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1. Obstacles for T-lymphocytes in the tumour microenvironment: Therapeutic challenges, advances and opportunities beyond immune checkpoint.

Author

Verma, Navin, Wong, Brandon, Poh, Zhi, Udayakumar, Aiswarya, Verma, Ritu, Goh, Ryan, Duggan, Shane, Shelat, Vishalkumar, Chandy, K, and Grigoropoulos, Nicholas

Subjects
Immunotherapy, Ionic checkpoint, Tumor-infiltrating lymphocytes, Tumor-interstitial fluid, Adenosine, Adenosine Triphosphate, Humans, Immune Checkpoint Proteins, Immunotherapy, Ligands, Neoplasms, T-Lymphocytes, Tumor Microenvironment
Abstract

The tumour microenvironment (TME) imposes a major obstacle to infiltrating T-lymphocytes and suppresses their function. Several immune checkpoint proteins that interfere with ligand/receptor interactions and impede T-cell anti-tumour responses have been identified. Immunotherapies that block immune checkpoints have revolutionized the treatment paradigm for many patients with advanced-stage tumours. However, metabolic constraints and soluble factors that exist within the TME exacerbate the functional exhaustion of tumour-infiltrating T-cells. Here we review these multifactorial constraints and mechanisms - elevated immunosuppressive metabolites and enzymes, nutrient insufficiency, hypoxia, increased acidity, immense amounts of extracellular ATP and adenosine, dysregulated bioenergetic and purinergic signalling, and ionic imbalance - that operate in the TME and collectively suppress T-cell function. We discuss how scientific advances could help overcome the complex TME obstacles for tumour-infiltrating T-lymphocytes, aiming to stimulate further research for developing new therapeutic strategies by harnessing the full potential of the immune system in combating cancer.

Published
2022

3. Transient Elastography Is the Best-Performing Non-Invasive Test of Liver Fibrosis in Obese Asian Patients with Non-Alcoholic Fatty Liver Disease: A Pilot, Cross-Sectional Study

Author

Kaliyaperumal Kalaiyarasi, Acharyya Sanchalika, Low Hsien Min, Yap Wei Ming, Shelat Vishalkumar, Yew Kuo Chao, Low Jee Keem, Junnarkar Sameer, Huey Cheong Wei Terence, and Tan Yen Ping

Subjects
transient elastography, non-alcoholic fatty liver disease, liver fibrosis, non-invasive assessment, Medicine (General), R5-920
Abstract

Background and Objectives: The prevalence of NAFLD (non-alcoholic fatty liver disease) is increasing, and up to 64% of Asian patients with NAFLD are obese. Non-invasive tests (NITs) for the assessment of liver fibrosis are increasingly being used, but data on their performance in obese Asian patients are lacking. In this pilot cross-sectional study, we aim to compare the distribution of serum and radiological markers of fibrosis between obese Asian biopsy-proven NAFLD patients with and without fibrosis and estimate the diagnostic accuracies of these indices. Materials and Methods: Obese Asian patients with NAFLD and who had undergone a liver biopsy showing histological evidence of NAFLD were invited to participate. Liver fibrosis was assessed using laboratory (APRI, AAR, BARD, FIB4, NFS, and Asia–Pacific NAFLD advanced fibrosis score) and imaging modalities (TE: transient elastography, MRE: magnetic resonance elastography, and SWU: shear wave ultrasonography). Results: A total of 16 patients were included in the final analysis. On liver biopsy, nine patients (56.3%) had significant fibrosis (F2 or higher), and six of these patients had advanced fibrosis (F3 or higher). F4 fibrosis was present in one patient (6.3%). For the laboratory markers, we found that the BARD score correctly identified five out of six patients with advanced fibrosis (83.4%, p value 0.045). Among all the NITs studied, liver stiffness measured by TE had the highest accuracy of 87.5% in its established threshold of 8.5 kPa for the detection of advanced fibrosis. MRE also performed well (81.2% in 3.64 kPa). Conclusions: In conclusion, TE has performed well in the detection of advanced fibrosis in obese Asian patients with biopsy-proven NAFLD in our pilot study. Further large-scale definitive studies are needed to validate the results of our findings.

Published
2024
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8. High Extracellular K+ Drives T-Cell Exhaustion by Disrupting TCR Signals Implicated in Tumor Immune Evasion

Author

Wong, Brandon Han Siang, primary, Poh, Zhi Sheng, additional, Wei, James Tan Chia, additional, Amuthavalli, Kottaiswamy, additional, Ho, Ying Swan, additional, Chen, Shuwen, additional, Mak, Shi Ya, additional, Bi, Xuezhi, additional, Webster, Richard, additional, Shelat, Vishalkumar, additional, Chandy, K. George, additional, and Verma, Navin Kumar, additional

Published
2024
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14. Augmenting the activity of calcium-activated potassium channel KCa3.1 revitalizes T-cell function in the immunosuppressive tumor microenvironment

Author

Verma, Navin K., primary, Siang Wong, Brandon Han, additional, Theng Ong, Seow, additional, Min Goay, Stephanie Shee, additional, Swan Ho, Ying, additional, Chen, Shuwen, additional, Bi, Xuezhi, additional, Shim, Heesung, additional, Wulff, Heike, additional, Webster, Richard D., additional, Shelat, Vishalkumar G., additional, and Chandy, K. George, additional

Published
2023
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15. Baseline Albumin-Bilirubin grade as a predictor of response and outcome of regorafenib therapy in patients with hepatocellular carcinoma: a systematic review and meta-analysis

Author

Xu, Huilin, primary, Cao, Dedong, additional, Zhou, Dingjie, additional, Zhao, Nan, additional, Tang, Xixian, additional, Shelat, Vishalkumar G., additional, Samant, Hrishikesh, additional, Satapathy, Sanjaya K., additional, Tustumi, Francisco, additional, Aprile, Giuseppe, additional, He, Anbing, additional, Xu, Ximing, additional, and Ge, Wei, additional

Published
2023
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20. Pancoast syndrome due to pulmonary metastasis of sarcomatoid hepatocellular carcinoma.

Author

Ryan HOO and SHELAT, Vishalkumar G.

Abstract

Introduction: Hepatocellular carcinoma is the most common primary liver malignancy, and sarcomatoid hepatocellular carcinoma is a rare malignancy containing both carcinomatous and sarcomatous components. Case Report: We report a 64-year-old male patient treated with open right trisectionectomy for a 16cm right hemiliver tumour. The diagnosis of sarcomatoid hepatocellular carcinoma was confirmed on histology. Five months after hepatic resection, patient had symptoms suggestive of Horner's syndrome along with left sided shoulder pain, hand weakness, reduced power of the intrinsic hand muscles and reduced pain perception over the C8/T1 dermatome. Magnetic Resonance Imaging (MRI) showed a mass at the left lung apex/superior sulcus involving the left C8, T1 nerve roots, scalene muscles, and brachial plexus. The mass closely abutted the left first rib and partially encased the left subclavian artery. The patient was managed with palliative chemoradiotherapy for Pancoast syndrome. Discussion: Hepatocellular carcinoma pulmonary metastasis causing Pancoast syndrome is a rare occurrence with only four prior reports, and to the best of our knowledge, pulmonary metastasis from sarcomatoid hepatocellular carcinoma causing Pancoast syndrome is unreported. In this report, we will discuss the clinicopathological characteristics of this case which may provide insight into diagnosis and management of other sarcomatoid hepatocellular carcinoma patients. [ABSTRACT FROM AUTHOR]

Published
2023

21. Opisthorchis viverrini —Current Understanding of the Neglected Hepatobiliary Parasite.

Author

Liau, Matthias Yi Quan, Toh, En Qi, and Shelat, Vishalkumar Girishchandra

Subjects
OPISTHORCHIS viverrini, BILE ducts, CHOLANGITIS, TREMATODA, VACCINE development, DRUG target
Abstract

Opisthorchiasis due to Opisthorchis viverrini infection continues to be a significant public healthcare concern in various subregions of Southeast Asia, particularly in Thailand, Laos, Cambodia, Myanmar, and Vietnam. The main mode of transmission is via consumption of raw or undercooked fish, which is deeply embedded in the culture and tradition of the people living near the Mekong River. After ingestion, the flukes migrate to the bile ducts, potentially causing many hepatobiliary complications, including cholangitis, cholecystitis, cholelithiasis, advanced periductal fibrosis and cholangiocarcinoma. Several mechanisms of opisthorchiasis-associated cholangiocarcinogenesis have been proposed and elucidated in the past decade, providing insight and potential drug targets to prevent the development of the sinister complication. The gold standard for diagnosing opisthorchiasis is still via stool microscopy, but the advent of novel serological, antigen, and molecular tests shows promise as more convenient, alternative diagnostic methods. The mainstay of treatment of opisthorchiasis is praziquantel, while treatment of opisthorchiasis-associated cholangiocarcinoma depends on its anatomic subtype and resectability. Thus far, the most successful fluke control programme is the Lawa model based in Thailand, which raised awareness, incorporated education, and frequent surveillance of intermediate hosts to reduce transmission of opisthorchiasis. Development of vaccines using tetraspanins shows promise and is currently ongoing. [ABSTRACT FROM AUTHOR]

Published
2023
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27. Psychological impact of the COVID-19 pandemic on training of postgraduate year 1 doctors in Singapore.

Author

Kai Siang Chan, Shelat, Vishalkumar Girishchandra, and Li-Ann Chia, Faith

Subjects
COVID-19 pandemic, PSYCHOLOGICAL factors, PHYSICIANS, MEDICAL students, MEDICAL personnel
Abstract

The article reports that the Coronavirus Disease 2019 pandemic had a profound impact on both the community and healthcare workers. Topics include examines major reforms have been made to the healthcare system to effectively manage the pandemic and considered graduating medical students worldwide either experienced expedited graduation to provide manpower support or faced a delay in graduation due to the barring of clinical placements.

Published
2022
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28. A study of 3013 cases of hepatocellular carcinoma: Etiology and therapy before and during the current decade

Author

Lim, Miao‐Shan, primary, Goh, George B‐B, additional, Chang, Jason P‐E, additional, Low, Jee‐Keem, additional, Shelat, Vishalkumar G, additional, Huey, Terence C‐W, additional, Dan, Yock‐Young, additional, Kow, Alfred, additional, Shridhar, Iyer, additional, Tan, Poh‐Seng, additional, Padmakumar, Junnarkar S, additional, and Tan, Chee‐Kiat, additional

Published
2021
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32. Predictive value of post-operative drain amylase levels for post-operative pancreatic fistula

Author

Woon Wei Liang Winston, Shelat Vishalkumar G, Tang Ee Ling Serene, Huey Cheong Wei Terence, Junnarkar Sameer Padmakumar, Low Jee Keem, and Wang Bei

Subjects
medicine.medical_specialty, Amylase levels, Distal pancreatectomy, 03 medical and health sciences, 0302 clinical medicine, medicine, General Materials Science, Clinical severity, Amylase, Post operative, Enhanced recovery after surgery, biology, Pancreatoduodenectomy, business.industry, Retrospective cohort study, medicine.disease, Predictive value, Surgery, Pancreatic fistula, 030220 oncology & carcinogenesis, biology.protein, 030211 gastroenterology & hepatology, Original Article, business
Abstract

Backgrounds/Aims Traditionally, surgically placed pancreatic drains are removed, at the discretion of the operating surgeon. Moving towards enhanced recovery after surgery (ERAS), we looked for predictors for early drain removal. The purpose of this paper was to establish which postoperative days' (POD) drain amylase is most predictive against post-operative pancreatic fistula (POPF). Methods We conducted a retrospective study of 196 patients who underwent pancreatic resection at our institute from January 2006 to October 2013. Drain amylase levels were routinely measured. The International Study Group of Pancreatic Fistula (ISGPF) definition of POPF, and clinical severity grading were used. Results 5.1% (10 of 196) patients developed ISGPF Grades B and C POPF. Negative predictive value of developing significant POPF, if drain amylase values were low on PODs 1 and 3 was 98.7% (95% CI: 0.93-1.00). This translated to confidence in removing surgically placed pancreatic drains, at POD 1 and 3 when drain amylase values are low. Conclusions Patients with low drain amylase values on POD 1 and 3, are unlikely to develop POPF and may have pancreatic drains removed earlier.

Published
2018

35. Perceived Stress, Stigma, Traumatic Stress Levels and Coping Responses amongst Residents in Training across Multiple Specialties during COVID-19 Pandemic—A Longitudinal Study

Author

Chew, Qian Hui, primary, Chia, Faith Li-Ann, additional, Ng, Wee Khoon, additional, Lee, Wan Cheong Ivan, additional, Tan, Pei Lin Lynnette, additional, Wong, Chen Seong, additional, Puah, Ser Hon, additional, Shelat, Vishalkumar G., additional, Seah, Ee-Jin Darren, additional, Huey, Cheong Wei Terence, additional, Phua, Eng Joo, additional, and Sim, Kang, additional

Published
2020
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36. Comparison of hepatocellular carcinoma between the current decade and the past - a study of 3,013 cases

Author

Lim, Miao-Shan, primary, George Goh, Boon Bee, additional, Jason Chang, Pik Eu, additional, Low, Jee-Keem, additional, Shelat, Vishalkumar Grishchandra, additional, Cheong, Wei-Huey Terence, additional, Dan, Yock-Young, additional, Kow, Alfred, additional, Iyer, Shridhar, additional, Tan, Poh-Seng, additional, Junnarkar, Sameer Padmakumar, additional, and Tan, Chee-Kiat, additional

Published
2020
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42. The use of Early Achievable SeveritY (EASY) index is beneficial for rapid risk stratification in acute pancreatitis on hospital admission

Author

Balázs Kui, Szilárd Gódi, Judit Bajor, Imola Török, Melania Macaria, Hunor Farkas, Artautas Mickevicius, Ville Sallinen, Elena Ramirez Maldonado, Mária Papp, György Kovács, Eszter Fehér, Patrícia Sarlós, Shamil Galeev, Balázs Németh, Áron Vincze, Petr Pencik, Imanta Ozola-Zalite, Aldis Pukitis, Andrey Litvin, Inna Kovalskaya, József Czimmer, Gabriella Pár, István Hritz, Dóra Illés, Andrea Szentesi, László Lakatos, Gabriele Capurso, Árpád Patai, Elena Stilidi, Giulia Peserico, Kristina Zadorozhna, Ertan Sonmez, Ali Tüzün Ince, Shelat Vishalkumar, Masayasu Horibe, Miklós Ihász, Bálint Mihály Erőss, Katalin Márta, Zsolt Szakács, Nelli Farkas, Noémi Gede, Adrienn Halász, László Gajdán, Ferenc Izbéki, Goran Poropat, Mariana Jinga, Georgiana Robu, and Péter Hegyi

Subjects
Hepatology, Endocrinology, Diabetes and Metabolism, Gastroenterology
Published
2019

46. Improving postoperative mobilisation rates in patients undergoing elective major hepatopancreatobiliary surgery.

Author

Tang, Jun Han, Bei Wang, Jie Ling Jaclyn Chow, Joseph, Priscilla M., Jia Ying Chan, Rahman, Nursharazilla Abdul, Yi Hui Low, Yen Pin Tan, Shelat, Vishalkumar G., Wang, Bei, Chow, Jie Ling Jaclyn, Chan, Jia Ying, Abdul Rahman, Nursharazilla, Low, Yi Hui, and Tan, Yen Pin

Subjects
EARLY ambulation (Rehabilitation), MEDICAL personnel, CENTRAL venous pressure, ELECTIVE surgery, LENGTH of stay in hospitals, COST control, DIGESTIVE organ surgery, QUALITY assurance, ECONOMICS
Abstract

Background: Early mobilisation reduces postoperative complications such as pneumonia, deep vein thrombosis and hospital length of stay. Many authors have reported poor compliance with early mobilisation within Enhanced Recovery After Surgery initiatives.Objectives: The primary objective was to increase postoperative day (POD) 2 mobilisation rate from 23% to 75% in patients undergoing elective major hepatopancreatobiliary (HPB) surgery within 6 months.Methods: We report a multidisciplinary team clinical practice improvement project (CPIP) to improve postoperative mobilisation of patients undergoing elective major HPB surgery. We identified the common barriers to mobilisation and analysed using the fishbone or cause-and-effect diagram and Pareto chart. A series of Plan-Do-Study-Act cycles followed this. We tracked the rate of early mobilisation and mean distance walked. In the post hoc analysis, we examined the potential cost savings based on reduced hospital length of stay.Results: Mobilisation rate on POD 2 following elective major HPB surgery improved from 23% to 78.9%, and this sustained at 6 months after the CPIP. Wound pain was the most common reason for failure to ambulate on POD 2. Hospital length of stay reduced from a median of 8 days to 6 days with an estimated cost saving of S$2228 per hospital stay.Conclusion: Multidisciplinary quality improvement intervention effort resulted in an improved POD 2 mobilisation rate for patients who underwent elective major HPB surgery. This observed outcome was sustained at 6 months after completion of the CPIP with potential cost savings. [ABSTRACT FROM AUTHOR]

Published
2021
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49. The Global Alliance for Infections in Surgery: defining a model for antimicrobial stewardship-results from an international cross-sectional survey

Author

Sartelli, Massimo, Labricciosa, Francesco M., Barbadoro, Pamela, Pagani, Leonardo, Ansaloni, Luca, Brink, Adrian J., Carlet, Jean, Khanna, Ashish, Chichom-Mefire, Alain, Coccolini, Federico, Di Saverio, Salomone, May, Addison K., Viale, Pierluigi, Watkins, Richard R., Scudeller, Luigia, Abbo, Lilian M., Abu-Zidan, FikriM., Adesunkanmi, Abdulrashid K., Al-Dahir, Sara, Al-Hasan, Majdi N., Alis, Halil, Alves, Carlos, Araujo da Silva, Andre R., Augustin, Goran, Bala, Miklosh, Barie, Philip S., Beltran, Marcelo A., Bhangu, Aneel, Bouchra, Belefquih, Brecher, Stephen M., Cainzos, Miguel A., Camacho-Ortiz, Adrian, Catani, Marco, Chandy, Sujith J., Jusoh, Asri Che, Cherry-Bukowiec, Jill R., Chiara, Osvaldo, Colak, Elif, Cornely, Oliver A., Cui, Yunfeng, Demetrashvili, Zaza, De Simone, Belinda, De Waele, Jan J., Dhingra, Sameer, Di Marzo, Francesco, Dogjani, Agron, Dorj, Gereltuya, Dortet, Laurent, Duane, ThereseM., Elmangory, Mutasim M., Enani, Mushira A., Ferrada, Paula, Foianini, J. Esteban, Gachabayov, Mahir, Gandhi, Chinmay, Ghnnam, Wagih Mommtaz, Giamarellou, Helen, Gkiokas, Georgios, Gomi, Harumi, Goranovic, Tatjana, Griffiths, Ewen A., Guerra Gronerth, Rosio I., Haidamus Monteiro, Julio C., Hardcastle, Timothy C., Hecker, Andreas, Hodonou, Adrien M., Ioannidis, Orestis, Isik, Arda, Iskandar, Katia A., Kafil, Hossein S., Kanj, Souha S., Kaplan, Lewis J., Kapoor, Garima, Karamarkovic, Aleksandar R., Kenig, Jakub, Kerschaever, Ivan, Khamis, Faryal, Khokha, Vladimir, Kiguba, Ronald, Kim, Hong B., Ko, Wen-Chien, Koike, Kaoru, Kozlovska, Iryna, Kumar, Anand, Lagunes, Leonel, Latifi, Rifat, Lee, Jae G., Lee, Young R., Leppaniemi, Ari, Li, Yousheng, Liang, Stephen Y., Lowman, Warren, Machain, Gustavo M., Maegele, Marc, Major, Piotr, Malama, Sydney, Manzano-Nunez, Ramiro, Marinis, Athanasios, Martinez Casas, Isidro, Marwah, Sanjay, Maseda, Emilio, McFarlane, Michael E., Memish, Ziad, Mertz, Dominik, Mesina, Cristian, Mishra, ShyamK., Moore, Ernest E., Munyika, Akutu, Mylonakis, Eleftherios, Napolitano, Lena, Negoi, Ionut, Nestorovic, Milica D., Nicolau, David P., Omari, Abdelkarim H., Ordonez, Carlos A., Paiva, Jose-Artur, Pant, Narayan D., Parreira, Jose G., Pedziwiatr, Michal, Pereira, BrunoM., Ponce-de-Leon, Alfredo, Poulakou, Garyphallia, Preller, Jacobus, Pulcini, Celine, Pupelis, Guntars, Quiodettis, Martha, Rawson, Timothy M., Reis, Tarcisio, Rems, Miran, Rizoli, Sandro, Roberts, Jason, Pereira, Nuno Rocha, Rodriguez-Bano, Jesus, Sakakushev, Boris, Sanders, James, Santos, Natalia, Sato, Norio, Sawyer, Robert G., Scarpelini, Sandro, Scoccia, Loredana, Shafiq, Nusrat, Shelat, Vishalkumar, Sifri, Costi D., Siribumrungwong, Boonying, Soreide, Kjetil, Soto, Rodolfo, de Souza, Hamilton P., Talving, Peep, Trung, Ngo Tat, Tessier, Jeffrey M., Tumbarello, Mario, Ulrych, Jan, Uranues, Selman, Van Goor, Harry, Vereczkei, Andras, Wagenlehner, Floriann, Xiao, Yonghong, Yuan, Kuo-Ching, Wechsler-Foerdoes, Agnes, Zahar, Jean-Ralph, Zakrison, Tanya L., Zuckerbraun, Brian, Zuidema, Wietse P., Catena, Fausto, Sartelli, Massimo, Labricciosa, Francesco M., Barbadoro, Pamela, Pagani, Leonardo, Ansaloni, Luca, Brink, Adrian J., Carlet, Jean, Khanna, Ashish, Chichom-Mefire, Alain, Coccolini, Federico, Di Saverio, Salomone, May, Addison K., Viale, Pierluigi, Watkins, Richard R., Scudeller, Luigia, Abbo, Lilian M., Abu-Zidan, FikriM., Adesunkanmi, Abdulrashid K., Al-Dahir, Sara, Al-Hasan, Majdi N., Alis, Halil, Alves, Carlos, Araujo da Silva, Andre R., Augustin, Goran, Bala, Miklosh, Barie, Philip S., Beltran, Marcelo A., Bhangu, Aneel, Bouchra, Belefquih, Brecher, Stephen M., Cainzos, Miguel A., Camacho-Ortiz, Adrian, Catani, Marco, Chandy, Sujith J., Jusoh, Asri Che, Cherry-Bukowiec, Jill R., Chiara, Osvaldo, Colak, Elif, Cornely, Oliver A., Cui, Yunfeng, Demetrashvili, Zaza, De Simone, Belinda, De Waele, Jan J., Dhingra, Sameer, Di Marzo, Francesco, Dogjani, Agron, Dorj, Gereltuya, Dortet, Laurent, Duane, ThereseM., Elmangory, Mutasim M., Enani, Mushira A., Ferrada, Paula, Foianini, J. Esteban, Gachabayov, Mahir, Gandhi, Chinmay, Ghnnam, Wagih Mommtaz, Giamarellou, Helen, Gkiokas, Georgios, Gomi, Harumi, Goranovic, Tatjana, Griffiths, Ewen A., Guerra Gronerth, Rosio I., Haidamus Monteiro, Julio C., Hardcastle, Timothy C., Hecker, Andreas, Hodonou, Adrien M., Ioannidis, Orestis, Isik, Arda, Iskandar, Katia A., Kafil, Hossein S., Kanj, Souha S., Kaplan, Lewis J., Kapoor, Garima, Karamarkovic, Aleksandar R., Kenig, Jakub, Kerschaever, Ivan, Khamis, Faryal, Khokha, Vladimir, Kiguba, Ronald, Kim, Hong B., Ko, Wen-Chien, Koike, Kaoru, Kozlovska, Iryna, Kumar, Anand, Lagunes, Leonel, Latifi, Rifat, Lee, Jae G., Lee, Young R., Leppaniemi, Ari, Li, Yousheng, Liang, Stephen Y., Lowman, Warren, Machain, Gustavo M., Maegele, Marc, Major, Piotr, Malama, Sydney, Manzano-Nunez, Ramiro, Marinis, Athanasios, Martinez Casas, Isidro, Marwah, Sanjay, Maseda, Emilio, McFarlane, Michael E., Memish, Ziad, Mertz, Dominik, Mesina, Cristian, Mishra, ShyamK., Moore, Ernest E., Munyika, Akutu, Mylonakis, Eleftherios, Napolitano, Lena, Negoi, Ionut, Nestorovic, Milica D., Nicolau, David P., Omari, Abdelkarim H., Ordonez, Carlos A., Paiva, Jose-Artur, Pant, Narayan D., Parreira, Jose G., Pedziwiatr, Michal, Pereira, BrunoM., Ponce-de-Leon, Alfredo, Poulakou, Garyphallia, Preller, Jacobus, Pulcini, Celine, Pupelis, Guntars, Quiodettis, Martha, Rawson, Timothy M., Reis, Tarcisio, Rems, Miran, Rizoli, Sandro, Roberts, Jason, Pereira, Nuno Rocha, Rodriguez-Bano, Jesus, Sakakushev, Boris, Sanders, James, Santos, Natalia, Sato, Norio, Sawyer, Robert G., Scarpelini, Sandro, Scoccia, Loredana, Shafiq, Nusrat, Shelat, Vishalkumar, Sifri, Costi D., Siribumrungwong, Boonying, Soreide, Kjetil, Soto, Rodolfo, de Souza, Hamilton P., Talving, Peep, Trung, Ngo Tat, Tessier, Jeffrey M., Tumbarello, Mario, Ulrych, Jan, Uranues, Selman, Van Goor, Harry, Vereczkei, Andras, Wagenlehner, Floriann, Xiao, Yonghong, Yuan, Kuo-Ching, Wechsler-Foerdoes, Agnes, Zahar, Jean-Ralph, Zakrison, Tanya L., Zuckerbraun, Brian, Zuidema, Wietse P., and Catena, Fausto

Abstract

Background: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). Conclusion: T

Published
2017

50. The Global Alliance for Infections in Surgery: defining a model for antimicrobial stewardship—results from an international cross-sectional survey

Author

Sartelli, Massimo, primary, Labricciosa, Francesco M., additional, Barbadoro, Pamela, additional, Pagani, Leonardo, additional, Ansaloni, Luca, additional, Brink, Adrian J., additional, Carlet, Jean, additional, Khanna, Ashish, additional, Chichom-Mefire, Alain, additional, Coccolini, Federico, additional, Di Saverio, Salomone, additional, May, Addison K., additional, Viale, Pierluigi, additional, Watkins, Richard R., additional, Scudeller, Luigia, additional, Abbo, Lilian M., additional, Abu-Zidan, Fikri M., additional, Adesunkanmi, Abdulrashid K., additional, Al-Dahir, Sara, additional, Al-Hasan, Majdi N., additional, Alis, Halil, additional, Alves, Carlos, additional, Araujo da Silva, André R., additional, Augustin, Goran, additional, Bala, Miklosh, additional, Barie, Philip S., additional, Beltrán, Marcelo A., additional, Bhangu, Aneel, additional, Bouchra, Belefquih, additional, Brecher, Stephen M., additional, Caínzos, Miguel A., additional, Camacho-Ortiz, Adrian, additional, Catani, Marco, additional, Chandy, Sujith J., additional, Jusoh, Asri Che, additional, Cherry-Bukowiec, Jill R., additional, Chiara, Osvaldo, additional, Colak, Elif, additional, Cornely, Oliver A., additional, Cui, Yunfeng, additional, Demetrashvili, Zaza, additional, De Simone, Belinda, additional, De Waele, Jan J., additional, Dhingra, Sameer, additional, Di Marzo, Francesco, additional, Dogjani, Agron, additional, Dorj, Gereltuya, additional, Dortet, Laurent, additional, Duane, Therese M., additional, Elmangory, Mutasim M., additional, Enani, Mushira A., additional, Ferrada, Paula, additional, Esteban Foianini, J., additional, Gachabayov, Mahir, additional, Gandhi, Chinmay, additional, Ghnnam, Wagih Mommtaz, additional, Giamarellou, Helen, additional, Gkiokas, Georgios, additional, Gomi, Harumi, additional, Goranovic, Tatjana, additional, Griffiths, Ewen A., additional, Guerra Gronerth, Rosio I., additional, Haidamus Monteiro, Julio C., additional, Hardcastle, Timothy C., additional, Hecker, Andreas, additional, Hodonou, Adrien M., additional, Ioannidis, Orestis, additional, Isik, Arda, additional, Iskandar, Katia A., additional, Kafil, Hossein S., additional, Kanj, Souha S., additional, Kaplan, Lewis J., additional, Kapoor, Garima, additional, Karamarkovic, Aleksandar R., additional, Kenig, Jakub, additional, Kerschaever, Ivan, additional, Khamis, Faryal, additional, Khokha, Vladimir, additional, Kiguba, Ronald, additional, Kim, Hong B., additional, Ko, Wen-Chien, additional, Koike, Kaoru, additional, Kozlovska, Iryna, additional, Kumar, Anand, additional, Lagunes, Leonel, additional, Latifi, Rifat, additional, Lee, Jae G., additional, Lee, Young R., additional, Leppäniemi, Ari, additional, Li, Yousheng, additional, Liang, Stephen Y., additional, Lowman, Warren, additional, Machain, Gustavo M., additional, Maegele, Marc, additional, Major, Piotr, additional, Malama, Sydney, additional, Manzano-Nunez, Ramiro, additional, Marinis, Athanasios, additional, Martinez Casas, Isidro, additional, Marwah, Sanjay, additional, Maseda, Emilio, additional, McFarlane, Michael E., additional, Memish, Ziad, additional, Mertz, Dominik, additional, Mesina, Cristian, additional, Mishra, Shyam K., additional, Moore, Ernest E., additional, Munyika, Akutu, additional, Mylonakis, Eleftherios, additional, Napolitano, Lena, additional, Negoi, Ionut, additional, Nestorovic, Milica D., additional, Nicolau, David P., additional, Omari, Abdelkarim H., additional, Ordonez, Carlos A., additional, Paiva, José-Artur, additional, Pant, Narayan D., additional, Parreira, Jose G., additional, Pędziwiatr, Michal, additional, Pereira, Bruno M., additional, Ponce-de-Leon, Alfredo, additional, Poulakou, Garyphallia, additional, Preller, Jacobus, additional, Pulcini, Céline, additional, Pupelis, Guntars, additional, Quiodettis, Martha, additional, Rawson, Timothy M., additional, Reis, Tarcisio, additional, Rems, Miran, additional, Rizoli, Sandro, additional, Roberts, Jason, additional, Pereira, Nuno Rocha, additional, Rodríguez-Baño, Jesús, additional, Sakakushev, Boris, additional, Sanders, James, additional, Santos, Natalia, additional, Sato, Norio, additional, Sawyer, Robert G., additional, Scarpelini, Sandro, additional, Scoccia, Loredana, additional, Shafiq, Nusrat, additional, Shelat, Vishalkumar, additional, Sifri, Costi D., additional, Siribumrungwong, Boonying, additional, Søreide, Kjetil, additional, Soto, Rodolfo, additional, de Souza, Hamilton P., additional, Talving, Peep, additional, Trung, Ngo Tat, additional, Tessier, Jeffrey M., additional, Tumbarello, Mario, additional, Ulrych, Jan, additional, Uranues, Selman, additional, Van Goor, Harry, additional, Vereczkei, Andras, additional, Wagenlehner, Florian, additional, Xiao, Yonghong, additional, Yuan, Kuo-Ching, additional, Wechsler-Fördös, Agnes, additional, Zahar, Jean-Ralph, additional, Zakrison, Tanya L., additional, Zuckerbraun, Brian, additional, Zuidema, Wietse P., additional, and Catena, Fausto, additional

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2017
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