Factores de riesgo asociados a osteomielitis por Corynebacterium striatum en pacientes con pie diabético / Risk factors associated with osteomyelitis due to Corynebacterium striatum in patients with diabetic foot

Objetivo Corynebacterium striatum (C. striatum) es un microorganismo emergente en la infección de pie diabético poco estudiado. El objetivo es evaluar los factores de riesgo (FR) relacionados con osteomielitis por C. striatum en paciente con pie diabético. Métodos Estudio casos-controles en la Unidad de Pie Diabético entre 2015 y 2021. Un número de 44 pacientes con osteomielitis por C. striatum (casos) y 44 con osteomielitis por microorganismo distinto (controles) fueron incluidos. Resultados Enfermedad arterial periférica (odds ratio [OR]: 2,8, p = 0,037), fibrilación auricular (OR: 3,7, p = 0,034), pie diabético isquémico (OR: 3,3, p = 0,020) y antibioterapia previa prolongada más de 14 días (OR: 3,4, p = 0,012) fueron FR para la osteomielitis por C. striatum. En el análisis multivariado la antibioterapia más de 14 días fue el único FR independiente (OR: 3,46; p = 0,017) para osteomielitis por C. striatum. Conclusiones La antibioterapia previa recibida durante más de 14 días es un FR independiente y estadísticamente significativo de osteomielitis por C. striatum en pacientes con pie diabético (AU)

Objective Corynebacterium striatum (CS) is an emerging micro-organism in diabetic foot infection for which there are currently few studies. The objective was to analyze the risk factors (RF) related to CS osteomyelitis in patients with diabetic foot. Methods A case–control study was conducted in the Diabetic Foot Unit between 2015 and 2021. Forty-four patients with osteomyelitis due to CS (cases) and 44 patients with osteomyelitis due a different micro-organism (controls) were included. Results Peripheral artery disease (OR: 2.8, p = 0.037), atrial fibrillation (OR: 3.7, p = 0.034), ischemic diabetic foot (OR: 3.3, p = 0.020) and previous prolonged antibiotic therapy more than 14 days (OR: 3.4, p = 0.012) were identified as RF for osteomyelitis due to CS. When performing the multivariate analysis antibiotic therapy >14 days was independent RF (OR: 3.46; p = 0.017). Conclusions Previous antibiotic therapy received more than 14 days is an independent and statistically significant RF for CS osteomyelitis in patients with diabetic foot (AU)

[Risk factors associated with osteomyelitis due to Corynebacterium striatum in patients with diabetic foot]. / Factores de riesgo asociados a osteomielitis por Corynebacterium striatum en pacientes con pie diabético.

OBJECTIVE: Corynebacterium striatum (CS) is an emerging micro-organism in diabetic foot infection for which there are currently few studies. The objective was to analyze the risk factors (RF) related to CS osteomyelitis in patients with diabetic foot. METHODS: A case-control study was conducted in the Diabetic Foot Unit between 2015 and 2021. Forty-four patients with osteomyelitis due to CS (cases) and 44 patients with osteomyelitis due a different micro-organism (controls) were included. RESULTS: Peripheral artery disease (OR: 2.8, p = 0.037), atrial fibrillation (OR: 3.7, p = 0.034), ischemic diabetic foot (OR: 3.3, p = 0.020) and previous prolonged antibiotic therapy more than 14 days (OR: 3.4, p = 0.012) were identified as RF for osteomyelitis due to CS. When performing the multivariate analysis antibiotic therapy >14 days was independent RF (OR: 3.46; p = 0.017). CONCLUSIONS: Previous antibiotic therapy received more than 14 days is an independent and statistically significant RF for CS osteomyelitis in patients with diabetic foot.

Sucrose octasulfate dressing versus control dressing in patients with neuroischaemic diabetic foot ulcers (Explorer): an international, multicentre, double-blind, randomised, controlled trial.

BACKGROUND: Diabetic foot ulcers are serious and challenging wounds associated with high risk of infection and lower-limb amputation. Ulcers are deemed neuroischaemic if peripheral neuropathy and peripheral artery disease are both present. No satisfactory treatment for neuroischaemic ulcers currently exists, and no evidence supports one particular dressing. We aimed to assess the effect of a sucrose octasulfate dressing versus a control dressing on wound closure in patients with neuroischaemic diabetic foot ulcers. METHODS: We did a randomised, double-blind clinical trial (Explorer) in 43 hospitals with specialised diabetic foot clinics in France, Spain, Italy, Germany, and the UK. Eligible participants were inpatients or outpatients aged 18 years or older with diabetes and a non-infected neuroischaemic diabetic foot ulcer greater than 1 cm2 and of grade IC or IIC (as defined by the University of Texas Diabetic Wound Classification system). We excluded patients with a severe illness that might lead to them discontinuing the trial and those who had surgical revascularisation in the month before study entry. We randomly assigned participants (1:1) via a computer-generated randomisation procedure (concealed block size two); stratified by study centre and wound area (1-5 cm2 and 5-30 cm2), to treatment with either a sucrose octasulfate wound dressing or a control dressing (the same dressing without sucrose octasulfate) for 20 weeks. Both groups otherwise received the same standard of care for a 2-week screening period before randomisation and throughout the 20-week trial. Dressings were applied by nursing staff (or by instructed relatives for some outpatients). Frequencies of dressing changes were decided by the investigator on the basis of the clinical condition of the wound. Patients were assessed 2 weeks after randomisation, then monthly until week 20 or occurrence of wound closure. The primary outcome, assessed by intention-to-treat, was proportion of patients with wound closure at week 20. This trial is registered with ClinicalTrials.gov, number NCT01717183. FINDINGS: Between March 21, 2013, and March 31, 2016, we randomly assigned 240 individuals to treatment: 126 to the sucrose octasulfate dressing and 114 to the control dressing. After 20 weeks, wound closure occurred in 60 patients (48%) in the sucrose octasulfate dressing group and 34 patients (30%) in the control dressing group (18 percentage points difference, 95% CI 5-30; adjusted odds ratio 2·60, 95% CI 1·43-4·73; p=0·002). In both groups, the most frequent adverse events were infections of the target wound: 33 wound infections in 25 (20%) patients of 126 in the sucrose octasulfate dressing group and 36 in 32 (28%) patients of 114 in the control dressing group. Minor amputations not affecting the wound site were also reported in one (1%) patient in the sucrose octasulfate dressing group and two (2%) patients in the control dressing group. Three (2%) patients assigned to the sucrose octasulfate dressing and four (4%) assigned to the control dressing died, but none of the deaths were related to treatment, procedure, wound progression, or subsequent to amputation. INTERPRETATION: A sucrose octasulfate dressing significantly improved wound closure of neuroischaemic diabetic foot ulcers without affecting safety after 20 weeks of treatment along with standard care. These findings support the use of sucrose octasulfate dressing as a local treatment for neuroischaemic diabetic foot ulcers. FUNDING: Laboratoires Urgo Medical.

Diagnóstico del paciente vascular en una única consulta. Hacia una aplicación racional de los recursos / Diagnosis of vascular patients in a single visit. Towards a rational use of resources

Introducción. En cirugía vascular el modelo tradicional de la consulta médica exigía que el enfermo visitara el centro sanitario al menos en tres ocasiones. En el modelo de consulta de alta resolución, al realizar las exploraciones complementarias, se unifican las tres consultas en una. Objetivo. Plantear el modelo de única consulta en nuestro medio y analizar sus ventajas y desventajas mediante una descripción de los recursos necesarios. Pacientes y métodos. Estudio descriptivo de la actividad de consulta externa de Angiología y Cirugía Vascular en nuestro centro durante el mes de noviembre de 2004. Resultados. Durante ese mes atendimos en consulta a 432 pacientes: 148 nuevos (34,25%) y 284 (65,74%) revisiones. Se realizó alguna prueba diagnóstica al 100% de los pacientes con patología de troncos supraaórticos (TSA), hipertensión arterial /insuficiencia renal y fístula arteriovenosa; al 83% de los enfermos con aneurisma aortoilíaco; al 56% con arteriopatía periférica; y al 41% con insuficiencia venosa. Así, las pruebas complementarias se realizaron en el 40% (59/148) de los pacientes nuevos y en el 58% (165/284) de las revisiones. En todas las consultas se informó a los enfermos del resultado del estudio y del tratamiento necesario, por lo que evitamos 302 consultas sucesivas. El tiempo medio para la realización de un Doppler de miembros inferiores fue de 6 minutos; de un eco-Doppler de TSA, de 14 minutos; de uno abdominal, 9,6 minutos; femoral, 10 minutos; arterial preoperatorio de miembros inferiores, 50 minutos; venoso, 7,4 minutos, y renal, 30 minutos. Conclusiones. La consulta de alta resolución es factible en la mayoría de nuestros pacientes y disminuye el número de revisiones por cada caso

Introduction. In vascular surgery the traditional model of medical clinics required the patient to visit the health care centre on at least three occasions. In the one-stop clinic model, on performing the complementary examinations, the three visits become just one. Aim. To propose the single visit model in our area and to analyse its advantages and disadvantages by means of a description of the resources that would be needed. Patients and methods. We conducted a descriptive study of the activity in the Angiology and Vascular Surgery outpatient department in our centre during November 2004. Results. Throughout that month 432 patients visited: 148 were new cases (34.25%) and 284 (65.74%) were checkups. Diagnostic tests were carried out in 100% of patients with pathologies involving the supra-aortic trunks (SAT), arterial hypertension/renal failure and arteriovenous fistula; in 83% of patients with aortoiliac aneurysms; 56% of those with peripheral arterial disease; and 41% of subjects with venous insufficiency. Complementary tests were performed in 40% (59/148) of new patients and in 58% (165/284) of the checkups. In all visits patients were informed of the results of the study and the treatment they would require, which avoided the need for 302 successive visits. The average time required to perform a Doppler of the lower limbs was 6 minuts; a Doppler ultrasound recording of the SAT was 14 minutes; of the abdomen, 9.6 minutes; femoral, 10 minutes; preoperative arterial of the lower limbs, 50 minutes; venous, 7.4 minutes; and renal, 30 minutes. Conclusions. The one-stop clinic is a feasible proposition with most of our patients and reduces the number of checkups required by each case

Stent carotídeo por vía transcervical con reversión de flujo / Transcervical approach to carotid stenting with flow reversal

Introducción. El stent carotídeo con protección cerebral es una alternativa al tratamiento quirúrgico convencional en los pacientes de alto riesgo. Los sistemas de protección proximal son los únicos que previenen la embolia cerebral antes de cruzar la lesión. Recientemente se ha descrito una nueva técnica de stent carotídeo mediante abordaje cervical con reversión de flujo. Presentamos nuestra experiencia inicial con este procedimiento. Pacientes y métodos. Entre octubre de 2003 y noviembre de 2004 hemos tratado a 11 pacientes de alto riesgo, 9 varones y 2 mujeres, con una media de edad de 80 años (rango: 72-83 años), de los cuales el 91% era sintomático, uno de ellos con oclusión de la carótida interna contralateral. Resultados. Todos los pacientes se intervinieron con anestesia local, sin complicaciones neurológicas ni locales. Todos presentaron buena tolerancia a la reversión del flujo, y sólo hubo una bradicardia durante la dilatación (9%) resuelta con atropina. Todos fueron dados de alta en 48 horas. Durante el seguimiento medio de 11,1 meses (rango: 6-12 meses), un paciente falleció a los 3 meses por infección respiratoria. No hubo ningún evento neurológico. También hubo un paciente con reestenosis asintomática superior al 70%. Conclusiones. El tratamiento de la estenosis carotídea puede realizarse de forma sencilla y segura mediante la implantación de un stent por abordaje cervical con reversión de flujo. Elimina la dificultad de acceso en pacientes con enfermedad aortoilíaca o anatomía desfavorable del cayado, y evita las complicaciones femorales pospunción. Mientras no dispongamos de más datos sobre la efectividad y permeabilidad a largo plazo, preferimos reservar este procedimiento para los pacientes de alto riesgo (AU)

Introduction. Carotid stenting with cerebral protection is an option for the treatment of high-risk patients. Proximal occlusion catheters have the advantage of preventing cerebral embolisms before crossing the plaque. Recently a new transcervical approach with carotid flow reversal has been introduced for carotid artery stenting. We describe our initial experience with this technique. Patients and methods. Between October 2003 and November 2004 we have stented 11 high-risk patients, 9 men and 2 women, mean age 80 years (range: 72-83 years); 91% symptomatic, one of them associated contralateral carotid artery occlusion. Results. All procedures were successfully performed under local anesthesia without neurologic or local complications. Flow reversal was well tolerated in everyone, and one patient had angioplasty-induced bradycardia (9%) treated with atropine. All patients were discharged within 48 hours. During the 11.1 mean follow up (6-12 months) one patient died because of pneumonia. There was not any neurologic event. One patient had an asymptomatic reestenosis higher than 70%. Conclusions. Treatment of carotid stenosis can be accomplished simply and safely using the transcervical carotid artery stenting with flow reversal. It eliminates the problems of access in patients with aortoiliac disease or unfavourable arch anatomy, and avoids the femoral postpuncture complications. We prefer to keep this procedure for high-risk patients until more long-term patency rates are available (AU)