ABSTRACT
Surgical site infections are related to a high morbidity, mortality and healthcare costs. Despite ample evidence demonstrating the effectiveness of antimicrobials to prevent surgical site infections, inappropriate timing, antibiotic selection and excessive continuation of antibiotics are common in practice. In this study, we compare the appropriateness of antibiotic prophylaxis in gastrointestinal surgery, before and after an evidence-based guideline implementation. One hundred patients were evaluated in each group. The implementation of the guideline resulted in significant reduction of incorrect use of antibiotics from 55% to 18% (P = 0.002). It also reduced duration of prophylactic antibiotics (43% vs. 23%, P = 0.025). Inappropriate doses diminished but not significantly (8% vs. 5%, P = 0.321). Based on our results, in more than half of of these cases patients received incorrect antibiotic prophylaxis regimens for gastrointestinal surgery in this hospital. Local guideline implementation can result in reduction of antibiotic use, dose and duration errors.
Subject(s)
Antibiotic Prophylaxis , Digestive System Surgical Procedures , Humans , Antibiotic Prophylaxis/methods , Surgical Wound Infection/prevention & control , Anti-Bacterial Agents/therapeutic use , Hospitals, TeachingABSTRACT
The plasma level of adenosine increases under ischemic and inflamed conditions in tumor microenvironment. Adenosine elicits a range of signaling pathways in tumors, resulting in either inhibition or enhancement of tumor growth depending upon different subtypes of adenosine receptors activation and type of cancer. Metabolism of adenosine-5'-triphosphate (ATP) and its derivatives including adenosine is dysregulated in the breast tumor microenvironment, supporting the role of this metabolite in the pathogenesis of breast cancer. Adenosine regulates inflammation, apoptosis, cell proliferation, and metastasis in breast cancer cells. This review summarizes the role of adenosine in the pathogenesis of breast cancer for a better understanding and hence a better management of this disease.