The Experts below are selected from a list of 44163 Experts worldwide ranked by ideXlab platform
Matthew J. Roberts - One of the best experts on this subject based on the ideXlab platform.
-
Infectious Complications of prostate biopsy: winning battles but not war
World Journal of Urology, 2020Co-Authors: Okan Derin, Limírio Fonseca, Rafael Sanchez-salas, Matthew J. RobertsAbstract:Prostate biopsy is a standard tool for diagnosing prostate cancer, with more than 4 million procedures performed worldwide each year. Infectious Complications and economic burden are reportedly rising with continued use of trans-rectal ultrasound-guided biopsy, despite the transperineal approach being associated with less Infectious Complications. In this review, the contemporary literature on pathophysiology, epidemiology, risk factors, causative organisms and emerging approaches for prevention of Infectious Complications are outlined. Management of Infectious Complications after TRUSB has caused significant financial burden on health systems. The most frequent causative agents of Infectious Complications after prostate biopsy are Gram-negative bacilli are particularly concerning in the era of antibiotic resistance. Increasing resistance to fluoroquinolones and beta-lactam antibiotics has complicated traditional preventive measures. Patient- and procedure-related risk factors, reported by individual studies, can contribute to Infectious Complications after prostate biopsy. Recent literature shows that the transrectal ultrasound-guided prostate biopsy results in higher Infectious Complication rate than the transperineal prostate biopsy. NAATs, recently introduced technique to detect FQr may detect all antibiotic-resistant rectal microbiota members-included MDRs-although the technique still has limitations and economical burdens. Transient solutions are escalating antibiotic prophylaxis and widening the indications for TPB.
-
Infectious Complications of prostate biopsy: winning battles but not war
World Journal of Urology, 2020Co-Authors: Okan Derin, Limírio Fonseca, Rafael Sanchez-salas, Matthew J. RobertsAbstract:Background Prostate biopsy is a standard tool for diagnosing prostate cancer, with more than 4 million procedures performed worldwide each year. Infectious Complications and economic burden are reportedly rising with continued use of trans-rectal ultrasound-guided biopsy, despite the transperineal approach being associated with less Infectious Complications. Objective and methods In this review, the contemporary literature on pathophysiology, epidemiology, risk factors, causative organisms and emerging approaches for prevention of Infectious Complications are outlined. Results Management of Infectious Complications after TRUSB has caused significant financial burden on health systems. The most frequent causative agents of Infectious Complications after prostate biopsy are Gram-negative bacilli are particularly concerning in the era of antibiotic resistance. Increasing resistance to fluoroquinolones and beta-lactam antibiotics has complicated traditional preventive measures. Patient- and procedure-related risk factors, reported by individual studies, can contribute to Infectious Complications after prostate biopsy. Conclusions Recent literature shows that the transrectal ultrasound-guided prostate biopsy results in higher Infectious Complication rate than the transperineal prostate biopsy. NAATs, recently introduced technique to detect FQr may detect all antibiotic-resistant rectal microbiota members—included MDRs—although the technique still has limitations and economical burdens. Transient solutions are escalating antibiotic prophylaxis and widening the indications for TPB.
-
The effectiveness of targeted relative to empiric prophylaxis on Infectious Complications after transrectal ultrasound-guided prostate biopsy: a meta-analysis
World Journal of Urology, 2018Co-Authors: Susan Scott, Patrick N. Harris, Deborah A. Williamson, Michael A. Liss, Matthew J. RobertsAbstract:Purpose Rectal culture screening for fluoroquinolone (FQ)-resistant Enterobacteriaceae before transrectal ultrasound guided prostate (TRUSPB) biopsy and targeted antibiotic prophylaxis (TAP) may decrease post-TRUSPB infection rates compared to empiric (EAP) regimens. The objective of this study was to evaluate the effectiveness of targeted relative to empiric prophylaxis regimens on rates of Infectious Complications after TRUSPB and to determine the baseline prevalence of FQ resistance based on prior rectal swabs. Methods An electronic search within literature databases including EMBASE and Web of Science (all databases) for articles assessing TAP as an approach to TRUSPB prophylaxis was conducted. Quality assessment was performed using the Hoy instrument. Meta-analysis was performed using MetaXL 5.3. Results From 15 studies (eight retrospective and seven prospective) representing 12,320 participants, Infectious Complication incidence was 3.4% in EAP and 0.8% in TAP patients. The number needed to treat with TAP to avoid one more infection when compared to the EAP group was 39. Effect sizes were homogeneous. Prevalence of FQ resistance showed low (15%) and high (28%) subgroups, likely due to region of origin (within and outside USA, respectively). Conclusions Rectal culture prior to TRUSPB and use of TAP adjusts for endemic FQ resistance and is associated with less Infectious Complications and resulting morbidity when compared to EAP. Overtreatment associated with augmented prophylaxis approaches may be reduced as a result. Further prospective assessment and cost–benefit analyses are required before widespread implementation can be recommended.
-
Comparison of fosfomycin against fluoroquinolones for transrectal prostate biopsy prophylaxis: an individual patient-data meta-analysis
World Journal of Urology, 2018Co-Authors: Matthew J. Roberts, Susan Scott, Patrick N. Harris, Kurt Naber, Florian M. E. WagenlehnerAbstract:Purpose To systematically review and meta-analyse available evidence comparing fosfomycin trometamol (FT) to fluoroquinolone (FQ) prophylaxis to prevent transrectal ultrasound-guided prostate biopsy (TRUSPB) related Infectious Complications. Methods Electronic databases were queried for studies comparing FT to FQ-based TRUSPB prophylaxis. Studies were assessed for comparable outcomes and methodological quality (ROBINS-I modification). The primary outcome measure was the relative odds of overall Infectious Complications following TRUSPB according to FT/FQ treatment, which was evaluated with meta-analysis. Safety and tolerability were also assessed. The relative odds of infections of different severity [Grade 1, bacteriuria and afebrile urinary tract infection (UTI); Grade 2, bacteraemia, febrile UTI, and urosepsis] according to FT/FQ treatment were also estimated. Results Five studies, being three prospective randomised trials and two retrospective cohort studies, representing 3112 patients, were included. The relative odds of an Infectious Complication (OR 0.22, 95% CI 0.09–0.54) or of a more severe (Grade 2) infection (OR 0.13, 95% CI 0.07–0.26) were significantly lower in those receiving FT compared to FQ prophylaxis. A low incidence of medication-related side effects was observed. There were less observed infections due to FQ-resistant pathogens in those receiving FT prophylaxis. Conclusions Patients who received FT prophylaxis were less likely than those who received FQ prophylaxis to develop infections overall, as well as severe and resistant infections after TRUSPB. Assessing the performance of FT in other geographic locations or in comparison to targeted prophylaxis based on risk assessment or rectal cultures is desired.
Masanori Terashima - One of the best experts on this subject based on the ideXlab platform.
-
Preoperative risk factors for postoperative intra-abdominal Infectious Complication after gastrectomy for gastric cancer using a Japanese web-based nationwide database
Gastric Cancer, 2020Co-Authors: Keiichi Fujiya, Akira Tsuburaya, Hiraku Kumamaru, Yoshiyuki Fujiwara, Hiroaki Miyata, Yasuhiro Kodera, Yuko Kitagawa, Hiroyuki Konno, Masanori TerashimaAbstract:Background Postoperative intra-abdominal Infectious Complication (PIIC) after gastrectomy for gastric cancer worsens in-hospital death or long-term survival. However, the methodology for PIIC preoperative risk assessment remains unestablished. We aimed to develop a preoperative risk model for postgastrectomy PIIC. Methods We collected 183,936 patients’ data on distal or total gastrectomy performed in 2013–2016 for gastric cancer from the Japanese National Clinical Database and divided into development (2013–2015; n = 140,558) and validation (2016; n = 43,378) cohort. The primary outcome was the incidence of PIIC. The risk model for PIIC was developed using 18 preoperative factors: age, sex, body mass index, activities of daily living, 12 comorbidity types, gastric cancer stage, and surgical procedure in the development cohort. Secondarily, we developed another model based on the new scoring system for clinical use using selected factors. Results The overall incidence of PIIC was 4.7%, including 2.6%, 1.7%, and 1.3% in anastomotic leakage, pancreatic fistula, and intra-abdominal abscess, respectively. Among the 18 preoperative factors, male [odds ratio, (OR) 1.92], obesity (OR, 1.52–1.96), peripheral vascular disease (OR, 1.55), steroid use (OR, 1.83), and total gastrectomy (OR, 1.89) strongly correlated with PIIC incidence. The entire model using the 18 factors had good discrimination and calibration in the validation cohort. We selected eight relevant factors to create a simple scoring system, using which we categorized the patients into three risk groups, which showed good calibration. Conclusion Using nationwide clinical practice data, we created a preoperative risk model for postgastrectomy PIIC for gastric cancer.
-
preoperative risk factors for postoperative intra abdominal Infectious Complication after gastrectomy for gastric cancer using a japanese web based nationwide database
Gastric Cancer, 2020Co-Authors: Keiichi Fujiya, Akira Tsuburaya, Hiraku Kumamaru, Yoshiyuki Fujiwara, Hiroaki Miyata, Yasuhiro Kodera, Yuko Kitagawa, Hiroyuki Konno, Masanori TerashimaAbstract:BACKGROUND: Postoperative intra-abdominal Infectious Complication (PIIC) after gastrectomy for gastric cancer worsens in-hospital death or long-term survival. However, the methodology for PIIC preoperative risk assessment remains unestablished. We aimed to develop a preoperative risk model for postgastrectomy PIIC. METHODS: We collected 183,936 patients' data on distal or total gastrectomy performed in 2013-2016 for gastric cancer from the Japanese National Clinical Database and divided into development (2013-2015; n = 140,558) and validation (2016; n = 43,378) cohort. The primary outcome was the incidence of PIIC. The risk model for PIIC was developed using 18 preoperative factors: age, sex, body mass index, activities of daily living, 12 comorbidity types, gastric cancer stage, and surgical procedure in the development cohort. Secondarily, we developed another model based on the new scoring system for clinical use using selected factors. RESULTS: The overall incidence of PIIC was 4.7%, including 2.6%, 1.7%, and 1.3% in anastomotic leakage, pancreatic fistula, and intra-abdominal abscess, respectively. Among the 18 preoperative factors, male [odds ratio, (OR) 1.92], obesity (OR, 1.52-1.96), peripheral vascular disease (OR, 1.55), steroid use (OR, 1.83), and total gastrectomy (OR, 1.89) strongly correlated with PIIC incidence. The entire model using the 18 factors had good discrimination and calibration in the validation cohort. We selected eight relevant factors to create a simple scoring system, using which we categorized the patients into three risk groups, which showed good calibration. CONCLUSION: Using nationwide clinical practice data, we created a preoperative risk model for postgastrectomy PIIC for gastric cancer.
Akira Tsuburaya - One of the best experts on this subject based on the ideXlab platform.
-
preoperative risk factors for postoperative intra abdominal Infectious Complication after gastrectomy for gastric cancer using a japanese web based nationwide database
Gastric Cancer, 2020Co-Authors: Keiichi Fujiya, Akira Tsuburaya, Hiraku Kumamaru, Yoshiyuki Fujiwara, Hiroaki Miyata, Yasuhiro Kodera, Yuko Kitagawa, Hiroyuki Konno, Masanori TerashimaAbstract:BACKGROUND: Postoperative intra-abdominal Infectious Complication (PIIC) after gastrectomy for gastric cancer worsens in-hospital death or long-term survival. However, the methodology for PIIC preoperative risk assessment remains unestablished. We aimed to develop a preoperative risk model for postgastrectomy PIIC. METHODS: We collected 183,936 patients' data on distal or total gastrectomy performed in 2013-2016 for gastric cancer from the Japanese National Clinical Database and divided into development (2013-2015; n = 140,558) and validation (2016; n = 43,378) cohort. The primary outcome was the incidence of PIIC. The risk model for PIIC was developed using 18 preoperative factors: age, sex, body mass index, activities of daily living, 12 comorbidity types, gastric cancer stage, and surgical procedure in the development cohort. Secondarily, we developed another model based on the new scoring system for clinical use using selected factors. RESULTS: The overall incidence of PIIC was 4.7%, including 2.6%, 1.7%, and 1.3% in anastomotic leakage, pancreatic fistula, and intra-abdominal abscess, respectively. Among the 18 preoperative factors, male [odds ratio, (OR) 1.92], obesity (OR, 1.52-1.96), peripheral vascular disease (OR, 1.55), steroid use (OR, 1.83), and total gastrectomy (OR, 1.89) strongly correlated with PIIC incidence. The entire model using the 18 factors had good discrimination and calibration in the validation cohort. We selected eight relevant factors to create a simple scoring system, using which we categorized the patients into three risk groups, which showed good calibration. CONCLUSION: Using nationwide clinical practice data, we created a preoperative risk model for postgastrectomy PIIC for gastric cancer.
-
Preoperative risk factors for postoperative intra-abdominal Infectious Complication after gastrectomy for gastric cancer using a Japanese web-based nationwide database
Gastric Cancer, 2020Co-Authors: Keiichi Fujiya, Akira Tsuburaya, Hiraku Kumamaru, Yoshiyuki Fujiwara, Hiroaki Miyata, Yasuhiro Kodera, Yuko Kitagawa, Hiroyuki Konno, Masanori TerashimaAbstract:Background Postoperative intra-abdominal Infectious Complication (PIIC) after gastrectomy for gastric cancer worsens in-hospital death or long-term survival. However, the methodology for PIIC preoperative risk assessment remains unestablished. We aimed to develop a preoperative risk model for postgastrectomy PIIC. Methods We collected 183,936 patients’ data on distal or total gastrectomy performed in 2013–2016 for gastric cancer from the Japanese National Clinical Database and divided into development (2013–2015; n = 140,558) and validation (2016; n = 43,378) cohort. The primary outcome was the incidence of PIIC. The risk model for PIIC was developed using 18 preoperative factors: age, sex, body mass index, activities of daily living, 12 comorbidity types, gastric cancer stage, and surgical procedure in the development cohort. Secondarily, we developed another model based on the new scoring system for clinical use using selected factors. Results The overall incidence of PIIC was 4.7%, including 2.6%, 1.7%, and 1.3% in anastomotic leakage, pancreatic fistula, and intra-abdominal abscess, respectively. Among the 18 preoperative factors, male [odds ratio, (OR) 1.92], obesity (OR, 1.52–1.96), peripheral vascular disease (OR, 1.55), steroid use (OR, 1.83), and total gastrectomy (OR, 1.89) strongly correlated with PIIC incidence. The entire model using the 18 factors had good discrimination and calibration in the validation cohort. We selected eight relevant factors to create a simple scoring system, using which we categorized the patients into three risk groups, which showed good calibration. Conclusion Using nationwide clinical practice data, we created a preoperative risk model for postgastrectomy PIIC for gastric cancer.
-
Infectious Complication and recurrence after surgery for gastric cancer
Journal of Clinical Oncology, 2012Co-Authors: Tsutomu Hayashi, Akira Tsuburaya, Takaki Yoshikawa, Takashi Ogata, Toru AoyamaAbstract:85 Background: There are many known prognostic indicators following surgery for gastric cancer. However, the impact of Infectious Complication on prognosis is less clear. The aim of the present stu...
Keiichi Fujiya - One of the best experts on this subject based on the ideXlab platform.
-
Preoperative risk factors for postoperative intra-abdominal Infectious Complication after gastrectomy for gastric cancer using a Japanese web-based nationwide database
Gastric Cancer, 2020Co-Authors: Keiichi Fujiya, Akira Tsuburaya, Hiraku Kumamaru, Yoshiyuki Fujiwara, Hiroaki Miyata, Yasuhiro Kodera, Yuko Kitagawa, Hiroyuki Konno, Masanori TerashimaAbstract:Background Postoperative intra-abdominal Infectious Complication (PIIC) after gastrectomy for gastric cancer worsens in-hospital death or long-term survival. However, the methodology for PIIC preoperative risk assessment remains unestablished. We aimed to develop a preoperative risk model for postgastrectomy PIIC. Methods We collected 183,936 patients’ data on distal or total gastrectomy performed in 2013–2016 for gastric cancer from the Japanese National Clinical Database and divided into development (2013–2015; n = 140,558) and validation (2016; n = 43,378) cohort. The primary outcome was the incidence of PIIC. The risk model for PIIC was developed using 18 preoperative factors: age, sex, body mass index, activities of daily living, 12 comorbidity types, gastric cancer stage, and surgical procedure in the development cohort. Secondarily, we developed another model based on the new scoring system for clinical use using selected factors. Results The overall incidence of PIIC was 4.7%, including 2.6%, 1.7%, and 1.3% in anastomotic leakage, pancreatic fistula, and intra-abdominal abscess, respectively. Among the 18 preoperative factors, male [odds ratio, (OR) 1.92], obesity (OR, 1.52–1.96), peripheral vascular disease (OR, 1.55), steroid use (OR, 1.83), and total gastrectomy (OR, 1.89) strongly correlated with PIIC incidence. The entire model using the 18 factors had good discrimination and calibration in the validation cohort. We selected eight relevant factors to create a simple scoring system, using which we categorized the patients into three risk groups, which showed good calibration. Conclusion Using nationwide clinical practice data, we created a preoperative risk model for postgastrectomy PIIC for gastric cancer.
-
preoperative risk factors for postoperative intra abdominal Infectious Complication after gastrectomy for gastric cancer using a japanese web based nationwide database
Gastric Cancer, 2020Co-Authors: Keiichi Fujiya, Akira Tsuburaya, Hiraku Kumamaru, Yoshiyuki Fujiwara, Hiroaki Miyata, Yasuhiro Kodera, Yuko Kitagawa, Hiroyuki Konno, Masanori TerashimaAbstract:BACKGROUND: Postoperative intra-abdominal Infectious Complication (PIIC) after gastrectomy for gastric cancer worsens in-hospital death or long-term survival. However, the methodology for PIIC preoperative risk assessment remains unestablished. We aimed to develop a preoperative risk model for postgastrectomy PIIC. METHODS: We collected 183,936 patients' data on distal or total gastrectomy performed in 2013-2016 for gastric cancer from the Japanese National Clinical Database and divided into development (2013-2015; n = 140,558) and validation (2016; n = 43,378) cohort. The primary outcome was the incidence of PIIC. The risk model for PIIC was developed using 18 preoperative factors: age, sex, body mass index, activities of daily living, 12 comorbidity types, gastric cancer stage, and surgical procedure in the development cohort. Secondarily, we developed another model based on the new scoring system for clinical use using selected factors. RESULTS: The overall incidence of PIIC was 4.7%, including 2.6%, 1.7%, and 1.3% in anastomotic leakage, pancreatic fistula, and intra-abdominal abscess, respectively. Among the 18 preoperative factors, male [odds ratio, (OR) 1.92], obesity (OR, 1.52-1.96), peripheral vascular disease (OR, 1.55), steroid use (OR, 1.83), and total gastrectomy (OR, 1.89) strongly correlated with PIIC incidence. The entire model using the 18 factors had good discrimination and calibration in the validation cohort. We selected eight relevant factors to create a simple scoring system, using which we categorized the patients into three risk groups, which showed good calibration. CONCLUSION: Using nationwide clinical practice data, we created a preoperative risk model for postgastrectomy PIIC for gastric cancer.
Susan Scott - One of the best experts on this subject based on the ideXlab platform.
-
The effectiveness of targeted relative to empiric prophylaxis on Infectious Complications after transrectal ultrasound-guided prostate biopsy: a meta-analysis
World Journal of Urology, 2018Co-Authors: Susan Scott, Patrick N. Harris, Deborah A. Williamson, Michael A. Liss, Matthew J. RobertsAbstract:Purpose Rectal culture screening for fluoroquinolone (FQ)-resistant Enterobacteriaceae before transrectal ultrasound guided prostate (TRUSPB) biopsy and targeted antibiotic prophylaxis (TAP) may decrease post-TRUSPB infection rates compared to empiric (EAP) regimens. The objective of this study was to evaluate the effectiveness of targeted relative to empiric prophylaxis regimens on rates of Infectious Complications after TRUSPB and to determine the baseline prevalence of FQ resistance based on prior rectal swabs. Methods An electronic search within literature databases including EMBASE and Web of Science (all databases) for articles assessing TAP as an approach to TRUSPB prophylaxis was conducted. Quality assessment was performed using the Hoy instrument. Meta-analysis was performed using MetaXL 5.3. Results From 15 studies (eight retrospective and seven prospective) representing 12,320 participants, Infectious Complication incidence was 3.4% in EAP and 0.8% in TAP patients. The number needed to treat with TAP to avoid one more infection when compared to the EAP group was 39. Effect sizes were homogeneous. Prevalence of FQ resistance showed low (15%) and high (28%) subgroups, likely due to region of origin (within and outside USA, respectively). Conclusions Rectal culture prior to TRUSPB and use of TAP adjusts for endemic FQ resistance and is associated with less Infectious Complications and resulting morbidity when compared to EAP. Overtreatment associated with augmented prophylaxis approaches may be reduced as a result. Further prospective assessment and cost–benefit analyses are required before widespread implementation can be recommended.
-
Comparison of fosfomycin against fluoroquinolones for transrectal prostate biopsy prophylaxis: an individual patient-data meta-analysis
World Journal of Urology, 2018Co-Authors: Matthew J. Roberts, Susan Scott, Patrick N. Harris, Kurt Naber, Florian M. E. WagenlehnerAbstract:Purpose To systematically review and meta-analyse available evidence comparing fosfomycin trometamol (FT) to fluoroquinolone (FQ) prophylaxis to prevent transrectal ultrasound-guided prostate biopsy (TRUSPB) related Infectious Complications. Methods Electronic databases were queried for studies comparing FT to FQ-based TRUSPB prophylaxis. Studies were assessed for comparable outcomes and methodological quality (ROBINS-I modification). The primary outcome measure was the relative odds of overall Infectious Complications following TRUSPB according to FT/FQ treatment, which was evaluated with meta-analysis. Safety and tolerability were also assessed. The relative odds of infections of different severity [Grade 1, bacteriuria and afebrile urinary tract infection (UTI); Grade 2, bacteraemia, febrile UTI, and urosepsis] according to FT/FQ treatment were also estimated. Results Five studies, being three prospective randomised trials and two retrospective cohort studies, representing 3112 patients, were included. The relative odds of an Infectious Complication (OR 0.22, 95% CI 0.09–0.54) or of a more severe (Grade 2) infection (OR 0.13, 95% CI 0.07–0.26) were significantly lower in those receiving FT compared to FQ prophylaxis. A low incidence of medication-related side effects was observed. There were less observed infections due to FQ-resistant pathogens in those receiving FT prophylaxis. Conclusions Patients who received FT prophylaxis were less likely than those who received FQ prophylaxis to develop infections overall, as well as severe and resistant infections after TRUSPB. Assessing the performance of FT in other geographic locations or in comparison to targeted prophylaxis based on risk assessment or rectal cultures is desired.