Intra-abdominal Research Articles

Image Guided Drainage of Intra Abdominal Abscess

Image Guided Drainage of Intra Abdominal Abscess

Pengukuran Tekanan Intra Abdominal Sebagai Penanda Toleransi Nutrisi Enteral pada Pasien ICU

This aim of this study is to determine the effectiveness of intra-abdominal pressure measurement as a marker of enteral nutrient tolerance in ICU patients. The method of this study used systematic review searched several eligible research articles from October 2013 to October 2023 using Scopus, ProQuest, Science Direct, and PubMed databases with the keywords critical ill patient, intra abdominal pressure measurement, gastric residual volume, and enteral nutrition.The result of this study show that based on six eligible research articles from 5 different countries that had been identified, show that intra-abdominal pressure measurements can predict enteral nutrient tolerance, although there was one study that had low sensitivity and significance. This systematic review concluded that intra-abdominal pressure measurements is one of the effective strategies that can be used to predict enteral nutrient tolerance in adult ICU patients. Keywords: Critical Ill Patient, Intra Abdominal Pressure Measurement, Gastric Residual Volume, Enteral Nutrition

The Role of Intra Abdominal Pressure In Predicting the Severity in Acute Pancreatitis

The Role of Intra Abdominal Pressure In Predicting the Severity in Acute Pancreatitis

Growth hormone insensitivity and adipose tissue: tissue morphology and transcriptome analyses in pigs and humans.

Growth hormone receptor knockout (GHR-KO) pigs have recently been developed, which serve as a large animal model of Laron syndrome (LS). GHR-KO pigs, like individuals with LS, are obese but lack some comorbidities of obesity. The purpose of this study was to examine the histological and transcriptomic phenotype of adipose tissue (AT) in GHR-KO pigs and humans with LS. Intraabdominal (IA) and subcutaneous (SubQ) AT was collected from GHR-KO pigs and examined histologically for adipocyte size and collagen content. RNA was isolated and cDNA sequenced, and the results were analyzed to determine differentially expressed genes that were used for enrichment and pathway analysis in pig samples. For comparison, we also performed limited analyses on human AT collected from a single individual with and without LS. GHR-KO pigs have increased adipocyte size, while the LS AT had a trend towards an increase. Transcriptome analysis revealed 55 differentially expressed genes present in both depots of pig GHR-KO AT. Many significant terms in the enrichment analysis of the SubQ depot were associated with metabolism, while in the IA depot, IGF and longevity pathways were negatively enriched. In pathway analysis, multiple expected and novel pathways were significantly affected by genotype, i.e. KO vs. controls. When GH related gene expression was analyzed, SOCS3 and CISH showed species-specific changes. AT of GHR-KO pigs has several similarities to that of humans with LS in terms of adipocyte size and gene expression profile that help describe the depot-specific adipose phenotype of both groups.

Famitinib for familial adenomatous polyposis-associated aggressive desmoid tumors: A single-center exploratory study.

10513 Background: Desmoid tumour (DT) is a common extra-intestinal manifestation of familial adenomatosis polyposis (FAP), with high risk of recurrence and became the second leading cause of FAP patients’ death. The treatment of FAP-associated DTs are limited. Famitinib is a orally bioavailable, tyrosine kinase inhibitor against VEGFR-2, PDGFR, c-kit, and FGFR, and has shown antitumor activity in these patients (pts). Methods: This is a prospective, single arm study of FAP pts with progressing DT per RECIST v1.1, treated with famitinib 20 mg QD since 11/2021. The primary endpoint was objective response rate (ORR), with secondary endpoints of safety, progression-free survival (PFS), and quality of life (EORTC QLQ C30). We also collected the FFPE slices of DTs to test both genetic and proteomic backgrounds of pts with different therapeutic results. Results: Between Nov 24, 2021 and Aug 8, 2022, 11 pts were enrolled and evaluated every 9 weeks. The median follow-up time was 9.4 m (6.6 to 14.9 m). The median age was 36 (28-53) and 45% were male. Nine pts were diagnosed with intra-abdominal (IA) tumors while two had extra-abdominal (EA) DTs. Eight had stage III-IV DTs with rapid growth and severe symptoms. 10 of them had history of intestinal resection. Two pts were treated with dacarbazine and epirubicin before enrollment, while one patient received radiotherapy before famitinib. Five pts achieved partial response (PR) and six achieved stable disease (SD), with a median time to response of 7.0 months. The ORR was 45.5% and the disease control rate (DCR) was 100%. The 6-month PFS rate was 91%. The ORR of pts with IA DTs was 55.6%. Of adverse events (AEs) with famitinib, 87% were grade 1/2, the most frequently reported being hypertension (73%), neutropenia (64%), bilirubinemia (55%) and proteinuria (36%). Mean global health status/QoL before and after 6 months’ treatment was 58.3 vs 75.8 ( P= 0.09). Of all 11 pts, germline APC mutations scattered from codon 457 to 1578, and five of them detected somatic APC mutations from codon 547 to 1896 in DTs. Correlative study analysis will be presented. Conclusions: Famitinib demonstrated promising efficacy and a favorable safety profile in FAP-associated aggressive DTs.

Activity of imipenem/relebactam against Enterobacterales and Pseudomonas aeruginosa in Spain. SMART 2016-2020.

To determine susceptibility to the novel β-lactam/β-lactamase inhibitor combination imipenem/relebactam in clinical isolates recovered from intra-abdominal (IAI), urinary (UTI), respiratory (RTI) and bloodstream (BSI) infections in the SMART (Study for Monitoring Antimicrobial Resistance Trends) study in SPAIN during 2016 - 2020. Broth microdilution MICs for imipenem/relebactam and comparators were determined by a central laboratory against isolates of Enterobacterales and Pseudomonas aeruginosa. MICs were interpreted using EUCAST-2021 breakpoints. In total, 5,210 Enterobacterales and 1,418 P. aeruginosa clinical isolates were analyzed. Imipenem/relebactam inhibited 98.8% of Enterobacterales. Distinguishing by source of infection susceptibility was 99.1% in BSI, 99.2% in IAI, 97.9% in RTI, and 99.2% in UTI. Of intensive care unit isolates (ICU) 97.4% were susceptible and of non-ICU isolates 99.2% were susceptible. In Enterobacterales, activity against Class A, Class B and Class D carbapenemases was 96.2%, 15.4% and 73.2%, respectively. In P. aeruginosa, imipenem/relebactam was active in 92.2% of isolates. By source of infection it was 94.8% in BSI, 92.9% in IAI, 91.7% in RTI, and 93.1% in UTI. An 88.7% of ICU isolates and 93.6% of non-ICU isolates were susceptible to imipenem/relebactam. Imipenem/relebactam remained active against P. aeruginosa ceftazidime-resistant (76.3%), cefepime-resistant (73.6%), imipenem-resistant (71.5%) and piperacillin-resistant (78.7%) isolates. Of all multidrug-resistant or difficult-to-treat resistance P. aeruginosa isolates, 75.1% and 46.2%, respectively, were susceptible to imipenem/relebactam. Imipenem/relebactam showed high rates of susceptibility in Enterobacterales and P. aeruginosa isolates from different sources of infection as well as depending on patients' location (ICU or non-ICU scenarios).

Risk factors and therapeutic options for postoperative intra-abdominal septic complication in Crohn’s disease

Background: Approximately 70% of patients suffering from Crohns disease require surgery in their lifetime. The postoperative course is complex, with higher complication rates compared to major colorectal surgery and with a high incidence of Intra Abdominal Septic Complications (IASC).

1809. Treatment Outcomes in Piperacillin-tazobactam Non-susceptible (TZP-NS)/Ceftriaxone Susceptible (CRO-S) Infections

Abstract Background Piperacillin-tazobactam-non-susceptible/ceftriaxone-susceptible (TZP-NS/CRO-S) Escherichia coli (Ec) and Klebsiella pneumoniae (Kp) phenotypes are hypothesized to be due to hyperproduction of TEM-1/2 and SHV-1 penicillinases. Limited available literature evaluating treatment outcomes in patients with TZP-NS/CRO-S infections may lead to unnecessary carbapenem use. Methods This was a retrospective study of non-critically ill adults hospitalized between 2013-2021, and treated for at least 48 hours for TZP-NS/CRO-S Ec or Kp infections. Patients with concomitant multi-drug resistant gram-negative infections were excluded. The primary composite endpoint included the need for escalation to intensive care unit (ICU), infection- or treatment-related readmission, mortality, and infection recurrence. Outcomes were compared between groups who received carbapenem (CG) vs carbapenem-sparing agents (CSG) as targeted therapy. Results Out of 1062 patients screened, 200 were included, with 51 in the CG and 149 in the CSG. Baseline characteristics, including Charlson Comorbidity Index (6 [IQR 3-10] vs 6 [4-9], p=0.64), were similar between groups, except for more immunocompromised patients in the CG (29% vs 11%, p=0.001). The most common infection sources were urinary (31% vs 57%, p=0.002), bloodstream (BSI) (18% vs 17%, p=0.887) and intra-abdominal (IAI) (20% vs 8%, p=0.023). Eighty-eight percent of the CG received meropenem, while the most common targeted therapy in the CSG was ceftriaxone (58%) followed by cefepime (24%). The primary composite endpoint was numerically higher in the CG (27% vs 17%, p=0.123), with no differences based on infection type (urine 25% vs 18%, p=0.495; BSI 33% vs 16%, p=0.348; IAI 40% vs 33%, p=1). More patients in the CSG were switched to oral therapy (15 [29%] vs 100 [67%], p< 0.001), with numerically 2 days shorter time to oral switch (6 [3-9] vs 4 [3-7] days, p=0.196). Out of those switched to oral therapy, most had a urinary source (8/15 [53%] vs 59/100 [59%]). Conclusion Our study did not find better clinical outcomes with carbapenem therapy for TZP-NS/CRO-S infections, thus CS agents may be considered to spare carbapenems in non-critically ill patients. Further studies are warranted to compare these outcomes in the critically ill. Disclosures All Authors: No reported disclosures.

Comparison of Results of Primary Repair Versus Ileostomy in Enteric Fever Ileal Perforation in Different Gender Groups

Background: Processes of Ileostomy in patient having Enteric fever perforation with friable gut defunctions the diseased gut, change the route of the infected fecal matter, protects the intestinal repair done in septic tissues and reduces the anastomotic dehiscence. Disadvantage is that it needs further surgery for its closure, leads to Ileostomy related complications. Method: A Randomized controlled study. At BMC Hospital Bolan Quetta Started in November 2015 to May 2016. Our objectives were to compare post-operative wound infection between primary closure and Ileostomy in patients undergoing surgery for Enteric fever ileal perforation. Total One Hundred and Fifty patients who underwent Enteric fever perforation surgery were included. The surgical treatment was done as primary repair (group-A) and Ileostomy (group-B). Post-operative complications like wound infection and wound intra abdominal abscess were evaluated till 5 days of hospital stay. Comparison between 2 groups was done using chi square. Stratification was done and p-value ≤0.05 was considered as significant. Results: In group-A 47 maless and 28 femalesss and in group-B 52 maless and 23 femalesss patients were included. In group-A, 40% observed wound discharge while in group-B it was 24%. In group-A, acceptable comesis were observed for 80% cases and in group-B, it was 93.3%. Results showed significant association of wound discharge and acceptable cosmesis with the 2 study groups. Conclusion: Better results in Ileostomy group than primary repair group was significant observed in the study. Keywords: Enteric fever , Acceptable cosmesis, Wound Discharge, Intra Abdominal Collection, Ileostomy, Enteric fever Ileal Perforation

Comparison of Outcomes of Primary Repair Versus Ileostomy in Typhoid Ileal Perforation in Different Age Groups

Background: Procedure of ileostomy in patients of Typhoid fever perforation with friable gut defunctions the diseased gut, repair the infected fecal matter, protects the intestinal repair done in septic tissues and reduces the anastomotic dehiscence. Method: This was a Randomized controlled study. Started in November 2015 to May 2016 at BMC Hospital balochistan. Main objectives were to compare the infectionof postoperative wound between ileostomy and primary closure in patients undergoing surgery for Typhoid fever ileal perforation. Study done by One fifty patients who underwent Typhoid fever perforation surgery. The surgical management was done as primary repair (group-A) and ileostomy (group-B). Postoperative complications were evaluated till 5 days of hospital stay. Comparison between two groups was done using chi square. Stratification was done and p-value ≤0.05 was considered as significant. Results: In group-A 47 male and 28 females and in group-B 52 male and 23 female patients were included. In group-A, 40 Percent observed wound discharge while in group-B it was 24 Percent. In group-A, acceptable comesis were observed for 80 Percent patients and in group-B, it was 93.3 Percent. Results showed significant association of wound discharge and acceptable cosmesis with the two study groups. Conclusion: Better outcome in ileostomy group than primary repair group was significant observed in the study. Keywords: Typhoid fever , Salmonella Typhi Acceptable cosmesis, Wound Discharge, Intra Abdominal Collection, Ileostomy, Typhoid fever Ileal Perforation

Efficacy of liposomal doxorubicin in patients with intra- and extra-abdominal desmoid fibromatosis.

11581 Background: Desmoid tumors (DT) or aggressive fibromatosis are rare growths of fibroblastic connective tissue that can be locally aggressive but without metastatic potential. Most cases are sporadic, but 5-20% of cases are associated with Familial adenomatous polyposis (FAP). Despite numerous systemic options, optimal choice is unclear, and there is a paucity of studies comparing efficacy based on tumor site. Liposomal doxorubicin (LD) can be an appealing option for DT patients (pts) given its favorable schedule and toxicity profile. In this study, we compared outcomes in pts with intra-abdominal (IA) and extra-abdominal (EA) DT who received LD. Methods: We identified pts with DT who were treated with LD between 1/2010 - and 2/2022 at two sarcoma centers. Tumor and pt characteristics and outcomes were clinically (symptom improvement) and radiologically (RECIST 1.1) assessed. Results: 40 pts with DT treated with LD were identified; 58% female and 42% male. Pt characteristics and outcomes are summarized in Table 1. Primary tumor site was IA in 21 (53%) pts. FAP was present more commonly in pts with IA vs EA DT, 8/21 (43%) and 4/19 (21%), respectively. In the IA cohort, LD was given as first (15/21, 71%), second (10%) or third (19%) line therapy. LD was used more commonly as a later line in the EA cohort with 16%, 52%, 16%, and 16% receiving it in first, second, third, and fourth lines, respectively. 37 pts were evaluable for response. Response rate in the IA cohort treated in first-line was 50% (8 of 16) and 10 of 12 evaluable pts had symptomatic improvement. No first-line responses were seen in the EA cohort. As later lines of therapy, 7/12 pts had disease control in the second line, 6/8 pts in the third line, and 1/2 pts in the fourth line with LD in the IA cohort. 1 patient had fourth line response to LD in the EA cohort. Disease control rate with LD was 72.5% across all pts. Reasons for early discontinuation of LD included progression or lack of symptom improvement (20%), allergic reaction (12.5%), adverse effects (7.5%), or infection (2.5%). No acute or long-term cardiotoxicity was reported. 2 pts had no signs of recurrence or symptoms at follow-up, 33 pts were alive with symptomatic DT, 1 patient died from disease, and 3 were lost to follow-up. Conclusions: In our study, LD provided tumor response, disease control, and symptomatic improvement regardless of location or prior therapy, with responses most frequently seen in IA DT in first line setting. Further studies should include comparison of efficacy, adverse effects, and patient-reported outcomes while accounting for tumor location and line of therapy. [Table: see text]

Renal Resistive Index and Intraabdominal Pressure as Predictors of Hepatorenal Syndrome in Decompensated Chronic Liver Disease: A Prospective Cohort study

Background/Aims: Hepatorenal Syndrome(HRS) is a life-threatening complication of cirrhosis characterized by renal arterial vasoconstriction, which preceeds clinically manifest renal dysfunction.Renal Resistive Index(RRI) is used to assess intrarenal arterial vasoconstriction.Raised Intra Abdominal Pressure(IAP) is known to cause reduction in renal blood flow thereby compromising renal function.

Accuracy and utilization patterns of intra-abdominal imaging for major trauma in pregnancy

Imaging protocols for maternal major trauma during pregnancy are not standardized and it is uncertain whether focused assessment with sonography for trauma (FAST) or computed tomography of the abdomen/pelvis (CTAP) is preferred for detecting intra-abdominal (IA) hemorrhage. We aimed to estimate the accuracy of FAST compared to CTAP, validate imaging accuracy with clinical outcomes and describe clinical factors associated with use of each imaging mode.

1250. Development of Linezolid and Daptomycin Resistance in Vancomycin Resistant Enterococcus faecium (VRE) during prolonged treatment for Intraabdominal Abscess

BackgroundVancomycin-resistant enterococci (VRE) are nosocomial pathogens with extensive intrinsic and acquired antimicrobial resistance (AMR) mechanisms. We report a case in which intraabdominal (IA) and blood cultures grew linezolid and daptomycin resistant VRE (DLVRE).MethodsWe report a case of DLVRE bacteremia after prolonged treatment with linezolid and daptomycin.ResultsThe patient was a 65-year-old female with a history of multiple abdominal surgeries who presented for elective incisional hernia repair. Her post-operative course was complicated by the development of loculated IA abscesses. A drain was placed into the largest abscess, and aspiration cultures were polymicrobial containing vancomycin-resistant E. faecium (Isolate 1). The patient was treated meropenem, fluconazole and linezolid for 6 weeks. Clinical and radiographic improvement was achieved. However, 4 days after competing antibiotics she developed recurrent abdominal pain and a leukocytosis. Daptomycin was chosen out of concern for long-term linezolid toxicity and IA cultures demonstrated new linezolid resistance (Isolate 2, LVRE). After an additional three weeks of therapy, she developed a catheter-associated bloodstream infection (CLABSI). Blood cultures revealed daptomycin-resistant LVRE bacteremia (Isolate 3, DLVRE). She was started empirically on a combination of ceftaroline and daptomycin, her PICC line removed, and her blood cultures cleared. Her antibiotic course is presented in Figure 1 and resistance patterns of the VRE in Table 1. ConclusionIn this patient, an IA abscess known to harbor VRE developed resistance to both linezolid and daptomycin during prolonged treatment with both agents. Ultimately, the patient experienced an episode of CLABSI DLVRE. Limited data exists on appropriate antibiotic choice in such challenging situations. Based on prior clinical and experimental data, we elected to use daptomycin in conjunction with ceftaroline for synergy, and the patient achieved the desired clinical response, clearance of her blood cultures and diminishing size of her IA abscess. Further work is needed to elucidate the best course of treatment for patients with VRE requiring long-term antibiotic therapy and for those who have developed extensively drug-resistant E. faecium.Disclosures All Authors: No reported disclosures

1225. In Vitro Activity of Aztreonam-Avibactam and Comparator Agents Against Enterobacterales Collected from Geriatric Patients in ICU and non-ICU wards, ATLAS Surveillance Program 2016-2019

BackgroundElevated resistance rates have been reported in ICUs. Aztreonam (ATM) combined with avibactam (AVI) is being developed for use against drug-resistant Enterobacterales (Ebact), including metallo-β-lactamase (MBL)-positive isolates. We examined the activity of ATM-AVI and comparators against Ebact isolates collected from geriatric patients in ICU and non-ICU wards as part of the ATLAS surveillance program.Methods23754 non-duplicate Ebact isolates were collected in 53 countries in Asia/Pacific (excluding mainland China and India), Europe, Latin America, and Middle East/Africa from patients ≥65 years with lower respiratory tract (LRTI), urinary tract (UTI), skin and soft tissue (SSTI), intra-abdominal (IAI), and bloodstream (BSI) infections. Susceptibility testing was performed by CLSI broth microdilution and values interpreted using CLSI 2021 breakpoints. PCR and sequencing were used to determine the β-lactamase genes present in isolates with meropenem MIC >1 µg/mL, and Escherichia coli, Klebsiella spp. and Proteus mirabilis with ATM or ceftazidime MIC >1 µg/mL.ResultsSusceptibility of the studied comparator agents was generally slightly lower among Ebact from BSI than other infection types (Table). Susceptibility was also generally lower among Ebact from ICU than non-ICU wards by up to 10 percentage points, and MIC90 values were up to 32-fold higher. ATM-AVI MIC90 values were within one doubling-dilution across all studied strata (0.12-0.25 µg/mL), were comparable to or lower than for meropenem in all strata, and were 2 to ≥9 dilutions lower than all other tested comparators. MBL-positive Ebact were found in 1.5% of LRTI (n=91), 1.2% of UTI (n=70), 1.1% of SSTI (n=52), 1.3% of BSI (n=49), and 0.7% of IAI isolates (n=22). MBL-positive rates were higher among ICU (1.7%, n=101) than non-ICU isolates (1.0%, n=183). ATM-AVI MIC90 values were 0.5 µg/mL against MBL-positive isolates from all ward and infection types except SSTI (MIC90 0.25 µg/mL) and BSI (MIC90 1 µg/mL), 2-4 dilutions lower than tigecycline and at least 5-10 dilutions lower than the other comparators.Results Table ConclusionATM-AVI could provide a valuable therapeutic option for treatment of infections caused by Ebact in patients ≥65 years old in both ICU and non-ICU wards.Disclosures Sibylle Lob, PhD, IHMA (Employee)Pfizer, Inc. (Independent Contractor) Krystyna Kazmierczak, PhD, IHMA (Employee)Pfizer, Inc. (Independent Contractor) Francis Arhin, PhD, Pfizer, Inc. (Employee) Daniel F. Sahm, PhD, IHMA (Employee)Pfizer, Inc. (Independent Contractor)

S3315 Efficacy and Safety of Biologic Agents on Crohn’s Disease Elderly Patients: A Retrospective Analysis

Introduction: There is limited literature available regarding the safety and efficacy of biological agents in Crohn's disease for patients aged 65 years old (yo) or greater (≥65). Existing knowledge from other autoimmune diseases regarding the initiation and maintenance of biologics in these patients has created skepticism given the potential risk of poor outcomes and mortality. We present a retrospective analysis of mortality, adverse events, rates of hospitalization, and remission in this vulnerable population compared with younger patients ( 0.05). Age stratification revealed those greater than 70 yo had higher intraabdominal (IA) infections (p<0.01), whereas 65-70 yo subgroup had higher occurrence of skin abscess and rash (p<0.01). Mild skin adverse events (itching) along with mortality (N=1;COVID/Pneumonia) were higher in the 75-80 yo subgroup (p <0.01). Conclusion: In a diverse multicultural population treated with biologic agents, the occurrence of infection, neoplasm, and skin adverse events were similar in both groups. Intraabdominal infection was associated with viral and bacterial diarrhea (not clostridium difficile) when ≥70 yo. On the other hand, rash and skin abscesses were predominant in those aged 65-70 yo and itching in those 75-80 yo. Efficacy (readmission or remission) does not change despite the age group. Safety when age ≥65 yo is not guaranteed and clinical judgment should be used in each case. Larger studies in these affected age subgroups may be beneficial in understanding the clinical significance..

Comparison of Intra Abdominal Pressure Monitoring Techniques and the Effects of the Abdominal Compartment Syndrome

Background: Abdominal compartment syndrome (ACS) is a life-threatening condition that develops in the setting of increasing and uncontrolled intra-abdominal hypertension (IAH), leading to cardiovascular, respiratory, neurologic and/or renal dysfunction. Aims: To establish a porcine model for the evaluation of the effects of IAH on renal blood flow (RBF) and to determine if IVC pressure and/or Camino fiberoptic direct intraabdominal pressure measurements can accurately predict IAPs that have been derived using bladder pressure measurements. Methods: Abdominal laparotomy, placement of IAP and RBF measuring devices, and fascial closure were performed on six adult feeder pigs with a mean body weight of 25 +/- 5 kg. A Transonic Doppler flow probe, a suprapubic bladder catheter, a Camino fiberoptic probe, and a triple lumen central venous catheter were placed and then baseline measurements were taken of renal blood flow, bladder pressure, direct intra-peritoneal Camino pressure and IVC pressure, respectively. Normal saline was then infused into the abdomen to simulate increasing IAP. Following a 5–10-minute stabilization period, all measurements were again taken. Results: The correlation between IVC pressure and bladder pressure was 0.98, with a mean bias of -0.5 (SD 2.0; 95% CI: -0.9, -0.2). The correlation between direct IAP readings by Camino probe and bladder pressure was 0.91, with a mean bias of -3.9 (SD 4.3; 95% CI: -4.6, -3.2). There was a strong negative correlation (-0.95) between RBF and bladder pressure. At an IAP of 20 mmHg, RBF reduced by an average of 45.4% (95% CI: 40%, 50.8%). Upon abdominal decompression, RBF returned to 66.6% (95% CI: 54.3%, 78.9%) of its baseline value. Conclusions: A porcine model is effective in accurately measuring changes in real time RBF. RBF progressively declines as IAP increases, however upon decompression, it fails to achieve complete recovery. IVC pressure measurements correlate well with, and therefore may substitute, the gold standard bladder pressure measurements as representatives of IAP. Keywords: Abdominal Compartment syndrome, renal blood flow, intrabdominal hypertension, bladder pressure

Antimicrobial activity of ceftolozane-tazobactam against Enterobacterales and Pseudomonas aeruginosa recovered during the Study for Monitoring Antimicrobial Resistance Trends (SMART) program in Spain (2016-2018).

ABSTRACTObjectiveTo analyse the susceptibility to ceftolozane-tazobactam and comparators in Enterobacterales and Pseudomonas aeruginosa isolates recovered from intraabdominal (IAI), urinary (UTI), respiratory (RTI) and bloodstream infection (BSI) in the SMART (Study for Monitoring Antimicrobial Resistance Trends) study.Methods. The susceptibility of 5,351 isolates collected in 11 Spanish hospitals (2016-2018) were analysed (EUCAST-2020 criteria) by broth microdilution and were phenotypically studied for the presence of extended-spectrum beta-lactamases (ESBL). Ceftolozane-tazobactam and/or carbapenem resistant isolates were genetically characterized for ESBL and carbapenemases.ResultsEscherichia coli was the most frequent pathogen (49.3% IAI, 54.9% UTI, 16.7% RTI and 50% BSI), followed by Klebsiella pneumoniae (11.9%, 19.1%, 13.1% and 15.4%, respectively). P. aeruginosa was isolated in 9.3%, 5.6%, 32% and 9%, respectively. The frequency of isolates with ESBLs (2016-2017) was: 30.5% K. pneumoniae, 8.6% E. coli, 2.3% Klebsiella oxytoca and 0.7% Proteus mirabilis. Ceftolozane-tazobactam was very active against non-ESBL-(99.3% susceptible) and ESBL-(95.2%) producing E. coli being less active against K. pneumoniae (98% and 43.1%, respectively) isolates. CTX-M-15 was the most prevalent ESBL in E. coli (27.5%) and K. pneumoniae (51.9%) frequently associated with OXA-48-like carbapenemase. Overall, 93% of P. aeruginosa isolates were susceptible to ceftolozane-tazobactam, preserving this activity (>75%) in isolates resistant to other beta-lactams except in those resistant to meropenen or ceftazidime-avibactam. GES-5, PER-1, VIM-1/2 were the most prevalent enzymes in isolates resistant to ceftolozane-tazobactam.ConclusionsCeftolozane-tazobactam showed high activity rates against isolates recovered in the SMART study although it was affected in K. pneumoniae and P. aeruginosa isolates with ESBL and/or carbapenemases.

Clinical and Laboratory Evaluation of Blunt Trauma Patients for the Early Diagnosis of Intra-Abdominal Injuries

Background: Blunt abdominal trauma is seen with increasing frequency in emergency rooms and is continuous to be associated with significant morbidity and mortality. Intra-abdominal injuries following blunt trauma are of great medico-legal importance to forensic experts. Aim: The study aimed to investigate the contribution of non-invasively and rapidly obtained clinical presentation and biochemical parameters in the early diagnosis of intra- abdominal (IA) injuries in blunt trauma patients, then develop a scoring system and investigate its clinical applicability as pre-test to determine whether abdominal CT should be performed during the diagnosis or not. This may help to decrease number of malpractice claims due to medical negligence. Methods and results: A prospective study was conducted on 30 adult patients with blunt abdominal trauma presented to Emergency department (ED) of Ain shams university hospitals (ASUHS). Patients were classified into two groups: group 1: adult patients with blunt abdominal trauma with normal CT abdomen. Group 2: adult patients with blunt abdominal trauma with abnormal CT abdomen. For every patient, demographic, trauma, and clinical data were collected. Laboratory parameters measured included blood hemoglobin level, liver enzymes, kidney function tests, pancreatic enzymes and finally CT abdomen was done. The mean age for the adult patients with blunt abdominal trauma was 34 ± 11 years. Male to female ratio was 2:1 with no significant importance. There was no significant difference between both groups of the study as regards aetiology and delay time of trauma and the most common cause of BAT was motor car accidents that compromised (36.7%) of all patients. There was no significant difference between both groups of study as regards abdominal symptoms and signs. Regarding vital signs, incidence of patients with high pulse rate per minute more than 100 bpm and high respiratory rate more than 20 brpm were highly significant in group II than group I. There was no significant difference between both groups regarding blood pressure. As regards the conscious level, there was significant difference between both groups of study. Hemoglobin level was significantly lower group II than group I with cutoff point level equal to or less than 9.8gm/dl. AST, ALT, urea, creatinine, amylase and lipase levels showed no significant difference between both groups. According to CT, the spleen was the most injured organ in blunt abdominal trauma patients (43.8%) followed by the liver 4 cases (25%). Conclusion: A scoring system could be done by the sum of points obtained from each parameter (Hb level, pulse rate, respiratory rate, and conscious level). The score points range from (0-4). It was found that the patients with score (0-2) were mainly with normal CT abdomen. On the other hand, patients with score (1-4) were mainly with positive CT findings. So, this scoring system can be used for the early prediction of the presence of IAIs in BAT patients and as a pretest for the need of CT. Recommendations: Blood hemoglobin level, pulse rate, respiratory rate and conscious level can be used as early predictors of IAIs in BAT patients. A scoring system using blood hemoglobin, pulse rate, respiratory rate and conscious level can be used as a pretest probability to determine the need for abdominal CT for the detection of intra-abdominal injury.

A Case of Intra Abdominal Desmoid Tumor Operated by Laparoscopic Surgery

患者は71歳の女性．当院内科で膵囊胞の経過観察中であった．経過観察中の腹部超音波検査所見は膵体部に約２cmの低エコー腫瘤を認めていた．直近の造影CT検査で囊胞に造影効果を認めたため悪性化を疑い腹腔鏡下膵体尾部切除術を行った．術後の病理組織学的検査で腹腔内デスモイドと診断した．WHO分類で本腫瘍は被膜を有さず浸潤性増殖を示し，しばしば局所再発をきたすが遠隔転移はないという特徴から良悪性中間的軟部腫瘍に位置付けられている．本症例も完全切除ができたが十分な経過観察が必要であると考えられた．