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Κυριακή 8 Οκτωβρίου 2017

The Influence of Reported Penicillin Allergy

prophylaxisantibioticsurgical site infectionsallergyvancomycin

The Impact of a Reported Penicillin Allergy on Surgical Site Infection Risk

Abstract
Background
A reported penicillin allergy may compromise receipt of recommended antibiotic prophylaxis intended to prevent surgical site infections (SSIs). Most patients with a reported penicillin allergy are not allergic. We determined the impact of a reported penicillin allergy on the development of SSIs.
Methods
In this retrospective cohort study of Massachusetts General Hospital hip arthroplasty, knee arthroplasty, hysterectomy, colon surgery, and coronary artery bypass grafting patients from 2010 to 2014, we compared patients with and without a reported penicillin allergy. The primary outcome was an SSI, as defined by the Centers for Disease Control and Prevention's National Healthcare Safety Network. The secondary outcome was perioperative antibiotic use.
Results
Of 8385 patients who underwent 9004 procedures, 922 (11%) reported a penicillin allergy, and 241 (2.7%) had an SSI. In multivariable logistic regression, patients reporting a penicillin allergy had increased odds (adjusted odds ratio, 1.51; 95% confidence interval, 1.02–2.22) of SSI. Penicillin allergy reporters were administered less cefazolin (12% vs 92%; P < .001) and more clindamycin (49% vs 3%; P < .001), vancomycin (35% vs 3%; P < .001), and gentamicin (24% vs 3%; P < .001) compared with those without a reported penicillin allergy. The increased SSI risk was entirely mediated by the patients' receipt of an alternative perioperative antibiotic; between 112 and 124 patients with reported penicillin allergy would need allergy evaluation to prevent 1 SSI.
Conclusions
Patients with a reported penicillin allergy had a 50% increased odds of SSI, attributable to the receipt of second-line perioperative antibiotics. Clarification of penicillin allergies as part of routine preoperative care may decrease SSI risk.

The Politics of Fear: Médecins Sans Frontières and the West African Ebola Epidemic

The Politics of Fear: Médecins Sans Frontières and the West African Ebola Epidemic Edited by HofmanMichiel and AuSokhieng Oxford University Press, 2017; 304 pages; Hardcover: $24.95. ISBN: 9780190624477

Comparing the Outcomes of Adults With Enterobacteriaceae Bacteremia Receiving Short-Course Versus Prolonged-Course Antibiotic Therapy in a Multicenter, Propensity Score–Matched Cohort

Abstract
Background
The recommended duration of antibiotic treatment for Enterobacteriaceae bloodstream infections is 7–14 days. We compared the outcomes of patients receiving short-course (6–10 days) vs prolonged-course (11–16 days) antibiotic therapy for Enterobacteriaceae bacteremia.
Methods
A retrospective cohort study was conducted at 3 medical centers and included patients with monomicrobial Enterobacteriaceae bacteremia treated with in vitro active therapy in the range of 6–16 days between 2008 and 2014. 1:1 nearest neighbor propensity score matching without replacement was performed prior to regression analysis to estimate the risk of all-cause mortality within 30 days after the end of antibiotic treatment comparing patients in the 2 treatment groups. Secondary outcomes included recurrent bloodstream infections, Clostridium difficile infections (CDI), and the emergence of multidrug-resistant gram-negative (MDRGN) bacteria, all within 30 days after the end of antibiotic therapy.
Results
There were 385 well-balanced matched pairs. The median duration of therapy in the short-course group and prolonged-course group was 8 days (interquartile range [IQR], 7–9 days) and 15 days (IQR, 13–15 days), respectively. No difference in mortality between the treatment groups was observed (adjusted hazard ratio [aHR], 1.00; 95% confidence interval [CI], .62–1.63). The odds of recurrent bloodstream infections and CDI were also similar. There was a trend toward a protective effect of short-course antibiotic therapy on the emergence of MDRGN bacteria (odds ratio, 0.59; 95% CI, .32–1.09; P = .09).
Conclusions
Short courses of antibiotic therapy yield similar clinical outcomes as prolonged courses of antibiotic therapy for Enterobacteriaceae bacteremia, and may protect against subsequent MDRGN bacteria.

Bacterial Infections After Burn Injuries: Impact of Multidrug Resistance

Abstract
Patients who are admitted to the hospital after sustaining a large burn injury are at high risk for developing hospital-associated infections. If patients survive the initial 72 hours after a burn injury, infections are the most common cause of death. Ventilator-associated pneumonia is the most important infection in this patient population. The risk of infections caused by multidrug-resistant bacterial pathogens increases with hospital length of stay in burn patients. In the first days of the postburn hospitalization, more susceptible, Gram-positive organisms predominate, whereas later more resistant Gram-negative organisms are found. These findings impact the choice of empiric antibiotics in critically ill burn patients. A proactive infection control approach is essential in burn units. Furthermore, a multidisciplinary approach to burn patients with a team that includes an infectious disease specialist and a pharmacist in addition to the burn surgeon is highly recommended.

Feeding filaggrin: effects of L-histidine supplementation in atopic dermatitis




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Editorial
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Simple software solution for portfolio management for medical consultants
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Comparison - effectiveness of oral steroid versus intratympanic Dexamethasone for sudden onset sensorineural hearing loss
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IntroductionA large percentage of the population has some degree of deviated nasal septum causing symptoms of nasal obstruction. Nasal septoplasty is the surgery of choice for symptomatic nasal septal deviations. ObjectiveTo describe the patient profile, indications, complications and evaluation of septoplasty...
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Is fine needle aspiration thyroid cytology (THY status) a good prognostic indicator of definitive histological diagnosis?
Although recently published research has focused on the addition of ultrasound scan findings to the evaluation of the thyroid gland, FNAC has long been the corner stone of thyroid lesion decision making. In our study population of 100 thyroidectomies we found out of those who had a cytological diagnosis...
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Use of a Suction drain in Thyroid Surgery
IntroductionThe use of a suction drain in Thyroid surgery is in common practice. This is done mainly to ‘prevent’ formation of haematomas and seromas on the Thyroid bed and subsequently to reduce complications and hospital stay. ObjectiveThe aim of this study is to determine the efficacy of routine drainage...
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Complete Branchial Fistula
No abstract available Published on 2017-01-25 00:00:00
Ceylon Journal of Otolaryngology Latest Articles

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Quadriplegia following Tracheoplasty
We report a case of a 19-year-old female who with tracheal stenosis following prolonged intubation due to organophosphorous poisoning. Crico tracheal resection and end to end laryngotracheal anastomosis was done. She developed quadriplegia on the 2nd post-operative day. MRI revealed ischemic segment...
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Clinical presentation of Thornwaldt’s cyst
No abstract avilable Published on 2017-01-25 00:00:00
Ceylon Journal of Otolaryngology Latest Articles

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Cochlear Implantation in Patients with Keratitis-Ichthyosis-Deafness Syndrome: A Report of Two Cases
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Case Reports in Otolaryngology

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Pneumocephalus Following Self-Inflicted Penetrating Brain Injury
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Case Reports in Otolaryngology

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Synchronous Ganglioneuroma and Schwannoma Mistaken for Carotid Body Tumor
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Case Reports in Otolaryngology
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Epithelial-Myoepithelial Carcinoma of the Base of Tongue with Possible Lung Metastases
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Case Reports in Otolaryngology

1d
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Case Reports in Otolaryngology

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Persistent Acute Onset Macroglossia Treated with Compression Therapy
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Case Reports in Otolaryngology
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Recovery from Repeated Sudden Hearing Loss in a Patient with Takayasu’s Arteritis Treated with Hyperbaric Oxygen Therapy: The First Report in the Literature
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Case Reports in Otolaryngology

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Bilateral Peritonsillar Abscess in an Infant: An Unusual Presentation of Sore Throat
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Case Reports in Otolaryngology

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Myoepithelioma of the Parotid Gland: A Case Report with Review of the Literature and Classic Histopathology
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Case Reports in Otolaryngology
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Ganglioneuroma of the External Auditory Canal and Middle Ear
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Case Reports in Otolaryngology

1d
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Case Reports in Otolaryngology

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Case Reports in Otolaryngology
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Case Reports in Otolaryngology

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Primary Small Cell Carcinoma of the Hypopharynx: A Report of Two Cases and Review of Nine Additional Cases
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Case Reports in Otolaryngology

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The Youngest Reported and Successfully Treated Patient with a Dermoid Cyst of the Parotid Gland: A Rare Pediatric Case
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Case Reports in Otolaryngology
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Repetitive Sinus-Related Symptoms May Accelerate the Progression of Chronic Maxillary Atelectasis
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Case Reports in Otolaryngology

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Tubercular Ulcer of Tongue in an Elderly Patient Masquerading as a Traumatic Ulcer
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Case Reports in Otolaryngology

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Case Reports in Otolaryngology
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The Relationship between Werner Syndrome and Sinonasal Malignant Melanoma: Two Sibling Cases of Werner Syndrome with Malignant Melanoma
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Case Reports in Otolaryngology

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Vagal Paraganglioma Presenting as a Neck Mass Associated with Cough on Palpation
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Case Reports in Otolaryngology

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Case Reports in Otolaryngology
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Mechanisms Underlying Improvement in Obstructive Sleep Apnea Syndrome by Uvulopalatopharyngoplasty
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Case Reports in Otolaryngology

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Aspiration of Aluminum Beverage Can Tab: Case Report and Literature Review
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Case Reports in Otolaryngology

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Sudden Onset, Rapidly Expansile, Cervical Cystic Hygroma in an Adult: A Rare Case with Unusual Presentation and Extensive Review of the Literature
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Case Reports in Otolaryngology
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Case Reports in Otolaryngology

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1d
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1d
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Case Reports in Otolaryngology