A quality audit of MRI knee exams with the implementation of a novel 2-point DIXON sequence.

INTRODUCTION: The objective of this study was to evaluate the effect on diagnostic image quality and acquisition time utilising a DIXON sequence to replace two standard proton density (PD) fat saturation (FS) sequences in routine magnetic resonance (MR) evaluation of the knee. METHODS: Thirty-one consecutive patients referred for an MR examination of the knee were examined using the routine departmental protocol along with the addition of a DIXON sequence. The sequences were all evaluated by a senior radiologist and feedback provided via both written and scored responses. The sequences were then repackaged for two additional reviewers with the sagittal PD FS (Chemical Shift Selective Fat Saturation or CHESS) and sagittal PD removed and replaced with the DIXON (fat suppressed and in-phase, respectively) sequence equivalents. Scored and written responses were tabled and reviewed to assess the suitability of sequence replacement. RESULTS: The DIXON-based images were judged as being comparable replacements for the sagittal PD fat sat and PD sequences. There was no report of any loss in diagnostic confidence across the 31 patients (total of 32 knees) with a time saving of just over 10% gained. The most common issues raised affecting image quality, though not affecting diagnostic attributes, were patient motion and a minor chemical shift artefact. CONCLUSION: The use of the DIXON technique in place of the PD sequences was of equivalent diagnostic quality with'good' to 'outstanding' fat suppression observed for the majority of cases using the DIXON sequence with an incremental time saving obtained.

Evaluating contemporary antibiotics as a risk factor for Clostridium difficile infection in surgical trauma patients.

BACKGROUND: With most Clostridium difficile infections (CDI) occurring after exposure to antimicrobial treatment, specific antibiotics and duration of exposure were evaluated independently for increased risk of CDI in surgical patients. METHODS: A retrospective, case-control design was used to study surgical inpatients. The case group had a positive Clostridium difficile toxin assay, whereas the control group did not. RESULTS: Four antibiotics had a risk that was statistically significant for causing CDI in surgical patients: cefepime (odds ratio [OR], 5.7; 95% confidence interval [CI], 1.7-19.1; p = 0.0044), imipenem/cilastatin (OR, 3.2; 95% CI, 1.2-8.9; p = 0.0388), piperacillin/tazobactam (OR, 2.4; 95% CI, 1.3-4.5; p = 0.0067), and vancomycin (OR, 1.9; 95% CI, 1.0-3.5; p = 0.0439). Exposure longer than 7 days to cefepime (p = 0.0006), piperacillin/tazobactam (p = 0.0021), and imipenem/cilastatin (p = 0.0171) also increased risk for development of CDI. CONCLUSION: The use of cefepime, imipenem/cilastatin, piperacillin/tazobactam, and vancomycin and the use of multiple classes of antibiotics for at least 7 days significantly increased the risk of CDI in surgical inpatients.