Impact of appropriateness of empiric therapy on outcomes in community-onset bacteremia by extended-spectrum-ß-lactamase producing Escherichia coli and Klebisella pneumoniae definitively treated with carbapenems.

Despite a significant increase of bloodstream infection caused by extended-spectrum-ß-lactamase (ESBL)-producing Enterobacteriaceae in the community-setting, information regarding clinical outcomes of inappropriate empiric therapy (IAT) in patients with those infections is limited. A multicenter-retrospective cohort study was conducted in four hospitals. A total of 249 adults were identified to have community-onset bacteremia caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae, and definitively treated with carbapenems. According to the appropriateness of empiric therapy, individuals were divided into an appropriate empiric therapy (AT) group (n = 106) and IAT group (n = 143). Patients who received AT showed more severe underlying conditions including underlying solid cancer, healthcare-association and intensive care unit (ICU) care, compared to the IAT group. Primary bacteremia was more commonly found in the AT group than in the IAT group, while urinary tract infection predominated more frequently in the IAT group than in the AT group. Multivariate analysis using propensity score analysis indicated that inappropriateness of empiric therapy was not an independent risk factor for 30-day death. ICU care, respiratory tract infection and underlying liver, renal and connective tissue diseases were significantly associated with mortality. In patients with bloodstream infections caused by ESBL-producing E. coli and K. pneumoniae in the community-setting, delay in appropriate therapy was not associated with an increased rate of death if the patients were definitively treated with carbapenems.

Surgical and clinical safety and effectiveness of robot-assisted laparoscopic hysterectomy compared to conventional laparoscopy and laparotomy for cervical cancer: A systematic review and meta-analysis.

AIM: This study aimed to evaluate the surgical safety and clinical effectiveness of RH versus LH and laparotomy for cervical cancer. METHODS: We searched Ovid-Medline, Ovid-EMBASE, and the Cochrane library through May 2015, and checked references of relevant studies. We selected the comparative studies reported the surgical safety (overall; peri-operative; and post-operative complications; death within 30 days; and specific morbidities), and clinical effectiveness (survival; recurrence; length of stay [LOS]; estimated blood loss [EBL]; operative time [OT]) and patient-reported outcomes. RESULTS: Fifteen studies comparing RH with OH and 11 comparing RH with LH were identified. No significant differences were found in survival outcomes. The LOS was shorter and transfusion rate was lower with RH compared to OH or LH. EBL was significantly reduced with RH compared to OH. Compared to OH, overall complications, urinary infection, wound infection, and fever were significantly less frequent with RH. The overall, peri-operative, and post-operative complications were similar in other comparisons. Several patient-reported outcomes were improved with RH, though each outcome was reported in only one study. CONCLUSIONS: RH appears to have a positive effect in reducing overall complications, individual adverse events including wound infection, fever, urinary tract infection, transfusion, LOS, EBL, and time to diet than OH for cervical cancer patients. Compared to LH, the current evidence is not enough to clearly determine its clinical safety and effectiveness. Further rigorous prospective studies with long-term follow-up that overcome the many limitations of the current evidence are needed.

Comparative safety and effectiveness of robot-assisted laparoscopic hysterectomy versus conventional laparoscopy and laparotomy for endometrial cancer: A systematic review and meta-analysis.

AIM: This study aimed to evaluate the surgical safety and clinical effectiveness of RH compared to OH and LH for endometrial cancer. METHODS: We searched Ovid-Medline, Ovid-EMBASE, and the Cochrane library for studies published through May 2015. The outcomes of interest included safety (overall; peri-operative and post-operative complications; death within 30-days; and specific morbidities), effectiveness (survival, recurrence, length of stay [LOS], estimated blood loss [EBL], and operative time [OT]), and patient-reported outcomes (pain score, pain medication use, length of pain medication use, and time to return to work). Two independent reviewers extracted data and assessed the risk of bias. RESULTS: Twenty-four studies comparing RH to OH and 24 comparing RH to LH were identified. No significant differences were found in survival outcomes. The LOS was shorter, there was less EBL, and the rates of complications, readmission, and transfusion were lower with RH compared to OH. However, RH showed a longer OT and a higher incidence of vaginal cuff dehiscence compared to those for OH. Compared to LH, the LOS was shorter, there was less EBL, and the rates of conversion to laparotomy, intra-operative complications, urinary tract injuries, and cystotomy were lower in RH. Several patient-reported outcomes showed a significant benefit of RH, but each outcome was reported in only one study. CONCLUSIONS: RH may be a generally safer and better option than OH and LH for patients with endometrial cancer. Further prospective studies with long-term follow-up are required.