Characterization of wound infections among patients injured during the Ruso-Ukrainian war in a Role 4 hospital.

INTRODUCTION: The management of infections in war wounds is a problem aggravated by the presence of multiresistant bacteria and requires a combined approach with surgery. Literature has identified the risks and patterns of antibiotic resistance in previous armed conflicts, but the Russian-Ukrainian conflict has required the study of specific bacterial resistance patterns. METHODS: We included war-injured patients from the Russian-Ukrainian conflict transferred for treatment to the General Defense Hospital of Zaragoza from May 2022 to October 2023. Epidemiological data, factors related to the injury, presence of infection and microbiological results were collected; These data were subsequently analyzed statistically. RESULTS: Fifty-three patients were included in the study, with a mean age of 35.6 years; 83% were injured by an explosive mechanism and all received antibiotic therapy prior to transfer. Seventeen patients had skin, soft tissue or joint infection. Correlation was demonstrated with the presence of bone lesion (p 0.03), skin coverage defect (p 0.000) and presence of foreign bodies (p 0.006). Nine patients had monomicrobial cultures, and the most frequently isolated microorganisms were Gram negative bacilli (GNB) and Staphylococcus aureus. Virtually all GNB presented some resistance mechanism. CONCLUSION: Our work shows the correlation of war wound infection with the presence of foreign bodies and affected tissues. Likewise, the presence of polymicrobial wounds is emphasized, with a predominance of GNB and multidrug-resistant S. aureus.

[Pleural empyema due to Gemella spp: report of 12 cases]. / Empiemas pleurales por Gemella spp: una etiología no tan infrecuente.

BACKGROUND: Gemella genus bacteria can produce localized or generalized severe infections, but very rarely they have been described as causing pulmonary infections or pleural empyemas. AIM: To characterize patients with empyema caused by Gemella genus bacteria. MATERIAL AND METHODS: The database of a Microbiology laboratory of a Spanish hospital was reviewed, searching for Gemella positive cultures of pleural effusions in a period of five years. RESULTS: We identified 12 patients (11 males) with Gemella spp pleural empyema. Eight were infected with G. haemolysans and four with G. morbillorum. All patients had predisposing factors such as poor oral hygiene, smoking, chronic cardiovascular or respiratory disease, alcoholism or malignancies. In ten cases, a thoracic drainage tube was placed with fibrinolysis in seven. One patient needed surgery because of a relapse of the empyema. Two patients died because of an advanced neoplasm, and the empyema was resolved in the rest. CONCLUSIONS: Gemella pleural empyema can occur and its isolation must not be seen as a contamination.

[Reliability of the PROFUND index to predict 4-year mortality in polypathological patients]. / Utilidad del índice PROFUND para predecir la mortalidad a los 4 años en pacientes pluripatológicos.

OBJECTIVE: To determine the usefullness of the PROFUND index to assess the risk of global death after 4 years in polypathological patients. PATIENTS AND METHODS: Multicenter prospective cohort (Internal Medicine and Geriatrics) study. Polypathological patients admitted between March 1st and June 30th 2011 were included. For each patient, data concerning age, sex, living at home or in a nursing residence, polypathology categories, Charlson, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, socio-familial Gijon scale, delirium, number of drugs, hemoglobin and creatinine values were gathered, and the PROFUND index was calculated. The follow-up lasted 4 years. RESULTS: We included 441 patients, 324 from Internal Medicine and 117 from Geriatrics, with a mean age of 80.9 (8.7) years. Of them, 245 (55.6%) were women. Heart (62.7%), neurological (41.4%) and respiratory (37.3%) diseases were the most frequent. Geriatrics inpatients were older and more dependants and presented greater cognitive deterioration. After 4 years, 335 (76%) patients died. Mortality was associated with age, dyspnoea, Barthel index<60, delirium, advanced neoplasia and≥4 admissions in the last year. The area under the curve of the PROFUND index was 0.748, 95% CI 0.689-0.806, P<.001 in Internal Medicine and 0.517, 95% CI 0.369-0.666, P=.818 in Geriatrics patients, respectively. CONCLUSIONS: The PROFUND index is a reliable tool for predicting long-term global mortality in polypathological patients from Internal Medicine but not from Geriatrics departments.

Empiemas pleurales por Gemella spp: una etiología no tan infrecuente / Pleural empyema due to Gemella spp: Report of 12 cases

Background: Gemella genus bacteria can produce localized or generalized severe infections, but very rarely they have been described as causingpulmonary infections or pleural empyemas. Aim: To characterize patients with empyema caused by Gemella genus bacteria. Material and Methods: The database of a Microbiology laboratory of a Spanish hospital was reviewed, searchingfor Gemella positive cultures ofpleural effusions in a period offive years. Results: We identified 12 patients (11 males) with Gemella spp pleural empyema. Eight were infected with G. haemolysans and four with G. morbillorum. All patients had predisposingfactors such as poor oral hygiene, smoking, chronic cardiovascular or respiratory disease, alcoholism or malignancies. In ten cases, a thoracic drainage tube was placed with fibrinolysis in seven. One patient needed surgery because of a relapse of the empyema. Two patients died because of an advanced neoplasm, and the empyema was resolved in the rest. Conclusions: Gemella pleural empyema can occur and its isolation must not be seen as a contamination.