RESUMEN
Background: Transrectal ultrasound (TRUS)-guided prostate biopsy is associated with infection rates between 0.3 % and 3.2%. Infectious complications include urinary tract infection, prostatitis, bacteraemia and sepsis. Surgical site surveillance in this patient cohort is becoming increasingly important given global increases in antimicrobial resistance. Methods: Surgical site surveillance for patients undergoing TRUS biopsies was introduced in our hospital in 2017. All patients had a risk assessment form completed to assess for carriage or risk of carriage of multi-drug resistant organisms. An intense analysis was completed on any patient who developed an infection post-TRUS biopsy. Data was fed back on a quarterly basis to a multi-disciplinary working group. Members of this group include a Consultant Microbiologist, Infection Prevention and Control Nurse, Consultant Urologist, Antimicrobial Pharmacists and Clinical Nurse Ward Managers. Results: 784 TRUS-guided biopsy of the prostate procedures were performed between January 1 st 2017 and the end of the third quarter, 2021. The rate of infection post-TRUS was 2.7% in 2017, 3.4% in 2018 and 3.2% in 2019. This improved to 0% in 2020 and 0.8% in the first three quarters of 2021. Conclusions: Several interventions were introduced resulting in a sustained reduction in infection rates in this cohort. These include changing the choice of surgical antibiotic prophylaxis, improvement in the timing of antibiotic prophylaxis and scheduling of other urology procedures. The introduction of surgical site surveillance and multi-disciplinary input has demonstrated a reduction in infection rates post TRUS biopsy.
RESUMEN
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder that affects approximately 10% to 20% of the general adult population in Europe and the Americas and is characterized by abdominal pain and altered bowel habits in the absence of reliable biomarkers. The pathophysiology of IBS is poorly understood and is currently thought to represent a complex interplay among the gut microbiota, low-grade inflammation, impaired mucosal barrier function, visceral hypersensitivity, gut motility, and alterations in the gut-brain axis. In any individual patient, 1 or more of these factors may interact to generate symptoms. Although up to 50% of patients report postprandial exacerbation of symptoms, few studies have critically assessed the role of diet in IBS. Furthermore, although many patients with IBS adopt any one of a host of dietary changes in an attempt to alleviate their symptoms, there has been, up until recently little scientific basis for any dietary recommendation in IBS. This review discusses the contribution of diet to the pathophysiology and symptoms of IBS.
RESUMEN
The gut microbiota is a complex ecosystem that has a symbiotic relationship with its host. An association between the gut microbiota and disease was first postulated in the early 20(th) century. However, until the 1990s, knowledge of the gut microbiota was limited because bacteriological culture was the only technique available to characterize its composition. Only a fraction (estimated at <30%) of the gut microbiota has been cultured to date. Since the 1990s, advances in culture-independent techniques have spearheaded our knowledge of the complexity of this ecosystem. These techniques have elucidated the microbial diversity of the gut microbiota and have shown that alterations in the gut microbiota composition and function are associated with certain disease states, such as IBD and obesity. These new techniques are fast, facilitate high throughput, identify organisms that are uncultured to date and enable enumeration of organisms present in the gut microbiota. This Review discusses the techniques that can used to characterize the gut microbiota, when they can be applied to human studies and their relative advantages and limitations.
