e Urosepsis can progress toward severe sepsis, septic shock, and, ultimately, death. Rapid antimicrobial susceptibility testing is crucial to decrease mortality and morbidity. This report shows that isothermal microcalorimetry can provide an antibiogram within 7 h with a sensitivity of 95% and specificity of 91% using Vitek-2 system as a reference. U rinary tract infections (UTIs) are the second-most-common type of infection. Patients at risk of urosepsis are those who are elderly, diabetic, immunocompromised, and with obstruction in the urinary tract. Urosepsis might progress to severe sepsis and septic shock, both associated with a high mortality rate ranging between 22% and 76% (1, 2). Treatment of urosepsis includes empirical broad-spectrum antimicrobial therapy and timely deescalation when antimicrobial susceptibility testing (AST) results become available (3-5). Identification of the pathogen and determination of its susceptibility patterns take at least 48 h on average. Moreover, several methods currently used for AST have additional drawbacks (6, 7). Isothermal microcalorimetry (IMC) that measures metabolic heat production by microbes was recently identified as a promising near-future alternative to conventional methods for AST (6, 7). As urosepsis is virtually always accompanied by UTIs with a high density of uropathogens, urine specimens could be used directly for AST by IMC. Other arguments also advocate such an approach. First, urine is a potent growth medium (8). Second, in 95% of uroseptic cases, urine culture and positive blood culture lead to similar pathogen isolation results (9). And third, polymicrobial infections are rare in bacteremic UTIs (5% to 11%), thus ensuring that only the targeted pathogen is investigated (10, 11). Before introducing IMC for AST in the clinic or performing a clinical study, one needs to determine its sensitivity, specificity, and accuracy. For this study, we used 15 uropathogens (9 Escherichia coli, 3 Enterococcus faecalis, and 3 Enterococcus faecium) previously identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Susceptibility patterns were obtained by the Vitek-2 system (an automated system for AST). Among the 9 E. coli strains, 3 were sensitive to all antimicrobials tested, 3 were resistant to at least ciprofloxacin, and 3 strains were extended-spectrum-beta-lactamase (ESBL)-producing strains. Among enterococci, all E. faecium strains and one E. faecalis strain were resistant to amoxicillin. Cultures of these strains were diluted in modified artificial urine (12) to obtain an optical density (OD) of 0.1. A 10-l volume of this dilution was added to a 4-ml microcalorimetric vial prefilled with 3 ml of artificial urine with or without antimicrobial (using the EUCAST guidelines for breakpoint concentration). For AST with E. coli, the following antimicrobials and their respective concentrations were used: ciprofloxacin at 0.5 mg/ liter, cotrimoxazole at 2 mg/liter, ceftriaxone at 1 mg/liter, amoxicillin at 8 mg/lit...

Background Effective interdisciplinary communication of imaging findings is vital for patient care, as referring physicians depend on the contained information for the decision-making and subsequent treatment. Traditional radiology reports contain non-structured free text and potentially tangled information in narrative language, which can hamper the information transfer and diminish the clarity of the report. Therefore, this study investigates whether newly developed structured reports (SRs) of prostate magnetic resonance imaging (MRI) can improve interdisciplinary communication, as compared to non-structured reports (NSRs). Methods 50 NSRs and 50 SRs describing a single prostatic lesion were presented to four urologists with expert level experience in prostate cancer surgery or targeted MRI TRUS fusion biopsy. They were subsequently asked to plot the tumor location in a 2-dimensional prostate diagram and to answer a questionnaire focusing on information on clinically relevant key features as well as the perceived structure of the report. A validated scoring system that distinguishes between “major” and “minor” mistakes was used to evaluate the accuracy of the plotting of the tumor position in the prostate diagram. Results The mean total score for accuracy for SRs was significantly higher than for NSRs (28.46 [range 13.33–30.0] vs. 21.75 [range 0.0–30.0], p < 0.01). The overall rates of major mistakes (54% vs. 10%) and minor mistakes (74% vs. 22%) were significantly higher (p < 0.01) for NSRs than for SRs. The rate of radiologist re-consultations was significantly lower (p < 0.01) for SRs than for NSRs (19% vs. 85%). Furthermore, SRs were rated as significantly superior to NSRs in regard to determining the clinical tumor stage (p < 0.01), the quality of the summary (4.4 vs. 2.5; p < 0.01), and overall satisfaction with the report (4.5 vs. 2.3; p < 0.01), and as more valuable for further clinical decision-making and surgical planning (p < 0.01). Conclusions Structured reporting of prostate MRI has the potential to improve interdisciplinary communication. Through SRs, expert urologists were able to more accurately assess the exact location of single prostate cancer lesions, which can facilitate surgical planning. Furthermore, structured reporting of prostate MRI leads to a higher satisfaction level of the referring physician.

BackgroundFournier’s gangrene (FG) is a life-threatening infection of the genital, perineal, and perianal regions with a morbidity range between 3 and 67%. Our aim is to report our experience in treatment of FG and to assess whether three different scoring systems can accurately predict mortality and morbidity in FG patients.MethodsAll patients that were treated for FG at the Department of Urology of the University Hospital Basel between June 2012 and March 2017 were included and assessed retrospectively by chart review. Furthermore, we calculated Fournier’s Gangrene Severity Index (FGSI), the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC), and the neutrophil–lymphocyte ratio (NLR) in every patient and assessed whether those scores correlate with the patients’ morbidity and mortality.ResultsTwenty patients were included, with a median (IQR) age of 66 (46–73) years. Fifteen of twenty (75%) patients required treatment on an intensive care unit, and three died (mortality rate: 15%). The mean FGSI, LRINEC, and NLR scores were 13.0, 9.3, and 45.3 for non-survivors and 7.7, 6.5, and 26 for survivors, respectively. None of the risk scores correlated significantly with mortality; however, all three significantly correlated with infection- and surgically-induced morbidity.ConclusionsIn our series, Fournier’s gangrene was associated with a mortality rate of 15% despite maximum multidisciplinary therapy at a specialized center. All risk scores were able to predict the morbidity of the disease in terms of local extent and the required surgical measures.

A 71-year-old female with symptomatic colonic lipoma is described. An uneventful colonoscopic removal of the lipoma was performed. Colonoscopic removal of symptomatic pedunculated submucosal colonic lipoma may be recommended.

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