Effects of extended oral antibiotic prophylaxis on surgical site infections after instrumented spinal fusion: a cohort study of 901 patients with a minimum follow-up of 1 year.

BACKGROUND AND PURPOSE: We aimed to determine whether an extended oral antibiotic prophylaxis protocol may reduce the rate of surgical site infection (SSI) in patients undergoing instrumented spinal fusion. PATIENTS AND METHODS: This retrospective cohort study comprise 901 consecutive patients subjected to spinal fusion between September 2011 and December 2018 with a minimum 1-year follow-up. 368 patients operated on between September 2011 and August 2014 were administered standard intravenous prophylaxis. 533 patients operated on between September 2014 and December 2018 were administered an extended protocol with 500 mg of oral cefuroxime axetil every 12 hours (clindamycin or levofloxacin in allergic individuals) until the removal of sutures. SSI was defined following the Centers for Disease Control and Prevention criteria. The association between risk factors and the incidence of SSI was evaluated by odds ratio (OR) with a multiple logistic regression model. RESULTS: The bivariate analysis showed a statistically significant association between SSI and the type of prophylaxis used ("extended"' = 1.7% vs. "standard" = 6.2%, p= 0.001), with a lower proportion of superficial SSIs with the extended regimen (0.8% vs. 4.1%, p = 0.001). The multiple logistic regression model showed an OR = 0.25 (95% confidence interval [CI] 0.10-0.53) for extended prophylaxis and an OR = 3.5 (CI 1.3-8.1) for non-beta-lactams antibiotics. CONCLUSION: Extended antibiotic prophylaxis seems to be associated with a reduction in the incidence of superficial SSI in instrumented spine surgery.

Accuracy of a Novel Preoperative Failure Risk Model for Debridement Antibiotics and Implant Retention (DAIR) in Acute Prosthetic Joint Infection.

Given the variable success of the debridement, antibiotics and implant retention (DAIR) procedure in patients with acute prosthetic joint infection (PJI), an accurate selection of candidates is critical. In this study, we set about calculating the predictive value of a novel algorithm for predicting outcome following DAIR developed by Shohat et al. Sixty-four patients who underwent debridement for (early and late) acute PJI in a tertiary-level university hospital were selected, and the aforementioned algorithm was retrospectively applied. Patients with model scores of 40−50%, 50−60%, 60−70%, 70−80% and 80−90% displayed success rates of 33.34%, 41.18%, 57.9%, 78.27% and 100%, respectively. The receiver operating characteristic curve showed an area under the curve of 0.69. The calibration intercept value was 0, and the calibration slope value was 1. Failure rates were significantly higher for the following variables: revision surgery (p = 0.012) index surgery for reasons other than osteoarthritis (p = 0.01), and C-reactive protein level >30 mg/L (p = 0.042). This analysis demonstrated that the Shohat algorithm is associated with an optimal calibration value and a moderate predictive value for failure of a DAIR procedure in patients with acute PJI. Its validation is recommended before it can be routinely applied in daily practice.

Redo DAIR: The Game Is Seldom Worth the Candle.

Debridement, antibiotics and implant retention (DAIR) remains a commonly utilized technique in the treatment of acute prosthetic joint infections despite its inconsistent outcomes. The performance of a second DAIR after a failed first debridement is controversial as outcomes are uncertain and the final prognosis in the event of failure may be unfavorable. This study analyzes 84 cases of acute prosthetic (hip & knee) joint infection treated with DAIR between 2011 and 2020 at the same institution. In 12 failed cases, a second DAIR was performed, whose success rate was significantly lower than that of the first procedure (8% [95% CI, 0-38] vs. 57% [46-68]). Moreover, the ultimate outcome of the second failed DAIRs was unfavorable with eradication of the infection being achieved in none of the patients. Due to the high likelihood of failure and the potentially grim final prognosis following a second debridement, removal of the components should be considered.

m-Health en pacientes atendidos por Medicina Interna / m-Health in patients attended in an Internal Medicine department

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[Prognostic significance of the hepatopulmonary syndrome in liver cirrhosis]. / Significado pronóstico del síndrome hepatopulmonar en la cirrosis hepática.

BACKGROUND AND OBJECTIVE: The prognosis of hepatopulmonary syndrome (HPS) has been only rarely investigated. PATIENTS AND METHOD: We investigated the survival of 32 cirrhotic patients, 14 (44%) with HPS and 18 with a normal gaseous exchange (NGE), and the associated factors. RESULTS: During a mean (standard deviation) of 56 (27) months, 9 patients in the HPS group (relative risk: 0.64) and 4 patients in the NGE group (relative risk: 0.22) died. The odds ratio was 6.42 (p < 0.01; 95% confidence interval, 0.04-0.80). Patients in the HPS group died after 44 (31) months, while patients in the NGE group died 65 (21) months after inclusion (p < 0.05). Overall, 46% of deaths were liver related. Factors associated with death were the right to left shunting and the increased plasmatic renin levels. Of note, the plasmatic volume and diffusing capacity were protective. CONCLUSIONS: The coexistence of HPS worsens the prognosis in liver cirrhosis.

Significado pronóstico del síndrome hepatopulmonar en la cirrosis hepática / Prognostic significance of the hepatopulmonary syndrome in liver cirrhosis

Fundamento y objetivo: El significado pronóstico del síndrome hepatopulmonar (SHP) se ha estudiado en pocas ocasiones. Pacientes y método: Observación de la supervivencia de 32 pacientes cirróticos, 14 (44%) de ellos con SHP y 18 con intercambio gasesoso normal (IGN), y estudio de los factores asociados. Resultados: Durante una media (desviación estándar) de 56 (27) meses fallecieron 9 pacientes (riesgo relativo de 0,64) del grupo SHP y 4 (riesgo relativo de 0,22) de los pacientes con IGN (odds ratio = 6,42; p < 0,01; intervalo de confianza del 95%, 0,04-0,80). Los pacientes con SHP fallecieron una media de 44 (31) meses tras la inclusión y los pacientes con IGN, 65 (21) meses tras la inclusión (p < 0,05). No todos los fallecimientos estuvieron relacionados con enfermedad hepática o disfunción pulmonar. Los factores asociados a mortalidad fueron el grado de shunt pulmonar y los valores plasmáticos de renina, mientras que el volumen plasmático y la capacidad de difusión de monóxido de carbono fueron factores de protección. Conclusiones: El SHP empeora el pronóstico de la cirrosis hepática

Background and objective: The prognosis of hepatopulmonary syndrome (HPS) has been only rarely investigated. Patients and method: We investigated the survival of 32 cirrhotic patients, 14 (44%) with HPS and 18 with a normal gaseous exchange (NGE), and the associated factors. Results: During a mean (standard deviation) of 56 (27) months, 9 patients in the HPS group (relative risk: 0.64) and 4 patients in the NGE group (relative risk: 0.22) died. The odds ratio was 6.42 (p < 0.01; 95% confidence interval, 0.04-0.80). Patients in the HPS group died after 44 (31) months, while patients in the NGE group died 65 (21) months after inclusion (p < 0.05). Overall, 46% of deaths were liver related. Factors associated with death were the right to left shunting and the increased plasmatic renin levels. Of note, the plasmatic volume and diffusing capacity were protective. Conclusions: The coexistence of HPS worsens the prognosis in liver cirrhosis