Transition zone biopsies have been found to increase the detection rates of cancer of the prostate in patients with negative digital rectal examination. There are however no data available whether the higher biopsy rate is associated with greater morbidity. The present study was therefore designed to evaluate the complication rate of extended sextant biopsy. In this prospective study, 162 consecutive patients who presented for prostatic evaluation were included. After starting prophylactic antibiotic treatment 48 h prior to the procedure, transrectal ultrasound-guided core biopsies were obtained from each lobe: three each from the peripheral zone (apex, mid-zone and base) and two from the transition zone of each prostatic lobe. In all patients a questionnaire was obtained 10–12 days after the procedure. Major complications occurred in 3 patients. In 2 of the 3 cases major macroscopic hematuria was treated by an indwelling catheter for 1 or 2 days and 1 patient developed fever >38.5°C for 1 day. Minor macroscopic hematuria was present in 68.5% of the patients. In 17.9% of these cases, the hematuria lasted for more than 3 days. Hematospermia was observed in 19.8% and minor rectal bleeding occurred in 4.9%. Ten-core biopsies did not lead to an increase in adverse effects or complications when compared to the results of sextant biopsies reported in the literature. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

En réanimation, les facteurs de risque d’infection à bactéries résistantes sont nombreux et il est nécessaire d’instaurer une antibiothérapie rapide et adéquate. Cela conduit donc souvent au choix empirique d’antibiotiques à large spectre. Ce travail de thèse regroupant quatre études porte sur les éléments de ce choix. Dans la première étude, les critères de "pneumopathie associée aux soins" sont discutés. Dans la seconde, il est rapporté que le traitement antibiotique prescrit au début du séjour en réanimation est associé à l’acquisition de Pseudomonas aeruginosa. Dans le diagnostic d’une pneumopathie acquise sous ventilation, la troisième étude décrit une technique rapide d’antibiogramme permettant une désescalade antibiotique plus précoce. La néphrotoxicité des aminoglycosides dans le traitement empirique des patients en sepsis sévère est présentée dans la dernière étude. Ces travaux participent à la bonne gestion des antibiotiques à la phase empirique du traitement des infections sévères en réanimation. / Intensive care units (ICU) are a niche for risk factors of infection due to multidrug resistant bacteria. ICU patients are in a need for a rapid and adequate antibiotic therapy. This leads ICU physicians to use empirical broad spectrum antibiotics. This thesis comprises four studies which focus on the empirical step of the treatment. In the first study, the criteria for "health-care-associated pneumonia" are discussed. The second shows that the antibiotic selection pressure administered early during the ICU stay could lead to Pseudomonas aeruginosa acquisition. In the third study, a rapid direct specimen testing method was assessed for ventilator-associated pneumonia diagnosis in order to hasten antibiotic de-escalation. Finally, a review on aminoglycosides’ nephrotoxicity in the severe sepsis setting represents the fourth study. These studies bring a loop forward into the understanding of the antibiotic stewardship of patients with severe sepsis, with particular focus on the empirical antibiotic treatment.

Transition zone biopsies have been found to increase the detection rates of cancer of the prostate in patients with negative digital rectal examination. There are however no data available whether the higher biopsy rate is associated with greater morbidity. The present study was therefore designed to evaluate the complication rate of extended sextant biopsy. In this prospective study, 162 consecutive patients who presented for prostatic evaluation were included. After starting prophylactic antibiotic treatment 48 h prior to the procedure, transrectal ultrasound-guided core biopsies were obtained from each lobe: three each from the peripheral zone (apex, mid-zone and base) and two from the transition zone of each prostatic lobe. In all patients a questionnaire was obtained 10–12 days after the procedure. Major complications occurred in 3 patients. In 2 of the 3 cases major macroscopic hematuria was treated by an indwelling catheter for 1 or 2 days and 1 patient developed fever >38.5°C for 1 day. Minor macroscopic hematuria was present in 68.5% of the patients. In 17.9% of these cases, the hematuria lasted for more than 3 days. Hematospermia was observed in 19.8% and minor rectal bleeding occurred in 4.9%. Ten-core biopsies did not lead to an increase in adverse effects or complications when compared to the results of sextant biopsies reported in the literature. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Bakgrund: Behandlingen av bakteriella infektioner med antibiotika har lett till ett ökat problem av antibiotikaresistens. Antibiotikaresistensens konsekvenser har resulterat i problem för både individer och sjukvård världen över. Både etiska aspekter och sjuksköterskans roll inom omvårdnaden behöver ses över för att finna lösningar till detta globala hot.   Syfte: Att beskriva sjuksköterskans förebyggande roll vid antibiotikaresistens.  Metod: En litteraturöversikt   Resultat: Sjuksköterskans roll i förebyggandet av antibiotikaresistens ansågs var otydliga. Sjuksköterskor belyste att utbildningen innehöll moment om förebyggande åtgärder för antibiotika resistens lika så i praktiken. Däremot upplevde sjuksköterskor i arbetslivet att de var exkluderade.   Sammanfattning: Författarna fann att det fanns en tydlig koppling mellan betydelsen av sjuksköterskans arbetsroll och det förebyggande arbetet kring antibiotikaresistens. Det fanns även en kunskapsbrist hos sjuksköterskorna kring antibiotikaresistensen och de förebyggande rutinerna samt att vikten av en fungerande kommunikation mellan vårdprofessionerna spelade stor roll. / Background: The treatment of bacterial infections with antibiotics has led to an increased problem with antibiotic resistance. The antibiotic resistance has had consequences that resulted in problems for both individuals as well as health care worldwide. Both ethical aspects and the nurse’s role within nursing needs to be reviewed to find solutions to this global threat.   Aim: To describe the nurse’s preventive roll in antibiotic resistance.  Method: Literature review  Results: The nurse’s role in the prevention of antibiotic resistance was seen as vague. Nurses illustrated that education contained elements on the prevention of antibiotic resistance as well as in practice. On the other hand, in the work life, nurses rather felt that they were excluded.   Summary: The authors found that there was a clear connection between the importance of the nurse’s work role and the preventative work regarding antibiotic resistance. There was a knowledge gap between the nurses when it came to antibiotic resistance and the preventative routines as well as bearing that a functioning communication between the nursing professions was of big importance.

Background: Pericoronitis is an oral condition characterized by inflammation caused by infection in the gingiva surrounding a partially erupted tooth. Terracortril® with Polymyxin B is an ointment with hydrocortisone, oxytetracycline and Polymyxin B that has been observed to occur in treatment of pericoronitis in general dental care, despite recommendations against local antibiotic treatment in dental care. Aim: The aim was to explore to what extent Terracortril® with Polymyxin B is used in the treatment of pericoronitis in general dental care, and to ascertain if the general dentist’s professional experience and degree of difficulty of the pericoronitis affects the choice of treatment. Methods: A survey was sent to general dentists in the Region Västerbotten, consisting of three patient cases with different severity of pericoronitis asking for acute stage treatment. Background questions about Terracortril® with Polymyxin B were included and working years were inquired for.   Results: 81.4% used Terracortril® with Polymyxin B. Usage was associated with professional experience, where dentists with 0-1 and ≥16 working years used Terracortril® with Polymyxin B more frequently than dentists with 2-5 and 6-15 working years.  The severity of symptoms of pericoronitis was decisive for if the dentist used Terracortril® with Polymyxin B, where usage increased with the severity of pericoronitis. Conclusion: Terracortril® with Polymyxin B is frequently used in treatment of pericoronitis. Both the professional experience and the degree of difficulty of the pericoronitis affect the usage. Terracortril® with Polymyxin B should presumably not be used in the treatment of pericoronitis until supporting evidence is available.

Made available in DSpace on 2016-01-26T12:51:45Z (GMT). No. of bitstreams: 1 marcelospegiorinmoreno_tese.pdf: 1082572 bytes, checksum: d3881298debccf50a2a1f76433f765a4 (MD5) Previous issue date: 2011-02-24 / Resumo:Introdução: Pneumonias adquiridas no hospital (PAH) e pneumonias associadas à ventilação mecânica (PAVM) são complicações frequentes e importantes causas de aumento da morbidade, mortalidade e dos custos. Objetivo: O objetivo do estudo foi avaliar o valor prognóstico da dosagem seriada da PCR nos pacientes com pneumonia nosocomial (PN). Casuística e Método: Estudo prospectivo e observacional, conduzido em uma UTI de 24 leitos em um hospital terciário. Pacientes com PN, incluindo pacientes não ventilados e pacientes com pneumonia associada à ventilação mecânica foram incluídos. Dosagens diárias da PCR e cálculo da Taxa da PCR (TPCR) eram realizadas do dia da prescrição do antibiótico (D0) até o décimo dia. Pacientes foram classificados de acordo com a TPCR em 2 grupos: boa resposta (TPCR < 0,67 no D10) e má resposta (não-resposta ou resposta bifásica - TPCR 0,67 no D10). Resultados: Cento e cinquenta e cinco pacientes com PN foram avaliados e 64 foram incluídos. O grupo má resposta (n= 34) teve uma taxa de mortalidade geral de 53% em comparação a 20% no grupo boa resposta (n= 30) (RR = 2,65; IC 95%, 1,21-5,79, p = 0,01). Diferenças significantes entre os xii dois grupos foram encontradas a partir do Dia 4 (p= 0,01). A adequacidade da antibioticoterapia foi muito menor no grupo má resposta em comparação ao grupo boa resposta, 14,3% vs 66,7% (p = 0,008), respectivamente. Conclusão: Dosagens seriadas de PCR e a análise da cinética da TPCR são úteis no seguimento de pacientes com pneumonia nosocomial.

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