Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

MRSA in Africa: filling the global map of antimicrobial resistance.

We sought to assess the prevalence of methicillin-resistance among Staphylococcus aureus isolates in Africa. We included articles published in 2005 or later reporting for the prevalence of MRSA among S. aureus clinical isolates. Thirty-two studies were included. In Tunisia, the prevalence of MRSA increased from 16% to 41% between 2002-2007, while in Libya it was 31% in 2007. In South Africa, the prevalence decreased from 36% in 2006 to 24% during 2007-2011. In Botswana, the prevalence varied from 23-44% between 2000-2007. In Algeria and Egypt, the prevalence was 45% and 52% between 2003-2005, respectively. In Nigeria, the prevalence was greater in the northern than the southern part. In Ethiopia and the Ivory Coast, the prevalence was 55% and 39%, respectively. The prevalence of MRSA was lower than 50% in most of the African countries, although it appears to have risen since 2000 in many African countries, except for South Africa

Susceptibility to different antibiotics of MRSA isolates collected in African countries of high, medium, and low human development index.

a<p>Vancomycin susceptibility was determined with a disk diffusion test.</p>b<p>Vancomycin and linezolid susceptibility was determined with automated system testing.</p>c<p>1 Isolate had a vancomycin minimum inhibitory concentration of 6 mg/l determined with the E-test method.</p>d<p>3 Isolates had vancomycin minimum inhibitory concentrations between 16 and 128 mg/L determined with the agar dilution method.</p><p>ERY: erythromycin; LIN: lincosamide; TET: tetracycline; RIF: rifampicin; SXT: trimethoprim-sulfamethoxazole; CLH: chloramphenicol; GEN: gentamicin; OFX: ofloxacin; CIP: ciprofloxacin; VAN: vancomycin; TEC: teicoplanin; FA: fusidic acid; FOF: fosfomycin; LZD: linezolid; AMK: amikacin; GISA: glycopeptide intermediate S. aureus</p

Graphical presentation of the process of selection of studies for inclusion in this review.

<p>Graphical presentation of the process of selection of studies for inclusion in this review.</p

Summary table of the temporal trends in the percentage of MRSA among <i>S. aureus</i> in different countries.

<p>MRSA: Methicillin-resistant <i>S. aureus</i>; CA: community-acquired; HA: hospital-acquired; MC: multicenter; NC: north-central; SW: south-west; NW: north-west; NE: north-east; NR: not reported</p