or those requiring antibiotics for other infections were excluded. The primary endpoint was time to de-escalation of antimicrobial therapy from before and after implementation of Accelerate PhenoTM (September 2017 to August 2018 and September 2018 to August 2019, respectively). Secondary outcomes included time to ID and AST, length of hospital stay, and days of antimicrobial therapy. The variables of gram-positive infections, use of Accelerate PhenoTM, and presence of infectious diseases consult and/or pharmacist antimicrobial stewardship note were included in a univariate analysis. Variables with a p-value< 0.2 were included in a multivariate regression. Results 168 patients were included, with 92 patients in the pre-implementation and 76 in the post-implementation group. Overall, mean age was 67 years and 162 (96%) were men. Staphylococcus spp. and Escherichia coli were the most common causative organisms. Time to de-escalation did not differ significantly between the post-implementation and pre-implementation groups (65 vs. 61 hours, p=0.47). Time to organism ID was decreased by 16 hours using Accelerate PhenoTM (50 vs. 66 hours, p=0.016). However, no difference was found in time to AST or length of hospital stay. Days of antimicrobial therapy while hospitalized was also similar between groups (6.8 vs. 5.9 days, p=0.256). Only gram-positive infections and presence of antimicrobial stewardship notes were included in the multivariate regression. Neither were independently associated with de-escalation within 48 hours. Conclusion Accelerate PhenoTM system did not impact time to de-escalation of antimicrobial therapy. Disclosures All Authors: No reported disclosures

scholarly journals Efficacy and safety of abdominal paracentesis drainage on patients with acute pancreatitis: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e045031
Author(s):  
Zongqing Lu ◽  
Xingxing Zhu ◽  
Tianfeng Hua ◽  
Jin Zhang ◽  
Wenyan Xiao ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Pancreatitis ◽  
Cohort Studies ◽  
Hospital Stay ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Infectious Complications ◽  
Efficacy And Safety ◽  
All Cause Mortality ◽  
Abdominal Paracentesis

ObjectivesTo conduct a systematic review and meta-analysis of the efficacy and safety of abdominal paracentesis drainage (APD) in patients with acute pancreatitis (AP) when compared with conventional ‘step-up’ strategy based on percutaneous catheter drainage (PCD).DesignSystematic review and meta-analysis.MethodsPubMed, EMBASE, Cochrane Library, MEDLINE (OVID), China National Knowledge Infrastructure and Wanfang Database were electronically searched to collect cohort studies and randomised controlled trials (RCTs) from inception to 25 July 2020. Studies related to comparing APD with conventional ‘step-up’ strategy based on PCD were included.OutcomesThe primary outcome was all-cause mortality. The secondary outcomes were the rate of organ dysfunction, infectious complications, hospitalisation expenses and length of hospital stay.ResultsFive cohort studies and three RCTs were included in the analysis. Compared with the conventional ‘step-up’ method, pooled results suggested APD significantly decreased all-cause mortality during hospitalisation (cohort studies: OR 0.48, 95% CI 0.26 to 0.89 and p=0.02), length of hospital stay (cohort studies: standard mean difference (SMD) −0.31, 95% CI −0.53 to –0.10 and p=0.005; RCTs: SMD −0.45, 95% CI −0.64 to –0.26 and p<0.001) and hospitalisation expenses (cohort studies: SMD −2.49, 95% CI −4.46 to –0.51 and p<0.001; RCTs: SMD −0.67, 95% CI −0.89 to –0.44 and p<0.001). There was no evidence to prove that APD was associated with a higher incidence of infectious complications. However, the incidence of organ dysfunction between cohort studies and RCTs subgroup slightly differed (cohort studies: OR 0.66, 95% CI 0.34 to 1.28 and p=0.22; RCTs: OR 0.58, 95% CI 0.35 to 0.98 and p=0.04).ConclusionsThe findings suggest that early application of APD in patients with AP is associated with reduced all-cause mortality, expenses during hospitalisation and the length of stay compared with the ‘step-up’ strategy without significantly increasing the risk of infectious complications. These results must be interpreted with caution because of the limited number of included studies as well as a larger dependence on observational trials.PROSPERO registration numberCRD42020168537.

scholarly journals Efficacy and Safety of Laparoscopic Appendectomy for Complicated Appendicitis in Children in Tertiary Care Hospital

2018 ◽  
Vol 28 (Number 1) ◽  
pp. 21-26
Author(s):  
Md. Anisuzzaman ◽  
ASM A Kabir ◽  
Md. A R l Sadiq ◽  
Md. A Matin ◽  
I Ahmed ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Laparoscopic Appendectomy ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Complicated Appendicitis ◽  
Safe Procedure ◽  
Care Hospital ◽  
Efficacy And Safety ◽  
The Mean

Laparoscopic appendectomy for uncomplicated appendicitis is associated with good outcomes but the role of laparoscopy in complicated appendicitis is more controversial because of high incidence of infectious complications. The aim of this current study is to evaluate the efficacy and safety of laparoscopic appendectomy in complicated appendicitis in children. This interventional study was carried out during the period from January 2015 to May 2018 in Holy Family Red Crescent Medical College Hospital. The study included 43 patients, age ranges from 3 years to 15 years who underwent laparoscopic appendectomy for complicated acute appendicitis. The following variables were analyzed : age, sex, operative findings, operative time, return of bowel function, resumption of oral feeds, length of hospital stay, postoperative complications such as deur, wound infection and intraabdominal abscess etc. The mean age of studied cases was 7.1 years. In 41 patients (95.3%) the procedure was completed laparoscopically. Two (4.7%) patients required conversion to open appendectomy. The operative time was 83.5+,25.8 minutes. Two patients (4.6%) had post-operative ileus. Four patients (9.7%) developed superficial wound infection. Three patients (7.3%) developed infra-abdominal collections. One (2.4%) patients were readmitted because of recurrent abdominal pain One patients (2.4%) developed postoperative pyrexia due to pneumonitis and Three patients (7.3) developed gastroenteritis. The mean length of hospital stay was 5.8±2.1 days. No mortality was recorded.Laparoscopic appendectomy can be the first choice for cases of complicated appendicitis in children. It is a feasible, safe procedure and is associated with acceptable post-operative morbidity with rapid recovery and better cosmetic results.

scholarly journals Uniportal VATS Pleural Biopsy in the Diagnosis of Exudative Pleural Effusion: Awake or Intubated?

2020 ◽  
Author(s):  
Mertol Gokce ◽  
Bulent Altinsoy ◽  
Ozcan Piskin ◽  
Burak Bahadir
Keyword(s):  
Pleural Effusion ◽  
Hospital Stay ◽  
Predictive Value ◽  
Length Of Hospital Stay ◽  
Efficacy And Safety ◽  
Pleural Biopsy ◽  
Diagnostic Efficacy ◽  
Sensitivity Specificity ◽  
Time Of Operation ◽  
Exudative Pleural Effusion

Abstract Background The aim of this study is to compare the diagnostic efficacy and safety of video-assisted thoracoscopic surgery (VATS) with awake VATS (AVATS) pleural biopsy in undiagnosed exudative pleural effusions. Methods The diagnostic efficacy of pleural biopsy by uniportal VATS under general anesthesia or AVATS under local anesthesia and sedation performed by the same surgeon in patients with undiagnosed exudative pleural effusion between 2007 and 2020 were retrospectively evaluated. Test sensitivity, specificity, positive predictive value and negative predictive value were compared as well as age, gender, comorbidities, procedure safety, additional pleural-based interventions, duration time of operation and length of hospital stay. Results Of 154 patients with undiagnosed exudative pleural effusion, 113 (73.37%) underwent pleural biopsy and drainage with VATS, while 41 (26.62%) underwent AVATS pleural biopsy. Sensitivity, specificity, positive predictive value and negative predictive value were 92%, 100%, 100%, and 85.71% for VATS, and 83.3%, 100%, 100%, and 78.9% for AVATS, respectively. There was no significant difference in diagnostic test performance between the groups, (p = 0.219). There was no difference in the rate of complications [15 VATS (13.3) versus 4 AVATS (9.8%), p = 0.557]. Considering additional pleural-based interventions, while pleural decortication was performed in 13 (11.5%) cases in the VATS group, no pleural decortication was performed in AVATS group, (p = 0.021). AVATS group was associated with shorter duration time of operation than VATS (22.17 + 6.57 min. versus 51.93 + 8.85 min., p < 0.001). Length of hospital stay was relatively shorter in AVATS but this was not statistically significant different (p = 0.063). Conclusions Uniportal AVATS and VATS have a similar diagnostic efficacy and safety profile in the evaluation of undiagnosed exudative pleural effusions. However, AVATS is associated with shorter operation time and relatively shorter hospital stay implying that AVATS may provide improved recovery time, less major complications, and thus increased patient satisfaction. VATS is easier and safer in patients with low or no pleural effusion and facilitates to perform pleural decortication in the presence of pleural thickening. Considering the general condition of the patient, the amount of pleural effusion and the experience of the operator AVATS may be a diagnostic choice in selected cases.

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

Indications and practice of enteral nutrition

2014 ◽  
Vol 155 (51) ◽  
pp. 2028-2033 ◽  
Author(s):  
Judit Hallay ◽  
Dániel Nagy ◽  
Béla Fülesdi
Keyword(s):  
Risk Factors ◽  
Treatment Outcome ◽  
Enteral Nutrition ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Nutrition Therapy ◽  
Present Review ◽  
Hospitalised Patients ◽  
Impact On Treatment ◽  
Efficacy Of Treatment

Malnutrition in hospitalised patients has a significant and disadvantageous impact on treatment outcome. If possible, enteral nutrition with an energy/protein-balanced nutrient should be preferred depending on the patient’s condition, type of illness and risk factors. The aim of the nutrition therapy is to increase the efficacy of treatment and shorten the length of hospital stay in order to ensure rapid rehabilitation. In the present review the authors summarize the most important clinical and practical aspects of enteral nutrition therapy. Orv. Hetil., 2014, 155(51), 2028–2033.

Effect of Chewing Gum on Bowel Motility in Women Undergoing Post-Operative Cesarean Section

2018 ◽  
Vol 3 (06) ◽  
Author(s):  
Dr.Randa Mohammed AboBaker
Keyword(s):  
Cesarean Section ◽  
Hospital Stay ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Chewing Gum ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Bowel Motility ◽  
Gum Chewing ◽  
Significant Difference

Postoperative Ileus (POI) is one of the most common problems after obstetrics, gynecologic and abdominal surgeries. Sham feeding, such as gum chewing, accelerates the return of bowel function and the length of hospital stay. The present study aims to evaluate the effect of chewing gum on bowel motility in women undergoing post-operative cesarean section. Intervention study was used at the Postpartum Department of Maternity and Children Hospital, KSA. A randomized controlled clinical trial research design. Through a convenience technique, 80 post Caesarian Section (CS) women were included in the study. Data were collected through three tools: Tool (I): Socio-demographic data and reproductive history interview schedule. Tool (II): Postoperative Assessment Sheet. Tool (III): Outcomes of gum chewing and the length of hospital stay.  Method: subjects were assigned randomly into two groups of (40) the experimental and (40) the control. Subjects in the study group were asked to chew two pieces of sugarless gum for 30 min/three times daily in the morning, noon, and evening immediately after recovery from anesthesia and in Postpartum Department; while subjects in the control group followed the hospital routine care. Each woman in both groups was tested abdominally using a stethoscope to auscultate the bowel sounds and asked to report immediately the time of either passing flatus or stool. Results: illustrated that a highly statistically significant difference was observed between the two groups concerning their gum chewing outcomes. Where, P = 0.000. The study concluded that gum chewing is safe, well tolerated and appears to be effective in reducing the incidence and consequences of POI following CS.

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