Is oral antibiotic therapy as effective as intravenous treatment in bacterial osteomyelitis? A real-life experience.

OBJECTIVE: Osteomyelitis is a relatively understudied disease with no standardized and evidence-based approach to treatment. We aimed to evaluate a cohort of patients with osteomyelitis, comparing the outcomes between intravenous (IV) and oral treatment. PATIENTS AND METHODS: We performed an observational retrospective study on osteomyelitis cases in adult patients seen for care between 2017 and 2019. We collected information on patient characteristics, microbiological etiology, infection treatment, and outcome. In addition, we divided osteomyelitis cases by antibiotic regimens [oral (OTG) vs. intravenous±oral (ITG)] and therapy durations to evaluate outcomes differences. RESULTS: A total of 235 episodes of osteomyelitis were evaluated, with a higher prevalence in male gender. Staphylococci, especially S. aureus, were the most common strains. Out of the 235 evaluated episodes, we selected 142 cases. Of these, 75 were treated with OTG and 67 with ITG. Gram-positive bacteria were the most frequent aetiological agents, with 81 isolates (61.8%). Full recovery was observed in 79 (55.6%) cases; of these, 36 (53.7%) were in the ITG and 43 (57.3%) in the OTG (p = 0.666). At the logistic regression, a polymicrobial infection [OR 4.16 (95%CI 1.28-13.4), p = 0.017] and a less than six weeks treatment duration [OR 4.24 (95%CI 1.38-5.43) p = 0.004] were significantly associated with a higher risk of treatment failure. CONCLUSIONS: Our study suggests that oral treatment efficacy is comparable to ITG therapy for osteomyelitis, confirming the most recent evidence suggesting that oral therapy is non-inferior to intravenous therapy to treat osteomyelitis.

Risk factors and incidence of long-COVID syndrome in hospitalized patients: does remdesivir have a protective effect?

BACKGROUND: The definition of 'long-COVID syndrome' (LCS) is still debated and describes the persistence of symptoms after viral clearance in hospitalized or non-hospitalized patients affected by coronavirus disease 2019 (COVID-19). AIM: In this study, we examined the prevalence and the risk factors of LCS in a cohort of patients with previous COVID-19 and followed for at least 6 months of follow-up. DESIGN: We conducted a prospective study including all hospitalized patients affected by COVID-19 at our center of Infectious Diseases (Vercelli, Italy) admitted between 10 March 2020 and 15 January 2021 for at least 6 months after discharge. Two follow-up visits were performed: after 1 and 6 months after hospital discharge. Clinical, laboratory and radiological data were recorded at each visit. RESULTS: A total of 449 patients were included in the analysis. The LCS was diagnosed in 322 subjects at Visit 1 (71.7%) and in 206 at Visit 2 (45.9); according to the post-COVID-19 functional status scale we observed 147 patients with values 2-3 and 175 with values >3 at Visit 1; at Visit 2, 133 subjects had the score between 2-3 and 73 > 3. In multivariate analysis, intensive care unit (ICU) admission (OR = 2.551; 95% CI = 1.998-6.819; P = 0.019), time of hospitalization (OR = 2.255; 95% CI = 1.018-6.992; P = 0.016) and treatment with remdesivir (OR = 0.641; 95% CI = 0.413-0.782; P < 0.001) were independent predictors of LCS. CONCLUSIONS: Treatment with remdesivir leads to a 35.9% reduction in LCS rate in follow-up. Severity of illness, need of ICU admission and length of hospital stay were factor associated with the persistence of PCS at 6 months of follow-up.

Epidemiological and clinical features of prosthetic joint infections caused by gram-negative bacteria.

OBJECTIVE: To review the clinical literature focusing on epidemiology, clinical presentation and outcomes of prosthetic joint infections (PJIs) due to gram-negative bacteria (GNB) and to report the experience of a multicentric cohort. PATIENTS AND METHODS: A retrospective, observational, cohort study was performed in three Italian hospitals. All consecutive PJIs caused by GNB over a 12-year period (from May 2007 to March 2018) were enrolled. Epidemiological, clinical, microbiological and therapeutic features were described. Factors related to treatment failure (defined as the occurrence of death, amputation or starting long-term antimicrobial suppression therapy) were analysed with a Cox regression model. RESULTS: A total of 82 PJIs due to GNB (42.7% men; median age 73 years) were studied. The implants included 65 (79.3%) hip, 16 (19.5%) knee and one (1.2%) shoulder. An early PJI was diagnosed in 16.2% of patients, a delayed PJI in 29.4% and a late PJI in 54.4%. The most common isolated organisms were Escherichia coli (21.7%) and Pseudomonas spp. (20.9%). 13.4% of the isolates were carbapenem-resistant bacteria (CRB). In 53.8% of cases a two-stage exchange arthroplasty was performed and in 32.5% a Girdlestone excision arthroplasty. The average therapeutic failure occurred in 17.7% of cases. The therapeutic failure rate of the two-stage was 10%. PJI due to CRB was identified as a potential risk factor for failure (aHR 4.90; IC 95%, 0.96-25.08; p=0.05). The therapeutic failure rate in the CRB group was 50%. CONCLUSIONS: The treatment with the two-stage procedure for PJIs caused by GNB seems to be associated with a low rate of failure, while PJI due to CRB seems to be related to the worst outcome.

Carotid stenting without use of balloon angioplasty and distal protection devices: preliminary experience in 100 cases.

BACKGROUND AND PURPOSE: A major concern during carotid artery stent placement is the potential for cerebral embolism. Diminishing the number of device manipulations across the lesion might reduce procedural stroke risk. For this purpose, we report our initial experience with carotid stent placement without the use of either balloon angioplasty or distal protection devices. MATERIALS AND METHODS: Eighty-seven consecutive patients with 100 carotid stenoses compose this series. Ninety four of the 100 hundred stented carotid arteries were either symptomatic (58 [58%]) or had a greater than 70% stenosis (36 [36%]). Six percent of them were asymptomatic and had stenosis between 50% and 70%. Patients underwent neurologic evaluation before the procedure and during follow-up at 1, 3, 6, and 12 months and annually thereafter. Carotid sonography and plain films of the neck were performed immediately after the procedure and then at the same time intervals. RESULTS: Primary stent placement was successful in 98 of 100 case subjects. In 2 case subjects, predilation was necessary before stent deployment. Neurologic periprocedural complications included 1 nondisabling and 1 disabling stroke and 5 transient ischemic attacks. The mean duration of follow-up was 23 months (range: 10-36 months). During the follow-up period, there were 5 deaths, all unrelated to the carotid disease, and no major stroke. The degree of stenosis decreased from a mean of 78.85% before the procedure to a mean of 21.23% immediately after. CONCLUSIONS: In this series, carotid stent placement without the use of either balloon angioplasty or distal protection devices was safe and effective with a low incidence of periprocedural complications.

Trombólisis y trombectomía endovascular selectiva en trombosis venosa profunda / Thrombolysis and selective endovascular thrombectomy in deep venous thrombosis

Se efectuó trombólisis y/o trombectomía selectiva en una serie de pacientes con trombosis axilosubclavia (n=13), trombosis en vena cava (n=10), trombosis en venas ileofemorales (n=15) y en venas braquiales o antebraquiales de los miembros superiores asociadas a fístulas de diálisis (n=43). Se realizó trombólisis intratrombótica por cateterismo utilizando Urokinasa (UK) 1000U/kg y/o tromboaspiración mecánica con abordaje percutáneo en la sala de angiografía continuando con infusión prolongada.El procedimiento fue técnicamente posible en todos los casos ...La trombólisis endovascular selectiva es una alternativa válida a tratamientos médicos o quirúrgicos clásicos.Realiazada con un equipo angiográfico adecuado y por un equipo médico experimentado en terapia endoluminal venosa, los resultados son muy satisfactorios y las complicaciones infrecuentes

Vertebroplastia percutanea como tratamiento de los colapsos vertebrales / Percutaneous vertebroplasty in the treatment

La vertebroplastia percutanea es una tecnica que consiste en la inyeccion de cemento acrilico en el interior del cuerpo de una vertebra patologica a traves de una aguja colocada bajo guia imagenologica. Esta indicada en colapsos vertebrales de origen neoplasico osteoporotico y en angiomas vertebrales. El objetivo es la analgesia y el refuerzo de la vertebra dañada por el colapso. En la serie que se presenta hemos tratado 46 vertebras en 35 pacientes: 3 angiomas, 9 metastasis, 3 mielomas y 31 aplastamientos osteoporoticos

Utilización de "stents" autoexpansibles en el síndrome de vena cava superior / Use of selfexpandable endoprosthesis in upper cava vein syndrome

Antecedentes: el SVCS responde a causas malignas en más del 90 por ciento de los casos. La conjunción de disnea y encefalopatía previene sobre un rápido curso ominoso. El tratamiento con quimio y/o radioterapia (a excepción de los linfomas) no suele tener éxito inmediato. La cirugía de derivación resulta difícil y sumamente riesgosa en pacientes con poca expectativa de supervivencia prolongada. Objetivos: demostrar la utilidad del empleo de endoprótesis auto expansibles para repermeabilizar la VCS. Lugar de aplicación: Centro Asistencial Universitario. Diseño: estudio observacional retrospectivo. Material y método: entre 1994 y 1999 fueron tratados 21 pacientes portadores de SVCS, con endoprótesis autoexpansibles. Hubo 15 hombres y 6 mujeres. La edad media fue 53 años (rango 26-70). La etiología fue benigna en 2 casos (trombosis por catéter) y maligna en 19. Once pacientes fueron tratados previamente con quimio y/o radioterapia. La colocación del "stent" se efectuó por punción percutánea vía femoral en 18 casos y por vena basílica en 3. Se utilizó un introductor 10 F valvulado y pre-dilatación con balón de angioplastía de 8-10 mm de diámetro. Los "stents" implantados fueron del tipo Wallstent Boston Scientific, cuyo diámetro osciló entre 10-16 mm. Quince pacientes efectuaron posteriormente tratamiento con quimio y/o radioterapia. Resultados: todos los procedimientos resultaron técnicamente exitosos, con desaparición de los síntomas dentro de las primeras 24-48 hs. Un paciente en el cual se demoró la indicación falleció después de la implantación del "stent" como consecuencia de insuficiencia respiratoria por neoplasia avanzada. La supervivencia media fue de 7 meses. Conclusiones: la utilización de endoprótesis para recanalización de la VCS ofrece excelentes resultados en manos de equipos experimentados con rápida remisión del cuadro clínico

Tratamiento del síndrome de vena cava superior maligno con stents autoexpandibles / Treatment of superior vena cava syndrome with endovascular stent placement

Debido al avance en técnicas de intervencionismo en los últimos años, se ha desarrollado una alternativa terapéutica que permite la repermeabilización completa de la vena cava superior (VCS) a través del uso de endoprótesis vasculares (stents) autoexpansibles. Esta técnica permite la resolución del síndrome de VCS en forma inmediata como tratamiento paliativo o adyuvante de otras modalidades terapéuticas en obstrucciones secundarias a patología maligna. Objetivo: comunicar los resultados de la primera serie consecutiva de pacientes con síndrome de VCS tratados con ésta técnica en nuestro país. Pacientes y métodos: once pacientes con síndrome de VCS, 8 con diagnóstico de cáncer de pulmón (4 adenocarcinomas, 4 epidermoides), 2 cánceres de mama y 1 paciente con un linfoma no Hodgkin fueron tratados con la implantación de stents autoexpandibles. Todos los procedimientos se realizaron en la sala de angiografía digital por punción percutánea de la vena femoral (10 casos) o basílica (1 caso) y cateterismo selectivo de la VCS. Resultados: la técnica resultó exitosa y la colocación correcta en todos los casos. En el 91 por ciento, los síntomas desaparecieron completamente, en el 9 por ciento restante (n=1) se observó una marcada mejoría sin obtener remisión completa. No se registraron recidivas. La sobrevida media fue 8 meses (rango 2-22). No se observó morbilidad ni mortalidad atribuibles al procedimiento. Conclusión: la colocación de stents es un procedimiento seguro y eficaz para el tratamiento de la obstrucción maligna de la VCS

Citopunción ecoguiada de lesiones mamarias no palpables. Ventajes y limitaciones / Cytopuncture guided of nonpalpable breast lessions. Advantes and limitations

La nueva imagenología mamaria ha descubierto un grupo de lesiones no palpables que puede alcanzar hasta el treinta por ciento de los casos examinados

Estudio multicéntrico de la metodología diagnóstica no intervencionista en patología mamaria: su evaluación crítica y estandarización / Multicentric study of the non interventional diagnostic methodology of breast pathology: evaluation and standard parameters

Un análisis crítico de todos los procesos que surgen en un estudio estándar básico mamario en mujeres asignológicas a la hora de emitir un diagnóstico, son considerados en este trabajo. El estándar del estudio básico mamario es la mamografía bilateral con sus prolongaciones axilares y el examen clínico de las mamas. La muestra poblacional representó 3.419 estudios mamarios consecutivos en 30 días de atención (99,7 por ciento mujeres y 0,3 por ciento hombres). Del análisis de la muestra poblacional femenina (3.410 mujeres) mostró un 68 por ciento (n=2.322) de asignológicas. Las imágenes problemas se presentaron en 1. la mama densa (n.791/34 por ciento), 2. la mama con prótesis (n.41/2 por ciento) y 3. en las anormalidades mamográficas focales: densidades y microcalcificaciones (n=796/34 por ciento). En estas tres circunstancias el mamografista tuvo que complementar la tarea realizando imágenes mamográficas y ecográficas extras cerrando así la cadena de la información. Estos procesos exigieron al médico mayor dedicación. Se documentó una duplicación promedio del gasto en materiales y tiempo. De la demanda de estudios mamarios estándar en mujeres iniciadas se observa que: 1. el mayor número correspondió a mujeres asignológicas (68 por ciento); 2. en este grupo sólo terminaron la indicación básica inicial el 30 por ciento; 3. el 70 por ciento restante, ofrece una tarea complementaria anexa y necesaria para expedirse como estudio integral y con una orientación diagnóstica confiable

Outcome of percutaneous intervention in iliac artery stents.

PURPOSE: To assess the safety and efficacy of secondary procedures in iliac artery stents. MATERIALS AND METHODS: Thirty-four patients (36 limbs) underwent one or more interventional procedures in iliac artery stents to treat restenosis (n = 30) or occlusion (n = 6). All patients were followed up by means of clinical and angiographic examination. Primary and secondary patency were assessed with angiography, duplex ultrasound, or both. Primary patency was determined after one interventional procedure, and secondary patency was determined at the end of the study (mean +/- standard deviation, 20.1 months +/- 17.5; range, 1-58 months). RESULTS: Immediate angiographic success was achieved in all cases. Four complications were observed. The primary and secondary cumulative patency rates were 77.5% +/- 7.6 and 94% +/- 4.1 at 6 months, 73% +/- 8.4 and 89.3% +/- 6 at 12 months, and 51.4% +/- 10.9 and 78.8% +/- 8.8 at 2 years. At the end of the study, 80% of the arteries were still nominally patent. CONCLUSION: Restenosis and chronic occlusion in iliac artery stents can be treated with percutaneous interventional procedures; however, stenosis can still recur.

Transjugular intrahepatic portosystemic shunt: early experience with a flexible trocar/catheter system.

OBJECTIVE: The purpose of this study was to determine the feasibility of using a flexible trocar/catheter system to create a transjugular intrahepatic portosystemic shunt (TIPS). SUBJECTS AND METHODS: A flexible needle/trocar was used to connect the hepatic vein to the portal vein in 23 patients with portal hypertension and a history of bleeding gastroesophageal varices. Five patients had signs and symptoms of encephalopathy before shunting; in four, the disease was classified as Child's class C and in one, as Child's class B. Nine-millimeter self-expandable metallic stents were used in all patients. RESULTS: The procedure was technically successful in all patients. The mean portosystemic pressure gradient decreased from 26 to 16 mm Hg (range, 7-23 mm Hg). Eight patients have died. One patient in a hepatic coma with hepatorenal failure survived percutaneous portosystemic shunting, but died 2 days after the TIPS procedure was done. After creation of the shunt, three other patients died of unrelated disease without recurrence of bleeding from gastroesophageal varices. Two patients died of massive bleeding from esophageal varices, one 24 hr after shunting and one of disseminated intravascular coagulation after a second attempt to establish a shunt. One patient died of sepsis associated with infected ascitic fluid 2 months after the TIPS procedure was done, and one died of unknown causes 4 months after the procedure was done. The mean follow-up time in the surviving 15 patients was 12 months. Seven patients had recurrence of gastrointestinal bleeding; the recurrence was due to a thrombosed shunt in two, to hepatic vein stenosis in four, and to a high portosystemic pressure gradient (22 mm Hg) after creation of the shunt in one. Hepatic vein stenosis was noted on portal venograms in another three otherwise asymptomatic patients. In four of five patients, encephalopathy was adequately controlled after shunting. The fifth patient with encephalopathy (Child's class C) and an additional patient in whom encephalopathy (Child's class C) developed after the TIPS procedure have had two additional hospital admissions because of difficulty in controlling the encephalopathy. The amount of ascitic fluid decreased or totally disappeared after treatment in all cases. No severe complications associated with creation of a TIPS were observed. CONCLUSION: Use of a flexible trocar/catheter system to create a TIPS is a simple, safe, and moderately reliable means of decompressing the portal vein in patients with portal hypertension.

Intraparenchymal anesthesia infiltration during transjugular intrahepatic portosystemic shunting.

The authors describe a technique for administration of anesthetic to the area of the transparenchymal tract during transjugular percutaneous transhepatic portosystemic shunting. Seven of the eight patients in whom the technique was used did not experience pain during balloon dilation of the tract, and one patient experienced only minimal pain. The technique allows good pain control in patients with severe liver failure and resultant inability of the liver to metabolize pharmaceuticals.