Predictive factors of acute kidney injury in patients undergoing rectal surgery

BACKGROUND: Despite major advance in surgical techniques from open surgery to robot-assisted surgery, acute kidney injury (AKI) is still major postoperative complication in rectal surgery. The purpose of this study is to compare the incidence of postoperative AKI according to different surgical techniques and also the risk factors, outcomes of AKI in patients undergoing rectal cancer surgery. METHODS: A retrospective medical chart review was done in a total of 288 patients who received proctectomy because of rectal cancer from 2011 to 2013. RESULTS: The mean patient age was 62 ± 12 years, and male was 64.2%. Preoperative creatinine was 0.91 ± 0.18 mg/dL. Open surgery was performed in 9%, and laparoscopy assisted surgery or robot assisted surgery were performed in 54.8% or 36.1% of patients, respectively. AKI developed in 11 patients (3.82%), 2 (18%) of them received acute hemodialysis. Incidence of AKI was not different according to the surgical technique, however, the presence of diabetes, intraoperative shock, and postoperative ileus was associated with the development of AKI. In addition, AKI patients showed significantly longer hospital stay and higher mortality than non-AKI patients. CONCLUSION: Our study demonstrated that despite advances in surgical techniques, incidence of postoperative AKI remains unchanged and also that postoperative AKI is associated with poor outcome. We also found that presence of diabetes, intraoperative shock and postoperative ileus are strongly associated with the development of AKI. More careful attention should be paid on high risk patients for the development of postoperative AKI regardless of surgical techniques.

Evaluation of Latex Agglutination Test Kit for Rapid Detection of Methicillin-Resistance in Staphylococcus aureus / 대한임상병리학회지

BACKGROUND: The identification of methicillin-resistant Staphylococcus aureus (MRSA) in the clinical laboratory has been typically performed by using methods that detect phenotypic expression of resistance determinants. However, these methods are not always reliable since phenotypic expression of methicillin resistance is known to be heterogeneous. In this study, MRSA-Screen test (Denka Seiken Co., Ltd., Tokyo, Japan), consisting of a slide latex agglutination kit that detects PBP 2a with a monoclonal antibody, was compared to the oxacillin disk diffusion test, the oxacillin-salt agar screen, agar dilution MIC and PCR of the mecA gene for the detection of methicillin resistance in S. aureus. METHODS: A total of 48 MRSA and 46 methicillin-susceptible S. aureus (MSSA) clinical isolates, defined by the presence or absence of the mecA gene, respectively, were tested. RESULTS: The MRSA-Screen test, the oxacillin disk diffusion test, and the oxacillin-salt agar screening test showed sensitivity of 97.9%, 93.8%, and 97.9% and specificity of 100% in all three tests. CONCLUSION: We conclude that the MRSA-Screen test is very accurate, reliable and easy to perform for detection of methicillin resistance in S. aureus.