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Keck JM, Viteri A, Schultz J, Fong R, Whitman C, Poush M, Martin M. New Agents Are Coming, and So Is the Resistance. Antibiotics (Basel) 2024; 13:648. [PMID: 39061330 PMCID: PMC11273847 DOI: 10.3390/antibiotics13070648] [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: 06/25/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Antimicrobial resistance is a global threat that requires urgent attention to slow the spread of resistant pathogens. The United States Centers for Disease Control and Prevention (CDC) has emphasized clinician-driven antimicrobial stewardship approaches including the reporting and proper documentation of antimicrobial usage and resistance. Additional efforts have targeted the development of new antimicrobial agents, but narrow profit margins have hindered manufacturers from investing in novel antimicrobials for clinical use and therefore the production of new antibiotics has decreased. In order to combat this, both antimicrobial drug discovery processes and healthcare reimbursement programs must be improved. Without action, this poses a high probability to culminate in a deadly post-antibiotic era. This review will highlight some of the global health challenges faced both today and in the future. Furthermore, the new Infectious Diseases Society of America (IDSA) guidelines for resistant Gram-negative pathogens will be discussed. This includes new antimicrobial agents which have gained or are likely to gain FDA approval. Emphasis will be placed on which human pathogens each of these agents cover, as well as how these new agents could be utilized in clinical practice.
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Affiliation(s)
- J. Myles Keck
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Alina Viteri
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | | | - Rebecca Fong
- Department of Pharmacy, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA
| | - Charles Whitman
- Department of Pharmacy, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA
| | - Madeline Poush
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Marlee Martin
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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2
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Roh S, Hashimoto K, Kiriishi R, Matsubara K, Isozaki Y, Tanaka H, Kuwata T. Piperacillin/tazobactam-induced sudden severe thrombocytopenia in a patient with a pressure ulcer: a case report. J Wound Care 2024; 33:S25-S30. [PMID: 38843043 DOI: 10.12968/jowc.2021.0074] [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] [Indexed: 06/10/2024]
Abstract
The standard treatment for an infected pressure ulcer (PU) with osteomyelitis is debridement, wound coverage and antibiotic administration. However, systemic administration of antibiotics in patients with osteomyelitis is controversial, and the optimal treatment duration for chronic osteomyelitis has not been standardised. We report a case of sudden severe thrombocytopenia induced by piperacillin/tazobactam (PIPC/TAZ) in a patient with PU-related osteomyelitis. A 57-year-old male patient with paraplegia, using a wheelchair full-time, presented to our plastic surgery department with infection of a stage IV hard-to-heal ischial PU. We surgically debrided the necrotising tissue and raised an ipsilateral biceps femoris musculocutaneous propeller flap for wound coverage. Polymicrobial infections, including Pseudomonas aeruginosa, were detected in the bone biopsy sample; therefore, systemic PIPC/TAZ was administered for the osteomyelitis. Unexpectedly, during the next 12 days of antibiotic administration, the patient's platelet count acutely dropped to 1×103/μl over three days. Based on a series of examinations, PIPC/TAZ was suspected to be the most likely cause of the severe thrombocytopenia. After drug discontinuation, the thrombocytopenia gradually improved. PIPC/TAZ is one of the most widely used antibiotic combinations in the plastic surgery field; it is conventionally administered for hard-to-heal wounds such as PUs and diabetic foot. The present case suggests that surgeons must take special precautions for patients undergoing PIPC/TAZ treatment. In this report, PIPC/TAZ-induced thrombocytopenia and the efficacy of antibiotic treatment for PU-related osteomyelitis are discussed in light of the available literature.
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Affiliation(s)
- Solji Roh
- Department of Plastic Surgery, Asahi General Hospital, Japan
| | - Kohei Hashimoto
- Department of Plastic Surgery, Asahi General Hospital, Japan
| | - Rina Kiriishi
- Department of Plastic Surgery, Asahi General Hospital, Japan
| | - Ken Matsubara
- Department of Plastic Surgery, Asahi General Hospital, Japan
| | - Yuki Isozaki
- Department of Plastic Surgery, Asahi General Hospital, Japan
| | | | - Tomoyuki Kuwata
- Department of Plastic Surgery, Asahi General Hospital, Japan
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Di Bella S, Luzzati R, Mearelli F, Papa G, Spazzapan L, Nunnari A, D’Aleo F, Papola C, Principe L. Anti-infective management of infected skin ulcers. LE INFEZIONI IN MEDICINA 2024; 32:138-147. [PMID: 38827836 PMCID: PMC11142418 DOI: 10.53854/liim-3202-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/19/2024] [Indexed: 06/05/2024]
Abstract
Infected skin ulcers represent a frequent and intricate clinical challenge, necessitating prompt and comprehensive multidisciplinary interventions to avert complications. Anti-infective therapy constitutes a cornerstone in the therapeutic paradigm. This manuscript delineates our approach to anti-infective management of infected ulcers, encompassing insights into clinical classifications, diagnostic features, exampless of early clinical decision-making in anti-infective treatment, comprehensive evaluation of infectious diseases encompassing host clinical considerations and potential interventions, determination of antibiotic therapy duration, methodologies for assessing clinical response, identification of potential causes for lack of clinical response, as well as strategies for outpatient parenteral antibiotic therapy and a diagnostic and therapeutic algorithm.
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Affiliation(s)
- Stefano Di Bella
- Clinical Department of Medical, Surgical, and Health Sciences, Trieste University, Trieste,
Italy
| | - Roberto Luzzati
- Clinical Department of Medical, Surgical, and Health Sciences, Trieste University, Trieste,
Italy
| | - Filippo Mearelli
- Internal Medicine Unit, Trieste University Hospital (ASUGI), Trieste,
Italy
| | - Giovanni Papa
- Clinical Department of Medical, Surgical, and Health Sciences, Trieste University, Trieste,
Italy
| | - Luca Spazzapan
- Plastic Surgery Unit, Trieste University Hospital (ASUGI), Trieste,
Italy
| | - Alessio Nunnari
- Internal Medicine Unit, Trieste University Hospital (ASUGI), Trieste,
Italy
| | - Francesco D’Aleo
- Clinical Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi-Melacrino-Morelli”, Reggio Calabria,
Italy
| | - Carmelo Papola
- Clinical Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi-Melacrino-Morelli”, Reggio Calabria,
Italy
| | - Luigi Principe
- Clinical Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi-Melacrino-Morelli”, Reggio Calabria,
Italy
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Jia Q, Zheng H, Lin J, Guo J, Fan S, Alimujiang A, Wang X, Fu L, Xie Z, Ma C, Wang J. Optimizing diagnosis and surgical decisions for chronic osteomyelitis through radiomics in the precision medicine era. Front Bioeng Biotechnol 2024; 12:1315398. [PMID: 38798953 PMCID: PMC11127625 DOI: 10.3389/fbioe.2024.1315398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction: Chronic osteomyelitis is a complex clinical condition that is associated with a high recurrence rate. Traditional surgical interventions often face challenges in achieving a balance between thorough debridement and managing resultant bone defects. Radiomics is an emerging technique that extracts quantitative features from medical images to reveal pathological information imperceptible to the naked eye. This study aims to investigate the potential of radiomics in optimizing osteomyelitis diagnosis and surgical treatment. Methods: Magnetic resonance imaging (MRI) scans of 93 suspected osteomyelitis patients were analyzed. Radiomics features were extracted from the original lesion region of interest (ROI) and an expanded ROI delineated by enlarging the original by 5 mm. Feature selection was performed and support vector machine (SVM) models were developed using the two ROI datasets. To assess the diagnostic efficacy of the established models, we conducted receiver operating characteristic (ROC) curve analysis, employing histopathological results as the reference standard. The model's performance was evaluated by calculating the area under the curve (AUC), sensitivity, specificity, and accuracy. Discrepancies in the ROC between the two models were evaluated using the DeLong method. All statistical analyses were carried out using Python, and a significance threshold of p < 0.05 was employed to determine statistical significance. Results and Discussion: A total of 1,037 radiomics features were extracted from each ROI. The expanded ROI model achieved significantly higher accuracy (0.894 vs. 0.821), sensitivity (0.947 vs. 0.857), specificity (0.842 vs. 0.785) and AUC (0.920 vs. 0.859) than the original ROI model. Key discriminative features included shape metrics and wavelet-filtered texture features. Radiomics analysis of MRI exhibits promising clinical translational potential in enhancing the diagnosis of chronic osteomyelitis by accurately delineating lesions and identifying surgical margins. The inclusion of an expanded ROI that encompasses perilesional tissue significantly improves diagnostic performance compared to solely focusing on the lesions. This study provides clinicians with a more precise and effective tool for diagnosis and surgical decision-making, ultimately leading to improved outcomes in this patient population.
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Affiliation(s)
- Qiyu Jia
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hao Zheng
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Jie Lin
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Jian Guo
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Sijia Fan
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | | | - Xi Wang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Lanqi Fu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Zengru Xie
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Chuang Ma
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Junna Wang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
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Tao H, Zhang H, Ma Y, Lv L, Pei J, Jiao Y, Han L. Comparison of the predictive validity of the Braden and Waterlow scales in intensive care unit patients: A multicentre study. J Clin Nurs 2024; 33:1809-1819. [PMID: 38031387 DOI: 10.1111/jocn.16946] [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: 04/14/2023] [Revised: 09/17/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND The first step in preventing pressure injuries (PIs), which represent a significant burden on intensive care unit (ICU) patients and the health care system, is to assess the risk for developing PIs. A valid risk assessment scale is essential to evaluate the risk and avoid PIs. OBJECTIVES To compare the predictive validity of the Braden scale and Waterlow scale in ICUs. DESIGN A multicentre, prospective and cross-sectional study. METHODS We conducted this study among 6416 patients admitted to ICUs in Gansu province of China from April 2021 to October 2022. The incidence and characteristics of PIs were collected. The risk assessment of PIs was determined using the Braden and Waterlow scale. The sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve of the two scales were compared. RESULTS Out of 5903 patients, 72 (1.2%) developed PIs. The sensitivity, specificity, positive and negative predictive, and the area under the curve of the Braden scale were 77.8%, 50.9%, 0.014 and 0.996, and 0.689, respectively. These values for the Waterlow scale were 54.2%, 71.1%, 0.017, 0.994 and 0.651. CONCLUSIONS Both scales could be used for risk assessment of PIs in ICU patients. However, the accuracy of visual inspection for assessment of skin colour, nursing preventive measures for patients and scales inter-rater inconsistency may limited the predictive validity statistics. RELEVANCE TO CLINICAL PRACTICE Both scales could be used for PIs risk assessment. The low specificity of the Braden scale and low sensitivity of the Waterlow scale remind medical staff to use them in combination with clinical judgement and other objective indicators. PATIENT OR PUBLIC CONTRIBUTION This study was designed to enhance the management of PIs. Patients and the general public were not involved in the study design, analysis, and interpretation of the data or manuscript preparation.
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Affiliation(s)
- Hongxia Tao
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
- Gansu Medical College, Pingliang, Gansu, China
| | - Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yuxia Ma
- Evidence-Based Nursing, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Lin Lv
- Wound and Ostomy Care Center, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Juhong Pei
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
| | - Yanxia Jiao
- Evidence-Based Nursing, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Lin Han
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, China
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6
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Ferris A. Should bone biopsy be the standard for suspected osteomyelitis in patients with pressure ulcers? J Wound Care 2024; 33:202-206. [PMID: 38451792 DOI: 10.12968/jowc.2024.33.3.202] [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] [Indexed: 03/09/2024]
Abstract
DECLARATION OF INTEREST The author has no conflicts of interest to declare.
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Affiliation(s)
- Amy Ferris
- Department of Wound Healing, University Hospital of Wales, Cardiff
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7
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Dong M, Yang X, Lu J, Siow L, He H, Liu A, Wu P, He Y, Sun M, Yu M, Wang H. Injectable rBMSCs-laden hydrogel microspheres loaded with naringin for osteomyelitis treatment. Biofabrication 2023; 15:045009. [PMID: 37494927 DOI: 10.1088/1758-5090/aceaaf] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/25/2023] [Indexed: 07/28/2023]
Abstract
Osteomyelitis, caused by purulent bacteria invading bone tissue, often occurs in long bones and seriously affects the physical and mental health and working ability of patients; it can even endanger life. However, due to bone cavity structure, osteomyelitis tends to occur inside the bone and thus lacks an effective treatment; anti-inflammatory treatment and repair of bone defects are necessary. Here, we developed injectable hydrogel microspheres loaded with naringin and bone marrow mesenchymal stem cells, which have anti-inflammatory and osteogenic properties. These homogeneous microspheres, ranging from 200 to 1000μm, can be rapidly fabricated using an electro-assisted bio-fabrication method. Interestingly, it was found that microspheres with relatively small diameters (200μm) were more conducive to the initial cell attachment, growth, spread, and later osteogenic differentiation. The developed microspheres can effectively treat tibial osteomyelitis in rats within six weeks, proving their prospects for clinical application.
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Affiliation(s)
- Minyi Dong
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou 310000, People's Republic of China
- Department of Stomatology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang 215600, People's Republic of China
| | - Xiaofu Yang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou 310000, People's Republic of China
| | - Jingyi Lu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou 310000, People's Republic of China
| | - Lixuen Siow
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou 310000, People's Republic of China
| | - Huihui He
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou 310000, People's Republic of China
| | - An Liu
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, People's Republic of China
| | - Pengcheng Wu
- State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, People's Republic of China
- Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, School of Mechanical Engineering, Zhejiang University, Hangzhou, People's Republic of China
| | - Yong He
- State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, People's Republic of China
- Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, School of Mechanical Engineering, Zhejiang University, Hangzhou, People's Republic of China
| | - Miao Sun
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou 310000, People's Republic of China
| | - Mengfei Yu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou 310000, People's Republic of China
| | - Huiming Wang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou 310000, People's Republic of China
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Bruzzese GL, McKenna S. Surgical Ulcer Debridement in a Patient With Spina Bifida Complicated by Osteomyelitis, Obesity, and Diabetes. Cureus 2023; 15:e43470. [PMID: 37588133 PMCID: PMC10425705 DOI: 10.7759/cureus.43470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 08/18/2023] Open
Abstract
The combination of obesity, diabetes mellitus (DM), and reduced mobility due to spina bifida can contribute to an increased risk of osteomyelitis. Spina bifida, a congenital defect of the spinal cord, causes vertebral column deformities and neurological impairment. Obesity can lead to increased pressure and stress on the bones and joints, as well as poor circulation and immune dysfunction, including neutrophil migration disorders. Similarly, DM can also contribute to poor circulation and inadequate immune function. These changes can increase the risk of neuropathic ulcerations and osteomyelitis. We report a case of a 59-year-old man who presented for surgical consultation at the inpatient care unit. He had a nonhealing sacral ulcer on the left buttock that persisted for a year. He had a history of spina bifida, type 2 DM, and anemia, and his body mass index was 57.6 kg/m2. Physical examination revealed an unstageable left buttock pressure ulcer. The patient was afebrile, and his laboratory findings and imaging results indicated osteomyelitis. Despite intravenous antibiotic treatment, healing of the sacral ulcer remained poor, and the patient experienced chronic pain. Subsequent surgical intervention in the operating room involved debridement of the skin and soft tissue using high-powered water via the VERSAJET™ Hydrosurgery System (Smith & Nephew, London, UK). Ulcerated and necrotic skin and subcutaneous tissue extending deeper than the muscles and bones were observed. Loop colostomy was performed after determining that the wound would not heal owing to its proximity to the rectum and the inevitable contamination with stool. Postoperatively, sacral bone biopsy confirmed osteomyelitis. Alternative treatment options remained limited, as several other treatment methods failed prior to surgical debridement and colostomy placement. Although repeated debridement improved tissue viability, loop colostomy was performed to divert stool and prevent contamination of the ulcer.
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Affiliation(s)
- Gabriella L Bruzzese
- Department of General Surgery, Frederick Health Hospital, Frederick, USA
- Department of Anatomy, West Virginia School of Osteopathic Medicine, Lewisburg, USA
| | - Stephen McKenna
- Department of General Surgery, Frederick Health Hospital, Frederick, USA
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Russell CD, Tsang STJ, Dudareva M, R. W. Simpson AH, Sutherland RK, McNally MA. A Survey of Orthopedic Surgical Management of Pressure Ulcer-Related Pelvic Osteomyelitis. Open Forum Infect Dis 2023; 10:ofad291. [PMID: 37323421 PMCID: PMC10264061 DOI: 10.1093/ofid/ofad291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/24/2023] [Indexed: 06/17/2023] Open
Abstract
Pressure-ulcer related pelvic osteomyelitis is managed with little high-quality evidence. We undertook an international survey of orthopedic surgical management, covering diagnostic parameters, multidisciplinary input, and surgical approaches (indications, timing, wound closure, and adjunctive therapies). This identified areas of consensus and disagreement, representing a starting point for future discussion and research.
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Affiliation(s)
| | - Shao-Ting Jerry Tsang
- Correspondence: Shao-Ting Jerry Tsang, MBChB, PhD, Department of Orthopaedic Surgery, University of Edinburgh, Chancellor's Bldg, 49 Little France Crescent, Old Dalkeith Rd, Edinburgh EH16 4SB, United Kingdom ()
| | - Maria Dudareva
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
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Dinh A, D'anglejan E, Leliepvre H, Bouchand F, Marmouset D, Dournon N, Mascitti H, Genet F, Herrmann JL, Chaussard H, Duran C, Noussair L. Short Antibiotic Treatment Duration for Osteomyelitis Complicating Pressure Ulcers: A Quasi-experimental Study. Open Forum Infect Dis 2023; 10:ofad088. [PMID: 36923117 PMCID: PMC10009872 DOI: 10.1093/ofid/ofad088] [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: 01/11/2023] [Accepted: 02/15/2023] [Indexed: 02/18/2023] Open
Abstract
Background Osteomyelitis-complicating pressure ulcers are frequent among patients with spinal cord injuries (SCIs), and the optimal management is unknown. In our referral center, the current management is debridement and flap coverage surgeries, followed by a short antibiotic treatment. We aimed to evaluate patients' outcomes a year after surgery. Methods We performed a quasi-experimental retrospective before/after study on SCI patients with presumed osteomyelitis associated with perineal pressure ulcers. We included all patients who underwent surgery with debridement and flap covering, followed by effective antibiotic treatment, between May 1, 2016, and October 30, 2020. The effective antimicrobial treatment duration included the 10 days leading up to January 1, 2018 (before period), and the 5 to 7 days after (after period). We also compared the efficacy of 5-7-day vs 10-day antibiotic treatment and performed uni- and multivariable analyses to identify factors associated with failure. Results Overall, 415 patients were included (77.6% male patients; mean age ± SD, 53.0 ± 14.4 years). Multidrug-resistant organisms (MDROs) were involved in 20.7% of cases. Favorable outcomes were recorded in 69.2% of cases: 117/179 (65.3%) in the 10-day treatment group vs 169/287 (71.9%) in the 5-7-day treatment group (P = .153). The only factor associated with failure in the multivariate analysis was a positive culture from suction drainage (odds ratio, 1.622; 95% CI, 1.005-2.617; P = .046). Effective treatment duration >7 days and intraoperative samples negative for MDROs were not associated with better outcomes (P = .153 and P = .241, respectively). Conclusions A treatment strategy combining surgical debridement and flap covering, followed by 5 to 7 days of effective antibiotic treatment seems safe.
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Affiliation(s)
- Aurélien Dinh
- Infectious Disease Department, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Emma D'anglejan
- Infectious Disease Department, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Helene Leliepvre
- Physical Medicine and Rehabilitation, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Frédérique Bouchand
- Pharmacy, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Damien Marmouset
- Orthopaedics Department, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Nathalie Dournon
- Infectious Disease Department, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Hélène Mascitti
- Infectious Disease Department, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - François Genet
- Physical Medicine and Rehabilitation, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Jean-Louis Herrmann
- Microbiological Laboratory, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Haude Chaussard
- Orthopaedics Department, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Clara Duran
- Infectious Disease Department, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
| | - Latifa Noussair
- Microbiological Laboratory, University Hospital Raymond-Poincaré, APHP Paris Saclay, Versailles Saint Quentin University, Garches, France
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11
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Scheel-Sailer A, Koligi K, Lampart P, Fähndrich C, Gmünder HP, Metzger S, Schaefer D, Schmitt K, Stalder S, Wettstein R, Gemperli A. Effect of a computerized decision support system on the treatment approach of stage III or IV pressure injury in patients with spinal cord injury: a feasibility study. BMC Health Serv Res 2023; 23:103. [PMID: 36721265 PMCID: PMC9890825 DOI: 10.1186/s12913-023-09045-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 01/06/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Stage III and IV pressure injuries (PIs) in patients with spinal cord injury (SCI) require complex interdisciplinary and interprofessional treatment approaches that are difficult to implement. Practical aspects, such as information exchange and coordination, remain challenging. We investigated whether a computerized decision support system (CDSS) could increase treatment adherence and improve clinical outcomes and interprofessional collaboration. METHOD In this feasibility study, a core team developed the initial treatment process and adapted it based on several discussions with clinical experts and information technologists. The CDSS followed the Basel Decubitus Approach and was used in a clinic specializing in SCI. Thirty patients with SCI admitted for stage III/IV PI between July 2016 and May 2017 were randomly allocated to standard or CDSS-supported care. Between-group differences in treatment adherence, complication rates, length of stay, and costs were analyzed using descriptive statistics. The use of the CDSS and potential barriers and facilitators were evaluated through interprofessional focus groups, transcribed verbatim, and thematically analyzed (30 participants). RESULTS No differences in SCI characteristics, comorbidities, or PI characteristics (localization: ischium [number (n) = 19 PI, 63%], sacrum [n = 10 PI, 33%], recurrent PI [n = 21, 70%]) were found between the two groups. Furthermore, no statistically significant differences were observed in treatment adherence, frequency of major (20% vs. 13% between CDSS and control group) and minor (33% vs 27%) complications, and length of stay (98 [±28] vs 81 [±23] days). Healthcare professionals found the CDSS to be helpful for visualizing the treatment process. However, the high workload and difficulties in the information technology processes, such as missing reminders, slow computer performance and data processing, and poor accessibility, hindered the effective implementation of the CDSS. CONCLUSION The implementation of the CDSS to support the treatment of stage III/IV PI in patients with SCI was feasible and included definitions of milestones, interventions, and outcomes. However, to assess the impact of the CDSS, a longer observation period is required. Further, the technical difficulties must be addressed, and solid integration of the CDSS into the clinical information system is necessary. TRIAL REGISTRATION This quality improvement project received a declaration of no objection from the Ethics Committee of Northwest and Central Switzerland (EKNZ UBE-16/003), and ethical approval was received for the focus groups (EKNZ Req-2017-00860).
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Affiliation(s)
- Anke Scheel-Sailer
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland ,grid.449852.60000 0001 1456 7938Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Kamran Koligi
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Patricia Lampart
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Carina Fähndrich
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Hans Peter Gmünder
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Stefan Metzger
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Dirk Schaefer
- grid.410567.1Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Klaus Schmitt
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Stefan Stalder
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Reto Wettstein
- grid.410567.1Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Armin Gemperli
- grid.449852.60000 0001 1456 7938Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland ,grid.419770.cSwiss Paraplegic Research, Nottwil, Switzerland
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Damioli L, Shepard Z, Wilson MP, Erlandson KM. Retrospective analysis of the management of pelvic decubitus ulcers and their outcomes. Ther Adv Infect Dis 2023; 10:20499361231196664. [PMID: 37693861 PMCID: PMC10483971 DOI: 10.1177/20499361231196664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Background Many patients with decubitus-related osteomyelitis are ineligible for myocutaneous flapping, and optimal management in this population is unknown. We describe treatments and outcomes of hospitalized patients with decubitus ulcer-related osteomyelitis who did not undergo surgical reconstruction or coverage. Methods We systematically identified hospitalized patients with diagnoses of pelvic, sacral, or femoral osteomyelitis due to decubitus ulceration between 1 January 2018 and 31 December 2018. Demographics, comorbidities, laboratory data, and outcomes were collected by manual chart review. T-tests or Chi-square tests were used for descriptive statistical comparisons; logistic regressions were used to explore the odds of readmission, osteomyelitis-related readmission, and death. Results Of 89 patients meeting inclusion criteria, 34 (38%) received surgical debridement and ⩾6 weeks of antibiotics; 55 (62%) received either antibiotics alone or debridement and <6 weeks of antibiotics. Mean age was 55 (standard deviation 18) years, 55% of patients were male, and 69% had spinal cord injury or other form of paralysis. Within 1 year, 56 (63%) patients were readmitted, 38 (44%) patients were readmitted due to complications from osteomyelitis, and 15 (17%) died. We found no significant differences in readmission (OR = 1.33, 95% CI: 0.54-3.21, p = 0.53), readmission related to osteomyelitis (OR = 1.64, 95% CI: 0.69-4.04, p = 0.27), subsequent sepsis (OR = 2.27, 95% CI: 0.83-6.93, p = 0.13), or death (OR = 2.88, 95% CI: 0.83-13.4, p = 0.12) by treatment group. Conclusions Among patients with decubitus-related osteomyelitis who did not undergo myocutaneous flapping, outcomes were generally poor regardless of treatment, and not significantly improved with prolonged antibiotics. Prospective studies are needed to assess best practice strategies for this challenging patient population.
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Affiliation(s)
- Laura Damioli
- Infectious Disease Division, University of Colorado Hospital, 12700 E. 19th Avenue B-168, Research Complex 2 Building, Aurora, CO 80045, USA
| | - Zachary Shepard
- Division of Infectious Diseases, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Melissa P. Wilson
- Department of Bioinformatics and Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kristine M. Erlandson
- Division of Infectious Diseases, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
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13
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Kandi LA, Rangel IC, Movtchan NV, Van Spronsen NR, Kruger EA. Comprehensive Management of Pressure Injury. Phys Med Rehabil Clin N Am 2022; 33:773-787. [DOI: 10.1016/j.pmr.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Application Value of Management Model Based on “Zero Tolerance” Concept in Pressure Ulcer Management. Emerg Med Int 2022; 2022:6792584. [PMID: 36262118 PMCID: PMC9576404 DOI: 10.1155/2022/6792584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/14/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background Pressure injuries are the most prevalent health problem worldwide. Improving the quality of hospital pressure injury management is an important indicator to improve the quality of hospital management. Objective To explore the application value of the management model centered on the concept of “zero tolerance” in the management of pressure ulcers (PU). Methods The effects of conventional management mode and management mode centered on the concept of “zero tolerance” on PU patients and nursing staff were retrospectively analyzed. The patients were evaluated by the general comfort questionnaire (GCQ), Generic Quality of Life Inventory 74 (GQOL-74), and pressure ulcer healing scale (PUSH). At the same time, the satisfaction of PU patients and nursing staff with different management modes was investigated. Results When comparing the conditions of patients under different management modes, it was found that the “zero tolerance” management mode can improve the comfort and quality of life of patients during hospitalization. Compared with the conventional management mode, the “zero tolerance” management mode can significantly improve the degree of pressure ulcer healing in patients. In addition, the “zero tolerance” management model can not only improve the satisfaction of patients with management but also improve the satisfaction of nursing staff with management. Conclusion Standardized management of PU patients with the concept of “zero tolerance” as the core can improve the health status and quality of life of patients, promote wound healing, and improve the satisfaction of patients and nurses with the management plan.
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Muacevic A, Adler JR. Diagnosis and Treatment Modalities for Osteomyelitis. Cureus 2022; 14:e30713. [PMID: 36439590 PMCID: PMC9695195 DOI: 10.7759/cureus.30713] [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: 09/15/2022] [Accepted: 10/26/2022] [Indexed: 01/25/2023] Open
Abstract
Osteomyelitis is an infection-related inflammatory disease of the bones. Imaging and laboratory results are typically used to support a clinical diagnosis of osteomyelitis. Microbial cultures and bone biopsies provide conclusive diagnoses. The first imaging procedure that needs to be done is radiography, but its sensitivity is low in the early stages of the disease. The sensitivity of magnetic resonance imaging, both with and without contrast material, is higher for detecting areas of bone necrosis in advanced stages. Patients can be categorised for surgical treatment using a staging system based on major and minor risk factors. The main course of treatment should be antibiotics, which should be chosen depending on the findings of the culture and the characteristics of each patient. Bony debridement surgery is frequently required, and in high-risk patients or those with severe illness, additional surgical intervention can be necessary. Better outcomes are being attained in the treatment of this illness thanks to advancements in surgical treatment, antibiotic therapy, and the current resources for precise diagnosis and tailored responses to each kind of osteomyelitis. The classification systems that are most frequently employed, as well as the general epidemiological ideas, are presented together with the discussion of acute and chronic osteomyelitis. The key recommendations for diagnosing infections clinically, in the laboratory, and through imaging are covered, along with the recommendations for surgical and antibiotic procedures, and the function of hyperbaric oxygen as adjuvant therapy. We evaluate the osteomyelitis-related articles, summarise the most recent developments in diagnostic procedures and therapeutic regimens, evaluate the benefits and drawbacks of various diagnostic modalities and therapeutic approaches, and suggest areas of focus to help current diagnostic and therapeutic approaches.
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16
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Osteomyelitis and antibiotic treatment in patients with grade IV pressure injury and spinal cord lesion-a retrospective cohort study. Spinal Cord 2022; 60:540-547. [PMID: 35121846 DOI: 10.1038/s41393-022-00758-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To analyze characteristics and treatment of osteomyelitis (OM) in the treatment of grade IV pressure injury (PI) in patients with spinal cord injury/disorder (SCI/D) following the Basel Decubitus Concept. SETTING Acute care and rehabilitation clinic specialized in SCI/D. METHODS Patients with SCI/D were admitted for grade IV PI treatment between 1st January 2010 and 28th February 2015. Patients, SCI/D, and PI characteristics were collected from chart reviews. Descriptive statistics and differences between groups with and without OM were evaluated. RESULTS In total, 117 patients (87 male, 30 female) with 130 PI grade IV were included. In 95 patients (81%), OM was diagnosed histologically. In 87 cases, more than one bacterial species was involved. Out of 49 different bacterial species, Enterococcus faecalis and Staphylococus aureus were most frequently observed. Amoxicillin/clavulanic acid and ciprofloxacin were the most frequently used out of 24 different antibiotics. Length of antibiotic treatment varied between <8 days and >91 days with 31 patients receiving antibiotics for about 8 weeks. Complications occurred in all groups of antibiotic duration. Having a paraplegia, no OM and sacral PI was associated with increased complication rates, but the number of patients did not allow comprehensive risk factor analysis. CONCLUSION Because the variety of patients concerning SCI/D, PI, and OM characteristics did not show a conclusive relation between length of antibiotic treatment and complication rates, the development of a subgroup specific treatment concept for PI in patients with SCI/D would be favorable to further optimize antibiotic treatment.
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17
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Systematic review: investigating the added diagnostic value of gadolinium contrast agents for osteomyelitis in the appendicular skeleton. Skeletal Radiol 2022; 51:1285-1296. [PMID: 34643771 DOI: 10.1007/s00256-021-03915-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteomyelitis is an infection of the bone marrow. MRI with gadolinium-based contrast is frequently performed for cases of suspected osteomyelitis. The objective of this systematic review is to examine the diagnostic accuracy of contrast-enhanced vs non-contrast-enhanced MRI for osteomyelitis in the appendicular skeleton. MATERIALS AND METHODS We conducted a systematic review of MRI in the diagnosis of osteomyelitis by searching MEDLINE and EMBASE from January 2000 to March 2020. There were 21 studies that met the inclusion criteria for the systematic review for a total of 1095 patients. Analytic methods were based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Evidence was evaluated using the STARD criteria for evaluation of completeness and transparency of reporting. RESULTS For diagnosing osteomyelitis in the appendicular skeleton, MRI with gadolinium-based contrast has 89% sensitivity (95% CI, 86-92%), 79% specificity (95% CI, 75-83%), and 90% overall diagnostic accuracy ([SE] = 0.03). For diagnosing osteomyelitis in the appendicular skeleton, MRI without gadolinium-based contrast has a 92% sensitivity (95% CI, 87-96%), 89% specificity (95% CI, 84-93%), and 96% overall diagnostic accuracy ([SE] = 0.03). The median score of included studies was 85% utilizing the STARD criteria with excellent interobserver agreement of 83.4%. Limitations included small sample size of studies, with retrospective designs. CONCLUSION No evidence was found to suggest an added diagnostic value of gadolinium contrast for the diagnosis of osteomyelitis in the appendicular skeleton. For routine cases of suspected non-spinal osteomyelitis, non-contrast MRI of the area of interest is the next most appropriate study after radiographs.
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18
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Spellberg B, Aggrey G, Brennan MB, Footer B, Forrest G, Hamilton F, Minejima E, Moore J, Ahn J, Angarone M, Centor RM, Cherabuddi K, Curran J, Davar K, Davis J, Dong MQ, Ghanem B, Hutcheon D, Jent P, Kang M, Lee R, McDonald EG, Morris AM, Reece R, Schwartz IS, So M, Tong S, Tucker C, Wald-Dickler N, Weinstein EJ, Williams R, Yen C, Zhou S, Lee TC. Use of Novel Strategies to Develop Guidelines for Management of Pyogenic Osteomyelitis in Adults: A WikiGuidelines Group Consensus Statement. JAMA Netw Open 2022; 5:e2211321. [PMID: 35536578 PMCID: PMC9092201 DOI: 10.1001/jamanetworkopen.2022.11321] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence. OBJECTIVE To construct a clinical guideline for pyogenic osteomyelitis management, with a new standard of evidence to resolve the gap between strength of recommendation and quality of evidence, through the use of a novel open access approach utilizing social media tools. EVIDENCE REVIEW This consensus statement and systematic review study used a novel approach from the WikiGuidelines Group, an open access collaborative research project, to construct clinical guidelines for pyogenic osteomyelitis. In June 2021 and February 2022, authors recruited via social media conducted multiple PubMed literature searches, including all years and languages, regarding osteomyelitis management; criteria for article quality and inclusion were specified in the group's charter. The GRADE system for evaluating evidence was not used based on previously published concerns regarding the potential dissociation between strength of recommendation and quality of evidence. Instead, the charter required that clear recommendations be made only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were drafted to discuss pros and cons of care choices. Both clear recommendations and clinical reviews were planned with the intention to be regularly updated as new data become available. FINDINGS Sixty-three participants with diverse expertise from 8 countries developed the group's charter and its first guideline on pyogenic osteomyelitis. These participants included both nonacademic and academic physicians and pharmacists specializing in general internal medicine or hospital medicine, infectious diseases, orthopedic surgery, pharmacology, and medical microbiology. Of the 7 questions addressed in the guideline, 2 clear recommendations were offered for the use of oral antibiotic therapy and the duration of therapy. In addition, 5 clinical reviews were authored addressing diagnosis, approaches to osteomyelitis underlying a pressure ulcer, timing for the administration of empirical therapy, specific antimicrobial options (including empirical regimens, use of antimicrobials targeting resistant pathogens, the role of bone penetration, and the use of rifampin as adjunctive therapy), and the role of biomarkers and imaging to assess responses to therapy. CONCLUSIONS AND RELEVANCE The WikiGuidelines approach offers a novel methodology for clinical guideline development that precludes recommendations based on low-quality data or opinion. The primary limitation is the need for more rigorous clinical investigations, enabling additional clear recommendations for clinical questions currently unresolved by high-quality data.
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Affiliation(s)
- Brad Spellberg
- Los Angeles County+University of Southern California (USC) Medical Center, Los Angeles
| | - Gloria Aggrey
- Montgomery Medical Associates PC, Rockville, Maryland
| | - Meghan B. Brennan
- University of Wisconsin Hospital and Clinics, William S. Middleton Memorial Veterans Hospital, Madison
| | - Brent Footer
- Providence Portland Medical Center, Portland, Oregon
| | | | | | - Emi Minejima
- Los Angeles County+University of Southern California (USC) Medical Center, Los Angeles
- Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles
| | - Jessica Moore
- Providence Little Company of Mary Medical Center, San Pedro, California
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor
| | | | - Robert M. Centor
- Department of Medicine, Birmingham Veterans Affairs (VA) Medical Center, Birmingham, Alabama
| | | | - Jennifer Curran
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, Ann Arbor
| | - Kusha Davar
- Los Angeles County+University of Southern California (USC) Medical Center, Los Angeles
| | - Joshua Davis
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Mei Qin Dong
- New York Health and Hospitals Bellevue Hospital, New York, New York
| | | | - Doug Hutcheon
- Los Angeles County+University of Southern California (USC) Medical Center, Los Angeles
| | - Philipp Jent
- Department of Infectious Diseases, Inselspital Bern University Hospital, Bern, Switzerland
| | - Minji Kang
- University of Texas Southwestern, Dallas
| | - Rachael Lee
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham
| | - Emily G. McDonald
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Canada
| | - Andrew M. Morris
- Department of Medicine, Division of Infectious Diseases, Sinai Health, University Health Network, and University of Toronto, Toronto, Canada
| | - Rebecca Reece
- Section of Infectious Diseases, Department of Medicine, West Virginia University School of Medicine, Morgantown
| | - Ilan S. Schwartz
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Miranda So
- Sinai Health System-University Health Network Antimicrobial Stewardship Program, UHN and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Steven Tong
- Victorian Infectious Diseases Service, Royal Melbourne Hospital and University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Christopher Tucker
- Hospital Medicine, Magnolia Regional Health Center, Corinth, Mississippi
| | - Noah Wald-Dickler
- Los Angeles County+University of Southern California (USC) Medical Center, Los Angeles
| | - Erica J. Weinstein
- Division of Infectious Diseases, Department of Medicine and Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Riley Williams
- Pharmacy Service, Oklahoma City VA Health Care System, Oklahoma City, Oklahoma
| | | | - Shiwei Zhou
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, Ann Arbor
| | - Todd C. Lee
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Canada
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Grade IV Sacral Sore Treated with an Ointment Rich in PUFAs, Ceramides, and Antimicrobial Peptides. Case Rep Dermatol Med 2022; 2022:4445055. [PMID: 35295787 PMCID: PMC8920691 DOI: 10.1155/2022/4445055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/14/2022] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
This report presents the case of a 57-year-old male patient with a history of hypertension, obesity, dyslipidemia, and coronary disease that after a prolonged postcoronary surgery hospitalization developed a sacral butterfly-shaped sore, with asymmetric involvement of the base of both buttocks, grade III on the left and grade IV on the right sides. The lesion was very painful and had a negative impact on the patient's sleep and mood. Following the initial surgical debridement and treatment with collagenase ointment, the wound showed delayed healing, an increase in necrotic tissue, and purulent discharge, requiring a second surgical debridement that revealed a deeper involvement of the wound. After a month with poor therapeutic response, it was decided to change the treatment to the application of gauzes embedded in an ointment rich in polyunsaturated fatty acids (PUFAs), ceramides, and antimicrobial peptides, Curefini® ointment. After 30 days of treatment, a 50% reduction of the initial wound diameter was obtained with a positive impact on the patient's quality of life, together with a reduction of incidental and spontaneous local pain resulting in better night rest and a return of appetite and strength. During the treatment course, the patient did not suffer any local or systemic infection in connection with the wound. After one month, the patient could discontinue the use of opioid analgesics. A 95% closure of the lesion was achieved in 45 days. This case highlights the therapeutic efficacy of the treatment of cavitated wounds with a product based on natural ingredients that helps reduce pain and promotes granulation and reepithelialization.
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Wald-Dickler N, Holtom PD, Phillips MC, Centor RM, Lee RA, Baden R, Spellberg B. Oral Is the New IV. Challenging Decades of Blood and Bone Infection Dogma: A Systematic Review. Am J Med 2022; 135:369-379.e1. [PMID: 34715060 PMCID: PMC8901545 DOI: 10.1016/j.amjmed.2021.10.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/03/2021] [Accepted: 10/04/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND We sought to determine if controlled, prospective clinical data validate the long-standing belief that intravenous (IV) antibiotic therapy is required for the full duration of treatment for 3 invasive bacterial infections: osteomyelitis, bacteremia, and infective endocarditis. METHODS We performed a systematic review of published, prospective, controlled trials that compared IV-only to oral stepdown regimens in the treatment of these diseases. Using the PubMed database, we identified 7 relevant randomized controlled trials (RCTs) of osteomyelitis, 9 of bacteremia, 1 including both osteomyelitis and bacteremia, and 3 of endocarditis, as well as one quasi-experimental endocarditis study. Study results were synthesized via forest plots and funnel charts (for risk of study bias), using RevMan 5.4.1 and Meta-Essentials freeware, respectively. RESULTS The 21 studies demonstrated either no difference in clinical efficacy, or superiority of oral versus IV-only antimicrobial therapy, including for mortality; in no study was IV-only treatment superior in efficacy. The frequency of catheter-related adverse events and duration of inpatient hospitalization were both greater in IV-only groups. DISCUSSION Numerous prospective, controlled investigations demonstrate that oral antibiotics are at least as effective, safer, and lead to shorter hospitalizations than IV-only therapy; no contrary data were identified. Treatment guidelines should be modified to indicate that oral therapy is appropriate for reasonably selected patients with osteomyelitis, bacteremia, and endocarditis.
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Affiliation(s)
- Noah Wald-Dickler
- Los Angeles County + University of Southern California Medical Center, Los Angeles; Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Paul D Holtom
- Los Angeles County + University of Southern California Medical Center, Los Angeles; Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Matthew C Phillips
- Los Angeles County + University of Southern California Medical Center, Los Angeles
| | - Robert M Centor
- Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham; Birmingham Veterans Affairs (VA) Medical Center, Birmingham, Ala
| | - Rachael A Lee
- Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham; Birmingham Veterans Affairs (VA) Medical Center, Birmingham, Ala
| | - Rachel Baden
- Los Angeles County + University of Southern California Medical Center, Los Angeles
| | - Brad Spellberg
- Los Angeles County + University of Southern California Medical Center, Los Angeles.
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21
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Hsu KF, Kao LT, Chu PY, Chen CY, Chou YY, Huang DW, Liu TH, Tsai SL, Wu CW, Hou CC, Wang CH, Dai NT, Chen SG, Tzeng YS. Simple and Efficient Pressure Ulcer Reconstruction via Primary Closure Combined with Closed-Incision Negative Pressure Wound Therapy (CiNPWT)—Experience of a Single Surgeon. J Pers Med 2022; 12:jpm12020182. [PMID: 35207670 PMCID: PMC8875003 DOI: 10.3390/jpm12020182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 02/01/2023] Open
Abstract
Background: In this study, we aimed to analyze the clinical efficacy of closed-incision negative pressure wound therapy (CiNPWT) when combined with primary closure (PC) in a patient with pressure ulcers, based on one single surgeon’s experience at our medical center. Methods: We retrospectively reviewed the data of patients with stage III or IV pressure ulcers who underwent reconstruction surgery. Patient characteristics, including age, sex, cause and location of defect, comorbidities, lesion size, wound reconstruction methods, operation time, debridement times, application of CiNPWT to reconstructed wounds, duration of hospital stay, and wound complications were analyzed. Results: Operation time (38.16 ± 14.02 vs. 84.73 ± 48.55 min) and duration of hospitalization (36.78 ± 26.92 vs. 56.70 ± 58.43 days) were shorter in the PC + CiNPWT group than in the traditional group. The frequency of debridement (2.13 ± 0.98 vs. 2.76 ± 2.20 times) was also lower in the PC + CiNPWT group than in the traditional group. The average reconstructed wound size did not significantly differ between the groups (63.47 ± 42.70 vs. 62.85 ± 49.94 cm2), and there were no significant differences in wound healing (81.25% vs. 75.38%), minor complications (18.75% vs. 21.54%), major complications (0% vs. 3.85%), or mortality (6.25% vs. 10.00%) between the groups. Conclusions: Our findings indicate that PC combined with CiNPWT represents an alternative reconstruction option for patients with pressure ulcers, especially in those for whom prolonged anesthesia is unsuitable.
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Affiliation(s)
- Kuo-Feng Hsu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Li-Ting Kao
- Department of Pharmacy Practice, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 114202, Taiwan
| | - Pei-Yi Chu
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Chun-Yu Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Yu-Yu Chou
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Dun-Wei Huang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Ting-Hsuan Liu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Sheng-Lin Tsai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Chien-Wei Wu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Chih-Chun Hou
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Chih-Hsin Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Niann-Tzyy Dai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Shyi-Gen Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
| | - Yuan-Sheng Tzeng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan; (K.-F.H.); (C.-Y.C.); (Y.-Y.C.); (D.-W.H.); (T.-H.L.); (S.-L.T.); (C.-W.W.); (C.-C.H.); (C.-H.W.); (N.-T.D.); (S.-G.C.)
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan;
- Correspondence: ; Tel.: +886-2-8792-7195
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22
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Maamari J, Tande A, Diehn F, Tai DBG, Berbari E. Diagnosis of vertebral osteomyelitis. J Bone Jt Infect 2022; 7:23-32. [PMID: 35136714 PMCID: PMC8814828 DOI: 10.5194/jbji-7-23-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/06/2022] [Indexed: 12/19/2022] Open
Abstract
Native vertebral osteomyelitis (NVO) is a potentially fatal infection which
has seen a gradual increase in its incidence over the past decades. The
infection is insidious, presenting with symptoms of back pain. Fever is
present in about 60 % of patients. Prompt diagnosis of NVO is important to
prevent the development of complications. Numerous laboratory and imaging
tools can be deployed to accurately establish the diagnosis. Imaging
techniques such as magnetic resonance, nuclear imaging, and computed
tomography are essential in diagnosing NVO but can also be useful in
image-guided biopsies. Laboratory tools include routine blood tests,
inflammatory markers, and routine culture techniques of aspirated specimens.
Recent advances in molecular techniques can assist in identifying offending
pathogen(s). In this review, we detail the arsenal of techniques that can be
utilized to reach a diagnosis of NVO.
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Affiliation(s)
- Julian Maamari
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Aaron J. Tande
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Felix Diehn
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Elie F. Berbari
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
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23
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Team V, Jones A, Teede H, Weller CD. Pressure Injury Surveillance and Prevention in Australia: Monash Partners Capacity Building Framework. Front Public Health 2021; 9:634669. [PMID: 34778157 PMCID: PMC8581233 DOI: 10.3389/fpubh.2021.634669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 09/24/2021] [Indexed: 11/26/2022] Open
Abstract
A hospital-acquired pressure injury (HAPI) is a common complication across the globe. The severity of HAPI ranges from skin redness and no skin breakdown to full skin and tissue loss, exposing the tendons and bones. HAPI can significantly impact the quality of life. In addition to the human cost, this injury carries a high economic burden with the cost of treatment far outweighing the preventative measures. The HAPI rates are a key indicator of health services performance. Globally, healthcare services aim to reduce its incidence. In Australia, the federal health minister has prioritised the need for improvement in HAPI surveillance and prevention. Capacity building is vital to optimise pressure injury (PI) surveillance and prevention in acute care services. In this perspective article, we provide a framework for capacity building to optimise HAPI prevention and surveillance in a large cross-sector collaborative partnership in Australia. This framework comprises six key action areas in capacity building to optimise the HAPI outcomes, such as research, organisational development, workforce development, leadership, collaboration, and consumer involvement.
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Affiliation(s)
- Victoria Team
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Angela Jones
- Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Helena Teede
- Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Carolina D. Weller
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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24
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Rippon MG, Rogers AA, Ousey K. Estrategias de protección antimicrobiana en el cuidado de heridas: evidencia para el uso de apósitos recubiertos con DACC. J Wound Care 2021; 30:21-35. [PMID: 34558974 DOI: 10.12968/jowc.2021.30.latam_sup_1.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Antimicrobial resistance (AMR) is one of the most serious health threats globally. The development of new antimicrobials is not keeping pace with the evolution of resistant microorganisms, and novel ways of tackling this problem are required. One of such initiatives has been the development of antimicrobial stewardship programmes (AMS). The use of wound dressings that employ a physical sequestration and retention approach to reduce bacterial burden offers a novel approach to support AMS. Bacterial-binding by dressings and their physical removal can minimise their damage and prevent the release of harmful endotoxins. OBJECTIVE To highlight AMS to promote the correct use of antimicrobials and to investigate how dialkylcarbamyl chloride (DACC)-coated dressings can support AMS. METHOD MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar were searched to identify articles relating to AMS, and the use of wound dressings in the prevention and treatment of wound infections. The evidence supporting alternative wound dressings that can reduce bioburden and prevent wound infection in a way that does not kill or damage the microorganisms were reviewed. RESULTS The evidence demonstrated that using bacterial-binding wound dressings that act in a physical manner (eg, DACC-coated dressings) to preventing infection in both acute and hard-to-heal wounds does not exacerbate AMR and supports AMS. CONCLUSION Some wound dressings work via a mechanism that promotes the binding and physical sequestration and removal of intact microorganisms from the wound bed (eg, a wound dressing that uses DACC technology to prevent/reduce infection). They provide a valuable tool that aligns with the requirements of AMS by effectively reducing wound bioburden without inducing/selecting for resistant bacteria.
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Affiliation(s)
| | | | - Karen Ousey
- Huddersfield University, Reino Unido.,School of Nursing, Faculty of Health at the Queensland University of Technology, Australia.,Royal College of Surgeons in Ireland, Dublin, Irlanda
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25
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Crespo A, Stevens NM, Chiu E, Pham V, Leucht P. Incidence of Osteomyelitis in Sacral Decubitus Ulcers and Recommendations for Management. JBJS Rev 2021; 8:e0187. [PMID: 33006456 DOI: 10.2106/jbjs.rvw.19.00187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Stage-4 pressure ulcers are defined as ulcerations that violate the fascia and expose underlying bone, muscle, and tendon. Exposed bone is always colonized by bacteria, but this does not necessarily lead to osteomyelitis. The rates of osteomyelitis in exposed bone in stage-4 pressure ulcers range from 14% to 86%.There has been no evidence that the presence of osteomyelitis leads to higher complication rates following flap coverage. There has been no evidence that bone biopsy and preoperative treatment of osteomyelitis have any benefit before flap coverage.
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Affiliation(s)
- Alexander Crespo
- NYU Langone Orthopedics (A.C., N.M.S., and P.L.), NYU Langone Plastic Surgery Associates (E.C.), and Division of Infectious Diseases and Immunology (V.P.), NYU Langone Health, New York, NY
| | - Nicole M Stevens
- NYU Langone Orthopedics (A.C., N.M.S., and P.L.), NYU Langone Plastic Surgery Associates (E.C.), and Division of Infectious Diseases and Immunology (V.P.), NYU Langone Health, New York, NY
| | - Ernest Chiu
- NYU Langone Orthopedics (A.C., N.M.S., and P.L.), NYU Langone Plastic Surgery Associates (E.C.), and Division of Infectious Diseases and Immunology (V.P.), NYU Langone Health, New York, NY
| | - Vinh Pham
- NYU Langone Orthopedics (A.C., N.M.S., and P.L.), NYU Langone Plastic Surgery Associates (E.C.), and Division of Infectious Diseases and Immunology (V.P.), NYU Langone Health, New York, NY
| | - Philipp Leucht
- NYU Langone Orthopedics (A.C., N.M.S., and P.L.), NYU Langone Plastic Surgery Associates (E.C.), and Division of Infectious Diseases and Immunology (V.P.), NYU Langone Health, New York, NY.,Department of Cell Biology, NYU School of Medicine, New York, NY
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26
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Topaz M, Athamna A, Ashkenazi I, Shpitz B, Freimann S. In-vitro model for bacterial growth inhibition of compartmentalized infection treated by an ultra-high concentration of antibiotics. PLoS One 2021; 16:e0252724. [PMID: 34101731 PMCID: PMC8186763 DOI: 10.1371/journal.pone.0252724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/20/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Pseudomonas aeruginosa (P. aeruginosa), Escherichia coli (E. coli), and Staphylococcus aureus (S. aureus) are common pathogens encountered in infected cardiovascular-implantable electronic device (CIED). Continuous, in-situ targeted, ultra-high concentration antibiotic (CITA) treatment is a novel antibiotic treatment approach for localized infections. CITA provides sufficient local antibiotic concentrations to heavily infected cavities while avoiding systemic toxicity. AIM In-vitro confirmation of the efficacy of the CITA treatment approach in simulated compartmentalized infections. MATERIALS AND METHODS A rapid automated bacterial culture analyzing system) Uro4 HB&L™ (was applied to compare the efficacy of selected antibiotics at a standard minimal inhibitory concentration (1MIC), 4MIC, and CITA at 103MIC, for growth inhibition of high bacterial loads (106 colony-forming-units/ml) of ATCC strains of P. aeruginosa, E. coli, and S. aureus. RESULTS The addition of gentamicin and amikacin at 1MIC concentrations only temporarily inhibited the exponential growth of E. coli and P. aeruginosa. 4MIC level extended the delay of exponential bacterial growth. Increasing concentrations of vancomycin similarly temporarily delayed S. aureus growth. All tested antibiotics at CITA of 103MIC totally inhibited the exponential growth of the tested bacteria through 72 hours of exposure. (P<0.001). CONCLUSION In this in-vitro model, CITA at 103MIC effectively inhibited exponential bacterial growth of high loads of P. aeruginosa, E. coli, and S. aureus. This model offers preliminary laboratory support for the benefit of the in-situ antibiotic treatment, providing ultra-high concentrations directly at the compartmentalized infection site, not achievable by the conventional intravenous and oral routes.
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Affiliation(s)
- Moris Topaz
- Clinical Microbiology Laboratory, Hillel Yaffe Medical Center, Hadera, Israel
| | - Abed Athamna
- Clinical Microbiology Laboratory, Hillel Yaffe Medical Center, Hadera, Israel
| | | | - Baruch Shpitz
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sarit Freimann
- Clinical Microbiology Laboratory, Hillel Yaffe Medical Center, Hadera, Israel
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27
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McNeil JC, Joseph M, Sommer LM, Vallejo JG. The Contemporary Epidemiology, Microbiology and Management of Chronic Osteomyelitis in US Children. Pediatr Infect Dis J 2021; 40:518-524. [PMID: 33902075 DOI: 10.1097/inf.0000000000003067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While the majority of pediatric osteomyelitis cases are acute in nature, a significant subset present with prolonged symptoms often associated with substantial morbidity. Little data exist to guide clinicians in the management of these infections. We sought to describe the epidemiology, clinical features and management of chronic osteomyelitis (CO) in children. METHODS We reviewed hospital admissions for CO from 2011 to 2018 at Texas Children's Hospital. Cases were included if symptoms lasted ≥28 days on presentation. Cases were classified as those associated with: (1) a contiguous focus of infection; (2) penetrating trauma; (3) orthopedic hardware; (4) postacute CO (PACO, those occurring after ≥28 days of therapy for acute osteomyelitis); and (5) primary hematogenous CO. RESULTS One hundred fourteen cases met inclusion criteria. The median patient age was 11.8 years and 35.9% had comorbidities. 70.2% of patients underwent ≥1 surgical procedure. A microbiologic etiology was identified in 72.8% of cases and Staphylococcus aureus was most common (39.4%). Contiguous focus of infection was more often associated with polymicrobial disease with or without Pseudomonas. Postacute CO was caused by S. aureus in 95%. The median duration of total therapy was 210 days. 26.3% of patients experienced treatment failure of which 46% underwent repeat hospital admission/surgery. There was no association between duration of intravenous therapy for CO and treatment failure. CONCLUSIONS Children with CO represent a diverse group both in terms of pathogenesis and microbiology. Pathogenesis and clinical presentation can provide clues to microbiologic etiology. Prolonged intravenous therapy does not appear to improve outcomes in CO.
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Affiliation(s)
- J Chase McNeil
- From the Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
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28
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Mahmoud E, Abanamy R, Binawad E, Alhatmi H, Alzammam A, Habib A, Alturaifi D, Alharbi A, Alqahtani H, Aldohayan M. Infections and patterns of antibiotic utilization in support and comfort care patients: A tertiary care center experience. J Infect Public Health 2021; 14:839-844. [PMID: 34118733 DOI: 10.1016/j.jiph.2021.05.002] [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: 04/12/2021] [Revised: 05/07/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Little is known regarding the burden of infections and clinical practice towards hospitalized patients with limits on life-sustaining measures. We aim to describe the infectious syndromes, clinical care, the emergence of multi-drug resistant organisms and outcomes in this population. PATIENTS AND METHODS Retrospective cohort of patients labeled as support or comfort care in a tertiary care center between 2016-2019. RESULTS A total of 347 patients were included with a mean age of 68.5 years, who were predominantly males (59.94%), bedbound (69.74%), on tube feeding (66.86%), and required indwelling urinary catheters (61.96%). The total number of admissions during the first year was 498, with the mean length of stay being 30 days. The number of infectious syndromes identified during that period was 821episodes, with a mean of 2 infectious syndromes per admission. The most common infection identified was pneumonia (41.66%) followed by urinary tract infections (27.16%). A total of 3891 microbiological cultures were taken with a mean of 5 cultures per infectious syndrome. The most commonly identified pathogens were Gram-negative bacteria (61.03%), with a high rate of multidrug-resistant organisms (MDROs) (48.53%). The one-year mortality was 86.4%. Using carbapenem antibiotic and pneumonia were the independent predictors used for the MDROs. CONCLUSION Our study reflects the high burden of infections, antimicrobial resistance, and hospital admissions among a population with limited life expectancy. A consensus regarding investigating and managing of infectious syndromes, and antimicrobial prescription is needed to reduce the harms associated with overuse of antimicrobials.
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Affiliation(s)
- Ebrahim Mahmoud
- Division of Infectious Diseases, Department of Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
| | - Reem Abanamy
- Division of Infectious Diseases, Department of Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Eman Binawad
- Division of Infectious Diseases, Department of Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hind Alhatmi
- Division of Infectious Diseases, Department of Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Ali Alzammam
- Department of Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Abdulrahman Habib
- Department of Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Dana Alturaifi
- Department of Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed Alharbi
- Division of Infectious Diseases, Department of Medicine, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hajar Alqahtani
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Aldohayan
- Department of Health Informatics, CPHHI, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Data and Business Intelligence Management Department, ISID, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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29
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Rippon MG, Rogers AA, Ousey K. Antimicrobial stewardship strategies in wound care: evidence to support the use of dialkylcarbamoyl chloride (DACC)- coated wound dressings. J Wound Care 2021; 30:284-296. [PMID: 33856907 DOI: 10.12968/jowc.2021.30.4.284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Traditionally, infections are treated with antimicrobials (for example, antibiotics, antiseptics, etc), but antimicrobial resistance (AMR) has become one of the most serious health threats of the 21st century (before the emergence of COVID-19). Wounds can be a source of infection by allowing unconstrained entry of microorganisms into the body, including antimicrobial-resistant bacteria. The development of new antimicrobials (particularly antibiotics) is not keeping pace with the evolution of resistant microorganisms and novel ways of addressing this problem are urgently required. One such initiative has been the development of antimicrobial stewardship (AMS) programmes, which educate healthcare workers, and control the prescribing and targeting of antimicrobials to reduce the likelihood of AMR. Of great importance has been the European Wound Management Association (EWMA) in supporting AMS by providing practical recommendations for optimising antimicrobial therapy for the treatment of wound infection. The use of wound dressings that use a physical sequestration and retention approach rather than antimicrobial agents to reduce bacterial burden offers a novel approach that supports AMS. Bacterial-binding by dressings and their physical removal, rather than active killing, minimises their damage and hence prevents the release of damaging endotoxins. AIM Our objective is to highlight AMS for the promotion of the judicious use of antimicrobials and to investigate how dialkylcarbamoyl chloride (DACC)-coated dressings can support AMS goals. METHOD MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar were searched to identify published articles describing data relating to AMS, and the use of a variety of wound dressings in the prevention and/or treatment of wound infections. The evidence supporting alternative wound dressings that can reduce bioburden and prevent and/or treat wound infection in a manner that does not kill or damage the microorganisms (for example, by actively binding and removing intact microorganisms from wounds) were then narratively reviewed. RESULTS The evidence reviewed here demonstrates that using bacterial-binding wound dressings that act in a physical manner (for example, DACC-coated dressings) as an alternative approach to preventing and/or treating infection in both acute and hard-to-heal wounds does not exacerbate AMR and supports AMS. CONCLUSION Some wound dressings work via a mechanism that promotes the binding and physical uptake, sequestration and removal of intact microorganisms from the wound bed (for example, a wound dressing that uses DACC technology to successfully prevent/reduce infection). They provide a valuable tool that aligns with the requirements of AMS (for example, reducing the use of antimicrobials in wound treatment regimens) by effectively reducing wound bioburden without inducing/selecting for resistant bacteria.
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Affiliation(s)
| | | | - Karen Ousey
- WoundCareSol Consultancy, UK.,School of Nursing, Faculty of Health at the Queensland University of Technology, Australia.,Royal College of Surgeons in Ireland, Dublin, Ireland
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30
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Vocci MC, Fontes CMB, Abbade LPF. Cultural adaptation of the Glamorgan Scale to Brazilian Portuguese: Pressure Injury in Pediatrics. Rev Lat Am Enfermagem 2021; 29:e3424. [PMID: 33852689 PMCID: PMC8040784 DOI: 10.1590/1518-8345.4083.3424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 08/21/2020] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE to describe the methodological process of cultural adaptation of the Glamorgan Scale to Brazilian Portuguese. METHOD a methodological study of translation and cultural adaptation of the Glamorgan Scale, following the six stages: initial translation, synthesis of translations, back-translation, committee of experts, pre-test, and submission of the adapted version to the author for approval. The committee of experts was composed of five physicians and, during evaluation, a semantic, idiomatic, cultural and conceptual analysis was carried out. The agreement and representativeness of the items were assessed using the Content Validity Index. A minimum value of 80% agreement was considered. RESULTS all stages of the translation and cross-cultural adaptation process were satisfactory. In the evaluation made by the committee of experts, all items obtained an agreement greater than 80% in the first evaluation round. The pre-test stage allowed for a critical overview of the instrument, where few modifications were suggested by the participants. CONCLUSION the Glamorgan Scale was translated and culturally adapted to Brazilian Portuguese. Future psychometric studies are necessary to validate the scale.
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Affiliation(s)
- Marcelli Cristine Vocci
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
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31
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Gelis A, Morel J, Amara B, Mauri C, Rouays H, Verollet C, Almeras I, Frasson N, Dupeyron A, Laffont I, Daures JP, Herlin C. "Doctor, how long will it take?" Results from an historical cohort on surgical pressure ulcer healing delay and related factors in persons with spinal cord injury. J Tissue Viability 2021; 30:237-243. [PMID: 33579584 DOI: 10.1016/j.jtv.2021.02.001] [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: 04/14/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Flap surgery for deep pelvic pressure ulcers has already shown its effectiveness. Most studies relating to the postoperative period assessed complications rates and associated risk factors, but none focused on delayed wound healing. The objective of this study was to describe wound healing delay after primary flap surgery in patients with spinal cord injury (SCI) and to assess associated risk factors. METHODS This observational retrospective study based on medical charts included all persons with SCI operated for primary flap surgery for pelvic PU in the Hérault department of France between 2006 and 2014. Overall, 100 biomedical, psychological, socioeconomics and care management factors were studied. The primary outcome was wound healing delay, defined as time from surgery to complete cutaneous closure. RESULTS 85 patients were included. Median healing time was 48 days (R: 20-406). Healing rate was 70% at 3 months and 90% at 4 months. After a multivariate analysis three factors were significantly associated with delayed wound healing: duration of hospitalization in the acute care unit (HR = 2.68; p = 0.004), local post-operative complication (HR = 10.75; p = 0.02), and post-operative sepsis (HR = 2.18; p = 0.02). CONCLUSION After primary skin flap surgery for PU in persons with SCI, delayed wound healing is related to local or general complications as well as care management organization. The risk of delayed wound healing justifies the implementation of a coordinated pre-operative management to prevent complications and a structured care network for an earlier transfer to a SCI rehabilitation center.
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Affiliation(s)
- Anthony Gelis
- Centre Mutualiste Neurologique Propara, 263 Rue Du Caducée, 34090, Montpellier, France.
| | - Juliette Morel
- Institut de Rééducation, CHU des Alpes, Avenue de Kimberley, 38130, Echirolles, France
| | - Bouali Amara
- Service de Chirurgie Plastique, Clinique Clémentville, 25 Rue de Clementville, 34070, Montpellier, France
| | - Cécile Mauri
- Centre Mutualiste Neurologique Propara, 263 Rue Du Caducée, 34090, Montpellier, France
| | - Hélène Rouays
- Centre Mutualiste Neurologique Propara, 263 Rue Du Caducée, 34090, Montpellier, France
| | - Christine Verollet
- Centre Mutualiste Neurologique Propara, 263 Rue Du Caducée, 34090, Montpellier, France
| | - Isabelle Almeras
- Clinique Du Dr Ster, 9 Avenue Dr Jean Ster, 34240, Nîmes, France
| | - Nicolas Frasson
- Clinique Du Dr Ster, 9 Avenue Dr Jean Ster, 34240, Nîmes, France
| | - Arnaud Dupeyron
- Département de Médecine Physique et de Réadaptation, CHU Carémeau, 2 Rue Du Pr Debré, 30029, Nîmes, France
| | - Isabelle Laffont
- Département de Médecine Physique et de Réadaptation, CHU Lapeyronie, 371 Avenue Du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Jean-Pierre Daures
- Institut Universitaire de Recherche Clinique, 75 Rue Professeur Truc, 34090, Montpellier, France
| | - Christian Herlin
- Département de Chirurgie Plastique, CHU Lapeyronie, 371 Avenue Du Doyen Gaston Giraud, 34090, Montpellier, France
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Chicco M, Singh P, Beitverda Y, Williams G, Hirji H, Rao GG. Diagnosing pelvic osteomyelitis in patients with pressure ulcers: a systematic review comparing bone histology with alternative diagnostic modalities. J Bone Jt Infect 2020; 6:21-32. [PMID: 32983845 PMCID: PMC7517666 DOI: 10.5194/jbji-6-21-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/30/2020] [Indexed: 11/11/2022] Open
Abstract
Accurate diagnosis of osteomyelitis underlying pressure ulcers is essential, as overdiagnosis exposes patients to unnecessary and prolonged antibiotic therapy, while failure to diagnose prevents successful treatment. Histopathological examination of bone biopsy specimens is the diagnostic gold standard. Bone biopsy can be an invasive procedure, and, for this reason, other diagnostic modalities are commonly used. However, their accuracy is questioned in literature. This systematic review aims to assess accuracy of various modalities (clinical, microbiological and radiological) for the diagnosis of pelvic osteomyelitis in patients with pressure ulcers as compared to the gold standard. A systematic literature search was conducted in July 2019 using the MEDLINE (Medical Literature Analysis and Retrieval System - MEDLARS - Online) and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. The search terms were "decubitus ulcer", "pressure ulcer", "pressure sore", "bedsore" and "osteomyelitis". The inclusion criteria were original full-text articles in English comparing the results of bone histology with those of other diagnostic modalities in adult patients with pelvic pressure ulcers. Six articles were included in the systematic review. Clinical diagnosis was found to be neither specific nor sensitive. Microbiological examination, and in particular cultures of bone biopsy specimens, displayed high sensitivity but low specificity, likely reflecting contamination. Radiological imaging in the form of X-ray and CT (computed tomography) scans displayed high specificity but low sensitivity. MRI (magnetic resonance imaging), bone scanning and indium-labelled scintigraphy displayed high sensitivity but low specificity. Our systematic review did not find any diagnostic method (clinical, microbiological or radiological) to be reliable in the diagnosis of pelvic osteomyelitis associated with pressure ulcers as compared to bone histology.
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Affiliation(s)
- Maria Chicco
- Department of Microbiology, London North West University Healthcare NHS Trust, Northwick Park Hospital, Harrow, HA1 3UJ, UK
| | - Prashant Singh
- Department of Trauma and Orthopaedics, Royal Free London NHS Foundation Trust, Barnet Hospital, Barnet, EN5 3DJ, UK
| | - Younatan Beitverda
- Department of Geriatric Medicine, London North West University Healthcare NHS Trust, Northwick Park Hospital, Harrow, HA1 3UJ, UK
| | - Gillian Williams
- Department of Cellular Pathology, London North West University Healthcare NHS Trust, Northwick Park Hospital, Harrow, HA1 3UJ, UK
| | - Hassan Hirji
- Department of Radiology, London North West University Healthcare NHS Trust, Northwick Park Hospital, Harrow, HA1 3UJ, UK
| | - Guduru Gopal Rao
- Department of Microbiology, London North West University Healthcare NHS Trust, Northwick Park Hospital, Harrow, HA1 3UJ, UK.,Faculty of Medicine, Imperial College London, London, SW7 2BU, UK
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Team V, Tuck M, Reeves J, Way M, Enticott J, Evans S, Weller CD. Pressure injury data in Australian acute care settings: A comparison of three data sets. Int Wound J 2020; 17:578-586. [PMID: 32027094 PMCID: PMC7948723 DOI: 10.1111/iwj.13320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/27/2020] [Indexed: 12/22/2022] Open
Abstract
Hospital-acquired pressure injuries (HAPIs) represent a serious clinical and economic problem. The cost of treating HAPIs in Australian public hospitals was recently reported at AUS$983 million per annum. There are three main sources of data for documenting pressure injury (PI) occurrence in Australian hospitals: incident reporting, medical record coded data, and real-time surveys of pressure injury. PI data reported at hospital level and to external agencies using these three different sources are variable. This reporting issue leads to inaccurate data interpretation and hinders improvement in accuracy of PI identification and PI prevention. This study involved a comparison of the three different data sources in selected Australian hospitals, to improve the accuracy and comparability of data. Findings from this study provide benchmark areas for improvement in PI documenting and reporting. Better understanding the agreement between the three data sets could lead to a more efficient and effective sharing of data sources.
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Affiliation(s)
- Victoria Team
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
- Monash Partners Academic Health Science CentreMonash PartnersMelbourneVictoriaAustralia
| | - Michelle Tuck
- Nursing ServicesAlfred CentreMelbourneVictoriaAustralia
| | - Judy Reeves
- Nursing ServicesAlfred CentreMelbourneVictoriaAustralia
| | - Margaret Way
- Safety and QualityBarwon HealthGeelongVictoriaAustralia
| | - Joanne Enticott
- Monash Partners Academic Health Science CentreMonash PartnersMelbourneVictoriaAustralia
- Department of General Practice, School of Primary and Allied Health Care, Southern Synergy, Department of PsychiatryMonash UniversityMelbourneVictoriaAustralia
| | - Susan Evans
- Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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Russell CD, Tsang STJ, Simpson AHRW, Sutherland RK. Outcomes, Microbiology and Antimicrobial Usage in Pressure Ulcer-Related Pelvic Osteomyelitis: Messages for Clinical Practice. J Bone Jt Infect 2020; 5:67-75. [PMID: 32455097 PMCID: PMC7242403 DOI: 10.7150/jbji.41779] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 12/27/2019] [Indexed: 12/16/2022] Open
Abstract
Introduction: Pressure ulcer-related pelvic osteomyelitis is a relatively under-studied entity in the field of bone infection. We sought to add to the limited evidence base for managing this challenging syndrome. Methods: Cases were identified retrospectively from a surgical database and hospital discharge codes at a U.K. tertiary centre (2009-2018). Risk factors associated with outcomes were analysed by logistic regression. Results: We identified 35 patients (mean age 57.4 years), 69% managed with a combined medical and surgical approach, with mean follow-up of 3.7 years from index admission. Treatment failure (requiring further surgery or intravenous antimicrobials) occurred in 71% and eventual ulcer healing in 36%. One-year mortality was 23%. Lack of formal care support on discharge, post-traumatic (asensate) neurological deficit and index CRP (>184mg/L) were associated with treatment failure (p=0.001). Age (>59.5 years), lack of attempted soft tissue coverage, haemoglobin (<111g/L) and albumin (<25g/L) were associated with non-healing ulcers (p=0.003). Superficial wound swabs had low sensitivity and specificity compared to deep bone microbiology. Infection (based on deep bone microbiology from 46 infection episodes) was usually polymicrobial (87%), commonly involving S. aureus, Enterococci, GNB and anaerobes. Antimicrobial duration ranged from 0-103 days (mean 54) and was not associated with subsequent treatment failure. Conclusions: Attempted soft tissue coverage after surgical debridement, ensuring appropriate support for personal care after discharge and nutritional optimisation could improve outcomes. Superficial wound swabs are uninformative and deep bone sampling should be pursued. Long antimicrobial courses do not improve outcomes. Clinicians should engage patients in anticipatory care planning.
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Affiliation(s)
- Clark D Russell
- NHS Lothian Infection Service, Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, U.K.,University of Edinburgh Centre for Inflammation Research, Queen's Medical Research Institute, Edinburgh BioQuarter, Edinburgh, U.K
| | - Shao-Ting Jerry Tsang
- University of Edinburgh Centre for Inflammation Research, Queen's Medical Research Institute, Edinburgh BioQuarter, Edinburgh, U.K.,Department of Orthopaedic Surgery, University of Edinburgh, Chancellor's Building, Edinburgh, U.K
| | | | - Rebecca K Sutherland
- NHS Lothian Infection Service, Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, U.K
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Spellberg B, Wong D, Holtom P. Reply to Krsak and Damioli. Clin Infect Dis 2020; 70:180. [DOI: 10.1093/cid/ciz377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brad Spellberg
- Los Angeles County + University of Southern California Medical Center, and Division of Infectious Diseases, Keck School of Medicine, University of Southern California, Los Angeles
| | - Darren Wong
- Los Angeles County + University of Southern California Medical Center, and Division of Infectious Diseases, Keck School of Medicine, University of Southern California, Los Angeles
| | - Paul Holtom
- Los Angeles County + University of Southern California Medical Center, and Division of Infectious Diseases, Keck School of Medicine, University of Southern California, Los Angeles
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Krsak M, Damioli L. Is 2 Weeks of Treatment Enough for Cortical Bone Osteomyelitis? Clin Infect Dis 2020; 70:179. [DOI: 10.1093/cid/ciz375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Martin Krsak
- Division of Infectious Diseases, Subdivision Orthopedic Infectious Diseases, University of Colorado Denver, Aurora
| | - Laura Damioli
- Division of Infectious Diseases, Subdivision Orthopedic Infectious Diseases, University of Colorado Denver, Aurora
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Ingen-Housz-Oro S. Quoi de neuf en dermatologie clinique? Ann Dermatol Venereol 2019; 146:12S1-12S10. [DOI: 10.1016/s0151-9638(20)30100-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kaka AS, Beekmann SE, Gravely A, Filice GA, Polgreen PM, Johnson JR. Diagnosis and Management of Osteomyelitis Associated With Stage 4 Pressure Ulcers: Report of a Query to the Emerging Infections Network of the Infectious Diseases Society of America. Open Forum Infect Dis 2019; 6:ofz406. [PMID: 31696138 DOI: 10.1093/ofid/ofz406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/10/2019] [Indexed: 01/13/2023] Open
Abstract
Background Few studies exist to guide the management of patients with stage 4 pressure ulcers with possible underlying osteomyelitis. We hypothesized that infectious disease (ID) physicians would vary widely in their approach to such patients. Methods The Emerging Infections Network distributed a 10-question electronic survey in 2018 to 1332 adult ID physicians in different practice settings to determine their approach to such patients. Results Of the 558 respondents (response rate: 42%), 17% had managed no such patient in the past year. Of the remaining 464 respondents, 60% usually felt confident in diagnosing osteomyelitis; the strongest clinical indicator of osteomyelitis reported was palpable or visible bone at the ulcer base. Approaches to diagnosing osteomyelitis in patients with visible and palpable bone varied: 41% of respondents would assume osteomyelitis, 27% would attempt pressure off-loading first, and 22% would perform diagnostic testing immediately. Preferred tests for osteomyelitis were bone biopsy (for culture and histopathology) and magnetic resonance imaging. Respondents differed widely on favored route(s) (intravenous, oral, or both) and duration of antimicrobial therapy but would treat longer in the absence, vs presence, of full surgical debridement (P < .001). Overall, 62% of respondents opined that osteomyelitis under stage 4 pressure ulcers is usually or almost always treated excessively, and most (59%) suggested multiple topics for future research. Conclusions Regarding osteomyelitis underlying stage 4 pressure ulcers, ID physicians reported widely divergent diagnostic and treatment approaches. Most of the reported practice is not supported by the available evidence, which is quite limited and of low quality.
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Affiliation(s)
- Anjum S Kaka
- Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.,University of Minnesota, Minneapolis, USA
| | | | - Amy Gravely
- Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Gregory A Filice
- Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.,University of Minnesota, Minneapolis, USA
| | | | - James R Johnson
- Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.,University of Minnesota, Minneapolis, USA
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Zheng C, Mushatt D. Let's Join the Lane: The Role of Infectious Diseases Physicians in Preventing Gun Violence. Open Forum Infect Dis 2019; 6:ofz026. [PMID: 30882009 PMCID: PMC6411838 DOI: 10.1093/ofid/ofz026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 01/19/2019] [Indexed: 11/18/2022] Open
Abstract
On November 7, 2018, the National Rifle Association (NRA) issued a tweet advising “self-important anti-gun doctors to stay in their lane.” The tweet has galvanized physicians to share their experiences with gun violence through the grassroots #ThisISOurLane campaign. Infectious diseases physicians are regularly called upon to manage complications such as infected wounds and osteomyelitis in gunshot victims. Yet, Infectious Diseases as a specialty has been poorly represented in the national dialogue on gun violence. Over 80 medical societies have endorsed statements on gun violence, including the American College of Physicians (ACP) and the American College of Cardiology; the Infectious Diseases Society of America has not. We argue that gun violence does affect the Infectious Diseases community and issue a call to action to engage in the conversation, advocate for our patients, and join with other medical societies in affirming a commitment to gun violence prevention.
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Affiliation(s)
- Crystal Zheng
- Section of Infectious Diseases, Tulane University School of Medicine, New Orleans, Louisiana
| | - David Mushatt
- Section of Infectious Diseases, Tulane University School of Medicine, New Orleans, Louisiana
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