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1.
Pediatr Surg Int ; 40(1): 18, 2023 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-38082019

RESUMO

PURPOSE: The objective of this study was to determine the association between the presence of a microorganism resistant to the antibiotic used in empirical therapy and the development of intra-abdominal abscesses in children with perforated appendicitis. METHODS: A prospective cohort study was conducted in patients under 18 years of age who underwent laparoscopic appendectomy between November 1, 2019, and September 30, 2020, in whom perforated appendicitis was documented intraoperatively. Peritoneal fluid samples were taken for bacteria culture purposes, and clinical and microbiological data were collected from all patients. RESULTS: A total of 232 patients were included in the study. The most isolated microorganisms were Escherichia coli (80.14%) and Pseudomonas aeruginosa (7.45%). In addition, 5.31% of E. coli isolates were classified as ESBL-producing organisms. No association was found between a germ resistant to empiric antimicrobial therapy and the development of a postoperative intra-abdominal abscess. Multivariate analysis showed that being a high-risk patient on admission (OR 2.89 (p = 0.01)) was associated with the development of intra-abdominal abscesses postoperatively. CONCLUSION: E. coli was the most commonly isolated microorganism, with a low rate of ESBL-producing isolates. No association between resistance and risk of postoperative intra-abdominal abscess was found. However, it was identified that being a high-risk patient on admission was associated with this complication. TYPE OF STUDY: Prognosis study. LEVEL OF EVIDENCE: Level I.


Assuntos
Abscesso Abdominal , Apendicite , Criança , Humanos , Adolescente , Estudos de Coortes , Escherichia coli , Estudos Prospectivos , Apendicite/complicações , Apendicite/cirurgia , Apendicite/tratamento farmacológico , Estudos Retrospectivos , Antibacterianos/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico , Abscesso Abdominal/tratamento farmacológico , Apendicectomia/efeitos adversos
2.
Updates Surg ; 75(8): 2267-2272, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37794218

RESUMO

Intra-abdominal abscesses are a common issue after appendectomy. Antibiotics have shown efficacy in treating smaller abscesses, while larger ones have traditionally been treated with drainage. This study assesses the efficacy of antibiotics for post-appendectomy intra-abdominal abscess (PAA) in children regardless of size. Case-control study of children with PAA admitted at our hospital from 2010 to 2022. The efficacy of antibiotics was compared between abscesses less and more than 6 cm in diameter. The Institutional Review Board has approved this study. A total of 1766 appendectomies were performed from 2010 to 2022 with an incidence of PAA of 5% (n = 89): age 9.3 IQR 5.8, 63% male (n = 56). Sixty-seven patients presented with a ≤ 6 cm abscess (controls) and 22 children had a > 6 cm PAA (cases). Length of intravenous antibiotics were higher in cases (15 IQR 7 days) than controls (12 IQR 4 days), p = 0.003. The efficacy of antibiotics in controls was 97% whereas 86.4% in cases (p = 0.094), reoperation was needed in 2/67 controls and 3/22 cases, with no differences in complications or readmission. The length of stay was longer in cases (15 IQR 6 days) than controls (13 IQR 5 days), p = 0.042. Antibiotics seem a safe treatment for PAA in children regardless of the size. However, this approach is associated with a longer period of intravenous antibiotics and hospital stay, although not with a higher rate of therapeutic failure, complications or reoperations.


Assuntos
Abscesso Abdominal , Apendicite , Laparoscopia , Criança , Humanos , Masculino , Feminino , Abscesso/tratamento farmacológico , Abscesso/etiologia , Abscesso/cirurgia , Apendicectomia/efeitos adversos , Estudos de Casos e Controles , Estudos Retrospectivos , Apendicite/tratamento farmacológico , Apendicite/cirurgia , Apendicite/complicações , Laparoscopia/efeitos adversos , Antibacterianos/uso terapêutico , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Drenagem/efeitos adversos , Resultado do Tratamento , Complicações Pós-Operatórias/epidemiologia
3.
Updates Surg ; 75(4): 855-862, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37093495

RESUMO

Management of diverticular abscess (DA) is still controversial. Antibiotic therapy is indicated in abscesses ≤ 4 cm, while percutaneous drainage/surgery in abscesses > 4 cm. The study aims to assess the role of antibiotics and surgical treatments in patients affected by DA. We retrospectively analyzed 100 consecutive patients with DA between 2013 and 2020, with a minimum follow-up of 12 months. They were divided into two groups depending on abscess size ≤ or > 4 cm (group 1 and group 2, respectively). All patients were initially treated with intravenous antibiotics. Surgery was considered in patients with generalized peritonitis at admission or after the failure of antibiotic therapy. The primary endpoint was to compare recurrence rates for antibiotics and surgery. The secondary endpoint was to assess the failure rate of each antibiotic regimen resulting in surgery. In group 1, 31 (72.1%) patients were conservatively treated and 12 (27.9%) underwent surgery. In group 2, percentages were respectively 50.9% (29 patients) and 49.1% (28 patients). We observed 4 recurrences in group 1 and 6 in group 2. Recurrence required surgery in 3 patients/group. We administered amoxicillin-clavulanic acid to 74 patients, piperacillin-tazobactam to 14 patients and ciprofloxacin + metronidazole to 12 patients. All patients referred to surgery had been previously treated with amoxicillin-Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation clavulanic acid. No percutaneous drainage was performed in a hundred consecutive patients. Surgical treatment was associated with a lower risk of recurrence in patients with abscess > 4 cm, compared to antibiotics. Amoxicillin-clavulanic acid was associated with a higher therapeutic failure rate than piperacillin-tazobactam/ciprofloxacin + metronidazole.


Assuntos
Abscesso Abdominal , Doença Diverticular do Colo , Diverticulose Cólica , Humanos , Abscesso/complicações , Abscesso/cirurgia , Doença Diverticular do Colo/complicações , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Estudos Retrospectivos , Metronidazol , Combinação Amoxicilina e Clavulanato de Potássio , Colectomia/métodos , Diverticulose Cólica/cirurgia , Antibacterianos/uso terapêutico , Drenagem/métodos , Ciprofloxacina/uso terapêutico , Combinação Piperacilina e Tazobactam
4.
Clin Gastroenterol Hepatol ; 21(13): 3365-3378.e5, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-36731588

RESUMO

BACKGROUND & AIMS: The management of intra-abdominal abscesses complicating Crohn's disease (CD) is challenging, and surgery with delayed intestinal resection is often recommended. The aims of this study were to estimate the success rate of adalimumab (ADA) in patients with CD with an intra-abdominal abscess resolved without surgery, and to identify predictive factors for success. METHODS: A multicenter, prospective study was conducted in biologic-naïve patients with CD with resolved intra-abdominal abscess treated with ADA with a 2-year follow-up. The primary endpoint was ADA failure at week (W) 24 defined as a need for steroids after W12, intestinal resection, abscess recurrence, and clinical relapse. Secondary post-hoc endpoint was the long-term success defined as the survival without abscess relapse or intestinal resection at W104. The factors associated with ADA failure at W24 and W104 were identified using a logistic and a Cox regression, respectively. RESULTS: From April 2013 to December 2017, 190 patients from 27 GETAID centers were screened, and 117 were included in the analysis. Fifty-eight patients (50%) were male, and the median age at baseline was 28 years. At W24, 87 patients (74%; 95% confidence interval [CI], 65.5%-82.0%; n = 117) achieved ADA success. Among the 30 patients with ADA failure, 15 underwent surgery. At W104, the survival rate without abscess recurrence or surgery was 72.9% (95% CI, 62.1%-79.8%; n = 109). Abscess drainage was significantly associated with ADA failure at W24 (odds ratio, 4.18; 95% CI, 1.06-16.5; P =0 .043). Disease duration (hazard ratio [HR], 1.32; 95% CI, 1.09-1.59; P = .008), abscess drainage (HR, 5.59; 95% CI, 2.21-14.15; P = .001), and inflammatory changes in mesenteric fat (HR, 0.4; 95% CI, 0.17-0.94; P = .046) were significantly associated with ADA failure at W104. CONCLUSION: Provided that the abscess was carefully managed before initiating medical treatment, this study showed the high efficacy of ADA in the short and long term in biologic-naïve patients with CD complicated by an intra-abdominal abscess. CLINICALTRIALS: gov, Number: NCT02856763.


Assuntos
Abscesso Abdominal , Produtos Biológicos , Doença de Crohn , Humanos , Masculino , Adulto , Feminino , Adalimumab/uso terapêutico , Doença de Crohn/complicações , Doença de Crohn/tratamento farmacológico , Estudos Prospectivos , Abscesso/tratamento farmacológico , Resultado do Tratamento , Abscesso Abdominal/tratamento farmacológico , Recidiva , Produtos Biológicos/uso terapêutico
5.
ANZ J Surg ; 92(12): 3293-3297, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-35877550

RESUMO

BACKGROUND: There is limited literature on renal abscesses in children and therefore no consensus on management. The objectives of this study were to describe renal abscesses in a contemporary paediatric Australian population and present a 20 year review of the literature. METHODS: An 11 year retrospective comparative study was conducted of paediatric patients with renal abscesses. A literature review of all eight original articles on paediatric renal abscesses from January 2001 to December 2021 was performed. RESULTS: Fourteen children with a mean age of 11 years were diagnosed with a renal abscess on ultrasound and/or computed tomography. The most common presenting symptoms were fever (n = 13, 93%) and flank or abdominal pain (n = 12, 86%). The most common causative organisms were Staphylococcus aureus (n = 7, 50%) and Escherichia coli (n = 4, 29%). All renal abscesses less than 3 cm were managed with antibiotics alone. Five out of nine abscesses 3-5 cm were managed with percutaenous drainage (56%). Two multi-loculated abscesses greater than 5 cm required open drainage in theatre (100%). CONCLUSIONS: The most common causative organism in the North Queensland population was S. aureus, with a higher incidence of MRSA. This should be taken into consideration when prescribing empirical antibiotics. Most renal abscesses in children that are less than 3 cm in size can be managed with antibiotic therapy only. The evidence for management of larger abscesses is less clear, but where clinically appropriate conservative management with antibiotic therapy should be considered in the first instance, with percutaneous drainage in cases of antibiotic failure.


Assuntos
Abscesso Abdominal , Nefropatias , Infecções Urinárias , Criança , Humanos , Abscesso/diagnóstico , Abscesso/epidemiologia , Abscesso/terapia , Estudos Retrospectivos , Staphylococcus aureus , Austrália/epidemiologia , Abscesso Abdominal/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Drenagem/métodos , Nefropatias/epidemiologia , Nefropatias/terapia , Antibacterianos/uso terapêutico
6.
Ger Med Sci ; 20: Doc09, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35875245

RESUMO

Background: Pyometra is a rare gynecological condition and is characterized by pus accumulation in the uterine cavity. It occurs more frequently in postmenopausal women than tubo-ovarian abscesses, which constitute a more common gynecological complication among premenopausal women. Objective: A 72-year-old woman was admitted to our emergency department with lower abdominal pain, diarrhea and fever for the last three days. The laboratory results were indicative to sepsis. The clinical examination revealed sensitivity by palpation of the lower abdomen without any signs of acute abdomen. The gynecological assessment showed pus outflow through the cervix and a pus culture was done. The ultrasound examination found an enlarged uterus, full of hypoechoic fluid, unclear borders between endometrium-myometrium, a mixed echogenicity adnexal mass and no free fluid in the pouch of Douglas. A computed tomography (CT) of the abdomen showed the presence of pyometra and a tubo-ovarian abscess of the right adnexa. Method: The patient was treated with intravenous antibiotic therapy. When the patient was hemodynamically stable and afebrile, she underwent ultrasound-guided dilatation and curettage of the cervical canal and the endometrium in order to exclude an underlying malignancy, under general anesthesia. Results: The patient responded promptly to the intravenous antibiotic therapy which was adapted to the pus culture result. The laboratory results withdrew to normal values and the patient was discharged after fifteen days of hospitalization in an afebrile and hemodynamically stable condition. Conclusion: Pyometra and tubo-ovarian abscess in postmenopausal women could be a lethal complication of pelvic inflammatory disease. The key in treatment is the dilatation of the cervix and drainage of the pyometra. The administration of intravenous antibiotics and drainage through the cervix could be a suitable method of treatment for pyometra in older patients or those with poor performance status if only the histological examination is negative for malignancy.


Assuntos
Abscesso Abdominal , Ooforite , Piometra , Salpingite , Abscesso Abdominal/diagnóstico , Abscesso Abdominal/tratamento farmacológico , Abscesso/tratamento farmacológico , Abscesso/terapia , Idoso , Antibacterianos/uso terapêutico , Feminino , Humanos , Ooforite/tratamento farmacológico , Pós-Menopausa , Piometra/complicações , Piometra/tratamento farmacológico , Salpingite/tratamento farmacológico
7.
BMC Infect Dis ; 22(1): 557, 2022 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-35717143

RESUMO

BACKGROUND: Splenic cyst complicated by non-typhoid Salmonella infection is rare in healthy individuals in the era of antibiotics. Salmonella enterica subsp. enterica serovar Livingstone causing infection of giant splenic cyst has not been previously reported. CASE PRESENTATION: We report a case of giant splenic cyst (maximum diameter, 21 cm) complicated with Salmonella Livingstone infection, which resulted in splenic abscess, in a 16-year-old previously healthy adolescent male. The splenic abscess was successfully treated with ultrasonography-guided percutaneous drainage and antimicrobial therapy. CONCLUSION: Infection of splenic cyst may be caused by S. Livingstone in immunocompetent individuals. This case may help clinicians to raise awareness towards splenic abscess and highlights the importance of drainage and antimicrobial agents to avoid splenectomy.


Assuntos
Abscesso Abdominal , Cistos , Infecções Intra-Abdominais , Infecções por Salmonella , Salmonella enterica , Esplenopatias , Abscesso Abdominal/tratamento farmacológico , Abscesso/tratamento farmacológico , Adolescente , Antibacterianos/uso terapêutico , Drenagem/métodos , Humanos , Infecções Intra-Abdominais/tratamento farmacológico , Masculino , Salmonella , Infecções por Salmonella/complicações , Infecções por Salmonella/diagnóstico , Infecções por Salmonella/tratamento farmacológico , Sorogrupo , Esplenopatias/complicações , Esplenopatias/diagnóstico , Esplenopatias/cirurgia
8.
J Pediatr Surg ; 57(9): 102-106, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34991867

RESUMO

INTRODUCTION: Intraabdominal abscesses (IAA) are a common complication following appendectomy. Empiric antibiotic regimens may fail to prevent IAA due to changes in bacterial resistance. We aim to describe the bacteriology of pediatric patients requiring drainage of an IAA after an appendectomy for appendicitis. METHODS: We performed a retrospective study of patients ≤18 years who underwent percutaneous drainage of an IAA following appendectomy a single U.S. children's hospital between 2015 and 2018. Patient demographics, appendicitis characteristics, antibiotic regimens, and culture data were collected. RESULTS: In total, 71 patients required drainage of an IAA of which 48 (67%) were male, the average age was 9.81 (SD 3.31) years and 68 (95.7%) having complicated appendicitis. Ceftriaxone/metronidazole was the most common empiric regimen prior to IAA drainage occurring in 64 (90.1%) patients. IAA cultures isolated organisms in 34 (47.9%) patients. Of those with positive cultures, 17 (50%) cases demonstrated an antimicrobial resistant organism. Most notably, 20% of Escherichia coli was resistant to the empiric regimen. Empiric antimicrobial regimens did not appropriately cover 92.3% of Pseudomonas aeruginosa cultures or 100% of Enterococcus species cultures. Antimicrobial regimens were changed following IAA drainage in 30 (42.2%) instances with 23 (32.4%) instances due to resistance in culture results or lack of appropriate empiric antimicrobial coverage. CONCLUSIONS: IAA culture data following appendectomy for appendicitis frequently demonstrates resistance to or lack of appropriate coverage by empiric antimicrobial regimens. These data support close review of IAA culture results to identify prevalent resistant pathogens along with local changes in resistance. LEVEL OF EVIDENCE: Level III.


Assuntos
Abscesso Abdominal , Apendicite , Laparoscopia , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Abscesso/cirurgia , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Apendicectomia/efeitos adversos , Apendicite/complicações , Apendicite/cirurgia , Criança , Drenagem/métodos , Resistência Microbiana a Medicamentos , Escherichia coli , Feminino , Humanos , Laparoscopia/efeitos adversos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
9.
Gan To Kagaku Ryoho ; 49(13): 1980-1982, 2022 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-36733064

RESUMO

The patient was a 61-year-old man who visited the emergency department of our hospital for the exacerbation of left lower abdominal pain. CT scan revealed a tumor in the descending colon and fluid accumulation and extensive foamy gas in the retroperitoneal space, suggesting that the tumor in the descending colon penetrated the parietal peritoneum and formed an abscess. After percutaneous drainage for the retroperitoneal abscess, a transverse colostomy was performed. After the improvement of the general conditions, the patient underwent an endoscopic biopsy and was diagnosed with well-differentiated adenocarcinoma. After 4 courses of FOLFOX plus panitumumab(PANI), with the drainage and wound care continued, he was discharged and underwent 2 additional courses of chemotherapy. PET-CT revealed marked shrinkage of the descending colon tumor without distant metastasis. Therefore, left colectomy and transverse colostomy closure were performed as curative surgeries. After discharge, the patient underwent 6 courses of chemotherapy and has been followed up without recurrence for 13 months after the curative surgeries.


Assuntos
Abscesso Abdominal , Neoplasias do Colo , Masculino , Humanos , Pessoa de Meia-Idade , Abscesso/tratamento farmacológico , Abscesso/etiologia , Abscesso/cirurgia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Colo Descendente/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/cirurgia , Neoplasias do Colo/patologia , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia
10.
Medicine (Baltimore) ; 100(46): e27897, 2021 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-34797340

RESUMO

RATIONALE: Familial adenomatous polyposis (FAP) associated with desmoids tumors (DTs) complicated by abscess formation is rare. The management is not easy and the choice of the best treatment may be controversial. PATIENT CONCERNS: A 33-year-old man was admitted to our hospital for abdominal pain, fever, chills, nausea, and vomiting. He had a family history of FAP, and history of abdominal surgery. DIAGNOSES: An abdominal enhanced chest computed tomography (CT) scan revealed a soft tissue mass in the abdominal wall and an irregular mesenteric soft tissue mass with internal fistula and intra-abdominal abscess. A CT-guided biopsy of the abdominal wall mass revealed DTs. INTERVENTIONS: The patient was given oral antibiotics for 6 months, and ultimately underwent surgery. OUTCOMES: The patient had no evidence of recurrence on follow-up at 10 months. LESSONS: This case indicates that for patients with FAP who have a history of abdominal surgery and a progressively enlarging mass and abscess in the abdomen, it is necessary to consider the possibility of DTs. FAP-related DTs are rarely complicated by abscess formation. Antibiotic therapy plus surgical resection of the tumor may be effective and make good prognosis.


Assuntos
Abscesso Abdominal/etiologia , Polipose Adenomatosa do Colo/complicações , Polipose Adenomatosa do Colo/terapia , Fibromatose Abdominal/complicações , Fibromatose Abdominal/terapia , Fibromatose Agressiva/complicações , Fibromatose Agressiva/terapia , Abscesso Abdominal/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Biópsia , Fibromatose Abdominal/diagnóstico por imagem , Fibromatose Agressiva/diagnóstico , Humanos , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
Ann Surg ; 274(3): 406-410, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34132703

RESUMO

BACKGROUND: Perforated appendicitis is the most common cause of intraabdominal abscess (IAA) in children. The optimal postoperative antibiotic regimen to reduce IAA has evolved in the last decade from triple-drug to 2-drug therapy (CM). Recent retrospective studies show decreased infectious complications with monotherapy PT. To date prospective comparative data are lacking. Therefore, a prospective randomized trial comparing PT versus CM was conducted. METHODS: A multi-institutional prospective randomized trial was performed in children with perforated appendicitis comparing postoperative antibiotic regimens PT or CM. The primary outcome was 30-day postoperative IAA formation. Perforation was strictly defined as a hole in the appendix or fecalith in the abdomen, documented with intraoperative photographs. RESULTS: One hundred sixty-two patients were enrolled during the study period. No differences in age, weight, or duration of presenting symptoms were identified. In addition, length of stay, duration of intravenous antibiotic treatment, discharge oral antibiotic treatment, and antibiotic-related complications did not differ between groups. Compared to the CM group, the PT group had significantly lower IAA rate [6.1% vs 23.8%, odd ratio (OR) 4.80, P = 0.002], lower postoperative computed tomography imaging rate (13.9% vs 29.3%, OR 2.57, P = 0.030), and fewer emergency room visits (8.8% vs 26.4%, OR 3.73, P = 0.022). Multivariate logistic regression analysis found the use of CM versus PT (OR 9.21, P = 0.021) to be the most significant predictor for developing IAA. CONCLUSIONS: In children with perforated appendicitis, postoperative monotherapy with PT is superior to standard 2-drug therapy with CM and does not increase antibiotic-related complications or antibiotic exposure duration.


Assuntos
Abscesso Abdominal/tratamento farmacológico , Antibacterianos/administração & dosagem , Apendicite/cirurgia , Complicações Pós-Operatórias/tratamento farmacológico , Gestão de Antimicrobianos , Apendicectomia , Criança , Feminino , Humanos , Infusões Intravenosas , Masculino , Fotografação , Estudos Prospectivos
12.
Dan Med J ; 68(6)2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34060462

RESUMO

INTRODUCTION: Complicated appendicitis increases the risk of post-operative intra-abdominal abscess. Treatment of complicated appendicitis is usually a post-operative course of intravenous antibiotics. A study is needed to confirm the results of retrospective studies showing that a post-operative course of oral antibiotics is not inferior to intravenous antibiotics after laparoscopic surgery for complicated appendicitis. METHODS: The Per oral versus Intravenous Postoperative Antibiotics after surgery for complicated appendicitis (PIPA) trial will be a prospective, multicentre, cluster-randomised cluster-crossover non-inferiority study designed to test whether a three-day post-operative course of oral antibiotics is non-inferior to a three-day post-operative course of intravenous antibiotics as standard care after laparoscopic surgery for complicated appendicitis in regards to the risk of post-operative intra-abdominal abscess formation within 30 days. Participating hospitals will either be randomised to a six-month period with an oral antibiotic regime followed by a six-month period with an intravenous antibiotic regime for the post-operative treatment after laparoscopic surgery for complicated appendicitis, or to a six-month period with an intravenous antibiotic regime followed by a six-month period with an oral antibiotic regime for post-operative treatment after laparoscopic surgery for complicated appendicitis. CONCLUSIONS: The primary outcome will be the incidence of intra-abdominal abscess by post-operative day 30. FUNDING: none. TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency and by the National/Regional Committee on Health Research Ethics.


Assuntos
Abscesso Abdominal , Apendicite , Abscesso Abdominal/tratamento farmacológico , Antibacterianos/uso terapêutico , Apendicectomia/efeitos adversos , Apendicite/tratamento farmacológico , Apendicite/cirurgia , Humanos , Estudos Multicêntricos como Assunto , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Resultado do Tratamento
13.
Postgrad Med J ; 97(1151): 605-607, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33790034

RESUMO

INTRODUCTION: Metronidazole is commonly prescribed for intra-abdominal infections. Oral metronidazole has high bioavailability (>95%) and intravenous metronidazole should be reserved for patients not suitable for oral preparations. METHODS AND MATERIALS: This full cycle audit evaluated the type of metronidazole preparation prescribed in adult emergency surgical patients requiring first-line empirical antimicrobial therapy for intra-abdominal infections. The criterion for audit was the proportion of patients who were prescribed intravenous metronidazole when the oral route was available. The first cycle included all consecutive eligible patients between 20 April and 14 May 2020. After an intervention phase educating prescribers about the similar pharmacokinetic properties of oral and intravenous metronidazole, clinical practice was reaudited between 22 June and 16 July 2020. Data were collected by case note and drug chart review. RESULTS: A total of 54 patients were included in the first audit cycle. Of these, 11 (20.4%) were prescribed oral metronidazole and 43 (79.6%) were prescribed intravenous metronidazole. In the majority of cases (35/43, 81.4%), intravenous metronidazole was prescribed in the absence of clear contraindications to the oral preparation. Of the 61 patients included in the reaudit cycle, 23 (37.7%) were prescribed oral metronidazole and 38 (62.3%) were prescribed intravenous metronidazole. The proportion of patients prescribed intravenous metronidazole despite being suitable for oral preparation decreased from 81.4% in the first cycle to 34.2% (13/38) in the reaudit cycle (risk ratio 0.42, 95% CI: 0.26 to 0.67, p<0.0001). Prescribing oral metronidazole when suitable saved up to £10.53/day per patient. CONCLUSION: This full cycle audit led to a significant improvement in the use of oral metronidazole in suitable patients, as well as a considerable reduction in healthcare costs.


Assuntos
Antibacterianos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Metronidazol/uso terapêutico , Prescrições/estatística & dados numéricos , Abscesso Abdominal/tratamento farmacológico , Administração Oral , Idoso , Antibacterianos/administração & dosagem , Feminino , Custos de Cuidados de Saúde , Humanos , Prescrição Inadequada/prevenção & controle , Infecções Intra-Abdominais/tratamento farmacológico , Masculino , Metronidazol/administração & dosagem , Pessoa de Meia-Idade , Peritonite/tratamento farmacológico , Estudos Prospectivos
14.
Clin J Gastroenterol ; 14(2): 555-559, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33428067

RESUMO

We report a rare case of amebiasis associated with an intraabdominal abscess without colitis, an intestinal perforation, or other extraintestinal amebiasis. A patient was admitted with cirrhosis and a history of spontaneous bacterial peritonitis (SBP) and was found to have a high C-reactive protein (CRP) level. Dynamic CT and ultrasound echo findings showed an intraabdominal abscess. No intestinal lesions or extraintestinal lesions other than the intraabdominal abscess were observed. Blood cultures and puncture fluid cultures were negative for bacteria. However, microscopic examination of the puncture fluid showed a cystic form of amoeba, leading to a diagnosis of an amoeba abscess. The abscess disappeared after 10 days of oral treatment with metronidazole. When an abdominal abscess is seen in an immunocompromised patient such as a cirrhotic patient, amoeba infection should be considered as a possible diagnosis.


Assuntos
Abscesso Abdominal , Amoeba , Entamoeba histolytica , Entamebíase , Abscesso Hepático Amebiano , Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/etiologia , Humanos , Abscesso Hepático Amebiano/complicações , Abscesso Hepático Amebiano/diagnóstico , Abscesso Hepático Amebiano/tratamento farmacológico , Metronidazol/uso terapêutico
15.
J Obstet Gynaecol ; 41(7): 1097-1101, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33249968

RESUMO

This 5-year retrospective study aimed to investigate whether early surgical management improves outcomes in patients presenting with a tubo-ovarian abscess (TOA). Patient characteristics, investigation results and treatment outcomes were compared. 50 women were diagnosed with a TOA during the study period. Nineteen (38.0%) were treated with antibiotics (medical group) and thirty one (62.0%) were treated surgically on admission (early surgical group). The early surgical group was associated with a high success rate of 96.8% and the lowest risk of readmission within 12 months (16.1%). There was no significant difference in the length of stay between the early surgical and the successful medical group.Impact StatementWhat is already known on this subject? Tubo-ovarian abscess (TOA) is an inflammatory mass that forms most commonly as a complication of untreated pelvic inflammatory disease (PID). Traditionally, TOAs are treated first with broad-spectrum intra-venous antibiotics, with surgical intervention considered after 72 h. It is not known whether early surgical intervention would be beneficial to patient outcomes compared to traditional management.What do the results of this study add? In this study, we have demonstrated a high success rate with early surgical management. Readmission rate was lowest in the early surgical group compared to the medical and late surgical group. This suggests that early surgical intervention may be beneficial, compared to the standard management of trialling antibiotics and then proceeding to surgery 72 h later.What are the implications of these findings for clinical practice and/or further research? Our study suggests that early surgery may be beneficial in the management of TOAs. Although we were unable to demonstrate statistical significance, our data suggest that it would be worthwhile to investigate white blood cell (WBC) and C-reactive protein (CRP) further as a potential predictor for failure of medical management. In the future, more studies comparing early surgical management with medical and late surgical management could inform clinicians of the best mode of treatment for these patients.


Assuntos
Abscesso Abdominal/cirurgia , Antibacterianos/uso terapêutico , Doenças das Tubas Uterinas/cirurgia , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Doenças Ovarianas/cirurgia , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/etiologia , Adulto , Proteína C-Reativa/análise , Doenças das Tubas Uterinas/tratamento farmacológico , Doenças das Tubas Uterinas/etiologia , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Contagem de Leucócitos , Pessoa de Meia-Idade , Doenças Ovarianas/tratamento farmacológico , Doenças Ovarianas/etiologia , Doença Inflamatória Pélvica/sangue , Doença Inflamatória Pélvica/complicações , Estudos Retrospectivos , Resultado do Tratamento
16.
Can Vet J ; 61(12): 1307-1311, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33299249

RESUMO

A 12-year-old Warmblood mare was referred for evaluation of behavioral changes not explained by general physical examination or lameness evaluation. Transrectal ultrasound examination was performed to determine if the behavioral changes were related to ovarian abnormalities, and a large abscess was found near the base of the cecum. Laparoscopic-guided aspiration and lavage of the abscess cavity followed by injection of benzyl penicillin G was carried out. Culture of the lavage sample yielded Campylobacter fetus subspecies fetus, an organism not previously reported as an etiological agent in abdominal abscesses in horses. The mare was treated after surgery with an extended course of antibiotics (minocycline per os q12h for 10 days followed by enrofloxacin per os q24h for 42 days). The mare resumed work in competitive eventing 10 months after surgery, and the behavioral complaints had resolved according to the owner. Key clinical message: We describe the diagnosis and treatment of a mare with an abdominal abscess from which Campylobacter fetus subspecies fetus was cultured. This organism has not previously been reported as an etiological agent in abdominal abscesses in horses.


Isolement de Campylobacter fetus sous-espèce fetus d'un abcès abdominal chez une jument adulte. Une jument Warmblood âgée de 12 ans fut référée pour évaluation de changements de comportement non-expliqués par un examen physique général ou une évaluation de boiterie. Un examen échographique transrectal fut effectué afin de déterminer si les changements de comportement étaient reliées à des anomales ovariennes et un large abcès fut trouvé près de la base du caecum. Une aspiration guidée par laparoscopie et un lavage de la cavité de l'abcès suivis d'une injection de benzyle pénicilline G furent effectués. Une culture de l'échantillon de lavage permis d'identifier Campylobacter fetus sous-espèce fetus, un organisme n'ayant pas été rapporté antérieurement comme agent étiologique dans les abcès abdominaux chez les chevaux. La jument fut traitée après la chirurgie avec un régime prolongé d'antibiotiques (minocycline per os q12h pour 10 jours suivi d'enrofloxacine per os q24h pour 42 jours). La jument recommença à travailler dans des compétitions 10 mois après la chirurgie et les plaintes concernant le comportement étaient résolues selon le propriétaire.Message clinique clé:Nous décrivons le diagnostic et le traitement d'une jument avec un abcès abdominal à partir duquel on isola C. fetus sous-espèce fetus. Cet organisme n'a pas été rapporté antérieurement comme agent étiologique dans les abcès abdominaux chez les chevaux.(Traduit par Dr Serge Messier).


Assuntos
Abscesso Abdominal , Infecções por Campylobacter , Campylobacter , Doenças dos Cavalos , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/veterinária , Animais , Infecções por Campylobacter/diagnóstico , Infecções por Campylobacter/tratamento farmacológico , Infecções por Campylobacter/veterinária , Campylobacter fetus , Feminino , Feto , Doenças dos Cavalos/diagnóstico , Doenças dos Cavalos/tratamento farmacológico , Cavalos
17.
BMJ Case Rep ; 13(10)2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33122231

RESUMO

A 43-year-old woman with Crohn's disease was admitted to the hospital with weight loss and 1 week of fever, abdominal pain and diarrhoea. At presentation, the patient was not on steroids or other immunosuppressive agents. Cross-sectional imaging of the abdomen revealed active colitis and multiple splenic and hepatic abscesses. All culture data were negative, including aspiration of purulent material from the spleen. Despite weeks of intravenous antibiotics, daily fever and abdominal pain persisted, the intra-abdominal abscesses grew, and she developed pleuritic chest pain and consolidations of the right lung. The patient was ultimately diagnosed with aseptic abscess syndrome, a rare sequelae of inflammatory bowel disease. All antimicrobials were discontinued and she was treated with high-dose intravenous steroids, resulting in rapid clinical improvement. She was transitioned to infliximab and azathioprine as an outpatient and repeat imaging demonstrated complete resolution of the deep abscesses that had involved her spleen, liver and lungs.


Assuntos
Abscesso Abdominal/diagnóstico , Antibacterianos/uso terapêutico , Doença de Crohn/complicações , Imunossupressores/uso terapêutico , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/etiologia , Adulto , Doença de Crohn/diagnóstico , Diagnóstico Diferencial , Quimioterapia Combinada , Feminino , Humanos , Síndrome , Tomografia Computadorizada por Raios X
18.
Am Surg ; 86(4): 308-312, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32391754

RESUMO

Acute diverticulitis is an emergency surgical condition that is commonly managed via an acute surgical unit model. Operative surgery is indicated in selected situations including generalized peritonitis or fistulous disease; however, limited data exist on how borderline patients potentially needing surgery may be salvaged by close clinical management with modern interventional techniques. The aims of the study were to identify the operative surgery rates in acute diverticulitis and predictors for identifying patients with complicated diverticulitis. Retrospective data collection was performed on a prospectively held database at a high-volume acute surgical unit at Logan Hospital, Queensland. Patient demographic data, disease-related factors, and treatment-related factors were collected for reporting and analysis. Over three years (2016-2018), 201 patients (64%) were admitted with uncomplicated diverticulitis and 113 patients (36%) with complicated diverticulitis. An observable downward trend was noted in the number of yearly admissions for uncomplicated diverticulitis. Complicated diverticulitis was associated with male gender (P = 0.039), increased length of hospital stay (P < 0.001), temperature ≥37.5 (P = 0.025), increased white cell count (P < 0.001), and elevated C-reactive protein (P < 0.001). Twelve patients (11%) with complicated diverticulitis initially failed conservative management. Seven patients (6%) underwent a definitive Hartmann's procedure, and 5 patients (4%) underwent percutaneous drainage of abscesses. Acute diverticulitis can be safely managed nonoperatively by medical therapy and percutaneous drainage of abscesses, with surgery reserved for patients with complicated diverticulitis with sepsis or peritonitis.


Assuntos
Antibacterianos/uso terapêutico , Doença Diverticular do Colo/terapia , Drenagem , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Colostomia , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/tratamento farmacológico , Doença Diverticular do Colo/cirurgia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Peritonite/etiologia , Peritonite/cirurgia , Estudos Retrospectivos
19.
J Pediatr Surg ; 55(3): 414-417, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31672408

RESUMO

PURPOSE: To determine the optimal nonoperative management of periappendiceal abscess in a pediatric population, we compared the therapeutic efficacy and cost-effectiveness of antibiotics alone versus antibiotics plus percutaneous drainage (PD). METHODS: We conducted a 10-year retrospective chart review of pediatric patients less than 18 years of age who had acute perforated appendicitis complicated by periappendiceal abscess. Group 1 consisted of patients (N = 35) who received nonoperative management with antibiotics only. Group 2 consisted of patients (N = 11) who underwent PD and also received antibiotics. Group 1 was subdivided into groups 1A and 1B. Group 1A consisted of patients (N = 25) who responded to antibiotics treatment. Group 1B consisted of patients (N = 10) who were initially treated with antibiotics but subsequently required PD. Patients' demographics, initial clinical presentation, abscess size and location, length of hospital stay, outcome, and complications were compared among these groups. RESULTS: Median hospital stay of group 1A and group 2 was identical at 6 days. Group 1B had a significantly longer median hospital stay of 13 days. There were no deaths and no significant long-term complications in any group. One patient in group 1A returned to the emergency room (ER) for abdominal pain and was readmitted for observation. Four patients in group 1B returned to the ER shortly after discharge and required readmission. One of these 4 patients developed acute pancreatitis in addition to enlarging abscess and underwent surgical drainage. There were no documented failures or complications of treatment in group 2 prior to interval appendectomy with the exception of 1 patient lost to follow-up. The presence of small bowel obstruction at the time of admission was an independent predictor of increased length of stay. CONCLUSIONS: Antibiotic therapy alone can be effective in a majority of patients and is recommended as initial management. To prevent potential complications and increased cost, PD should not be delayed if clinical symptoms persist or the abscess remains unchanged. Reimaging 6 days after initiation of antibiotic therapy with ultrasound or MRI is recommended to identify patients who would progress on antibiotics alone or who need to receive drainage without delay. LEVEL OF EVIDENCE: Level III.


Assuntos
Antibacterianos , Apendicite , Drenagem , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/epidemiologia , Abscesso Abdominal/cirurgia , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Apendicite/tratamento farmacológico , Apendicite/epidemiologia , Apendicite/cirurgia , Criança , Drenagem/efeitos adversos , Drenagem/métodos , Drenagem/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias , Estudos Retrospectivos
20.
Ann Ital Chir ; 90: 432-441, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31814600

RESUMO

BACKGROUND: The treatment of acute diverticulitis is a matter of debate and has undergone significant changes. Currently the main focus of surgical treatment is a more conservative and less invasive management. AIMS AND METHODS: To focus the role of surgery in the treatment of acute diverticulitis, the Authors have conducted a review of the literature of the last two decades and have revised critically their own experience. RESULTS: The indications for elective surgery based on the number of episodes, the young age at diagnosis and the presence of risk factors such as immunosuppression, have to be overcome in favour of a more individual approach based on the severity of the disease. Similarly the presence of pneumoperitoneum is no longer a compelling indication for urgent surgery just as it was in the past. In the treatment of complicated diverticulitis with abscess (Hinchey I-II) is used more and more conservative treatments consisting of guided percutaneous drainage combined with antibiotics. Resection with primary anastomosis with or without diverting ileostomy is preferable to Hartmann's procedure in case of perforated diverticulitis with peritonitis (Hinchey III-IV), using the latter only in the case of comorbidities, severe sepsis, hemodynamic instability or longtime feculent peritonitis (Hinchey IV). Recently, laparoscopic peritoneal lavage was introduced in the treatment of diverticulitis. CONCLUSIONS: Thanks to the progress made in conservative and interventional treatment and laparoscopic surgery, an increasingly less invasive treatment is proposed in the management of acute diverticulitis. KEY WORDS: Acute diverticulitis, Laparoscopic surgery, Surgical treatment.


Assuntos
Diverticulite/cirurgia , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Doença Aguda , Idade de Início , Anastomose Cirúrgica/métodos , Antibacterianos/uso terapêutico , Colectomia , Colostomia/métodos , Terapia Combinada , Diverticulite/complicações , Diverticulite/tratamento farmacológico , Diverticulite/epidemiologia , Drenagem , Procedimentos Cirúrgicos Eletivos , Humanos , Hospedeiro Imunocomprometido , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Laparoscopia/métodos , Estudos Multicêntricos como Assunto , Peritonite/tratamento farmacológico , Peritonite/etiologia , Pneumoperitônio/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Fatores de Risco , Irrigação Terapêutica
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