30-day Mortality Rate Research Articles

Time to positivity as a predictor of catheter-related bacteremia and mortality in adults with Pseudomonas aeruginosa bloodstream infection

BackgroundTime to positivity (TTP) and differential TTP (DTP) emerge as diagnostic and prognostic tools for bloodstream infections (BSI) though specific cut-off values need to be determined for each pathogen. Pseudomonas aeruginosa BSI (PAE-BSI) is of critical concern, particularly in immunocompromised patients, due to high mortality rates. Catheter-related infections are a common cause, necessitating rapid and accurate diagnostic tools for effective management (source-control).MethodsUnicentric retrospective observational study analyzing the diagnostic utility and best cut-off values of time to positivity (TTP) and differential time to positivity (DTP) to identify catheter-related PAE-BSI and the association of TTP with 30-day mortality.Results1177 PAE-BSI cases TTP were included in the study. TTP was available in all episodes whereas DTP was available in 355 episodes. Breakthrough bacteremia disregarding the TTP, more than one positive blood culture or > 7 days with a catheter in place and both a TTP < 13h and a DTP > 2h were independently associated to catheter-related PAE-BSI. Secondly, lower TTP were significantly associated with higher 30-day mortality rates in both catheter-related and non-catheter-related PAE-BSI. For catheter-related infections, TTP < 14h exacerbated mortality among patients among patients in whom the catheter was not removed within 48h (OR 2.9[1.04–8]); whereas for other sources TTP < 16h increased mortality (OR 1.6[1.1–2.4]) particularly when the empiric antibiotic therapy was not active (OR 3.8[1.5–10]).ConclusionThese findings advocate for the routine use of TTP over DTP as a diagnostic tool to guide timely interventions such as catheter removal, thereby potentially improving patient outcomes in PAE-BSI. Moreover, lower TTP have also prognostic implications in both catheter-related and non-catheter-related infections.

Cardiovascular Hospitalizations Among Older Adults in the US and Denmark.

Cardiovascular disease is the leading cause of death in the US. However, it remains unclear how the burden of cardiovascular events in the US compares with that of other high-income countries with distinct health care systems like Denmark, both overall and by income. To compare cardiovascular hospitalization rates (acute myocardial infarction [MI], heart failure [HF], ischemic stroke) and associated outcomes among adults 65 years or older, overall and by income, between the US and Denmark. This population-based cross-sectional study used national data from the US and Denmark from January 1, 2021, to January 1, 2022. The study population included all Medicare beneficiaries 65 years or older in the US and all adults 65 years or older in Denmark. The primary outcome was age- and sex-standardized hospitalization rates for MI, HF, and ischemic stroke, as well as 30-day all-cause mortality rates. The US study population included 58 614 110 adults 65 years or older (mean [SE] age, 74.6 [7.7] years; 32 179 146 female [54.9%]) of whom 1 171 058 (2.0%) were hospitalized for a cardiovascular event. The Danish study population included 1 176 542 adults 65 years or older (mean [SE] age, 75.3 [7.1] years; 634 217 female [53.9%]) of whom 16 305 (1.4%) were hospitalized with a cardiovascular event. The overall age- and sex-standardized cardiovascular hospitalization rate was significantly higher in the US compared with Denmark (risk ratio [RR], 1.50; 95% CI, 1.47-1.52), as were associated 30-day all-cause mortality rates (RR, 1.12; 95% CI, 1.06-1.17). Across conditions, the risk of hospitalization for MI (RR, 1.56; 95% CI, 1.51-1.61) and HF (RR, 2.37; 95% CI, 2.31-2.43) was significantly higher in the US compared with Denmark, whereas hospitalizations for ischemic stroke were lower (RR, 0.90; 95% CI, 0.88-0.93). Overall cardiovascular hospitalization rates in the US were more than 2-fold higher among low-income adults compared with higher-income adults (RR, 2.38; 95% CI, 2.25-2.47), whereas the magnitude of income-based disparities was smaller in Denmark (RR, 1.45; 95% CI, 1.39-1.50). In this international cross-sectional study, cardiovascular hospitalization rates were significantly higher in the US compared with Denmark. There were income-based differences in the burden of cardiovascular hospitalizations in both countries, although the magnitude of these disparities was much greater in the US.

Risk and causes of early mortality among extremely preterm infants born small for gestational age.

Extreme preterm (EPT) delivery, occurring before 28 weeks of gestation, carries high morbidity and mortality risks. Small for Gestational Age (SGA) infants, about 8-20% of EPT neonates, face increased risks. Mortality risk varies with gestational age and birth weight, with mixed reports on specific morbidities. This study aims to determine mortality rates and common causes of death among EPT SGA infants. The study used data from the CDC National Vital Statistics System, covering births and deaths from 2016-2021, with follow-up through 2022. It included infants born between 22 and 27 weeks gestation who were admitted to the neonatal intensive care unit. The outcome was all-cause in-hospital mortality within 30 days of birth, with causes of mortality classified based on ICD-10 codes. Small for Gestational Age (SGA) was the primary independent variable. Based on a sample of N=96134 infants, we estimated 13% were born SGA and 30-day mortality rates were higher among SGA compared to non-SGA infants (31% vs. 13%). On multivariable analysis SGA infants had higher 30-day mortality than non-SGA (odds ratio: 3.82; 95% CI: 3.64, 4.01; p<0.001), and were more likely to have death ascribed to complications of short gestation rather than other causes of death (Relative Risk Ratio: 1.42; 95% CI: 1.27, 1.59; p<0.001). SGA infants receiving intensive care have high mortality risk, especially due to complications of short gestation and low birthweight complications.

Predictive factors for successful weaning from mechanical ventilation in the internal medicine department.

The aging of the Israeli population along with a shortage of ICU beds have led to hospitalization of invasive mechanical ventilation patients in internal medicine departments, where, as opposed to ICU, the treatment is less than optimal. The aims of the study were to evaluate the predictive factors for successful weaning from mechanical ventilation in ventilated patients admitted to internal medicine departments. A retrospective study that included non-COVID 19 ventilated patients in internal medicine departments in a university affiliated hospital in Israel between the years 2018-2019. We compared datapoints between patients who were weaned from ventilators versus those who remained ventilated during the hospitalization, and defined demographic and clinical predictive factors for successful weaning. Data were collected from electronic medical records and included demographic, clinical, laboratory and ventilator information. The study group included 348 patients. The rate of successful weaning was 19%; patients who were successfully weaned were primarily functionally independent prior to ventilation, ventilated with low PEEP values, had high hemoglobin and albumin levels alongside with low CRP and lactate levels. Those who remained ventilated either required vasopressor treatment, had positive blood cultures or had lower GFR levels. The overall in-hospital mortality rate was 60%, while the 30-day mortality rate was lower in the extubated group [214 (76%) vs. 6 (9%), P < 0.0001]. Our findings highlight the low rate of weaning from ventilation in the department of medicine, with higher mortality rate among the remained ventilated patients. Various favorable clinical parameters might predict successful weaning.

Predictors and outcomes of angioplasty and stenting in acute intracranial atherosclerosis-related vertebrobasilar artery occlusion

ObjectiveThis study aimed to investigate clinical outcomes and predictors of favorable functional outcomes after endovascular treatment, including emergent angioplasty and stenting, in patients with intracranial atherosclerotic stenosis (ICAS)-related occlusions in vertebrobasilar arteries.Materials and methodsThis retrospective case series included 46 patients with acute occlusions of vertebrobasilar arteries, due to underlying ICAS. All patients underwent a thrombectomy, followed by angioplasty and/or stenting. We performed logistic regression analyses to identify independent predictors of favorable outcomes. A favorable outcome was defined as a score of 0–3 on the 90-day modified Rankin Scale.ResultsOverall, successful reperfusion was achieved in 44/46 (95.7%) patients and 90-day favorable outcomes were achieved in 21/46 patients (45.7%). The 90-day mortality rate was 23.9% (11/46). In a multivariate binary logistic analysis, independent predictors of favorable outcome were hyperlipidemia (OR = 7.866, 95% CI: 1.093–56.590, p = 0.040), admission hyperglycemia (OR = 0.144, 95% CI: 0.023–0.914, p = 0.040), basilar artery occlusion (OR = 0.086, 95% CI: 0.008–0.907, p = 0.041), and treatment with angioplasty alone (OR = 9.779, 95% CI: 1.022–93.525, p = 0.048).ConclusionOur findings suggested that emergent angioplasty and/or stenting could yield high rates of successful reperfusion and favorable outcomes in patients with ICAS-related occlusions in vertebrobasilar arteries. Our study also demonstrated that hyperlipidemia and treatment with angioplasty alone were associated with favorable outcomes, in contrast, admission hyperglycemia and basilar artery occlusion were associated with unfavorable outcomes in these patients.

Relationship Between the Prognostic Nutritional index and Short-Term Prognosis among Patients with Community-Acquired Bacterial Pneumonia: A Retrospective Analysis of the MIMIC-IV.

The objective of this study was to investigate the association between the prognostic nutritional index (PNI) and the short-term outcomes in patients with community-acquired bacterial pneumonia (CABP). This study employed a retrospective design, utilizing data from the Medical Information Mart for Intensive Care (MIMIC)-IV database. 371 individuals from the MIMIC-IV database who were diagnosed with CABP. The primary endpoint was 28-day all-cause mortality. The secondary endpoint was the length of stay (LOS) in the intensive care unit (ICU) and in hospital. The area under the curve of PNI for predicting 28-day all-cause mortality is 0.702 (95% CI 0.630 to 0.775; p < 0.001). Patients were divided into two groups based on their PNI at admission: the low PNI (<35.75) group and the high PNI group (≥35.75). CABP patients with higher PNI presented a lower 28-day all-cause mortality rate (adjusted HR: 0.53, 95% CI 0.28-0.98, p = 0.044). Moreover, a negative linear correlation was found between the PNI and short-term mortality rates via restricted cubic splines. Eventually, there was no difference in the LOS in the ICU or hospital between the two groups. These findings suggest a negative correlation between the PNI at admission and the short-term mortality rate of CABP. PNI is helpful for early identification of high-risk patients.

Organisational management of the time-dependent network for the treatment of acute coronary syndrome.

Cardiovascular diseases are the leading cause of death in Italy, being responsible for 227,350 deaths in 2020, according to the National Institute of Statistics. The implementation of timely reperfusion therapy is crucial to improve patient outcomes, and time-dependent networks for the treatment of Acute Coronary Syndrome, particularly ST-elevation myocardial infarction, have been established. In Tuscany, the network for the treatment of Acute Coronary Syndrome-ST-elevation myocardial infarction covers a vast area encompassing three Local Health Authorities, including all of South-Eastern Tuscany. Key features include equity of access, patient safety, improving the quality of care, standardization, the enhancement of professional skills, technological innovation, increasing case volumes and multi-professional integration across emergency services, hospital facilities and primary care networks. The Tuscan Acute Coronary Syndrome network provides comprehensive treatment for Acute Coronary Syndrome-ST-elevation myocardial infarction in 12 hospitals with 24-hour hemodynamics laboratories and has been extended to new territories, namely Piombino and the Island of Elba. The aim of the present study was to assess the impact of an analytical system for monitoring times to reperfusion treatment and subsequent actions, in order to improve the performance of the network. In this retrospective study, we conducted an analytical evaluation of the network's performance, including reperfusion treatment times and factors causing delay. The study utilized data on patient transport, times from symptom onset to medical contact, and outcomes from the National Outcomes Program (NOP; "Programma Nazionale Esiti" in Italian). Analytical evaluations in 2021 measured the network's overall performance and identified the main causes of delay. The treatment process was divided into periods, from symptom onset to coronary reperfusion; interventions such as public awareness campaigns, electrocardiogram tele-transmission, and fast-track transfers were implemented in order to minimize delays. The lowest 30-day mortality rate in Acute Coronary Syndrome patients was recorded in hospitals that treated over 300 cases annually, according to the 2020 and 2021 National Outcomes Program of. Improvements continued into 2022 and 2023, with mortality rates also declining in patients initially admitted to peripheral hospitals. Among residents of Piombino and the Island of Elba, 30-day mortality decreased from 8.8% (2017-2020) to 5.7% in 2022. In 2022, the Grosseto Hub treated 80% of ST-elevation myocardial infarction patients within 90 minutes. The establishment of a well-organized time-dependent network for the treatment of Acute Coronary Syndrome-ST-elevation myocardial infarction in Tuscany significantly improved patient outcomes, thus demonstrating the critical role of timely and efficient care pathways. Our network's success is attributable to several factors, including improved accessibility, enhanced coordination among healthcare facilities, and the efficient use of technology and resources. These findings highlight the importance of structured clinical-care pathways in delivering high-quality care for Acute Coronary Syndrome patients.

Association of Intraoperative Occult Hypoxemia With 30-Day and 1-Year Mortality.

Despite the widespread use of pulse oximetry for intraoperative estimation of arterial oxygen saturation, there is growing evidence that certain patient populations may be vulnerable to inaccurate pulse oximetry measurements and that unrecognized hypoxemia is associated with end-organ damage and adverse outcomes. In this single-center retrospective cohort study, we sought to better elucidate the relationship between intraoperative occult hypoxemia and postoperative mortality among patients undergoing anesthesia and surgery. Data were collected from our departmental data warehouse for adult patients (≥18 years) undergoing anesthesia between 2008 and 2019 with at least 1 intraoperative arterial blood gas recorded. The number of occult hypoxemic events, defined as arterial oxygen saturation (Sao2) of <88% despite oxygen saturation measured by pulse oximetry (Spo2) >92%, were determined. Mortality data were obtained from the Social Security Death Master File and used to determine 30-day and 1-year postoperative mortality. Propensity score overlap-weighted Firth logistic regression and Cox proportional-hazard modeling were performed to analyze whether at least 1 occult hypoxemic event was predictive of 30-day and 1-year mortality. There were 25,234 patients and 62,707 paired readings included in the final analysis. There were 351 patients (1.4%) with at least 1 occult hypoxemic reading. The overall 30-day mortality rate was 3.3% and 1-year mortality rate was 10.2%. In the overlap-weighted models, patients who experienced at least 1 occult hypoxemic event had significantly higher odds of both 30-day mortality (odds ratio [OR] = 2.89, 95% confidence interval [CI], 1.46-5.72, P = .002) and 1-year mortality (hazard ratio [HR] = 1.90, CI, 1.48-2.43, P < .001). There was no significant interaction between occult hypoxemia and self-reported race/ethnicity for predicting mortality. Intraoperative occult hypoxemic events are associated with significantly higher odds of 30-day and 1-year mortality, independent of self-reported race/ethnicity.

Impact of acute respiratory distress syndrome on outcome in critically ill patients with liver cirrhosis.

We investigated the occurrence and outcome of respiratory failure and ARDS in critically ill patients with liver cirrhosis. This is a retrospective analysis of patients with liver cirrhosis at an ICU during an 8-Year period. An assessment of acute on chronic liver failure as well as the presence and grade of ARDS within the first 72h of admission to the ICU was performed. A total of 735 patients during the study period. Median age was 58 (50-69) years and 61% (n = 447) were male. 57% (n = 421) of the patients received mechanical ventilation (MV). Liver specific as well as ICU scores on admission were significantly higher in patients with MV. Necessity of vasopressor support (86%vs.25%, p < 0.001) and RRT (50%vs.11%, p < 0.001) was more frequent in patients with MV. The incidence of ARDS within the first 72h of admission was 8% (n = 61). We observed a 28-day mortality or liver transplantation rate of 54% (n = 196) and 66% (n = 66%) in patients with MV and ARDS, respectively. After 90-days 63% (n = 226) with MV and 70% (n = 43) with ARDS were dead or received liver transplantation. ARDS is a prognostic factor for mortality in patients with liver cirrhosis admitted to the ICU. One out of ten critically ill cirrhotic patients develop ARDS within 72h after admission. Although mortality rates are high initially critical care therapy should not be withheld and must be reevaluated regularly.

Factors Predicting Major Complications and Mortality in Percutaneous Endoscopic Gastrostomy: 8 Years of Experience of a Tertiary Surgery Center.

Percutaneous endoscopic gastrostomy (PEG) is a safe method of choice for patients who need long-term nutritional support. However, complications and high mortality rates have been reported. Based on 8 years of experience in tertiary care hospitals, we aimed to identify risk factors associated with major complications and 30-day mortality after PEG. Patients who underwent PEG in the General Surgery clinic of Tokat Gaziosmanpaşa University, Faculty of Medicine between January 2014 and March 2022 were included in the study. Data regarding patient demographics, comorbidities, laboratory data, drugs used together, and indications for PEG tube placement were collected. There were 429 patients. The mean age of the patients was 66.9±16.75 years, and 180 (44%) patients were female. The mean follow-up period was 8.84±6.75 months. Twenty patients (4.9%) had major complications. Female sex [Odds Ratio (OR) 0.33, 95% CI, CI=1.23-8.87, P=0.02] and diabetes mellitus (DM) (OR=0.23, 95% CI=1.93-6, P=0.002) were the independent variables associated with major complications. The all-cause 30-day mortality rate was 5.9% (n=24). Malignancy, DM, corticosteroid use, low albumin, and platelet values were associated with increased mortality in multivariate analysis as indications for PEG. Female sex and patients with DM may potentially face major complications. The patients with cancer, diabetes, and corticosteroid use were associated with higher mortality. In addition, low serum albumin and platelet levels were an effective factor for survival in patients undergoing PEG, and this should be taken into account in decision-making.

Effectiveness of an Impella Versus Intra-Aortic Balloon Pump in Patients Who Received Extracorporeal MembraneOxygenation.

It is unclear whether an intra-aortic balloon pump (IABP) or percutaneous ventricular assist device (Impella) in combination with extracorporeal membrane oxygenation (ECMO) is better. Using the Japanese Diagnosis Procedure Combination database from September 2016 to March 2022, we identified inpatients who received an Impella or IABP in combination with ECMO (ECPella or ECMO+IABP group, respectively). The primary outcome was in-hospital mortality, and the secondary outcomes included the length of hospital stay, length of ECMO, total hospitalization cost, complications, and durable mechanical circulatory support implantations. Propensity score matching was performed to compare the outcomes between the groups. Of 14 319 eligible patients, 590 (4.1%) received ECPella and 13 729 (96%) received ECMO+IABP. The mean age of patients was 65 years, 77% were men, and 57% had acute coronary syndrome. After propensity score matching, the patient characteristics were well balanced between the groups. The 14-day mortality rate was lower in the ECPella group than in the ECMO+IABP group (28.0% versus 36.8%; risk difference, -8.2% [95% CI, -13.8 to -2.7]), whereas there was no significant difference in in-hospital mortality between the groups (58.3% versus 56.6%; risk difference, 2.4% [95% CI, -3.5 to 8.2]). The ECPella group had a higher total hospitalization cost, increased renal replacement therapy during hospitalization, and more durable mechanical circulatory support implantations than the ECMO+IABP group. This nationwide inpatient database study showed no significant difference in in-hospital mortality between the groups, but ECPella was associated with a higher total hospitalization cost, increased renal replacement therapy during hospitalization, and more durable mechanical circulatory support implantations than ECMO+IABP.

L-shaped association of body mass index with prognosis in individuals with sepsis: a multicenter cohort study

ObjectiveThe relationship between body mass index (BMI) and sepsis prognosis remains highly controversial and uncertain. This study investigated the association between BMI and prognosis in patients with sepsis.MethodsThis retrospective observational cohort study included adult patients admitted to the intensive care unit (ICU) with sepsis from Medical Information Mart for Intensive Care-IV version 2.2 (MIMIC-IV V2.2) and eICU Collaborative Research Database (eICU-CRD). The cut-off value of BMI was identified by the restricted cubic spline (RCS) curve and included patients were categorized into two groups: the low BMI group (< 28 kg/m2) and the high BMI group (≥ 28 kg/m2). The primary outcome was ICU mortality, and secondary outcomes were in-hospital and 28-day mortality. We performed the log-rank test to detect whether there is a difference in prognosis among different groups in two different cohorts. Multiple distinct models were used to validate the robustness of the results.ResultsThere were 18,385 and 38,713 patients in the MIMIC-IV 2.2 and eICU-CRD cohorts, respectively. An L-shaped relationship was observed between BMI and ICU mortality in the primary analysis from MIMIC-IV 2.2. Similar relationships were found in eICU-CRD. When BMI was less than the cut-point, the risk of ICU mortality increased rapidly with decreasing BMI. When BMI was greater than the cut-point, the risk of ICU mortality levelled off as BMI increased. Sepsis patients with higher BMI values exhibited decreased ICU all-cause mortality rates (MIMIC-IV cohort: HR: 0.81, 95% CI 0.75–0.88, p < 0.001; eICU-CRD cohort: HR: 0.75, 95% CI 0.71–0.80, p < 0.001). Consistent trends were observed for both in-hospital mortality and 28-day mortality rates. The results remained robust in multiple distinct models and subgroup analyses.ConclusionAn L-shaped relationship was observed between BMI and prognosis in septic patients, indicating that lower BMI values are significantly linked to increased mortality. Targeted nutritional interventions and close monitoring for patients with low BMI could potentially enhance their prognosis. Therefore, BMI can also be utilized to categorize the risk levels of patients with sepsis and effectively predict their prognosis.

Serosal Patching with Glubran®2 on the Pancreatic Stump for Reducing Postoperative Pancreatic Fistulae After Robot-Assisted Distal Pancreatectomy: A Single-Center Retrospective Study

Background: Postoperative pancreatic fistulae (POPFs) are a significant cause of morbidity following left pancreatectomy. We hypothesized that incorporating serosal patching with the application of a synthetic sealant, a modified cyanoacrylate (Glubran®2), to the pancreatic stump, would decrease the incidence rate of clinically significant POPFs. Methods: This is a retrospective study of consecutive patients who underwent robot-assisted left pancreatectomy. The primary outcome was clinically significant POPFs within 90 days of surgery. Secondary outcomes included the incidence rate of POPFs (all the grades), 90-day morbidity, and 90-day mortality. Results: We compared outcomes between Glubran®2 sealant with serosal patching (GSP, n = 6) and Glubran®2 sealant without serosal patching (GNSP, n = 12) groups. The GSP group had significantly lower incidence rates of clinically significant POPFs (grades B/C) (p = 0.034) and overall POPFs (all the grades) (p = 0.046). No significant differences in 90-day postoperative morbidity were observed between the two groups (p = 0.56), and no 90-day mortality occurred in either group. Conclusions: Incorporating serosal patching along with Glubran®2 sealant in the management of the pancreatic stump during left pancreatectomy demonstrates promising results in reducing the incidence rate of clinically significant POPFs. This finding highlights the need for further research with larger sample sizes in order to confirm the observed outcomes and explore the long-term implications for postoperative complications and recovery in patients undergoing this procedure during pancreatic surgery.

Risk factors associated with mortality and pathogen characteristics of bloodstream infection-induced severe sepsis in the pediatric intensive care unit: a retrospective cohort study

BackgroundBloodstream infection (BSI)-induced severe sepsis is a common cause of mortality, frequently resulting in septic shock and multiple organ dysfunction syndrome (MODS). This study aimed to analyze mortality risk factors and summarize pathogen characteristics associated with BSI-induced severe sepsis in the pediatric intensive care unit (PICU).MethodsThis retrospective study was conducted at a tertiary pediatric hospital between January 2015 and December 2023, encompassing children with BSI-induced severe sepsis in the PICU. Clinical characteristics, laboratory parameters, pathogen characteristics, and drug resistance profiles of the patients were collected. Clinical and laboratory indicators along with pathogen characteristics were summarized. Logistic regression analysis was employed to identify independent risk factors associated with 28-day mortality.ResultsA total of 192 patients with bloodstream infection (BSI)-induced severe sepsis were identified, with a 28-day in-hospital mortality rate of 36.98% (71/192). The incidence of septic shock (42.1% vs. 69%, P &amp;lt; 0.001) and AKI (14% vs. 31%, P = 0.005) was significantly lower in the survival group compared to the non-survival group. In multivariate analysis, independent risk factors for 28-day mortality were the pediatric sequential organ failure assessment (pSOFA) score (OR 1.176; 95% CI: 1.046-1.321, p = 0.007) and the P/F value (OR 0.994; 95% CI: 0.991-0.997, P &amp;lt; 0.001). Double organism growth was detected in 8 cultures, and a total of 200 pathogenic bacteria were isolated from all blood cultures. Of these, 110 strains (55.0%) were Gram-negative bacteria, 88 strains (44.0%) were gram-positive bacteria, and 2 strains (1.0%) were Candida albicans. The most commonly isolated pathogens were Staphylococcus aureus, Coagulase-negative Staphylococcus, and Escherichia coli. The detection rate of carbapenem resistance (CR) in Acinetobacter baumannii (66.7%) was higher than that in Pseudomonas aeruginosa (15.4%). The detection rates of extended-spectrum cephalosporin resistance (ECR) and fluoroquinolone resistance (FQR) in Escherichia coli (E. coli) were higher than those in Klebsiella pneumoniae.ConclusionIn the PICU, higher mortality was observed in children with BSI-induced severe sepsis who presented with elevated pSOFA scores and low P/F values. Acinetobacter baumannii exhibited the highest levels of CR and FQR, while Escherichia coli demonstrated the highest level of ECR.

Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and meta-analysis.

Self-expanding metallic stents (SEMS) are an alternative to emergency surgery (ES) for malignant colorectal obstruction. This study aimed to compare surgical outcomes between SEMS as a bridge to surgery (BTS) and ES in patients with malignant colorectal obstruction. A comprehensive database search was conducted until October 2023 to compare outcomes between SEMS as a BTS and ES. A subgroup analysis of results by malignancy site was performed. We analyzed 57 studies, including 7,223 patients over a mean duration of 35.4 months. SEMS as a BTS showed clinical and technical success rates of 88.0% (95% confidence interval [CI], 86.1%-90.1%; I2=68%) and 91.6% (95% CI, 89.7%-93.7%; I2=66%), respectively. SEMS as a BTS revealed reduced postoperative adverse events (odds ratio [OR], 0.51; 95% CI, 0.41-0.63; I2=70%; p<0.001) and 30-day mortality (OR, 0.52; 95% CI, 0.37-0.72; I2=10%; p<0.001) compared to ES. Subgroup analysis showed postoperative mortality of 5% and 1.5% for left- and right-sided malignancies, respectively. Adverse events were 15% and 33% for the right and left colon, respectively. SEMS as a BTS demonstrated higher success rates, fewer postoperative adverse events, and a reduced 30-day mortality rate than ES, supporting its use as the preferred initial intervention for right- and left-sided obstructions and indicating broader clinical adoption.

Central-venous-catheter-related bloodstream infections in adult patients with sickle cell disease: a retrospective, two-centre study.

Although catheter-related infections are the leading cause of bloodstream infections in patients with sickle cell disease (SCD), data are scarce in adult patients. The objectives of the present study were to describe central-venous-catheter-related bloodstream infections in patients with SCD and identify risk factors. We conducted a retrospective, observational study of adult patients with SCD diagnosed with central-venous-catheter-related bloodstream infections between 2011 and 2023 in two SCD reference centres. Each patient with SCD and a bloodstream infection related to a totally implantable venous access port was matched with two control patients with SCD and an infection-free totally implantable venous access port. Thirty-five (6.6%) of the 534 patients experienced a total of 69 central-venous-catheter-related bloodstream infections. Concomitant vaso-occlusive crises were observed for 81.2% of the infections. The 30-day mortality rate was 2.8%, and the infection recurrence rate was 45.7%. We observed 26 totally implantable venous access port-related bloodstream infections in 19 patients, with an incidence rate of 0.31 per 1000 catheter-days. After adjustment, the frequency of hospital admission for a vaso-occlusive crisis (odds ratio (OR) [95% confidence interval (CI)] = 1.6 [1.2-2.4]) and the presence of a psychiatric comorbidity (19.8 [4.0-148.1]) remained significantly associated with totally implantable venous access port-related bloodstream infections. Suboptimal antibiotic levels were observed in five (39%) of the 13 patients having undergone therapeutic drug monitoring. The treatment failed in four (80%) of the five patients, who presented with glomerular hyperfiltration. A central-venous-catheter-related bloodstream infection is a severe complication in adult patients with SCD and is associated with psychiatric comorbidities and severe SCD.

Midterm Outcomes of Minimally Invasive Aortic Valve Replacement via Right Lateral Minithoracotomy.

Minimally invasive aortic valve replacement (MIAVR) procedures have been found to have good short-term results. However, no known reports regarding outcomes of MIAVR via a right lateral minithoracotomy (LT) approach over longer terms have been presented. The aim of the present study was to analyze the midterm outcomes of the use of MIAVR with the right LT approach over an 8-year period. Between September 2014 and February 2023, MIAVR was performed for 348 patients with severe aortic valve stenosis and regurgitation at our hospital. Operative mortality, all-cause mortality, and valve-related events were retrospectively examined. The mean patient age was 72.3 ± 10.9 years, while 78 patients (22.4%) were more than 80 years old. Surgical, cardiopulmonary bypass, and cross-clamp times were 194.7 ± 43.2, 118.6 ± 28.7, and 89.4 ± 23.3 min, respectively. The 30-day mortality rate was 0.3%. The mean follow-up period was 35.6 ± 25.9 months. Overall survival shown by Kaplan-Meier analysis at 1, 3, and 5 years was 96.4%, 90.3%, and 83.2%, respectively, and freedom from valve-related events at those time points was noted in 100%, 99.5%, and 96.9% of the cases, respectively. MIAVR via a right LT approach was found to be associated with excellent short-term and midterm outcomes and is considered to have the potential to become an established surgical option.

Trends and Outcomes of General Surgery in the Pakistani Population: A Retrospective Analysis

Background: General surgery in Pakistan addresses a broad spectrum of medical conditions. However, surgical outcomes in low- and middle-income countries (LMICs) are affected by resource limitations, disparities in healthcare access, and delayed presentations. Objectives: This study aims to evaluate trends, outcomes, and predictors of complications in general surgery over a two-year period in a tertiary care center in Pakistan. Methodology: A retrospective analysis was conducted on n=400 adult patients who underwent elective or emergency general surgical procedures from January 2022 to December 2024. Data on patient demographics, surgical approaches (open vs. laparoscopic), and postoperative outcomes were collected. Predictors of complications were analyzed using Chi-square tests, t-tests, and logistic regression. Results: The mean age of patients was 44.5 (±12.8) years, with 58% being male. Laparoscopic techniques were used in 52% of surgeries, with a 6% conversion rate. Overall, 14% of patients experienced complications, including surgical site infections (5%) and hemorrhage (4%). Emergency procedures were associated with higher complication rates (p&lt;0.01). Significant predictors of complications included BMI &gt;30 kg/m² (OR: 2.3, 95% CI: 1.5–3.2, p&lt;0.001), operative time &gt;90 minutes (OR: 2.7, 95% CI: 1.8–4.1, p&lt;0.001), and emergency surgery (OR: 3.2, 95% CI: 2.1–4.8, p&lt;0.001). The 30-day mortality rate was 2%, predominantly due to emergency cases. Conclusion: While laparoscopic techniques have improved surgical outcomes in Pakistan, disparities in emergency care and resource allocation persist. Addressing key predictors of complications through systemic reforms, enhanced training, and infrastructure improvements is crucial for aligning surgical outcomes with global standards.

A 10-year Retrospective Comparison of Endovascular and Open Aneurysm Repair for Infective Native Abdominal Aortic Aneurysm

BackgroundThis study compared outcomes of endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) in patients with infective native abdominal aortic aneurysms (INAAA), evaluating perioperative and in-hospital mortality, antibiotic treatment duration, complications, overall survival rates, and reintervention-free times at 10 years. MethodsA retrospective cohort study of 125 INAAA patients (80 EVAR, 45 OAR) diagnosed between January 2004 and December 2019 was conducted. Patients were categorized as fit or unfit for open surgery based on cardiac, respiratory, and renal status, following the guidelines established in the EVAR-1 and EVAR-2 trials. Primary outcomes included 30-day and in-hospital mortality. Secondary outcomes encompassed early and late complications requiring reintervention, antibiotic treatment duration, 10-year overall survival, 10-year reintervention-free survival, and factors influencing 30-day mortality. Statistical analysis used chi-square, t-tests, and Mann-Whitney U tests. Logistic regression assessed mortality. Kaplan-Meier estimation evaluated survival. Analyses used SPSS version 18.0 (p < 0.05 considered significant) ResultsMales predominated in both OAR (37/45, 82.2%) and EVAR (62/80, 77.5%) groups (P = 0.693). Mean age was 64.8 ± 9.8 years for OAR and 69.0 ± 12.6 years for EVAR (P = 0.063). The abdominal aorta was the most common aneurysm location, accounting for 91/125 (72.8%) cases. Salmonella spp. accounted for 19/45 (42.2%) of positive culture cases, and 34/125 (27.2%) patients had ruptured aneurysms. The EVAR group had a higher proportion of unfit patients (41/80, 51.2%) compared to OAR (10/45,22.2%; P=0.003). 30-day mortality rates were 6/80 (7.5%) for EVAR and 2/45 (4.4%) for OAR; OR = 1.75 (95% CI: 0.34 - 9.06), P = 0.508, while in-hospital mortality rates were 7/80 (8.8%) and 5/45 (11.1%); OR = 0.77 (95% CI: 0.23 - 2.58), P = 0.668. No significant differences were found in antibiotic treatment duration (median 11 vs 6 months, P=0.594), 10-year overall survival rates (62.8% vs 64.8%, P=0.90), or reintervention-free time (83.8% vs 82.2%, P=0.922), and aneurysm-related death (84.7% vs 92.9%, P=0.159), Unfit patient status was an independent predictor of 30-day mortality (adjusted OR, 10.654; 95% CI, 1.041-109.030; P=0.046). ConclusionsOur study demonstrates that EVAR and OAR provide comparable outcomes in INAAA management, despite EVAR being performed more frequently in unfit patients. The similar early mortality rates, antibiotic treatment durations, and long-term survival between the two approaches support EVAR as a viable alternative to OAR. Importantly, our finding that unfit patient status independently predicts perioperative mortality emphasizes the critical role of patient selection in treatment decisions. These results collectively suggest that EVAR may be particularly beneficial for high-risk INAAA patients unsuitable for OAR, potentially expanding treatment options for this challenging condition.

Long-term outcomes after postponing surgery to optimise patients with acute right-sided obstructing colon cancer.

To retrospectively analyse the short- and long-term oncological, morbidity and mortality outcomes in patients diagnosed with acute right-sided obstructing colon cancer. Patients who underwent pre-optimisation prior to the oncological resection were compared to patients who did not undergo pre-optimisation. All consecutive patients with right-sided obstructing colon cancer, either with a high clinical suspicion or confirmed diagnosis by histological analysis, who underwent curative-intent treatment between March 2013 and December 2020 were included. Patients were divided into two groups: an optimised group and a non-optimised group. Preoperative optimisation included additional nutrition, physiotherapy, and, if needed, bowel decompression. Data about disease-free survival and mortality were collected up to three years after surgery. Sixty-two patients were included. Thirty patients underwent the optimisation protocol before postponed surgery, and 32 patients received emergency surgery, without optimisation (surgery performed with a median of 9.6 days versus 22h after admission). The postoperative complication rate was significantly lower in the optimisation group (50% vs 78%, p=0.033). No significant differences were found in the 90-day mortality rate (7% vs 13%, p=0.672) and three-year overall survival rate (43% vs 56%, p=0.49). After three years, sixteen (53%) patients in the optimised group and twenty (63%) in the non-optimised were deceased (p=0.672). Postponing the surgery with preoperative optimisation in patients with obstructing right-sided colon cancer results in a significantly lower 90-day complication rate and suggests no negative effect on survival rates compared to an acute resection. Although, further research with a larger sample size is needed.