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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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Duewel AM, Doehmen J, Dittkrist L, Henrich W, Ramsauer B, Schlembach D, Abou-Dakn M, Maresh MJA, Schaefer-Graf UM. Antenatal risk score for prediction of shoulder dystocia with focus on fetal ultrasound data. Am J Obstet Gynecol 2022; 227:753.e1-753.e8. [PMID: 35697095 DOI: 10.1016/j.ajog.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Shoulder dystocia is one of the most threatening complications during delivery, and although it is difficult to predict, individual risk should be considered when counseling for mode of delivery. OBJECTIVE This study aimed to develop and validate a risk score for shoulder dystocia based on fetal ultrasound and maternal data from 15,000 deliveries. STUDY DESIGN Data were retrospectively obtained of deliveries in 3 tertiary centers between 2014 and 2017 for the derivation cohort and between 2018 and 2020 for the validation cohort. Inclusion criteria were singleton pregnancy, vaginal delivery in cephalic presentation at ≥37+0 weeks' gestation, and fetal biometry data available within 2 weeks of delivery. Independent predictors were determined by multivariate regression analysis in the derivation cohort, and a score was developed on the basis of the effect of the predictors. RESULTS The derivation cohort consisted of 7396 deliveries with a 0.91% rate of shoulder dystocia, and the validation cohort of 7965 deliveries with a 1.0% rate of shoulder dystocia. Among all women, 13.8% had diabetes mellitus, and 12.1% were obese (body mass index ≥30 kg/m2). Independent risk factors in the derivation cohort were: estimated fetal weight ≥4250 g (odds ratio, 4.27; P=.002), abdominal-head-circumference ≥2.5 cm (odds ratio, 3.96; P<.001), and diabetes mellitus (odds ratio, 2.18; P=.009). On the basis of the strength of effect, a risk score was developed: estimated fetal weight ≥4250 g=2, abdominal-head-circumference ≥2.5 cm=2, and diabetes mellitus=1. The risk score predicted shoulder dystocia with moderate discriminatory ability (area under the receiver-operating characteristic curve, 0.69; P<.001; area under the receiver-operating characteristic curve, 0.71; P<.001) and good calibration (Hosmer-Lemeshow goodness-of-fit; P=.466; P=.167) for the derivation and validation cohorts, respectively. With 1 score point, 16 shoulder dystocia cases occurred in 1764 deliveries, with 0.6% shoulder dystocia incidence and a number needed to treat with cesarean delivery to avoid 1 case of shoulder dystocia of 172 (2 points: 38/1809, 2.1%, 48; 3 points: 18/336, 5.4%, 19; 4 points: 10/96, 10.5%, 10; and 5 points: 5/20, 25%, 4); 40.8% of the shoulder dystocia cases occurred without risk factors. CONCLUSION The presented risk score for shoulder dystocia may act as a supplemental tool for the clinical decision-making regarding mode of delivery. According to our score model, in pregnancies with a score ≤2, meaning having solely estimated fetal weight ≥4250 g, or abdominal-head-circumference ≥2.5, or diabetes mellitus, cesarean delivery for prevention of shoulder dystocia should not be recommended because of the high number needed to treat to avoid 1 case of shoulder dystocia. Conversely, in patients with a score of ≥4 with or without diabetes mellitus, cesarean delivery may be considered. However, in 40% of the shoulder dystocia cases, no risk factors had been present.
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Affiliation(s)
- Antonia M Duewel
- Berlin Center for Diabetes and Pregnancy, Department for Obstetrics and Gynecology, St. Joseph Hospital, Berlin, Germany
| | - Julia Doehmen
- Berlin Center for Diabetes and Pregnancy, Department for Obstetrics and Gynecology, St. Joseph Hospital, Berlin, Germany
| | - Luisa Dittkrist
- Berlin Center for Diabetes and Pregnancy, Department for Obstetrics and Gynecology, St. Joseph Hospital, Berlin, Germany
| | - Wolfgang Henrich
- Department for Obstetrics, Campus Virchow, Charité, Humboldt University, Berlin, Germany
| | - Babett Ramsauer
- Clinic of Obstetric Medicine, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Dieter Schlembach
- Clinic of Obstetric Medicine, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Michael Abou-Dakn
- Berlin Center for Diabetes and Pregnancy, Department for Obstetrics and Gynecology, St. Joseph Hospital, Berlin, Germany
| | - Michael J A Maresh
- Department of Obstetrics, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center, Manchester, United Kingdom
| | - Ute M Schaefer-Graf
- Berlin Center for Diabetes and Pregnancy, Department for Obstetrics and Gynecology, St. Joseph Hospital, Berlin, Germany; Department for Obstetrics, Campus Virchow, Charité, Humboldt University, Berlin, Germany.
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Development and Validation of Scoring System to Predict Secondary Amputations in Free Flap Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3211. [PMID: 33299690 PMCID: PMC7722602 DOI: 10.1097/gox.0000000000003211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/01/2020] [Indexed: 11/26/2022]
Abstract
Need for amputation is a potential complication when limb salvage is attempted. The present study aimed to develop a risk assessment tool to predict the risk of future amputation when counseling patients about their reconstructive options. Methods All patients undergoing a free flap lower extremity soft tissue reconstruction by the senior author from 2005 to 2019 were retrospectively identified. Patient's demographics, comorbidities, and technical aspects of the operation were extracted. Logistic regressions were used to create a predictive scoring system for future amputation. Results A total of 277 patients were identified. Of these patients, two-thirds (183) were used to derive the scoring system and one-third (94) were used to validate the score. In total, 25 of 183 patients (14%) underwent an amputation. A stepwise forward logistic regression identified age > 55 years, smoking, acute wound, aggressive fluid resuscitation intra-operatively, inability to use a superficial vein for drainage, and inability to use the posterior tibialis artery for anastomosis as independent predictors of need for future amputations. The beta co-efficients were used to create the scoring system, and the patients were categorized into mild, moderate, and severe risk based on their cumulative score. The validity of the scoring system was verified by using the one-third validation cohort. Conclusions In patients undergoing free flap reconstruction of the lower extremity, the need for future amputation is 14%. The use of a scoring system can guide the surgeon's and patient's decision regarding limb salvage.
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