THERMOACTIVE NITINOL CLIPS AS PRIMARY AND SECONDARY STERNAL CLOSURE AFTER CARDIAC SURGERY - FIRST EXPERIENCE IN SLOVENIA.

Although there has been a trend towards minimally invasive and sternum-sparing procedures, median sternotomy is still a standard surgical approach in cardiac surgery. Many techniques and innovations for closure of sternal osteotomy have been developed with contradictory results. In this report, we present our first experience with the nitinol-made sternal closure system in the primary, as well as secondary closure of sternal osteotomy. A small series of 20 patients had their sternotomy closed with Flexigrip clips. In one case, the Flexigrip clips were used in secondary wound closure in a patient with deep sternal wound infection after full sternotomy and coronary bypass surgery. After 6-month follow-up, all patients were doing well with their sternums clinically stable and the sternotomy wounds completely healed. In conclusion, Flexigrip clips offered a stable alternative to steel wires in primary, as well as secondary sternal closure. Moreover, in secondary sternal closure, the thermoactive clips offered safety advantages over the standard wire cerclage technique because the need for dissection of the substernal adhesions could be avoided.

Antimicrobial Use in Hospitalised Patients with COVID-19: An International Multicentre Point-Prevalence Study.

Studies suggest that the incidence of coinfections in patients with the coronavirus disease 2019 (COVID-19) is low, but a large number of patients receive antimicrobials during hospitalisation. This may fuel a rise in antimicrobial resistance (AMR). We conducted a multicentre point-prevalence survey in seven tertiary university hospitals (in medical wards and intensive care units) in Croatia, Italy, Serbia and Slovenia. Of 988 COVID-19 patients, 521 were receiving antibiotics and/or antifungals (52.7%; range across hospitals: 32.9-85.6%) on the day of the study. Differences between hospitals were statistically significant (χ2 (6, N = 988) = 192.57, p < 0.001). The majority of patients received antibiotics and/or antifungals within 48 h of admission (323/521, 62%; range across hospitals: 17.4-100%), their most common use was empirical (79.4% of prescriptions), and pneumonia was the main indication for starting the treatment (three-quarters of prescriptions). The majority of antibiotics prescribed (69.9%) belonged to the "Watch" group of the World Health Organization AWaRe classification. The pattern of antimicrobial use differed across hospitals. The data show that early empiric use of broad-spectrum antibiotics is common in COVID-19 patients, and that the pattern of antimicrobial use varies across hospitals. Judicious use of antimicrobials is warranted to prevent an increase in AMR.

Mycoplasma hominis Ascending Aortic Graft Infection Successfully Treated With Graft Preservation Using Negative Pressure Wound Therapy With Instillation and Dwell Time.

INTRODUCTION: Thoracic aortic graft infection is a rare complication after cardiac surgery with no consensus having been reached on the most appropriate type of management. Although most commonly caused by gram-positive cocci, aortic graft infection by Mycoplasma hominis can occur. CASE REPORT: A 63-year-old male patient with an aneurysm of the ascending aorta was admitted to the authors' institution for surgical treatment. A replacement of the ascending aorta with a polyester vascular graft was performed using a valve-sparing aortic valve reimplantation technique. During postoperative course, the patient became septic with a spiking fever and elevated inflammatory markers. A computed tomography scan revealed signs of mediastinitis. M hominis was identified in blood cultures and intraoperative tissue samples. An antibiogram-based antibiotic solution (tigecycline in 5% glucose solution) was instilled twice daily into the thoracic cavity using negative pressure wound therapy with instillation and dwell time for 8 days. This type of management allowed the authors to avoid graft replacement, and good midterm outcomes were achieved. CONCLUSIONS: To the authors' best knowledge, this is the first described successful treatment of an aortic graft infection caused by M hominis without a surgical removal of the prosthetic material using antibiotic irrigation.

Complete Coding Sequence of a Chikungunya Virus Strain Imported into Slovenia from Thailand in Late 2018.

A case of chikungunya virus infection was imported from Thailand into Slovenia in late 2018. The infection was diagnosed using real-time reverse transcription-PCR, the virus was isolated in cell culture, and the whole genome was sequenced. Phylogenetic analysis of the nearly complete viral genome indicated that the virus belongs to the Indian Ocean lineage but does not possess the A226V mutation in the envelope protein E1.