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1.
Purpose
Although many patients receive antibiotic therapy for appendicitis, it is unclear if this treatment can be administered to elderly patients. We aimed to assess the outcomes of antibiotic therapy for appendicitis in elderly patients aged ≥80 years.Method
During this 4-year study, we enrolled 26 elderly patients who initially received antibiotic therapy. Of these, 3 were suspected to have complicated appendicitis. Antibiotic therapy consisted of second-generation cephalosporin and metronidazole that was administered for 4 days with a 24-hour fasting period. We evaluated the rates of treatment failure and recurrence.Results
Mean age was 83.5 years, and 57.7% (15/26) of patients had comorbidities. One patient (4.8%) failed to respond to antibiotic therapy and underwent subsequent appendectomy. During the median follow-up period of 17 months, 5 patients (20%) experienced recurrence; 3 underwent appendectomy and 2 received a new course of antibiotics.Conclusion
Antibiotic therapy without surgery may be a safe and effective treatment for appendicitis in selective patients aged ≥80 years. This is a good treatment option in patients with high operative risk. 相似文献2.
Richard Y. Kim Alex M. Ng Annuradha K. Persaud Stephen P. Furmanek Yash N. Kothari John D. Price Timothy L. Wiemken Mohamed A. Saad Juan J. Guardiola Rodrigo S. Cavallazzi 《The American journal of the medical sciences》2018,355(6):524-529
Background
We evaluated the effect of time spent in the emergency department (ED) and process of care on mortality and length of hospital stay in patients with sepsis or septic shock.Methods
An observational cohort study was conducted on 117 patients who came through the University of Louisville Hospital ED and subsequently were directly admitted to the intensive care unit (ICU). Variables of interest were time in the ED from triage to physical transport to the ICU, from triage to antibiotic(s) ordered, and from triage to antibiotic(s) administered. Expected mortality was calculated according to the University Health System Consortium Database. Primary and secondary outcomes were in-hospital death and hospital length of stay in days, respectively.Results
We found no significant association between time in the ED and mortality between survivors and nonsurvivors (5.5 versus 5.7 hours, P = 0.804). After adjusting for expected mortality, a 22% increase in mortality risk was found for each hour delay from triage to antibiotic(s) ordered; a 15% increase in mortality risk was observed for each hour from triage to antibiotic(s) given. Both time from triage to antibiotic(s) ordered (hazard ratio [HR] = 0.8, P = 0.044) and time from triage to antibiotic(s) delivery (HR = 0.79, P = 0.0092) were independently associated with an increased hospital stay (HR = 0.79, P = 0.0092).Conclusion
Though no significant association between mortality and ED time was demonstrated, we observed a significant increase in mortality in septic patients with both delays in antibiotic(s) order and administration. Delay in care also resulted in increased hospital stays both overall and in the ICU. 相似文献3.
To systematically evaluate the efficacy of antibacterial therapy in ulcerative colitis, we carried out a meta-analysis of
controlled clinical trials. Within the time period 1966 through September 2006, PUBMED, EMBASE, and SCOPUS were searched for
clinical trial studies that investigated the efficacy of antibiotics in ulcerative colitis. We considered clinical remission
as our key outcome of interest. Of 122 studies, 10 randomized placebo-controlled clinical trials matched our criteria and
were included in the analysis (530 patients). All the studies used antibiotics as an adjunct therapy to conventional treatment
of ulcerative colitis (i.e., corticosteroids and 5-aminosalycilic acid). Pooling of these trials yielded odds ratio (OR) of
2.14 (95% confidence interval [CI], 1.48–3.09; P<0.0001) in favor of antimicrobial therapy. Meta-analysis of short-term trials (5–14 days) showed a higher rate of clinical
remission in patients treated with antibiotics (OR, 2.02; 95% CI, 1.36–3). These results suggest that adjunctive antibacterial
therapy is effective for induction of clinical remission in ulcerative colitis. 相似文献
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目的 分析妊娠期高血压疾病并发肾病综合征的临床特征及其与不良妊娠结局的关系.方法 回顾性分析本院1997年1月互2008年1月35例妊娠期合并肾病综合征(肾病组)和121例未合并肾病综合征(对照组)的妊娠期高血压疾病重度子痫前期患者的临床资料,比较两组血压、生化指标和母婴并发症.结果 肾病组发病孕周早,24 h尿蛋白定量、低蛋白血症、肾功能受损、母婴并发症显著高于对照组(P<0.01),肾痛组围生儿死亡率高于对照组,差异有统计学意义(P<0.05).结论 妊娠期肾病综合征发病孕周早,对母婴影响大,早诊断、综合治疗和适时终止妊娠可减少妊娠期母婴并发症,改善母婴预后. 相似文献
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Roland E. Andersson 《Current infectious disease reports》2013,15(1):10-13
Nonsurgical treatment with antibiotics has recently been proposed as the first line of treatment for noncomplicated appendicitis. This has met with considerable interest, illustrated by the number of reviews and meta-analyses, which exceed the number of original reports of the issue. The results in these studies are seriously biased due to inclusion of patients with resolving appendicitis. At a time when we need to reduce inappropriate use of antibiotics in the struggle against the increasing rate of antibiotics resistance, there must be strong requirements of a proven effect and an improved cost–benefit ratio before antibiotics treatment is introduced for a new group of patients. These requirements have not yet been met for nonsurgical treatment with antibiotics for assumed uncomplicated appendicitis. Due to the high rate of spontaneous resolution, a randomized placebo-controlled trial is needed that can compare the efficiency of antibiotics treatment and expectant management in this group of patients. Antibiotics treatment, however, remains indicated for treatment of perforated appendicitis with localized abscess or phlegmone and in selected surgical high-risk patients. 相似文献
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Claudia Anderson Beckmann 《The Journal of asthma》2003,40(2):171-180
The objective of the study was to examine the perinatal outcomes of women who have asthma and to determine if peak flow values change during pregnancy. A retrospective chart audit was conducted analyzing records of 567 women with asthma who delivered between 1992 and 1997. The most common maternal complications were meconium-stained amniotic fluid, pretern labor or delivery this pregnancy, oligohydramnios, and pregnancy-induced hypertension. The most common neonatal complications were meconium staining, preterm infant, and intrauterine growth restriction. Women who required systemic steroids were more likely to have oligohydramnios, intrauterine growth restricted infant, meconium staining, or pregnancy-induced hypertension. Peak flow values did not change by trimester of pregnancy.While the percentage of women who smoked was higher than the general population, smoking was not correlated with increased adverse perinatal outcomes. This study suggests an increased incidence of oligohydramnios, intrauterine growth restriction, and meconium-stained amniotic fluid in women with asthma. More research is needed to further the understanding of the relationship between asthma and perinatal outcomes. Prior studies have shown an association between poor control and adverse outcomes. Education is a major nursing implication. 相似文献
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本文报告了作者对12只家兔的实验性阑尾炎模型和140例急、慢性阑尾炎进行B型超声显象研究的结果。诊断符合率:急性阑尾炎为92.59%;慢性阑尾炎为81.25%;总符合率为90%.作者认为超声显象有助于对阑尾炎的诊断以及对于右下腹疼痛的鉴别诊断;对阑尾位置的判断、切口选择也有一定的参考价值. 相似文献
11.
Mr. N. S. Ambrose M.S. F.R.C.S. R. N. Allan M.D. F.R.C.P. M. R. B. Keighley M.S. F.R.C.S. D. W. Burdon M.B. M.R.C.Path Denise Youngs M.L.S.O. P. Barnes M.R.C.P. J. E. Lennard-Jones M.D. F.R.C.P. 《Diseases of the colon and rectum》1985,28(2):81-85
We have undertaken a prospective randomized trial of one month's antimicrobial therapy for patients with symptomatic relapse
of Crohn's disease. Criteria for entry included two major symptoms: fever, abdominal pain, diarrhea, weight loss, abdominal
mass or complications (excluding perianal disease); and two hematologic abnormalities: hemoglobin, ESR, albumin, C reactive
protein, iron, or total iron binding capacity. Patients were monitored for the aforementioned clinical and hematologic (hemoglobin,
albumin, CRP) parameters over six weeks and for changes in fecal flora. Randomization was to four groups: metronidazole alone
(M), cotrimoxazole alone (C), metronidazole and cotrimoxazole (C plus M), or double placebo (P). Seventy-two patients entered
the study (18=M, 16=C 21=C plus M, 17=P). After two weeks, improvement was reported as follows: M=67 percent, C=17 percent,
C plus M=71 percent, P=35 percent. In the metronidazole group, two patients required surgery and one had trouble-some side
effects. In the cotrimoxazole group, two had side effects. In the combined group (C plus M), four had troublesome side effects
and two of the placebo group (P) required operation. By four weeks, there was no difference in response among the groups:
(M=44 percent, C=62 percent, C plus M=57 percent, P=41 percent). Antimicrobials had no effect on fecal flora or hematologic
parameters. These results indicate that antimicrobials have little therapeutic potential for relapse of intestinal Crohn's
disease. 相似文献
12.
E. Chantelau T. Tanudjaja F. Altenhfer Z. Ersanli S. Lacigova C. Metzger 《Diabetic medicine》1996,13(2):156-159
To investigate the effect of oral antibiotics in purely neuropathic ulcers (Wagner grade 1–2, no osteomyelitis), a double blind placebo-controlled study was performed. Forty-four patients were enroled and subjected to standard treatment with absolute pressure relief (half shoes), daily wound cleansing (topical disinfectant), sterile dressings (specialized nurse). Patients were randomized to an antibiotic (amoxicillin plus clavulanic acid), or placebo. The study was stopped when the antibiotic proved unsuitable according to swab result, or on clinical grounds (no improvement within 6 days of recruitment). Main outcome measure was the ulcer closing rate during 20 days, as assessed by standardized photographs. All ulcers except one were infected. Of the placebo group (n = 22), 2 patients had to be withdrawn within 6 days, versus 3 patients of the antibiotic-group (n = 22). In the placebo group, 10 ulcers were healed versus 6 ulcers in the antibiotic group (NS). Mean (95% CI) reduction in ulcer radius was 0.41 (0.21–0.61) mm day−1 in the placebo group versus 0.27 (0.15–0.39) mm day−1 in the antibiotic group (NS). In conclusion, there is no benefit from antibiotic treatment with amoxicillin plus clavulanic acid as a supplement to standard therapy in uncomplicated neuropathic foot ulcers, provided pressure relief is complete, and wound care is performed strictly supervised. However, a Type-II statistical error cannot be excluded in this small study. 相似文献
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Urinary tract infections are one of the most common infections in pregnant women and may produce important consequences in the mother and fetus. Prompt diagnosis and treatment are necessary to avoid those adverse events, but antibiotic drugs are not lacked of risk. Various teratogenic or toxic effects have been described with their use. Currently, there are no sufficient data to recommend a standard regimen to treat these infections. Betalactams, nitrofurantoins, or fosfomycins are appropriate regimens when based on the culture sensitivity, but the increasing problem of antibiotic resistance makes the selection more difficult. 相似文献
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Nicole Gidaya Bonine Ariel Berger Arman Altincatal Rosa Wang Tarun Bhagnani Patrick Gillard Thomas Lodise 《The American journal of the medical sciences》2019,357(2):103-110
Background
To examine the clinical and economic burdens associated with delayed receipt of appropriate therapy among patients with Gram-negative bacteria (GNB) infections, stratified by antibiotic resistance status.Materials and Methods
Retrospective analysis using the Premier Hospital Database. Adult admissions (July 2011-September 2014) with evidence of complicated urinary tract infection, complicated intra-abdominal infection, hospital-associated pneumonia, or bloodstream infection, length of stay (LOS) ≥1 days and a positive GNB culture from a site consistent with infection type (culture draw date?=?index date) were identified and stratified by antibiotic susceptibility to index pathogens. Delayed appropriate therapy was defined as no receipt of antibiotic(s) with relevant microbiological activity on or within 2 days of index date. Inverse probability weighting and multivariate regression analyses were used to estimate the association between delayed appropriate therapy and outcomes. Generalized linear models were used to evaluate postindex duration of antibiotic therapy, LOS and total in-hospital costs. Logistic models were used to evaluate discharge destination and in-hospital mortality/discharge to hospice.Results
A total of 56,357 patients with GNB infections were identified (resistant, n?=?6,055; susceptible, n?=?50,302). Delayed appropriate therapy was received by 2,800 (46.2%) patients with resistant and 16,585 (33.0%) patients with susceptible infections. Using multivariate analysis, delayed appropriate therapy was associated with worse outcomes including ~70% increase in LOS, ~65% increase in total in-hospital costs and ~20% increase in the risk of in-hospital mortality/discharge to hospice, regardless of susceptibility status.Conclusions
Our results suggest that outcomes in patients with GNB infections, regardless of resistance status, significantly improve if timely appropriate therapy can be provided. 相似文献15.
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Hao-Ming Li Lee-Ren Yeh Ying-Kai Huang Cheng-Li Lin Chia-Hung Kao 《The American journal of medicine》2017,130(1):54-60.e5
Objective
The incidence and association between appendicitis and barium examination (BE) remain unclear. Such potential risk may be omitted. We conducted a longitudinal, nationwide, population-based cohort study to investigate the association between BE and appendicitis risk.Methods
From the Taiwan National Health Insurance Research Database, a total of 24,885 patients who underwent BE between January 1, 2000 and December 31, 2010 were enrolled in a BE cohort; an additional 98,384 subjects without BE exposure were selected as a non-BE cohort, matched by age, sex, and index date. The cumulative incidences of subsequent appendicitis in the BE and non-BE cohorts were assessed using the Kaplan-Meier curves and log-rank test. Cox proportional hazards regression analyses were employed to calculate the appendicitis risk between the groups.Results
The cumulative incidence of appendicitis was higher in the BE cohort than in the non-BE cohort (P = .001). The overall incidence rates of appendicitis for the BE and non-BE cohorts were 1.19 and 0.80 per 1000 person-years, respectively. After adjustment for sex, age, and comorbidities, the risk of appendicitis was higher in the BE cohort (adjusted hazard ratio = 1.46, 95% confidence interval = 1.23-1.73) compared with the non-BE cohort, especially in the first 2 months (adjusted hazard ratio = 9.72, 95% confidence interval = 4.65-20.3).Conclusions
BE was associated with an increased, time-dependent appendicitis risk. Clinicians should be aware of this potential risk to avoid delayed diagnoses. 相似文献17.
Devika Nair Laura Kidd N. Kevin Krane 《The American journal of the medical sciences》2017,353(4):320-328
Background
Membranoproliferative glomerulonephritis (MPGN) is an uncommon form of glomerulonephritis and it can be particularly difficult to predict outcomes and manage women with this disorder during pregnancy.Materials and Methods
The management of 3 successful pregnancies in women with MPGN from 1 center and previously described cases from the world literature are reviewed. This includes a number of large studies of pregnancy in women with underlying glomerular disease as well as small case series and individual reports. Courses of these pregnancies, maternal and fetal outcomes, and management, when described, were included in this review.Results
Some successful outcomes used antiplatelet therapy and plasmapheresis, but high-dose intravenous, followed by oral, corticosteroid therapy was used most frequently in patients with successful outcomes.Conclusions
The data provided is meant as a guide for clinicians who provide care for women with MPGN who are considering pregnancy or women who present with this disorder while pregnant. 相似文献18.
中国幽门螺杆菌耐药研究现状 总被引:33,自引:0,他引:33
胡伏莲 《胃肠病学和肝病学杂志》2008,17(7):517-518
中国是一个幽门螺杆菌(H.pylori)感染率较高的国家,H.pylori的感染率42%~90%,所以H.pylori感染的治疗是H.pylori研究领域中的重点,而H.pylori感染治疗失败主要原因是H.pylori对抗生素的耐药性,所以H.pylori感染治疗中核心问题是日.pylori对抗生素的耐药性,其耐药性也是H.pylori感染研究中的重点课题。近年我国对H.pylori耐药研究已有新j生展,本文重点介绍如下5个方面:①H.pylori对常用抗生素耐药情况及地区差异性;②H.pylori对常用抗生素耐药性随时间变迁而逐渐上升;⑧H.pylori对四环素和左氧氟沙星耐药情况;④H.pylori耐药对H.pylori根除效果的影响;⑤如何克服H.pylori对抗生素耐药性。 相似文献
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