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Objective: Antibiogram preparation is important for the proper selection of antimicrobial agent in empiric therapy. It is recommended to prepare the antibiogram separately for inpatients and outpatients. However, the antimicrobial agent susceptibility of bacteria detected from an inpatient is thought to be different when detected at an early date after admission and after a certain period after admission.Methods: In this study, we defined the bacteria detected from an inpatient within 3 days after admission as “brought bacteria” and those over 3 days after admission as “bacteria detected after admission.” Antimicrobial agent susceptibilities of brought bacteria and bacteria detected after admission in our hospital between April 2018 and March 2019 were compared for Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa.Results: The occurrence rate of Escherichia coli producing an extended β-lactamase of bacteria detected after admission was found to be significantly higher compared with that of brought bacteria. The sulbactam/ampicillin susceptibility rate of bacteria detected after admission was significantly lower than that of brought bacteria. The occurrence rate of the two drug-resistant Pseudomonas aeruginosa detected after admission tends to be higher compared with that of brought bacteria.Conclusion: Our findings showed that the susceptibility rate of some drugs differed substantially between brought bacteria and bacteria detected after admission. Therefore, the inpatient’s antibiogram is thought to be prepared by separating bacteria detected at an early date after admission and after a certain period after admission, leading to the proper selection of antimicrobial agent in empiric therapy tailored to a patient’s number of days in the hospital.
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<b>Objective: </b>We have used therapeutic drug monitoring (TDM) analysis software to set the initial dose of vancomycin in our hospital. In contrast, the TDM guideline, in which the initial dose of vancomycin per body weight was set, was published in 2012. We looked forward with utilizing the TDM guideline in the clinical setting, after which we conducted multiple surveys to determine the important points of the TDM guideline.<br><b>Methods: </b>We surveyed patients treated with vancomycin, in whom the initial dose was set using the TDM analysis software and the concordance rate between the vancomycin dose set with the software and that set with the TDM guideline.<br><b>Results: </b>The concordance rate of vancomycin dose was 42.1%. The mean age of the high-dose group (vancomycin dose higher than that recommended by the TDM guideline), was younger than that of the recommended-dose group. Additionally, the mean body weight of the high-dose group was significantly lower than that of the recommended-dose group. The corrected creatinine clearance of the low-dose group was significantly lower than that of the recommended-dose group.<br><b>Conclusion: </b>Our results suggest that when the initial dose is set after referring the TDM guideline in patients who are not very high age, and having low body weight and decreased renal function, the dose may differ from the dose set by using TDM analysis software. In addition, since the recommended dose per body weight is a range and not a single value, setting the dose appropriate to target trough concentration is necessary.
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Objetivo: Se analiza la experiencia del tratamiento quirúrgico de la Enfermedad de Crohn para determinar las indicaciones y alternativas quirúrgicas, complicaciones postoperatorias y factores asociados, y las cifras de recurrencia. Material y métodos: Estudio retrolectivo de los pacientes operados por Enfermedad de Crohn entre 1979 y 1997. Se buscaron factores de riesgo para morbilidad quirúrgica y se construyeron curvas actuariales de recurrencia. Resultados: Se incluyeron 34 pacientes con edad promedio de 46 años. Todos los pacientes se operaron por complicaciones, las más frecuentes fueron estenosis y obstrucción. Los sitios de afección fueron ileocecal en 53%, colitis en 35%, y yeyuno en 12%. Los procedimientos quirúrgicos más frecuentes fueron resecciones segmentarias, principalmente ileocecales. La morbilidad operatoria fue de 32% y la mortalidad de 6%. La presencia de afección colónica y necesidad de reseccion del colon o recto tuvo más riesgo de complicaciones (P<0.05). La recurrencia actuarial fue del 39% a 107 meses. Conclusiones: La cirugía para Enfermedad de Crohn estuvo principalmente indicada en complicaciones, presentó altas cifras de morbilidad asociándose ésta con afección y/o resecciones del colon, y hubo altas cifras de recurrencia actuarial de enfermedad de Crohn a largo plazo.
Objective: The experience with the surgical treatment of Crohn's Disease is analyzed in order to determine the indications for surgery, surgical procedures, postoperative complications and associated risk factors, and recurrence rates. Material and methods: Retrolective analysis of patients operated upon for Crohn's Disease between 1979 and 1997. Risk factors for operative morbidity were searched, and actuarial curves for recurrence of disease were constructed. Results: There were 34 patients with a mean age of 46 years. All patients were operated upon because of complications; the most frequent ones were stenosis and obstruction. The affected patterns were ileocecal in 53%, colitis in 35% and small bowel in 12%. Segmental resections were the most frequent ones, mainly ileo cecal. Operative morbidity was 32% and mortality 6%. The presence of colonic affection and the necessity o f its resection was a higher risk for complications (P<0.05). Actuarial recurrence was 39% at 107 months. Conclusions: Surgery for Crohn's disease was mainly indicated in complications, presented high rates of morbidity associated with colonic involvement and resections, and there were high rates of recurrence at long term.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Crohn Disease/surgery , Postoperative Complications/epidemiology , Retrospective StudiesABSTRACT
We investigated the outcomes of nephron-sparing surgery in patients with small renal cell carcinomas by retrospectively reviewing the records of 20 elective cases of nephron-sparing surgery performed from 1994 to 2003. All patients had low pathologic stage, localized, unilateral tumors smaller than 4 cm and sporadic renal cell carcinomas. There were no significant differences between mean preoperative serum creatinine levels and postoperative levels. Nephron-sparing surgery may be safe and curative treatment for low pathologic stage, localized, unilateral tumors smaller than 4 cm and sporadic renal cell carcinomas.