論文

Background: Ultrasound is frequently used in emergency departments (EDs) for patient evaluation and diagnosis. Despite the risk of probe contamination from body fluids and blood, the rate of such contamination remains unclear. Aim: This study aimed to evaluate bacterial contamination of ultrasound probes in EDs, focusing on hospital types and reprocessing methods. Methods: A multi-centre prospective observational study was conducted at a university hospital, a non-academic tertiary hospital, and a regional hospital in 2023. Samples were collected from probes used on ED patients. Reprocessing methods included water-moistened wipes alone, water-moistened wipes with ethanol wipes, quaternary ammonium wipes alone, and quaternary ammonium wipes with ethanol or hypochlorite wipes. Outcomes included the level of bacterial contamination, measured by colony-forming units (cfu) per total surface area of each probe, and resistant bacterial strains. Findings: The median cfu was 10 (IQR: 0–50) at the university hospital, 40 (10–135) at the non-academic tertiary hospital, and 30 (1–95) at the regional hospital. By reprocessing method, the median cfu was 20 (1–90) for water-moistened wipes alone, 10 (0–20) for water-moistened wipes and additional ethanol wipe, 90 (40–180) for quaternary ammonium wipes alone, and 20 (1–50) for quaternary ammonium wipe and additional ethanol or hypochlorite wipe. Resistant bacterial strains were found on 18.2% of probes. Conclusion: High levels of bacterial contamination, including resistant strains, were observed on ultrasound probes in EDs, regardless of facility type and reprocessing method.

Background: Acute cholecystitis (AC) is an acute inflammatory disease of the gallbladder and one of the most frequent causes of acute abdominal pain. Early cholecystectomy is recommended for mild cholecystitis. However, the optimal surgical timing for moderate-to-severe cholecystitis requiring percutaneous transhepatic gallbladder drainage (PTGBD) remains unclear. We hypothesized that early elective surgery after PTGBD would reduce surgical morbidity. Methods: A retrospective analysis was performed on adult patients who underwent elective surgery for AC after PTGBD at our hospital between January 2011 and December 2020. Patient demographics, perioperative findings, and postoperative morbidity and mortality rates were also investigated. The patients were divided into two groups based on postoperative morbidity, and univariable analysis was performed for preoperative factors. Multivariable logistic regression analysis was performed for the potential independent variables. Results: A total of 891 patients were screened for eligibility, and 259 were included in the analysis. Among these patients, 32 developed postoperative morbidity; however, there was no postoperative mortality. Multivariable analysis revealed that the time from PTGBD to surgery was an independent predictor of surgical morbidity (odds ratio, 1.05; 95% confidence interval: 1.01–1.10). Conclusion: In early elective surgery for moderate-to-severe AC requiring PTGBD, a shorter interval from biliary drainage to surgery may decrease surgical morbidity.