Identification and detection of antibiotic susceptibility of the most common anerobes causing infection in surgical hospital, Faculty of Medicine Zagazig University, Egypt

Objectives: Anaerobic infections are considered to be the most difficult organisms to be identified in the microbiology laboratory. It requires strict conditions, proper sampling , long time and laboratory skills. In addition most of them are mixed infections having both aerobic and anaerobic organisms. Choice of the proper antibiotic for treating these anaerobes is live saving for the patient.Methods: Identification of anaerobic organisms using MALDI-TOF (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry) as a recent tool for identification together with API 20A (as a reference method). Antibiotic susceptibility test was done for the anaerobic isolates using Agar Dilution Method. With the the most commonly used antibiotic in our hospital which are Amoxacillin/Clavulonic acid, clindamycin, metronidazole and Imipenem.Results: Anaerobic infections constitutes 21.7% of total 249 specimen from different surgical departments. Bacteroids spp. (41%) were the most prevalent anaerobic organisms followed by peptostreptococcus (26.9%). MALDI TOF MS system and API achieved 100% agreement for identification of Porphoryomonas spp. and Fusobacterium, while near results were obtained for other isolates. Bacteroid spp. shows the highest rate of resistance to clindamycin (69%). Excellent results were obtained for Imipenem and metronidazole. Most of resistance to Amoxacillin/Clavulonic acid is related to Bacteroid spp. and Fusobacterium spp.Conclusion: MALDI TOF MS System is a useful tool for identification of. Anerobes are showing higher rates of resistance to commonly used antibiotics thus detection of resistant strains is vital for proper selection of antibiotics.Keywords: Anaerobes, MALDI TOF System, API 20, Agar Dilution Method, Zagazi

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone