Abstract. Inflammatory bowel diseases (IBD) are chronic intestinal disorders caused by a number of factors, including external influences, intestinal microbiota and genetics. The two major clinically defined types of IBD are Crohn's disease and ulcerative colitis, each of which is characterized by relapses in the clinical course, thus patients must be under constant observation via regular endoscopies. As endoscopy, which has been used for direct evaluation and diagnosis of IBD, requires uncomfortable and expensive bowel preparation, a non-invasive test was required to reduce the number of patients undergoing unnecessary endoscopy. Calprotectin is a protein occurring in the cytosol of inflammatory cells and is released by the activation of leukocytes. As it is elevated and stable in the faeces of patients with IBD and can be reliably detected in faecal samples of <5 g, it may serve as an inexpensive, non-invasive diagnostic method for IBD. This is explored in the following review.
Dual combinations of carbapenems, including those containing sub-inhibitory concentrations of antibiotics, were synergistic against multidrug-resistant (MDR) and extensively drug-resistant (XDR) K. pneumoniae isolates harbouring blaOXA-48.
PMQRs compromised the bactericidal activity of ciprofloxacin and levofloxacin when expressed in Enterobactercloacae, S. maltophilia or Klebsiellapneumoniae and when more than one co-existed. PMQR determinants represent an unrecognized threat, capable to compromise the in vitro activity of quinolones if expressed in a favourable genetic environment and to favour selection of resistant mutants by widening the mutant selection window of these agents.
INTRODUCTION: Surgical site infections (SSIs) represent significant morbidity and financial implications after colon surgery. The objective of this prospective study is to compare clinical outcomes pre-and post-implementation of a dedicated colon surgery bundle to reduce SSIs in our health system. METHODS: A prospective study was conducted in which a dedicated colon surgery bundle and interdisciplinary team for its implementation was established. The twenty-five components were divided into pre-hospital and pre-, intra-, and postoperative measures. These included standardized mechanical and antibiotic bowel preparation, skin cleansing, alcohol-based skin preparation, maintenance of normothermia, antimicrobial prophylaxis, optimal tissue oxygenation, glucose control, a clean standardized fascial closure process, and negative pressure wound therapy. Specific enhanced preoperative patient education was provided. Consecutive patients who underwent a colorectal procedure between January 2015 and January 2016 were included. SSIs were recorded and subdivided by wound class. RESULTS: Implementation of the colon bundle led to a significant decrease in SSIs 7% (11/198) vs 15% (26/175) (p <0.05) when compared to the year prior. Additionally, SSIs observed in clean-contaminated and contaminated procedures decreased from 34.6% to 14.3% and 38.5% to 14.3%, respectively (p<0.05%). CONCLUSIONS: We demonstrate that the implementation of a specific colon bundle resulted in a 54% decrease in post-operative SSIs. The greatest reduction of SSIs was seen in wound classes II and III. This approach to incorporating an advanced surgery bundle for colon and rectal procedures can provide an effective strategy to reduce SSIs.
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