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Gras E, Tran Y, Kably B, Lillo-Lelouet A, Caruba T, Sabatier B, Launay M, Billaud E, Smadja DM, Gendron N, Lebeaux D. Prospective assessment of the frequency of and risk factors for bleeding events in patients treated with cefazolin. Infection 2024; 52:557-566. [PMID: 38153684 DOI: 10.1007/s15010-023-02145-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/23/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE Major bleedings have been described with cefazolin. The objective was to determine the frequency of bleeding events in cefazolin-treated patients and to identify risk factors for these complications. METHODS Monocenter prospective observational study of all consecutive cefazolin-treated patients. Patients benefited from a daily clinical assessment of bleedings and a twice-a-week blood sampling including hemostasis. Bleedings were classified according to the International Society on Thrombosis and Hemostasis classification: major, clinically relevant non-major bleedings (CRNMB) and minor bleedings. RESULTS From September 2019 to July 2020, 120 patients were included, with a mean age of 59.4 (± 20.7) years; 70% of them (84/120) were men. At least 1 CRNMB or major bleeding were observed in 10% of the patients (12/120). Compared to patients with no or minor bleeding, patients with CRNMB or major bleeding were, upon start of cefazolin, more frequently hospitalized in an intensive care unit (7/12, 58.3%, vs. 12/108, 11.1%, P < 0.001, respectively) and receiving vitamin K antagonists (4/12, 33.3%, vs. 8/108, 7.4%, P = 0.019, respectively). After multivariate analysis, patients receiving vitamin K antagonists the day prior bleeding and/or treated for endocarditis were factors associated with an increased risk of CRNMB or major bleeding (odd ratio 1.36, confidence interval 95%, 1.06-1.76, P = 0.020 and 1.30, 1.06-1.61, P = 0.015, respectively). CONCLUSIONS Bleeding events associated with cefazolin treatment are frequent. Close clinical monitoring should be performed for patients treated for endocarditis and/or receiving vitamin K antagonists. Hemostasis work-up could be restricted to these patients.
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Affiliation(s)
- Emmanuelle Gras
- Université Paris Cité, 75006, Paris, France.
- Service de Microbiologie, Unité Mobile d'Infectiologie, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France.
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 27 rue de Chaligny, 75012, Paris, France.
| | - Yohann Tran
- Université Paris Cité, Assistance Publique - Hôpitaux de Paris, Unité de Recherche Clinique, Hôpital Européen Georges Pompidou, Paris, France
| | - Benjamin Kably
- Université Paris Cité, Assistance Publique - Hôpitaux de Paris, Service de Pharmacologie, Hôpital Européen Georges-Pompidou, Paris, France
| | - Agnès Lillo-Lelouet
- Université Paris Cité, Assistance Publique - Hôpitaux de Paris, Service de Pharmacovigilance, Hôpital Européen Georges-Pompidou, Paris, France
| | - Thibaut Caruba
- Université Paris Cité, Assistance Publique - Hôpitaux de Paris, Service de Pharmacie, Hôpital Européen Georges-Pompidou, Paris, France
| | - Brigitte Sabatier
- Université Paris Cité, Assistance Publique - Hôpitaux de Paris, Service de Pharmacie, Hôpital Européen Georges-Pompidou, Paris, France
- Université de Paris, INSERM U1138, 75006, Paris, France
| | - Manon Launay
- Université Paris Cité, Assistance Publique - Hôpitaux de Paris, Service de Pharmacologie, Hôpital Européen Georges-Pompidou, Paris, France
| | - Eliane Billaud
- Université Paris Cité, Assistance Publique - Hôpitaux de Paris, Service de Pharmacologie, Hôpital Européen Georges-Pompidou, Paris, France
| | - David M Smadja
- Université Paris Cité, Assistance Publique - Hôpitaux de Paris, Service d'hématologie Biologique, Hôpital Européen Georges-Pompidou, Paris, France
- Université Paris Cité, Innovative Therapies in Haemostasis, INSERM, 75006, Paris, France
| | - Nicolas Gendron
- Université Paris Cité, Assistance Publique - Hôpitaux de Paris, Service d'hématologie Biologique, Hôpital Européen Georges-Pompidou, Paris, France
- Université Paris Cité, Innovative Therapies in Haemostasis, INSERM, 75006, Paris, France
| | - David Lebeaux
- Service de Microbiologie, Unité Mobile d'Infectiologie, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
- Institut Pasteur, Université Paris Cité, CNRS UMR 6047, Genetics of Biofilms Laboratory, 75015, Paris, France
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Mercado-Longoria R, Galindo-Galindo JO, Ataxca-Gonzalez MA, Colunga-Pedraza PR, Peña-Lozano SP, Llaca-Díaz JM, Rendón-Ramírez EJ. Thoracic ultrasound alone or in combination with tracheal amylase as a tool predictor of ventilator-associated pneumonia in neurocritical patients. Medicine (Baltimore) 2022; 101:e32149. [PMID: 36482529 PMCID: PMC9726279 DOI: 10.1097/md.0000000000032149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In this study, we aim to evaluate whether thoracic ultrasound (TUS) and tracheal amylase (TA) alone or in combination can predict the development of ventilator-associated pneumonia (VAP) in neurocritical patients. Consecutive adult patients with neurocritical disease with normal chest radiographs who required intensive care unit admission and mechanical ventilation between March 2015 and July 2018 were included. TUS and Amylase levels were measured during the first 24 hours and repeated 48 hours after orotracheal intubation. Forty-three patients with a median age of 34 years (17-82) were included. TUS had a sensitivity of 100% and specificity of 96.3% as a predictor of VAP within the first 48 hours when nonpattern A was observed. TA levels > 200 UI/L in the first 48 hours had a sensitivity of 87.5%, and specificity of 63% as a predictor of VAP. Moreover, no benefit of TUS plus TA compared to TUS alone as a predictor of VAP was found. The identification of abnormal TUS patterns in the first 48 hours of orotracheal intubation is a significant predictor of VAP in neurocritical patients.
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Affiliation(s)
- Roberto Mercado-Longoria
- Pulmonary and Critical Care Medicine Service, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Juan O. Galindo-Galindo
- Pulmonary and Critical Care Medicine Service, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Mario A. Ataxca-Gonzalez
- Pulmonary and Critical Care Medicine Service, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Perla R. Colunga-Pedraza
- Internal Medicine, Department, Hospital Universitario Dr. José Eleuterio González, Universidad Autonoma de Nuevo León, Monterrey, México
| | - Samantha P. Peña-Lozano
- Internal Medicine, Department, Hospital Universitario Dr. José Eleuterio González, Universidad Autonoma de Nuevo León, Monterrey, México
| | - Jorge M. Llaca-Díaz
- Clinical Pathology Department, Hospital Universitario, UANL, Monterrey, Nuevo León, México
| | - Erick J. Rendón-Ramírez
- Pulmonary and Critical Care Medicine Service, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
- * Correspondence: Erick J. Rendón-Ramírez, Pulmonary and Critical Care Medicine Service, Hospital Universitario Dr. José Eleuterio, González, Universidad Autónoma de Nuevo León, Ave. Madero y Ave. Gonzalitos s/n, Colonia Mitras Centro, C.P., Monterrey, N.L. 64460, México (e-mail: )
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Experience on antibiotic-impregnated beads for intracranial epidural infection combined with osteomyelitis. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2021. [DOI: 10.1016/j.inat.2020.101036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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El Ouadih Y, Vernhes J, Mulliez A, Berton Q, Al Gahatany M, Traore O, Khalil T, Lemaire JJ. Postoperative empyema following chronic subdural hematoma surgery: Clinically based medicine. Neurochirurgie 2020; 66:365-368. [PMID: 32861684 DOI: 10.1016/j.neuchi.2020.06.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/01/2020] [Accepted: 06/19/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Subdural empyema (SDE) is a rare complication of chronic subdural hematoma (CSDH) surgery. We introduced antibiotic prophylaxis (AP) for this procedure in 2014 following a morbidity-mortality conference (MMC) in our department. We report the results of retrospective data analysis to assess the effect of systematic AP and to identify risk factors for SDE. MATERIAL AND METHODS Two hundred eight patients were recruited between January 2013 and December 2015; 5 were excluded for incomplete data: 107 without and 96 with AP (n=203). SDE was confirmed by clinical examination, imaging and bacteriological analysis. Comparisons between AP-(no cefuroxime) and AP+ (cefuroxime) groups were made with Chi2 test and Student's t-test. RESULTS One empyema was found in each group, indicating that AP had no effect (P=1). The only criterion associated with SDE for these two patients was a greater number of reoperations for CSDH recurrence (P=0.013). DISCUSSION The incidence of postoperative empyema was 1%, similar to the range of 0.2%-2.1% reported in the literature. This rare incidence explains why we found no significant effect of AP. The medical decision taken at the MMC did not help to reduce the rate of postoperative SDE. MMCs can help to define factors associated with adverse surgical events and identify opportunities for improvement. CONCLUSION AP, introduced after an MMC, did not impact SDE rates. In practice, AP should be required only in case of reoperation for CSDH recurrence. However, we still continue to use AP following the MMC considering different parameters discussed in the manuscript.
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Affiliation(s)
- Y El Ouadih
- Service de neurochirurgie, CHU de Clermont Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Université Clermont-Auvergne, Clermont-Ferrand, France; SIGMA Clermont, CNRS, Clermont-Ferrand, France.
| | - J Vernhes
- Service de neurochirurgie, CHU de Clermont Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - A Mulliez
- Service de biostatistiques, CHU de Clermont Ferrand, Clermont-Ferrand, France
| | - Q Berton
- Service de neurochirurgie, CHU de Clermont Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - M Al Gahatany
- Service de neurochirurgie, CHU de Clermont Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - O Traore
- Service d'hygiène hospitalière, CHU de Clermont Ferrand, Clermont-Ferrand, France; Université Clermont-Auvergne, Clermont-Ferrand, France
| | - T Khalil
- Service de neurochirurgie, CHU de Clermont Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - J-J Lemaire
- Service de neurochirurgie, CHU de Clermont Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Université Clermont-Auvergne, Clermont-Ferrand, France; SIGMA Clermont, CNRS, Clermont-Ferrand, France
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Yang SB, Cho SY, Kwon S, Jung WS, Moon SK, Park JM, Ko CN, Shin HS, Lee SH, Koh JS, Kim H, Park SU. Acupuncture attenuates postoperative inflammation in patients after craniotomy: A prospective, open-label, controlled trial. Medicine (Baltimore) 2020; 99:e19071. [PMID: 32176032 PMCID: PMC7440145 DOI: 10.1097/md.0000000000019071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND It is important to manage inflammation after craniotomy. It may be prudent to reduce the excessive usage of antibiotics and to add supplementary treatments like acupuncture, which would be effective and safe. However, there are only a few studies available to date on the effects of acupuncture on anti-inflammatory response after craniotomy. The aim of this study was to explore the anti-inflammatory effects of acupuncture in patients after a craniotomy. METHODS This study was a single-center, prospective, open-label, controlled trial. Forty-four subjects who underwent craniotomy for an unruptured aneurysm, facial spasm, or brain tumor were allocated to either an acupuncture group or a control group. Both groups received postoperative routine care in the Department of Neurosurgery. The subjects in the acupuncture group also received a total of 6 acupuncture treatments sessions within 8 days after craniotomy. Acupuncture treatments included acupuncture, electroacupuncture, and intradermal acupuncture. The serum interleukin (IL)-1β and IL-6, tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and erythrocyte sedimentation rate levels were assessed four times within 7 days after surgery. The presence of fever, use of additional antibiotics, presence of infection including pneumonia or urinary tract infection, and safety were also reviewed. RESULTS The IL-1β levels of subjects who underwent aneurysmal clipping were significantly lower in the acupuncture group (P = .02). TNF-α levels of subjects who underwent aneurysmal clipping at the seventh postoperative day were also significantly lower in the acupuncture group (P = .03). Six cases of fever of unknown origin were observed in the control group, while none were seen in the acupuncture group, revealing that the incidence of fever was significantly lower in the acupuncture group (P = .02). No adverse events occurred during the trial. CONCLUSION Acupuncture showed a possibility of alleviating inflammation by attenuating the levels of proinflammatory cytokines and significantly reduced the incidence of fever of unknown origin in patients after craniotomy. Acupuncture would be suitable as an adjunctive therapy to alleviate inflammation after craniotomy.
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Affiliation(s)
- Seung-Bo Yang
- Stroke and Neurological Disorders Center, Kyung Hee University Hospital at Gangdong
| | - Seung-Yeon Cho
- Stroke and Neurological Disorders Center, Kyung Hee University Hospital at Gangdong
- Department of Cardiology and Neurology, College of Korean Medicine
| | - Seungwon Kwon
- Department of Cardiology and Neurology, College of Korean Medicine
| | - Woo-Sang Jung
- Department of Cardiology and Neurology, College of Korean Medicine
| | - Sang-Kwan Moon
- Department of Cardiology and Neurology, College of Korean Medicine
| | - Jung-Mi Park
- Stroke and Neurological Disorders Center, Kyung Hee University Hospital at Gangdong
- Department of Cardiology and Neurology, College of Korean Medicine
| | - Chang-Nam Ko
- Stroke and Neurological Disorders Center, Kyung Hee University Hospital at Gangdong
- Department of Cardiology and Neurology, College of Korean Medicine
| | - Hee Sup Shin
- Stroke and Neurological Disorders Center, Kyung Hee University Hospital at Gangdong
- Department of Neurosurgery, College of Medicine, Kyung Hee University
| | - Seung Hwan Lee
- Stroke and Neurological Disorders Center, Kyung Hee University Hospital at Gangdong
- Department of Neurosurgery, College of Medicine, Kyung Hee University
| | - Jun Seok Koh
- Stroke and Neurological Disorders Center, Kyung Hee University Hospital at Gangdong
- Department of Neurosurgery, College of Medicine, Kyung Hee University
| | - Ho Kim
- Department of Epidemiology and Biostatistics, Graduate School of Public Health & Institute of Health and Environment, Seoul National University
| | - Seong-Uk Park
- Stroke and Neurological Disorders Center, Kyung Hee University Hospital at Gangdong
- Department of Cardiology and Neurology, College of Korean Medicine
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Surgical-site infections following cranial surgery: is it time to reconsider our preventive measures? Acta Neurochir (Wien) 2018; 160:2313-2314. [PMID: 30357486 DOI: 10.1007/s00701-018-3706-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 10/16/2018] [Indexed: 10/28/2022]
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