World Journal of Emergency Surgery最新文献

{"title":"Microbiological profile of patients treated for postoperative peritonitis: temporal trends 1999–2019","authors":"Philippe Montravers, Nathalie Grall, Elie Kantor, Pascal Augustin, Kevin Boussion, Nathalie Zappella","doi":"10.1186/s13017-023-00528-1","DOIUrl":"https://doi.org/10.1186/s13017-023-00528-1","url":null,"abstract":"Temporal changes in the microbiological resistance profile have been reported in several life-threatening infections. However, no data have ever assessed this issue in postoperative peritonitis (POP). Our purpose was to assess the rate of multidrug-resistant organisms (MDROs) in POP over a two-decade period and to analyse their influence on the adequacy of empirical antibiotic therapy (EAT). This retrospective monocentric analysis (1999–2019) addressed the changes over time in microbiologic data, including the emergence of MDROs and the adequacy of EAT for all intensive care unit adult patients treated for POP. The in vitro activities of 10 antibiotics were assessed to determine the most adequate EAT in the largest number of cases among 17 antibiotic regimens in patients with/without MDRO isolates. Our primary endpoint was to determine the frequency of MDRO and their temporal changes. Our second endpoint assessed the impact of MDROs on the adequacy of EAT per patient and their temporal changes based on susceptibility testing. In this analysis, the subgroup of patients with MDRO was compared with the subgroup of patients free of MDRO. A total of 1,318 microorganisms were cultured from 422 patients, including 188 (45%) patients harbouring MDROs. The growing proportions of MDR Enterobacterales were observed over time (p = 0.016), including ESBL-producing strains (p = 0.0013), mainly related to Klebsiella spp (p < 0.001). Adequacy of EAT was achieved in 305 (73%) patients. Decreased adequacy rates were observed when MDROs were cultured [p = 0.0001 vs. MDRO-free patients]. Over the study period, decreased adequacy rates were reported for patients receiving piperacillin/tazobactam in monotherapy or combined with vancomycin and imipenem/cilastatin combined with vancomycin (p < 0.01 in the three cases). In patients with MDROs, the combination of imipenem/cilastatin + vancomycin + amikacin or ciprofloxacin reached the highest adequacy rates (95% and 91%, respectively) and remained unchanged over time. We observed high proportions of MDRO in patients treated for POP associated with increasing proportions of MDR Enterobacterales over time. High adequacy rates were only achieved in antibiotic combinations involving carbapenems and vancomycin, while piperacillin/tazobactam is no longer a drug of choice for EAT in POP in infections involving MDRO. ","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"69 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138740583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cesena guidelines: WSES consensus statement on laparoscopic-first approach to general surgery emergencies and abdominal trauma","authors":"Giacomo Sermonesi, Brian W. C. A. Tian, Carlo Vallicelli, Fikri M. Abu‑Zidan, Dimitris Damaskos, Michael Denis Kelly, Ari Leppäniemi, Joseph M. Galante, Edward Tan, Andrew W. Kirkpatrick, Vladimir Khokha, Oreste Marco Romeo, Mircea Chirica, Manos Pikoulis, Andrey Litvin, Vishal Girishchandra Shelat, Boris Sakakushev, Imtiaz Wani, Ibrahima Sall, Paola Fugazzola, Enrico Cicuttin, Adriana Toro, Francesco Amico, Francesca Dal Mas, Belinda De Simone, Michael Sugrue, Luigi Bonavina, Giampiero Campanelli, Paolo Carcoforo, Lorenzo Cobianchi, Federico Coccolini, Massimo Chiarugi, Isidoro Di Carlo, Salomone Di Saverio, Mauro Podda, Michele Pisano, Massimo Sartelli, Mario Testini, Andreas Fette, Sandro Rizoli, Edoardo Picetti, Dieter Weber, Rifat Latifi, Yoram Kluger, Zsolt Janos Balogh, Walter Biffl, Hans Jeekel, Ian Civil, Andreas Hecker, Luca Ansaloni, Francesca Bravi, Vanni Agnoletti, Solomon Gurmu Beka, Ernest Eugene Moore, Fausto Catena","doi":"10.1186/s13017-023-00520-9","DOIUrl":"https://doi.org/10.1186/s13017-023-00520-9","url":null,"abstract":"Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma. This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement. A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma. The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"61 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138550765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Declaration on infection prevention and management in global surgery.","authors":"Massimo Sartelli, Federico Coccolini, Luca Ansaloni, Walter L Biffl, David P Blake, Marja A Boermeester, Raul Coimbra, Heather L Evans, Paula Ferrada, George Gkiokas, Marc G Jeschke, Timothy Hardcastle, Chandler Hinson, Francesco M Labricciosa, Sanjay Marwah, Antonio C Marttos, Martha Quiodettis, Kemal Rasa, Jianan Ren, Ines Rubio-Perez, Robert Sawyer, Vishal Shelat, Jeffrey S Upperman, Fausto Catena","doi":"10.1186/s13017-023-00526-3","DOIUrl":"10.1186/s13017-023-00526-3","url":null,"abstract":"<p><p>Surgeons in their daily practice are at the forefront in preventing and managing infections. However, among surgeons, appropriate measures of infection prevention and management are often disregarded. The lack of awareness of infection and prevention measures has marginalized surgeons from this battle. Together, the Global Alliance for Infections in Surgery (GAIS), the World Society of Emergency Surgery (WSES), the Surgical Infection Society (SIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), the American Association for the Surgery of Trauma (AAST), and the Panamerican Trauma Society (PTS) have jointly completed an international declaration, highlighting the threat posed by antimicrobial resistance globally and the need for preventing and managing infections appropriately across the surgical pathway. The authors representing these surgical societies call all surgeons around the world to participate in this global cause by pledging support for this declaration for maintaining the effectiveness of current and future antibiotics.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"56"},"PeriodicalIF":8.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10702029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138499884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance of ultrasound in acute cholecystitis: a systematic review and meta-analysis","authors":"Sih-Shiang Huang, Kai-Wei Lin, Kao-Lang Liu, Yao-Ming Wu, Wan-Ching Lien, Hsiu-Po Wang","doi":"10.1186/s13017-023-00524-5","DOIUrl":"https://doi.org/10.1186/s13017-023-00524-5","url":null,"abstract":"An updated overview of ultrasound (US) for diagnosis of acute cholecystitis (AC) remains lacking. This systematic review was conducted to evaluate the diagnostic performance of US for AC. A systematic review was conducted following PRISMA guidelines. We meticulously screened articles from MEDLINE, Embase, and the Cochrane Library, spanning from inception to August 2023. We employed the search strategy combining the keywords \"bedside US\", \"emergency US\" or \"point-of-care US\" with \"AC\". Two reviewers independently screened the titles and abstracts of the retrieved articles to identify suitable studies. The inclusion criteria encompassed articles investigating the diagnostic performance of US for AC. Data regarding diagnostic performance, sonographers, and sonographic findings including the presence of gallstone, gallbladder (GB) wall thickness, peri-GB fluid, or sonographic Murphy sign were extracted, and a meta-analysis was executed. Case reports, editorials, and review articles were excluded, as well as studies focused on acalculous cholecystitis. The study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Forty studies with 8,652 patients were included. The majority of studies had a low risk of bias and applicability concerns. US had a pooled sensitivity of 71% (95% CI, 69–72%), a specificity of 85% (95% CI, 84–86%), and an accuracy of 0.83 (95% CI, 0.82–0.83) for the diagnosis of AC. The pooled sensitivity and specificity were 71% (95% CI, 67–74%) and 92% (95% CI, 90–93%) performed by emergency physicians (EPs), 79% (95% CI, 71–85%) and 76% (95% CI, 69–81%) performed by surgeons, and 68% (95% CI 66–71%) and 87% (95% CI, 86–88%) performed by radiologists, respectively. There were no statistically significant differences among the three groups. US is a good imaging modality for the diagnosis of AC. EP-performed US has a similar diagnostic performance to radiologist-performed US. Further investigations would be needed to investigate the impact of US on expediting the management process and improving patient-centered outcomes.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"120 15","pages":""},"PeriodicalIF":8.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138455656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing operative documentation of emergency laparotomy: a systematic review and development of a synoptic reporting template","authors":"Aiman Elamin, Emma Walker, Michael Sugrue, Syed Yousaf Khalid, Ian Stephens, Angus Lloyd","doi":"10.1186/s13017-023-00523-6","DOIUrl":"https://doi.org/10.1186/s13017-023-00523-6","url":null,"abstract":"Currently, operative reports are narrative and often handwritten, making interpretation difficult and potentially omitting key steps of the procedure. This study undertook a systematic review to determine the current availability of synoptic operative reporting and develop a synoptic operative record template for emergency laparotomy (EL). A PROSPERO registered study from January 1st, 2012, to December 31st, 2022, was conducted using PubMed, Scopus, and Web of Science databases in February 2023. Keywords: emergency laparotomy AND operation notes OR operative notes OR documentation OR report OR pro forma OR narrative OR synoptic OR digital OR audio-visual. Studies on paediatric or pregnant patients, systematic reviews, meta-analyses, case reports, editorial comments, and letters were excluded. A synoptic operative record was designed to include key standards in the documentation, as suggested by the Colleges of Surgeons. The literature search yielded 4687 articles, and no relevant published articles were found. A detailed synoptic template was developed, which included 111 fields related to patient demographics, operative findings, interventions, and documentation of key variables associated with patient outcomes. 11 were text boxes, two were related to digital audio-visual uploads, and three facilitated the digital scoring/grading of findings. This systematic review identified a limited number of publications reporting synoptic operative reporting, and none related to emergency laparotomy. This novel operative template provides a platform for clear documentation of the surgery performed during emergency laparotomy, potentially facilitating data analysis, resident training, and research, in turn leading to a better understanding of patient outcomes.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"120 18","pages":""},"PeriodicalIF":8.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138455653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective study of laparoscopic, robotic-assisted, and open emergent/urgent cholecystectomy based on the PINC AI Healthcare Database 2017–2020","authors":"Stephen Campbell, Shih-Hao Lee, Yuki Liu, Sherry M. Wren","doi":"10.1186/s13017-023-00521-8","DOIUrl":"https://doi.org/10.1186/s13017-023-00521-8","url":null,"abstract":"Robotic-assisted cholecystectomy (RAC) is becoming increasingly common, but the outcomes of emergent/urgent robotic-assisted cholecystectomies compared to emergent laparoscopic (LC) and open cholecystectomies (OC) remain understudied. The PINC AI Healthcare Database was queried to identify adults who underwent emergent or urgent (Em-Ur) cholecystectomy between January 1, 2017, and December 31, 2020. Immediate postoperative and 30-day outcomes were identified including intraoperative complications, transfusion, conversion, postoperative complication, and hospital length of stay. Propensity score matching was done to compare outcomes between Em-Ur robotic-assisted, laparoscopic, and open cholecystectomies Subgroup analyses were performed comparing RAC done with and without fluorescent imaging as well as comparing RAC and LC performed for patients with class 3 obesity (BMI ≥ 40 kg/m2). RAC Em-Ur cholecystectomies are being performed with increasing frequency and is the most utilized modality for patients with class 3 obesity. There was no difference in intraoperative complications (0.3%), bile duct injury (0.2%), or postoperative outcomes between RAC and LC. LC had significantly shorter operating room times (96 min (75,128)) compared to RAC (120 min (90,150)). There was a significant lower rate of conversion to open in RAC (1.9%) relative to LC (3.2%) in both the overall population and the class 3 obesity sub-analysis (RAC-2.6% vs. LC-4.4%). There was no difference in outcomes in robotic-assisted cholecystectomies done with and without fluorescent imaging. A comparison of propensity score-matched cohorts of emergent/urgent robotic-assisted and laparoscopic cholecystectomy indicates that robotic-assisted cholecystectomy is a safe alternative to laparoscopic cholecystectomy, and that both have superior outcomes to open cholecystectomies.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"120 16","pages":""},"PeriodicalIF":8.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138455655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings.","authors":"Simone Frassini, Lorenzo Cobianchi, Paola Fugazzola, Walter L Biffl, Federico Coccolini, Dimitrios Damaskos, Ernest E Moore, Yoram Kluger, Marco Ceresoli, Raul Coimbra, Justin Davies, Andrew Kirkpatrick, Isidoro Di Carlo, Timothy C Hardcastle, Arda Isik, Massimo Chiarugi, Kurinchi Gurusamy, Ronald V Maier, Helmut A Segovia Lohse, Hans Jeekel, Marja A Boermeester, Fikri Abu-Zidan, Kenji Inaba, Dieter G Weber, Goran Augustin, Luigi Bonavina, George Velmahos, Massimo Sartelli, Salomone Di Saverio, Richard P G Ten Broek, Stefano Granieri, Francesca Dal Mas, Camilla Nikita Farè, Jacopo Peverada, Simone Zanghì, Jacopo Viganò, Matteo Tomasoni, Tommaso Dominioni, Enrico Cicuttin, Andreas Hecker, Giovanni D Tebala, Joseph M Galante, Imtiaz Wani, Vladimir Khokha, Michael Sugrue, Thomas M Scalea, Edward Tan, Mark A Malangoni, Nikolaos Pararas, Mauro Podda, Belinda De Simone, Rao Ivatury, Yunfeng Cui, Jeffry Kashuk, Andrew Peitzman, Fernando Kim, Emmanouil Pikoulis, Gabriele Sganga, Osvaldo Chiara, Michael D Kelly, Ingo Marzi, Edoardo Picetti, Vanni Agnoletti, Nicola De'Angelis, Giampiero Campanelli, Marc de Moya, Andrey Litvin, Aleix Martínez-Pérez, Ibrahima Sall, Sandro Rizoli, Gia Tomadze, Boris Sakakushev, Philip F Stahel, Ian Civil, Vishal Shelat, David Costa, Alain Chichom-Mefire, Rifat Latifi, Mircea Chirica, Francesco Amico, Amyn Pardhan, Vidya Seenarain, Nikitha Boyapati, Basil Hatz, Travis Ackermann, Sandun Abeyasundara, Linda Fenton, Frank Plani, Rohit Sarvepalli, Omid Rouhbakhshfar, Pamela Caleo, Victor Ho-Ching Yau, Kristenne Clement, Erasmia Christou, Ana María González Castillo, Preet K S Gosal, Sunder Balasubramaniam, Jeremy Hsu, Kamon Banphawatanarak, Michele Pisano, Adriana Toro, Altomare Michele, Stefano P B Cioffi, Andrea Spota, Fausto Catena, Luca Ansaloni","doi":"10.1186/s13017-023-00522-7","DOIUrl":"10.1186/s13017-023-00522-7","url":null,"abstract":"","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"52"},"PeriodicalIF":8.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10683098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138446664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous versus interrupted abdominal wall closure after emergency midline laparotomy: CONTINT: a randomized controlled trial [NCT00544583].","authors":"Georgios Polychronidis, Nuh N Rahbari, Thomas Bruckner, Anja Sander, Florian Sommer, Selami Usta, Janssen Hermann, Max Benjamin Albers, Mine Sargut, Phillip Knebel, Rosa Klotz","doi":"10.1186/s13017-023-00517-4","DOIUrl":"10.1186/s13017-023-00517-4","url":null,"abstract":"<p><strong>Background: </strong>High-level evidence regarding the technique of abdominal wall closure for patients undergoing emergency midline laparotomy is sparse. Therefore, we conducted a randomized controlled trial (RCT) to evaluate the efficacy and safety of two commonly applied abdominal wall closure strategies after primary emergency midline laparotomy.</p><p><strong>Methods/design: </strong>CONTINT was a multi-center pragmatic open-label exploratory randomized controlled parallel trial. Two different abdominal wall closure strategies in patients undergoing primary midline laparotomy for an emergency surgical intervention with a suspected septic focus in the abdominal cavity were compared: the continuous, all-layer suture and the interrupted suture technique. The primary composite endpoint was burst abdomen within 30 days after surgery or incisional hernia within 12 months. As reliable data on this composite primary endpoint were not available for patients undergoing emergency surgery, it was planned to initially recruit 80 patients and conduct an interim analysis after these had completed the 12 months follow-up.</p><p><strong>Results: </strong>From August 31, 2009, to June 28, 2012, 124 patients were randomized of whom 119 underwent surgery and were analyzed according to the intention-to-treat (ITT) principal. The primary composite endpoint did not differ between the continuous suture (C: 27.1%) and the interrupted suture group (I: 30.0%). None of the individual components of the primary endpoint (reoperation due to burst abdomen after 30 days (C: 13.5%, I: 15.1%) and reoperation due to incisional hernia (C: 3.0%, I:11.1%)) differed between groups. Time needed for fascial closure was longer in the interrupted suture group (C: 12.8 ± 4.5 min, I: 17.4 ± 6.1 min). BMI was associated with burst abdomen during the first 30 days with an OR of 1.17 (95% CI 1.04-1.32).</p><p><strong>Conclusion: </strong>This RCT showed no difference between continuous suture with slowly absorbable suture versus interrupted rapidly absorbable sutures after primary emergency midline laparotomy in rates of postoperative burst abdomen and incisional hernia after one year. However, the trial was stopped after the interim analysis due to futility as there was no chance to show superiority of one suture technique.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"51"},"PeriodicalIF":8.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10583371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41240019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action.","authors":"","doi":"10.1186/s13017-023-00518-3","DOIUrl":"10.1186/s13017-023-00518-3","url":null,"abstract":"<p><p>Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or \"golden rules,\" for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"50"},"PeriodicalIF":8.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10580644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41240020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limb salvage and survival after urgent surgical treatment of popliteal artery aneurysm.","authors":"Sara Pomatto, Gianluca Faggioli, Rodolfo Pini, Ilaria Ficarelli, Alessia Pini, Cecilia Angherà, Cristina Rocchi, Stefania Caputo, Andrea Vacirca, Carlo Ruotolo, Mauro Gargiulo","doi":"10.1186/s13017-023-00514-7","DOIUrl":"10.1186/s13017-023-00514-7","url":null,"abstract":"<p><strong>Background: </strong>Popliteal artery aneurysms (PAAs) need urgent treatment in case of acute thrombosis, distal embolization, or rupture. Few data are available in the literature about the treatment results in these scenarios. The aim of the present study was to evaluate an 11-year multicenter experience in the urgent treatment of PAAs.</p><p><strong>Methods: </strong>All symptomatic PAAs surgically treated in two vascular centers between 2010 and 2021 were retrospectively analyzed. In the postoperative period periodical clinical and Duplex-Ultrasound evaluation were performed. The evaluated endpoint was the outcome of urgent PAAs treatment according to their clinical presentation. Statistical analysis was performed by Kaplan-Meier log-rank evaluation and multivariable Cox regression tests.</p><p><strong>Results: </strong>Sixty-six PAAs needed an urgent repair. Twelve (18%) patients had a PAA rupture and 54 (82%) had an acute limb ischemia (ALI) due to either distal embolization or acute thrombosis. Patients with ALI underwent bypass surgery in 51 (95%) cases, which was associated with preoperative thrombolysis in 18 (31%) cases. A primary major amputation was performed in 3 (5%) cases. The mean follow-up was 52 ± 21 months with an overall 5-year limb salvage of 83 ± 6%. Limb salvage was influenced only by the number of patent tibial arteries (pTA) [5-years limb salvage 0%, 86 ± 10%, 92 ± 8% and 100% in case of 0, 1, 2 or 3 pTA, respectively (P = .001)]. An independent association of number of pTA and limb loss was found [hazard ratio (HR): 0.14 (95% confidence interval (CI) 0.03-0.6), P = .001]. Overall 5-year survival was 71 ± 7%. Ruptured PAAs were associated with lower 5-year survival compared with the ALI group (48 ± 2% vs. 79 ± 7%, P = .001). The number of pTA (33 ± 20%, 65 ± 10%, 84 ± 10% and 80 ± 10% for 0, 1, 2 and 3 pTA, respectively, P = .001) and the thrombolysis (94 ± 6% vs. 62 ± 10%, P = .03) were associated with higher survival in patients with ALI. There was an independent association of number of pTA and long-term survival [HR 0.15 (95% CI 0.03-0.8), P = .03].</p><p><strong>Conclusions: </strong>PAA rupture is the cause of urgent PAA treatment in almost one fifth of cases, and it is associated with lower long-term survival. ALI can benefit from thrombolysis, and long-term limb salvage and survival are associated with the number of pTA.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"49"},"PeriodicalIF":8.0,"publicationDate":"2023-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10576300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41216828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}