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RISS 인기검색어
- 검색키워드
- 저자 : Liam Toner (검색결과 3 건)
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Prevention of sepsis prior to prostate biopsy
Liam Toner,Damien M Bolton,Nathan Lawrentschuk 대한비뇨의학회 2016 Investigative and Clinical Urology Vol.57 No.2
Purpose: Urosepsis is the most feared complication of transrectal prostate biopsy. The incidence may be increasing from <1% to 2%–3% in contemporary series. Historically, fluoroquinolones have been effective antibiotic prophylaxis to prevent infective complications but antibiotic resistance is increasing. The increase in antibiotic resistance may contribute to reported increases in urosepsis and hospitalization after transrectal biopsy. This article will review other methods clinicians may employ to reduce the incidence of infective complications after prostate biopsy. Materials and Methods: A systematic review of the literature was conducted using literature databases PubMed and Ovid MEDLINE in August 2015 in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) criteria. Results: Effective strategies to reduce infective complications after transrectal prostate biopsy include augmented prophylaxis with other antibiotics, rectal swab culture directed antibiotic prophylaxis or a transperineal biopsy approach. Needle disinfection, minimizing the number of biopsy needles and rectal disinfectants may also be of use. These methods may be of particular utility in patients with risk factors for developing urosepsis such as recent antibiotic use and overseas travel. Conclusions: The scientific literature describes various techniques designed to reduce infective complications caused by prostate biopsy. Clinicians should consider incorporating these novel techniques into their contemporary practice.
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Liam Toner,Nathan Papa,Sani H. Aliyu,Harveer Dev,Nathan Lawrentschuk,Samih Al-Hayek 대한비뇨의학회 2016 Investigative and Clinical Urology Vol.57 No.2
Purpose: Enterococci are a common cause of urinary tract infection and vancomycin-resistant strains are more difficult to treat. The purpose of this surveillance program was to assess the prevalence of and determine the risk factors for vancomycin resistance in adults among urinary isolates of Enterococcus sp. and to detail the antibiotic susceptibility profile, which can be used to guide empirical treatment. Materials and Methods: From 2005 to 2014 we retrospectively reviewed 5,528 positive Enterococcus sp. urine cultures recorded in a computerized laboratory results database at a tertiary teaching hospital in Cambridge, United Kingdom. Results: Of these cultures, 542 (9.8%) were vancomycin resistant. No longitudinal trend was observed in the proportion of vancomycin-resistant strains over the course of the study. We observed emerging resistance to nitrofurantoin with rates climbing from near zero to 40%. Ampicillin resistance fluctuated between 50% and 90%. Low resistance was observed for linezolid and quinupristin/dalfopristin. Female sex and inpatient status were identified as risk factors for vancomycin resistance. Conclusions: The incidence of vancomycin resistance among urinary isolates was stable over the last decade. Although resistance to nitrofurantoin has increased, it still serves as an appropriate first choice in uncomplicated urinary tract infection caused by vancomycin-resistant Enterococcus sp.
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Current role of multiparametric magnetic resonance imaging in the management of prostate cancer
Nikolas Christopher Katelaris,Damien Michael Bolton,Mahesha Weerakoon,Liam Toner,Phillip Mark Katelaris,Nathan Lawrentschuk 대한비뇨의학회 2015 Investigative and Clinical Urology Vol.56 No.5
The purpose of this review was to evaluate the current role of multiparametric magnetic resonance imaging (mp-MRI) in the managementof prostate cancer (PC). The diagnosis of PC remains controversial owing to overdetection of indolent disease, whichleads to overtreatment and subsequent patient harm. mp-MRI has the potential to equilibrate the imbalance between detectionand treatment. The limitation of the data for analysis with this new technology is problematic, however. This issue has been compoundedby a paradigm shift in clinical practice aimed at utilizing this modality, which has been rolled out in an ad hoc fashionoften with commercial motivation. Despite a growing body of literature, pertinent clinical questions remain. For example, can mp-MRI be calibrated to reliably detect biologically significant disease? As with any new technology, objective evaluation of the clinicalapplications of mp-MRI is essential. The focus of this review was on the evaluation of mp-MRI of the prostate with respect to clinicalutility.
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