Epidemiological study of community- and hospital-acquired intraabdominal infections

Purpose： To investigate and analyze the clinical and etiological characteristics of community-acquired intraabdominal infections （CIAIs） and hospital-acquired or nosocomial intraabdominal infections （NIAIs） in a comprehensive hospital, to understand the characteristics, pathogen composition, and drug resistance of CIAls as well as NIAIs, and to provide a reference for clinical treatment. Methods： We collected the clinical data of patients with intraabdominal infections admitted to our hospital from June 2013 to June 2014. In vitro drug sensitivity tests were conducted to separate pathogens, and the data were analyzed using the WHONET 5.4 software and SPSS 13.0 software. Results： A total of 221 patients were enrolled in the study, including 144 with CIAls （55 mild-moderate and 89 severe） and 77 with NIAIs. We isolated 322 pathogenic strains, including 234 strains of gramnegative bacteria, 82 strains of gram-positive bacteria, and 6 strains of fungi. Based on clinical features, NIAIs and severe ClAls presented significantly higher values in age, length of hospital stay, mortality, and the incidence of severe intra-abdominal infection than mild-moderate CIAIs （p 〈 0.05）. There was no significant difference in the prognosis between NIAIs and severe CIAIs. Primary diseases leading to CIAIs and NIAIs mostly were hepatobiliary diseases and gastrointestinal diseases respectively. Bacteria isolated from various types of IAls mainly were Enterobacteriaceae; mild-moderate CIAIs mostly were mono-infection of gram-negative bacteria; NIAIs mostly were mixed infections of gram-negative and grampositive bacteria; and severe CIAls were from either type of infection. The rate of Extended Spectrum β-Lactamase-producing Escherichia coil and Klebsiella pneurnoniae was much higher in NIAIs than in CIAIs （p 〈 0.05）. The antimicrobial drug sensitivity of gram-negative bacteria isolated from NIAIs was significantly lower than that of CIAIs. Conclusion： CIAIs and NIAIs have their own unique clinical features and epidemiological features of pathogens which should be considered during the initial empiric therapy for the rational use of anti- microbial drugs. Regional IAls pathogenic bacteria have their own features in drug resistance, slightly different from some recommendations of 2010 Infectious Diseases Society of America guidelines.

Bacterial infection after liver transplantation

Infectious complications are major causes of morbidity and mortality after liver transplantation,despite recent advances in the transplant field.Bacteria,fungi,viruses and parasites can cause infection before and after transplantation.Among them,bacterial infections are predominant during the first two months posttransplantation and affect patient and graft survival.They might cause surgical site infections,including deep intra-abdominal infections,bacteremia,pneumonia,catheter-related infections and urinary tract infections.The risk factors for bacterial infections differ between the periods after transplant,and between centers.Recently,the emergence of multi-drug resistant bacteria is great concern in liver transplant(LT)patients.The instructive data about effects of infections with extended-spectrum beta lactamase producing bacteria,carbapenem-resistant gram-negative bacteria,and glycopeptide-resistant gram-positive bacteria were reported on a center-by-center basis.To prevent posttransplant bacterial infections,proper strategies need to be established based upon center-specific data and evidence from well-controlled studies.This article reviewed the recent epidemiological data,risk factors for each type of infections and important clinical issues in bacterial infection after LT.

Safety in Surgery:Evaluation of Safety and Efficiency in Use of Aminoglycosides in Acute Appendicitis

Background: Aminoglycosides are used as empirical antibiotic treatment of intraabdominal infections which are caused by Gram negative bacteria and for which the treatment of choice is surgery. Aminoglycosides maintain good efficacy against these bacteria and reduce the need for prescribing fluoroquinolone, cephalosporin and carbapenem antibiotics which contribute to the development of resistant bacterial strains. In recent years, several clinical trials and international guidelines have advised against the use of aminoglycosides owing largely to doubts about their effectiveness and to the concern for their known nephrotoxicity and ototoxicity. Aim: In our study, we aimed to prove whether aminoglycosides are appropriate agents in the treatment of acute appendicitis. Methods: Retrospectively, patients with acute appendicitis we included in the trial. Demographic characteristics, comorbidities, clinical signs and symptoms, the type of antibiotic and surgical treatment were analyzed. The effect of independent variables on the occurrence of complications was calculated using Student’s T-test and Fisher’s precise test. The effect of aminoglycosides on the loss of kidney function was determined by means of a linear regression method. Results: 300 patients proved acute appendicitis were included in the study. Univariate statistical analysis showed that the risk factors for postoperative complications in treating acute appendicitis were: age over 76 years (p Conclusion: Aminoglycoside antibiotics are a safe and effective treatment of acute appendicitis;our not published data are positive of AGs use in acute cholecystitis and left colon diverticulitis which requires surgery. If used for a limited time period, they do not increase the risk for kidney injury and remain a stable low level of all over complications.