Case Report
Scheduled Surgery and Antibiotic Therapy in Catarrhal Acute Appendicitis
Issue:
Volume 10, Issue 3, June 2024
Pages:
38-41
Received:
16 September 2024
Accepted:
6 October 2024
Published:
29 October 2024
Abstract: Introduction: Appendicitis is an acute inflammation of the appendix. Appendectomy remains one of the most frequently performed digestive surgeries in the world. The degree of urgency of this surgery and the increasingly proven efficacy of antibiotics still remains a debate. The main objectiveof our study is to compare the therapeutic results of a programmed appendectomy initially treated by antibiotic versus emergency appendectomies performed from the outset in casesof simple acute appendicitis. Patients and method: Our comparative study was carried out at the Joseph Ravoahangy Andrianavalona University Hospital from 01th August 2021 to 31th July 2022. Group A included simple acute appendicitis patients who underwent emergency surgery, while group B included patients who had been treated with antibiotics for ten days before undergoing surgery. Results: Our cohort of 95 patients comprised 70 patients (group A) versus 25 patients (group B). Twenty-three patients (92%) in group B had a Clavien-Dindo I score compared with 74.3% in group A. Parietal infections were 21% (group A) vs 4% (group B). There was no significant difference inpatient outcome between the two groups. Conclusion: Antibiotic therapy has already proved effective in the treatment of simple acute appendicitisin recent years, and means that emergency surgery can be avoided. However, the timingof surgery remains debatable in fragile patients.
Abstract: Introduction: Appendicitis is an acute inflammation of the appendix. Appendectomy remains one of the most frequently performed digestive surgeries in the world. The degree of urgency of this surgery and the increasingly proven efficacy of antibiotics still remains a debate. The main objectiveof our study is to compare the therapeutic results of a p...
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Research Article
Clinical Practice: Estimating the Breakpoints for EUCAST Fast Antimicrobial Susceptibility Testing Using Flagged BacT/Alert Blood Culture Bottles
Issue:
Volume 10, Issue 3, June 2024
Pages:
42-50
Received:
4 September 2024
Accepted:
21 September 2024
Published:
29 October 2024
Abstract: Introduction: The escalating prevalence of multidrug resistance is a global threat to human health particularly in critically ill patients with bloodstream infections (BSIs). Delay in the administration of the appropriate antimicrobial treatment is associated with higher mortality rates and adverse consequences. This study attempted to estimate the rapid antimicrobial susceptibility testing (RAST) breakpoints directly from flagged BacT/Alert blood culture bottles in clinical practice. Material & Methods: A descriptive, cross-sectional study conducted at a tertiary care hospital in Delhi over a period of two months. The RAST was performed directly from the clinical samples for blood cultures received in our laboratory in parallel with the routine antimicrobial testing as per standard CLSI guidelines. Blood cultures were routinely incubated in BacT/Alert 3D. The inhibition zones were read at 4, 6, 8 and 16-20 hour of incubation as per European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. The identification of the isolates was confirmed by Vitek-2 compact system. Results: In our study, the area of technical uncertainty (ATU) percentage was initially high at 4 hours but decreased significantly in later incubation periods. At 4 hours, none of the S. aureus isolates showed >90% categorical agreement (CA) for any antimicrobial tested. However, clindamycin achieved the highest CA (100%) at 6 hours and 90% thereafter, with no very major errors (VME) or major error (ME). Cefoxitin required 8 hours to reach >90% CA, with no VME observed at any time point, but up to 75% ME at 8 hours. At 4 hours, most antimicrobials had high (>1.5%) rates of VME among Enterobacteriales. By 6 hours, only Meropenem and Gentamicin had >90% CA, with no VME observed for other antibiotics. Conclusion: The RAST method is relatively easy to implement in clinical microbiology labs, offering cost-effectiveness, simplicity, and rapid results, especially in resource-limited settings. However, reporting RAST results can be complex due to potential challenges with CA, VME, and ME, particularly in the initial hours of incubation and within the ATU.
Abstract: Introduction: The escalating prevalence of multidrug resistance is a global threat to human health particularly in critically ill patients with bloodstream infections (BSIs). Delay in the administration of the appropriate antimicrobial treatment is associated with higher mortality rates and adverse consequences. This study attempted to estimate the...
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Rakotonaivo Mamisoa Judicael
