Maria Infantino, Arianna Damiani, Francesca Li Gobbi, Valentina Grossi, Barbara Lari, Donatella Macchia, Patrizia Casprini, Francesca Veneziani, Danilo Villalta, Nicola Bizzaro, Piero Cappelletti, Martina Fabris, Luca Quartuccio, Maurizio Benucci and Mariangela Manfredi
Ariel Kerpel MD, Noam Nissan MD, Maximiliano Klug MD, Sharon Amit MD PhD, Eli Konen MD and Edith M Marom MD
Robert M. Kaplan MBChB FRANZCP MA MPhil
Ron Eremenko BSc, Shira Barmatz MSc, Nadia Lumelsky MD, Raul Colodner PhD, Merav Strauss PhD and Yoav Alkan MD
Background: Urinary tract infection (UTI) is a common bacterial infection in children.
Early treatment may prevent renal damage in pyelonephritis. The choice of empiric antibiotic treatment is based on knowledge of the local susceptibility of urinary bacteria to antibiotics. In Israel the recommended empiric oral antibiotic treatment are First or second generation cephalosporin, trimethoprim-sulfamethoxazole or amoxicillin-clavulanic acid.
Objectives: To describe resistance rates of urine bacteria isolated from children with UTI in the community settings. Identify risk factors for resistance.
Methods: A retrospective cross-sectional study of UTI in children aged 3 months to 18 years diagnosed with UTI and treated as outpatients in a large community clinic between 7/2015 and 7/2017 with a diagnosis of UTI.
Results: A total of 989 urinary samples were isolated, 232 were included in the study. Resistance rates to cephalexin, cefuroxime, ampicillin/clavulanate and Trimethoprim-Sulfamethoxazole were 9.9%, 9.1%, 20.7%, and 16.5%, respectively. Urinary tract abnormalities and recurrent UTI were associated with an increase in antibiotic resistance rates. Other factors such as age, fever, and previous antibiotic treatment were not associated with resistance differences.
Conclusions: Resistance rates to common oral antibiotics were low compared to previous studies performed in Israel in hospital settings. First generation cephalosporins are the preferred empiric antibiotics for febrile UTI for outpatient children. Amoxicillin/clavulanate is not favorable due to resistance of over 20% and the broad spectrum of this antibiotic. Care should be taken in children with renal abnormalities as there is a worrying degree of resistance rates to the oral first line antibiotic therapy.
Nir Horesh MD, Yasmin Abu-Ghanem MD, Tomer Erlich MD, Danny Rosin MD, Mordechai Gutman MD FACS, Dorit E. Zilberman MD, Jacob Ramon MD and Zohar A. Dotan MD
Background: Pancreatic injuries during nephrectomy are rare, despite the relatively close anatomic relation between the kidneys and the pancreas. The data regarding the incidence and outcome of pancreatic injuries are scarce.
Objectives: To assess the frequency and the clinical significance of pancreatic injuries during nephrectomy.
Methods: A retrospective analysis was conducted of all patients who underwent nephrectomy over a period of 30 years (1987–2016) in a large tertiary medical center. Demographic, clinical, and surgical data were collected and analyzed.
Results: A total of 1674 patients underwent nephrectomy during the study period. Of those, 553 (33%) and 294 patients (17.5%) underwent left nephrectomy and radical left nephrectomy, respectively. Among those, four patients (0.2% of the total group, 0.7% of the left nephrectomy group, and 1.36% of the radical left nephrectomy) experienced iatrogenic injuries to the pancreas. None of the injuries were recognized intraoperatively. All patients were treated with drains in an attempt to control the pancreatic leak and one patient required additional surgical interventions. Average length of stay was 65 days (range 15–190 days). Mean follow-up was 23.3 months (range 7.7–115 months).
Conclusions: Pancreatic injuries during nephrectomy are rare and carry a significant risk for postoperative morbidity.
Yael Peled MD, Eilon Ram MD and Yehuda Shoenfeld MD FRCP MACR
The innovation that has taken place in medicine, combined with state-of-the-art technological developments, provides therapeutic options for patients in conditions that were previously considered incurable. This promotion at the same time presents us with new ethical challenges. In this article, we review the journey through life of an advanced heart failure patient, covering a variety of potential clinical and ethics subjects in the field of heart failure treatment. We review the ethical principles of the Hippocratic Oath against the background of the realities of practicing medicine and of the enormous advances in therapeutics.
Firas Abu Hanna MD, Dario Prais MD, Yoav Zehavi MD, Waheeb Sakran MD and Ronen Spiegel MD
Eliyakim Hershkop BA and Bishara Bisharat MD MPH