Antibiotic Therapy for Appendicitis in Patients Aged ≥80 Years

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.     

Antibiotic Timing and Outcomes in Sepsis

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.

A Meta-Analysis of Antibiotic Therapy for Active Ulcerative Colitis

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.     

妊娠期高血压疾病并发肾病综合征对母婴的影响

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.     

The Role of Antibiotic Therapy in the Management of Acute Appendicitis

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.     

The Effects of Asthma on Pregnancy and Perinatal Outcomes

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.     

B型超声显象诊断阑尾炎的实验和临床研究

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.     

Antibiotic therapy for treatment in relapse of intestinal Crohn's disease

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.     

Antibiotic Treatment for Uncomplicated Neuropathic Forefoot Ulcers in Diabetes: a Controlled Trial

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.     

Antibiotic Considerations for Urinary Tract Infections in Pregnancy

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.     

Impact of Delayed Appropriate Antibiotic Therapy on Patient Outcomes by Antibiotic Resistance Status From Serious Gram-negative Bacterial Infections

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.

The Association Between Barium Examination and Subsequent Appendicitis: A Nationwide Population-Based Study

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.

Membranoproliferative Glomerulonephritis in Pregnancy

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.

中国幽门螺杆菌耐药研究现状

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。