ABSTRACT
INTRODUCTION: Prophylactic antibiotics in urological procedures are essential to prevent postoperative infections. A different approach in selecting antibiotic prophylaxis according to the type of procedure is needed. METHODOLOGY: A retrospective study was carried out at an academic hospital in Surabaya, Indonesia, by collecting medical records of patients who underwent urologic procedures within 2019- 2020, including microbiological data. RESULT: One hundred seventy-nine urological procedures were assessed. Antibiotic prophylaxis was administered in the clean-contaminated and clean procedures (93.2% and 6.8%, respectively). Ceftriaxone was commonly used (69.3%), single-dose, one day before the surgery. Gram-negative bacteria were widely found in the urinary culture of patients (75.2%). E. coli, K. pneumoniae, and P. aeruginosa were dominating with low susceptibility to cephalosporins. ESBL-producing bacteria were E. coli (64%) and K. pneumoniae (89%). CONCLUSIONS: The 3rd generation cephalosporins (ceftriaxone) are mostly used in urological procedures despite the low susceptibility against this antibiotic in cultured E coli, P. aeruginosa, and K. pneumonia. The aminoglycosides have relatively good activity and have been suggested in several guidelines for urologic procedures, such as prostate and urinary tract stone procedures. It is crucial to consider the incision site, type of procedure, and bacterial profile in the hospital to propose antibiotic prophylaxis guidelines.
Subject(s)
Anti-Bacterial Agents , Antibiotic Prophylaxis , Gram-Negative Bacterial Infections , Urologic Surgical Procedures , Antibiotic Prophylaxis/methods , Retrospective Studies , Humans , Male , Postoperative Complications/prevention & control , Anti-Bacterial Agents/therapeutic use , Gram-Negative Bacteria , Gram-Negative Bacterial Infections/drug therapy , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Urologic Surgical Procedures/adverse effectsABSTRACT
OBJECTIVES: Tumor lysis syndrome (TLS) is a life-threatening oncology emergency disorder, which may cause acute kidney injury (AKI), arrhythmias, seizures, and sudden death. Hydration is used to prevent TLS in medium-high risk patients, and treatment in TLS patients. According to the pediatric protocol in Dr. Soetomo District General and Teaching Hospital, close monitoring is required to prevent the progression of hematological malignancy towards TLS. The study aimed to analyze the hydration effect on potassium, calcium, and phosphate levels; serum creatinine (sCr); and blood urea nitrogen (BUN) level. METHODS: This was an observational and prospective study conducted at Dr. Soetomo District General and Teaching Hospital for four months on 15 pediatric hemato-oncology patients who got TLS and in risk of TLS. Laboratory parameters were observed in 11 days, pre and post hydration. RESULTS: Among the 15 patients who met the inclusion criteria, there were eight TLS patients and seven TLS risk patients. After hydration administration 67% of TLS patients achieved normal potassium level, 75% achieved normal phosphate level, 0% achieved normal calcium level, and 50% achieved normal sCr and BUN levels. Meanwhile, TLS risk patients reached normal level in all parameters. This difference in performance is caused by disease progression. CONCLUSIONS: Hydration can maintain serum electrolytes and renal function in a normal range, preventing TLS in TLS risk patients. In TLS patients, hydration only tends slow the progression of the disease.