Trends of genital and nongenital community-acquired methicillin-resistant Staphylococcus aureus infections in an urban pediatric population.

OBJECTIVE: The study aimed to identify etiologies and risk factors associated with any possible trends in the number of genital-region community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections among children and adolescents aged 1 to 18 years. MATERIALS AND METHODS: Demographic, exposure, and treatment data were collected from patients with community-acquired MRSA-positive abscess fluid cultures obtained from inpatient, outpatient, and pediatric emergency department visits from 2004 to 2008. The data were analyzed using IBM SPSS for statistically significant trends or risk factors both within and between groups. RESULTS: A statistically significant increase in the total number of MRSA abscesses as well as the proportion of genital to nongenital abscesses was observed in 2008 when compared with those of the previous 4 years (p = .026). This increase is largely due to an increase in affected male patients as genital MRSA infections among female patients remained stable. Methicillin-resistant S. aureus genital infections were more likely to occur in children with a history of MRSA infection (p = .017) and were most common in the age group 1 to 4 years. Both male and female patients with nongenital MRSA infections were more likely to have experienced recent surgery (p = .04). Female patients with nongenital abscess were twice as likely to have been recently hospitalized as those with genital MRSA infections (p = .02). No statistically significant differences were found in the rates of genital or nongenital abscesses between ethnic groups (p = .22). The rates of genital and nongenital abscesses differed in male and female patients, although these differences did not achieve statistical significance (p = .23). CONCLUSIONS: Although the total number of genital infections has increased, infections among female children remain largely unchanged. Community-acquired methicillin-resistant S. aureus genital abscesses are more likely to be the result of colonization, rather than de novo infection, than nongenital abscesses. The effectiveness of individual treatment modalities and rates of recurrence are independent of abscess location, but genital abscesses may indicate the presence of resistant organisms, colonization, or both.

Carbon footprint of robotically-assisted laparoscopy, laparoscopy and laparotomy: a comparison.

BACKGROUND: To date there have been no comprehensive, comparative assessments of the environmental impact of surgical modalities. Our study seeks to quantify and compare the total greenhouse gas emissions, or 'carbon footprint', attributable to three surgical modalities. METHODS: A review of 150 staging procedures, employing laparotomy (LAP), conventional laparoscopy (LSC) or robotically-assisted laparoscopy (RA-LSC), was performed. The solid waste generated (kg) and energy consumed (kWh) during each case were quantified and converted into their equivalent mass of carbon dioxide (kg CO(2) e) release into the environment. The carbon footprint is the sum of the waste production and energy consumption during each surgery (kg CO(2) e). RESULTS: The total carbon footprint of a RA-LSC procedure is 40.3 kg CO(2) e/patient (p < 0.01). This represents a 38% increase over that of LSC (29.2 kg CO(2) e/patient; p < 0.01) and a 77% increase over LAP (22.7 kg CO(2) e/patient; p < 0.01). CONCLUSIONS: Our results provide clinicians, administrators and policy-makers with knowledge of the environmental impact of their decisions to facilitate adoption of sustainable practices.