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1781. Prevention of infection after induced abortion

the use of prophylactic antibiotics for surgical abortion in the first trimester. For medical abortion, treatment-dose antibiotics may lower the risk of serious infection. However, the number-needed-to-treat is high. Consequently, the balance of risk and benefits warrants further investigation. Perioperative oral doxycycline given up to 12 h before a surgical abortion appears to effectively reduce infectious risk. Antibiotics that are continued after the procedure for extended durations meet (...) the definition for a treatment regimen rather than a prophylactic regimen. Prophylactic efficacy of antibiotics begun after abortion has not been demonstrated in controlled trials. Thus, the current evidence supports pre-procedure but not post-procedure antibiotics for the purpose of prophylaxis. No controlled studies have examined the efficacy of antibiotic prophylaxis for induced surgical abortion beyond 15 weeks of gestation. The risk of infection is not altered when an intrauterine device is inserted

2011 Society of Family Planning

1782. Multidisciplinary Practical Guidelines for Gastrointestinal Access for Enteral Nutrition and Decompression From the Society of Interventional Radiology and American Gastroenterological Association (AGA) Institute, With Endorsement by Canadian Intervention

. Clopidogrel: Withhold for 5 days before the procedure. 4. Aspirin: Do not withhold. 5. Low molecular weight heparin (therapeutic dose): Withhold one dose before the procedure. Antibiotic Prophylaxis Patients undergoing gastrostomy placement are often at increased risk for infection secondary to poor nutritional status, advanced age, comorbidi- ties, and immune compromise. Factors that increase risk for infection are patient-related (eg, diabetes, obesity, malnutrition, chronic steroid admin- istration (...) ), technique-related (eg, transoral technique vs transabdominal technique or failure to provide antibiotic prophylaxis), and external bolster traction–related. The incidence of peristomal infection following percuta- neous transoral tube placement ranges from 5.4% to 30.0% (32). The majority of infections ( 70%) are minor (32,33). Major infections re- quiring speci?c medical or surgical therapy are rare, involving fewer than 1.6% of cases (33). A metaanalysis of 11 prospective randomized trials (34

2011 Society of Interventional Radiology

1783. Labor induction abortion in the second trimester

. Acute cervical infection or pelvic infection is a relative contraindication to performing surgical abortion until antibiotic treatment has been started, whereas labor induction techniques can be started immediately. However, a serious pelvic infection may be associated with impaired uterine contractility, which can limit the effectiveness of induction methods. In the case of severe anemia, or if there is significant vaginal bleeding from placental abruption, a D&E procedure will generally stop (...) and D&E (mean± SD) Labor induction (n=158) D&E (n=139) p Any complication 45±28.5 5±3.6 b.001 Failed initial method 11±7.0 0±0 b.01 Hemorrhage with transfusion 1±0.6 1±0.7 NS Infection with intravenous antibiotics 2±1.3 0±0 NS Retained products of conception a 33±20.9 1±0.7 b.001 Cervical laceration with repair 2±1.3 3±2.2 NS Organ damage (including perforation) 2±1.3 0±0 NS Hospital readmission 1±0.6 1±0.7 NS84 NS, not significant. Adapted from Autry et al. [22]. a Requiring dilation and curettage

2011 Society of Family Planning

1784. Management of Patients with Infections Caused by Methicillin-Resistant Staphylococcus Aureus Full Text available with Trip Pro

of skin and soft-tissue infections (SSTIs) in the era of community-associated MRSA (CA-MRSA)? SSTIs For a cutaneous abscess, incision and drainage is the primary treatment (A-II). For simple abscesses or boils, incision and drainage alone is likely to be adequate, but additional data are needed to further define the role of antibiotics, if any, in this setting. Antibiotic therapy is recommended for abscesses associated with the following conditions: severe or extensive disease (eg, involving multiple (...) is unknown. Empirical coverage for CA-MRSA is recommended in patients who do not respond to β-lactam therapy and may be considered in those with systemic toxicity. Five to 10 days of therapy is recommended but should be individualized on the basis of the patient's clinical response. For empirical coverage of CA-MRSA in outpatients with SSTI, oral antibiotic options include the following: clindamycin (A-II) , trimethoprim-sulfamethoxazole (TMP-SMX) (A-II), a tetracycline (doxycycline or minocycline) (A-II

2011 Infectious Diseases Society of America

1786. The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age Full Text available with Trip Pro

-quality evidence) 49. Vancomycin or clindamycin (based on local susceptibility data) should be provided in addition to β-lactam therapy if clinical, laboratory, or imaging characteristics are consistent with infection caused by S. aureus ( ). (strong recommendation; low-quality evidence) VI. How Can Resistance to Antimicrobials Be Minimized? Recommendations 50. Antibiotic exposure selects for antibiotic resistance; therefore, limiting exposure to any antibiotic, whenever possible, is preferred (...) , public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future

2011 Infectious Diseases Society of America

1788. Endoscope Disinfection - a Resource-Sensitive Approach

Detergents with or without enzymes, and detergents containing antimicrobial substances, can be used for endoscope cleaning. Use of nonfoaming detergents is recommended. Foaming can inhibit good fluid contact with device surfaces and prevent a clear field of vision during the cleaning process, with a risk of injury to personnel. The detergent selected should effectively loosen organic and nonorganic material so that the flushing action of the detergent fluid and subsequent rinsing water removes (...) contain antimicrobial substances that reduce the risk of infection to reprocessing personnel, but they do not replace disinfection. • Enzymes generally function more effectively above room temperature (> 20– 22 °C) and should be used in accordance with the manufacturer’s recommendations. 3 Endoscope disinfection 3.1 General procedures Endoscopes should be disinfected in dedicated rooms by trained staff at the beginning and at the end of each patient list, as well as between patients. The European

2011 World Gastroenterology Organisation

1789. Standard of Practice for the Interventional Management of Isolated Iliac Artery Aneurysms

/operating theatre. The choice will depend on local facilities and practice. Antibiotics and 3000–5000 U heparin are administered at the beginning of the procedure when using a stent-graft. This is not neces- sary if a purely embolic procedure is being performed. Stent-Grafts Several iliac stent-grafts are available that are either bal- loon expandable (e.g., Jostent Peripheral Stentgraft [Jomed, Cheshire, UK] or Advanta [Atrium Medical International, Manchester, UK]) or self-expanding (e.g., Fluency

2011 Cardiovascular and Interventional Radiological Society of Europe

1790. Evidence-based Guidelines from ESPGHAN and NASPGHAN for Helicobacter Pylori Infection in Children

of primary antibiotic resistance of Helicobacter pylori at centres in England and Wales over a six-year period (2000–2005). Euro Surveill 2007;12: E3–4. 125. Kato S, Fujimura S. Primary antimicrobial resistance of Helicobacter pylori in children during the past 9 years. Pediatr Int 2010;52: 187–90. 126. BoyanovaL,GergovaG,NikolovR,etal.Prevalenceandevolutionof Helicobacter pylori resistance to 6 antibacterial agents over 12 years and correlation between susceptibility testing methods. Diagn Micro- biol (...) infection. Conclusions: These clinical practice guidelines represent updated, best- available evidence and are meant for children and adolescents living in Europe and North America, but they may not apply to those living on other continents, particularly in developing countries with a high H pylori infection rate and limited health care resources. Key Words: antibiotic resistance, children and adolescents, diagnostic tests, Helicobacter pylori, treatment (JPGN 2011;53: 230–243) SYNOPSIS T he current

2011 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

1792. Use of Galactogogues in Initiating or Augmenting the Rate of Maternal Milk Secretion

on domperidone. 45 Theoretically: asthma, bleeding, dizziness, ?atulence, hypoglycemia, loss of consciousness, skin rash, wheezing—but no reports in lactating women. irreversible), causing the FDA to place a ‘‘black box warning’’ on this drug in the United States. Interactions Increased blood levels of domperidone when combined with some substrates metabolized by CYP3A4 enzyme inhibitors, e.g., ?uconazole, grapefruit juice, ketoconozole, macrolide antibiotics, and others Hawthorne, hypoglycemics including

2011 Academy of Breastfeeding Medicine

1793. Breast Reduction Mammaplasty

the use of perioperative antibiotic prophylaxis compared to no perioperative antibiotic prophylaxis reduce the risk of infection? • In patients with symptomatic breast hypertrophy undergoing reduction mammaplasty, is a single preoperative dose of antibiotics compared to a perioperative course (24 hr period) effective at reducing the risk of infection? • In patients with symptomatic breast hypertrophy undergoing reduction mammaplasty, does the use of drains (compared to no drains) decrease risk (...) . Arms are padded and secured. Screening of the resected breast tissue, including pathology evaluation, may be recommended when clinically indicated and after careful consideration of patient history, risks, and benefits. After surgery, dressings, brassieres, and/or wraps may be used according to surgeon preference. Antibiotic prophylaxis. Evidence indicates that perioperative antibiotics may reduce the risk of infection associated with reduction mammaplasty, 22-24 as it has been more definitively

2011 American Society of Plastic Surgeons

1794. Interpretation of Exhaled Nitric Oxide Levels (FENO) for Clinical Applications: An Official ATS Clinical Practice Guideline

molecule/free radical and may have oxidant properties directlyorintheformofthemorenoxiousperoxynitrite.These properties give NO its bactericidal and cytotoxic effects and may participate in host defense by mediating antimicrobial ac- tivity and cytotoxicity for tumor cells (4). The exact pathophys- iologicalroleofNOintheairwaysandlungsiscomplex(4,6–8). On the one hand, it may act as a proin?ammatory mediator predisposingtothedevelopmentofairwayhyperresponsiveness (AHR) (4, 9). On the other, under

2011 American Thoracic Society

1796. The role of endoscopy in the management of choledocholithiasis

shouldgenerallyleadtoanexpeditiousERC,thedegreeof procedure urgency depends on the clinical severity; con- sensus criteria for de?ning the severity of acutecholangitis havebeenproposed. 29 TrulyurgentERCisindicatedwhen obstructing biliary stones are associated with severe acute cholangitis that is not responding to intravenous antibiot- ics and ?uid resuscitation. 29-31 In these instances, biliary drainage is the primary focus of management rather than stone extraction. Early ERC (variably de?ned, but generally 72 hours (...) In preparation for ERC, antibiotic prophylaxis is unnec- essary in the majority of patients with suspected choledo- cholithiasis, unless cholangitis or immunosuppression is present or biliary drainage is predicted to be incomplete; a relevant ASGE guideline covers this topic in detail. 54 Proper technique for cholangiographic imaging is essen- tial for successful identi?cation of stones at ERC. 55 Despite careful attention to technique, the sensitivity of cholan- giography for choledocholithiasis

2011 American Society for Gastrointestinal Endoscopy

1797. The role of endoscopy in enteral feeding

shown that anti- microbial prophylaxis leads to a statistically signi?cant reduction in the frequency of peristomal wound infec- tion. 29,30 Antimicrobial prophylaxis is also cost-effective. 31 Parenteralcefazolin(oranotherantibioticwithsimilarcov- erage) should be administered 30 minutes before PEG placement. 32 Such prophylaxis is only necessary in those patients not already receiving appropriate antibiotic treat- ment at the time of PEG insertion. In situations in which methicillin-resistant (...) gastrostomy tube or button. Nonendoscopic replacement of a dislodged tube or button is contraindi- cated in the absence of a mature tract because of the potential for intraperitoneal spillage. In the absence of peritonitis, nonoperative management of early dislodg- ment of PEG usually requires nasogastric decompression, intravenous antibiotics, and PEG replacement several days later. DPEJ is associated with the same type of complications as seen with PEG. In a large retrospective study from

2011 American Society for Gastrointestinal Endoscopy

1798. Complications of colonoscopy

outpatient management with oral antibiotics has also been reported. 48 MORTALITY Death has been rarely reported in relation to colonos- copy, with or without polypectomy. In a 2010 review of colonoscopy complications based on prospective studies and retrospective analyses of large clinical or administra- tive databases, there were 128 deaths reported among 371,099 colonoscopies, for an unweighted pooled death rate of 0.03%. 2 All studies reported mortality within 30 days of the colonoscopy, although some (...) of infection are rare. 57 Although individual cases of infec- tion after colonoscopy have been reported, there is no de?nite causal link with the endoscopic procedure and no proven bene?t for antibiotic prophylaxis. 58 Therefore, cur- rent guidelines from the American Heart Association and ASGE recommend against antibiotic prophylaxis for pa- tients undergoing colonoscopy. 58-59 A 2008 review 60 re- ported that subsequent to the 2003 Multisociety Guideline for Reprocessing of Flexible GI Endoscopes, 61 all

2011 American Society for Gastrointestinal Endoscopy

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