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  • ISSN: 2573-1637
    Current Issue
    Volume 2, Issue 2
    Research Article
    Elizabeth Lucas*, Chandra Singh, Cheryl Baxter, Rayce Risser, Ahmad Z. Mohamed, Venkata R. Jayanthi, Stephen A. Koff, Brian VanderBrink, and Sheryl S. Justice
    Clean intermittent catheterization (CIC) is a frequently performed procedure on patients with neurogenic bladder to assist with voiding and is associated with bacteriuria. Due to this bacteriuria, this patient population is frequently subjected to multiple courses of antibiotics, whether appropriate or not and often become colonized with multi-drug resistant organisms. Choosing appropriate empirical antibiotics is a clinical dilemma when encountering these patients at the beginning of an illness. We reviewed antimicrobial susceptibility patterns of urine cultures for 50 myelomeningocele patients over the course of 1 year. Data for 192 organisms was available for analysis and E. coli was the most commonly recovered organism. Using univariate analysis we sought to detect differences identifying subjects who were most likely to be colonized with resistant E. coli strains versus those subjects that had susceptible strains. Though the probability of resistance is higher than that in the community, it did not proportionately increase with olderage, increased duration of clean catheterization, or related to route of catheterization. Decisions for empirical therapy ought to be guided by individual patient’s previous culture results with particular attention to colonization with resistant organisms, but broad spectrum coverage may not be necessary in all patients utilizing clean intermittent catheterization.
    David Sikule, Tracey Ho, John Perrotti, Julianne Wilkinson, Alan Perrotti, James Cavalcante, Leigh Python, Gerald Wilkinson, and Michael Perrotti*
    Purpose: Clinical care pathways have been shown to reduce hospital length of stay without increasing post operative adverse events. In the present study, we sought to determine whether universally applied precautionary measures to prevent peri-operative hypertension (HTN) into an established standardized care pathway may reduce acute post operative hemorrhage (APOH) following partial nephrectomy.
    Methods: We retrospectively reviewed a database comprised of patients undergoing partial nephrectomy at our institution by the same surgical team. Starting in January of 2013, all patients undergoing partial nephrectomy received screening for and universally applied aggressive management of HTN and its prevention in the peri-operative period. The APOH rate was calculated for the study cohort (Group 1, n=52) and compared to the control group (Group 2, n=200) managed immediately preceding implementation of HTN universal precautions. Clinico-pathologic factors assessed for their relationship to APOH were patient age, gender, diabetes, smoking, hypertension, coronary artery disease, American Society of Anesthesia Score (ASA), tumor size, pathologic result, cancer margin status, operative time and estimated intra-operative blood loss.
    Results: Data were analyzed from 252 consecutive patients. In Group 1 (n=200), 7 patients (3.5%) experienced APOH. In that cohort, risk factors for APOH were male gender and hypertension. The impact of APOH on subsequent hospital course, ancillary procedures and renal loss are reported. In Group 2 (n=52) hypertensive precautions were universally applied. In this cohort, there were no episodes of APOH, and no required ancillary procedures.
    Conclusion: Our preliminary results at the time of this early interim analysis appear to indicate that hypertensive universal precautions in a previously established partial nephrectomy clinical care pathway reduced the incidence of acute post operative hemorrhage. Reduction of APOH reduced additional adverse post operative sequelae and improved renal preservation.
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