In Vitro Efficacy of Six Alternative Antibiotics against Multidrug Resistant Escherichia Coli and Klebsiella Pneumoniae from Urinary Tract Infections

<p><b>INTRODUCTION</b>Increasing resistance in Escherichia coli and Klebsiella pneumoniae to firstline antibiotics makes therapeutic options for urinary tract infections (UTIs) challenging. This study investigated the in vitro efficacies of 6 antibiotics against multidrug resistant (MDR) uropathogens.</p><p><b>MATERIALS AND METHODS</b>Minimum inhibitory concentrations to ceftibuten, cefpodoxime, fosfomycin, mecillinam, temocillin, and trimethoprim were determined against 155 MDR-isolates of E. coli and K. pneumoniae. The presence of extended-spectrum beta-lactamases (ESBL) and plasmid-borne AmpC enzymes was determined by phenotypic testing with genotyping performed by multiplex polymerase chain reaction.</p><p><b>RESULTS</b>Temocillin demonstrated highest susceptibility rates for both E. coli (95%) and K. pneumoniae (95%) when breakpoints for uncomplicated UTIs were applied; however, temocillin susceptibility was substantially lower when "systemic infection" breakpoints were used. Fosfomycin demonstrated the best in vitro efficacy of the orally available agents, with 78% and 69% of E. coli and K. pneumoniae isolates susceptible, respectively. The next most effective antibiotics were ceftibuten (45%) and mecillinam (32%). ESBL and ampC genes were present in 47 (30%) and 59 (38%) isolates.</p><p><b>CONCLUSION</b>This study demonstrated few oral therapeutic options for MDR-uropathogens, with fosfomycin demonstrating the best in vitro activity.</p>

Gynaecologic robot-assisted cancer and endoscopic surgery (GRACES) in a tertiary referral centre

<p><b>INTRODUCTION</b>Robotic-assisted gynaecologic surgery is gaining popularity and it offers the advantages of laparoscopic surgery whilst overcoming the limitations of operative dexterity. We describe our experience with the fi rst 40 cases operated under the GRACES (Gynaecologic Robot- Assisted Cancer and Endoscopic Surgery) programme at the Department of Obstetrics & Gynecology, National University Hospital, Singapore.</p><p><b>MATERIALS AND METHODS</b>A review was performed for the fi rst 40 women who had undergone robotic surgery, analysing patient characteristics, surgical timings and surgery-related complications. All cases were performed utilising the da Vinci® surgical system (Intuitive Surgical, Sunnyvale, CA) with 3 arms and 4 ports. Standardised instrumentation and similar cuff closure techniques were used.</p><p><b>RESULTS</b>Seventeen (56%) were for endometrial cancer and the rest, for benign gynaecological disease. The mean age of the patients was 52.3 years. The average docking time was 11 minutes (SD 0.08). The docking and operative times were analysed in tertiles. Data for patients with endometrial cancer and benign cases were analysed separately. There were 3 cases of complications- cuff dehiscence, bleeding from vaginal cuff and tumour recurrence at vaginal vault.</p><p><b>CONCLUSION</b>Our caseload has enabled us to replicate the learning curve reported by other centres. We advocate the use of a standard instrument set for the fi rst 20 cases. We propose the following sequence for successful introduction of robot-assisted gynaecologic surgery - basic systems training, followed shortly with a clinical case, and progressive development of clinical competence through a proctoring programme.</p>

Demographic and clinical characteristics for infantile haemangioma in a tertiary centre in Malaysia

Introduction: Infantile haemangioma is the most common tumor in infancy. They are extremely heterogenous clinically. Established risk factors for infantile haemangioma include female sex, white ethnicity, prematurity, low birth weight and multiple gestation. There is a lack of demographic studies in the Asian population especially in the Malay ethnic group. Objective: To describe the demographics and clinical characteristics of infantile haemangioma in a tertiary centre in Malaysia. To describe associated complications and the need for therapeutic intervention. To determine whether there is any difference in demographics and clinical characteristics of infantile hemangiomas in a Malaysian population comprising predominantly Malay ethnic group with published reports of Western population. Design Retrospective review of patients with infantile haemangioma referred to the Paediatric Dermatology unit, Kuala Lumpur Hospital between January 2009 and May 2011. Main Outcome Measures: Demographic and clinical characteristics were summarized and compared with data from previous studies. The study included 50 patients (38 females and 12 males) with a mean age of 6.23 months (range 0.1 to 16 months) at presentation. 11(22%) patients were premature. The mean age of onset was 20 days (range 0 to 5 months). 18(37%) patients had a premonitory mark at birth. Of 62 hemangiomas in 50 patients, 45(72.5%) were localized, 5(8.1%) were segmental, 11(17.7%) indeterminate and 1(1.6%) multifocal. The most frequent location of the haemangiomas was in the face with 29(46.8%) lesions, followed by 10(16.1%) lesions in the head and neck, 10(16.1%) lesions in the extremities, 8(12.9%) lesions in the trunk and 5(8.1%) in the perineum. Complications that occurred included ulceration in 8(16%) patients, threat to vision in 7(14%), infection in 2 (4%) and bleeding in 6(12%) patients. Of the 50 patients, 24(48%) patients required interventions. These interventions included propranolol only in 12(24%) patients, prednisolone only in 4(8%), both propranolol and prednisolone in 5(10%), wound care in 2(4%) and pulse dye laser in 1(2%). Conclusion: The demographics and clinical characteristics of infantile haemangiomas in Malaysia are similar to published reports.