Acute Soft Tissue Research Articles

Evaluation of Dalbavancin Use on Clinical Outcomes, Cost-Savings, and Adherence at a Large Safety Net Hospital.

Dalbavancin is a second-generation lipoglycopeptide antibiotic with activity against Gram-positive organisms. Dalbavancin is Food and Drug Administration (FDA)-approved for acute bacterial skin and soft tissue infections (ABSSTIs). There is a lack of substantial data on dalbavancin in more invasive infections, particularly in high-risk populations (patients with intravenous drug use and unstable living conditions). In this retrospective observational study, we reviewed all patients that received at least one dose of dalbavancin in an inpatient or outpatient setting at Parkland Hospital from February of 2019 to August of 2021. The demographics, type of infection, and rationale for dalbavancin were collected at the baseline. Clinical failure was measured by an avoidance of emergency department (ED) visits or hospital readmission at 30, 60, and 90 days. A separate analysis was conducted to estimate hospital, rehabilitation, or nursing facility days saved based on the projected length of treatment. 40 patients were included, and the majority were uninsured (85%), experiencing homelessness (60%), or had intravenous drug use (IDU) (57.5%). Indications for use included ABSSTIs (45%), bloodstream infection (67.5%), osteomyelitis (40%), infective endocarditis (10%), and septic arthritis (10%). Clinical failure was observed in 5 of the 40 patients (12.5%). Nonadherence to medical recommendations, a lack of source control, and ongoing IDU increased the risk of failure. Dalbavancin saved a total of 566 days of inpatient, rehabilitation, and nursing facility stays. Dalbavancin is a reasonable alternative to the standard of care in an at-risk population, offering decreased lengths of stays and cost savings. The uses of second-generation lipoglycopeptides are desirable alternatives to traditional outpatient parenteral antibiotic therapies for patients who otherwise would not qualify or for patients who desire less hospital contact in light of the COVID-19 pandemic. IMPORTANCE This study contributes additional experience to the literature of dalbavancin use in off-label indications, particularly for patients who do not qualify for outpatient parenteral antimicrobial therapy. The majority of the patient population were people who inject drugs and the uninsured. There is difficulty in tracking outcomes in this patient population, given their outpatient follow-up rates; however, we were able to track emergency room visits and readmissions throughout the majority of the local metroplex. The clinical use of dalbavancin at our institution also increased in the midst of the COVID-19 pandemic in an effort to preserve hospital resources and limit health care exposure. In addition, we are able to provide institution-specific cost-saving data with the use of dalbavancin.

A ENFERMAGEM NAS LESÕES DE TORNOZELO COM BASE NO EXERCÍCIO DE APTIDÃO FÍSICA

ABSTRACT Introduction Ankle injury is an acute soft tissue pathology where the ankle ligaments are distended, lacerated, or ruptured due to violence during sport. This joint is also one of the most vulnerable in sports. After an injury, immediate and adequate care is significant in reducing pain and complication. Objective Statistically analyze the sports injuries of the ankle cases, determining the principal reasons for injury and outlining preventive measures. Methods A statistical investigation on the sports injuries of 275 Qiqihar higher education students was performed with questionnaires and teaching practice methods. The research was focused on the injured structures and the injury causes analysis. In parallel, corresponding proposals aimed at preventing these sports injuries were raised. Results Joint injuries and ankle sprains followed by hematomas represented the most significant proportion of ankle injuries. The reasons are lack of physical fitness, lack of awareness of self-protection, inadequate preparation in the sporting environment facilities, and performing tasks outside what the superior specified was specified. Conclusion Medical work needs to increase dissemination so that people realize the causes of sports injuries. At the same time, it helps people master the care measures before and after the injury. This reduces the incidence of sports injuries and reduces the occurrence of complications. Evidence level II; Therapeutic Studies - Investigating the results.

Update on the Use of Platelet-Rich Plasma Injections in the Management of Musculoskeletal Injuries: A Systematic Review of Studies From 2014 to 2021.

There has been expanding use of platelet-rich plasma (PRP) in the management of musculoskeletal soft tissue injuries. To determine if there are any recent studies that show any clear benefits regarding the use of PRP in the management of soft tissue injuries. Systematic review. This review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The EMBASE, MEDLINE, PubMed, and Cochrane Bone, Joint and Muscle Group Specialised Register databases were queried for randomized controlled trials comparing PRP with a non-PRP/placebo in participants >18 years of age with musculoskeletal soft tissue injuries. Exclusion criteria were non-soft tissue injuries and research published in journals with an impact factor <3.5. The main outcome measure analyzed across all injury types was the effect of PRP injections on pain and function. Of the 853 studies initially screened, 32 were included in this review. There were 13 studies that investigated the effects of PRP on the management of rotator cuff injuries; 7 studies that investigated PRP in conjunction with arthroscopy found no significant difference between PRP groups and controls, while 5 of 6 studies that investigated nonsurgical management showed positive results for PRP. Eight studies investigated various tendinopathies; of these, 2 studies demonstrated positive results for PRP in Achilles and gluteal tendinopathy management. Six studies examined PRP in acute soft tissue injuries, with 2 of these reporting significant improvements in recovery time for hamstring injuries and 1 study showing positive results for ankle ligament injuries. Two studies looked at acute rupture of soft tissues and found no benefit to PRP use. Two studies investigated PRP injections for chronic plantar fasciitis, and both reported positive results in pain and function with PRP. Finally, 1 study evaluated the effects of PRP on meniscal injuries and reported significant improvement in the healing rate and a decreased need for surgical repair. Currently, there is no research strongly advocating the use of PRP compared with traditional management strategies (rest, ice, corticosteroid injection, rehabilitation program). No long-term physiological benefits were reported to justify the invasive and costly technique of obtaining, producing, and implementing PRP.

Antimicrobial sensitivity testing of levonadifloxacin – A novel benzoquinolizine drug against MRSA isolates in a tertiary care hospital

Methicillin-resistant Staphylococcus aureus (MRSA) adds a significant burden for health-care workers. In India there is a significant rise in prevalence of Methicillin resistant Staphylococcus aureus recently. Treatment has become very difficult among the resistant Staphylococcal isolates. Currently vancomycin and linezolid are the commonly used antibiotics. But these drugs have their adverse effects. Hence improved bactericidal antibiotics with increased tissue penetration and low possibility of developing resistance and safe to be used in chronic cases should be used for management of Methicillin resistant Staphylococcus aureus infections. The drug Levonadifloxacin acts actively against Methicillin resistant Staphylococcus aureus and Quinolone - resistant Staphylococcus aureus phenotypes. Recently in India, levonadifloxacin has been approved for the treatment of various infections like acute bacterial skin and soft tissue infections with complicating blood stream infections and also for diabetes complicating infections. Hence we evaluated the activity of levonadifloxacin (10g) by Kirby– Bauer disk diffusion assay against Methicillin resistant Staphylococcus aureus isolates in the central laboratory of a tertiary care centre for a period of 1year between May 2021 to April 2022. 296 isolates of Staphylococcus aureus were identified from various clinical samples. Based on the results of disc diffusion test using Cefoxitin disc, Of the 296 Staphylococcus aureus isolates 104 were methicillin resistant and the rest of the 192 were methicillin sensitive. Methicillin resistant Staphylococcus aureus isolates were tested against levonadifloxacin by disc diffusion which yielded 100% susceptibility rate. Hence this study displays potent activity of the drug levonadifloxacin against Methicillin resistant Staphylococcus aureus isolates and is recommended for therapeutic use.

Efficacy of Cryo-compression on Shin Splints in Female Amateur Marathon Runners

Background: Medial tibial stress syndrome (MTSS) or Shin splints is exercise-induced lower leg pain along the distal posterior-medial aspect of tibia caused by repetitive loading stress during running and jumping. It is one of the most common lower leg sports injury. Cryotherapy is the most commonly used treatment during immediate care of athletic injuries and acute soft tissue injuries and is also included as part of RICE (rest, ice, compression and elevation). Cryotherapy is helpful in reducing swelling as well as it exerts analgesic effect. The external compression is also used during immediate care phase and it helps in decrease tissue temperature and prevent oedema formation. Cryotherapy in combination with intermittent pneumatic compression hypothetically help in reducing the physiologic effects of traumatic tissue damage which is based on the models of cryotherapy and static compression therapy. This study aims to establish the efficacy of cryo-compression on shin splints in female amateur marathon runners. Methods: A total 30 subjects diagnosed with shin splints were selected for study. Subjects received cryo-compression for reducing pain and swelling and exercises to strengthen the muscles. Each session was conducted for 45 minutes duration, 5 days per week for 4 weeks. Outcome measure used was Numerical Pain Rating Scale (NPRS), Goniometry for ROM and Manual muscle testing (MMT). Results: According to statistical analysis, the results of the study demonstrate that there was a significant effect of the use of cryo-compression on numerical pain rating scale (p&lt;0.0001), range of motion (ankle plantarflexion, dorsiflexion, eversion and inversion) (p&lt;0.0001), manual muscle testing – ankle plantarflexors (p=0.0028) and ankle dorsiflexors (p&lt;0.0001) during the pre and post intervention assessment. Conclusion: The conducted study shows that efficacy of cryo-compression on shin splints in female amateur marathon runners is very effective in reducing pain, increasing range of motion (ROM) and strength of muscles along with other treatment program. KEYWORDS: Cryo-compression, shin splints, numerical pain rating scale (NPRS), range of motion, ankle plantarflexion, ankle dorsiflexion, ankle eversion, ankle inversion, manual muscle testing, ankle plantarflexors, ankle dorsiflexors.

Sport and exercise medicine approach to acute lower limb soft tissue injury management in the emergency department.

Sport and exercise medicine approach to acute lower limb soft tissue injury management in the emergency department.

Antibiotic Prescribing Patterns for Pediatric Urgent Care Clinicians.

Previous studies have reported high rates of inappropriate antibiotic prescriptions in urgent care (UC). Specific prescribing patterns for the most common diagnoses are not known. The aim of the study is to determine the diagnoses for which antibiotics are prescribed in pediatric UC settings. We recruited pediatric UC providers via email to participate in a national multisite quality improvement study. Participants completed a survey on 10 consecutive encounters in which an antibiotic was given between March and May 2018. Encounters in which only topical antibiotics were prescribed were excluded. We categorized the encounters into 3 previously established tiers to determine appropriateness of antibiotic use. The tiers represent a descending order for antibiotic need based on diagnoses, with the first tier representing diagnoses almost always requiring antibiotics and the third tier representing diagnoses when an antibiotic is almost never required. We reported the diagnoses and frequency of antibiotic prescription within each tier. The 157 providers from 20 institutions submitted a total of 2809 encounters. We excluded 339 encounters in which only topical antibiotics were prescribed. Most diagnoses fell into the tier 2 category (85.81%), with only 9.12% in tier 1 and 5.06% in tier 3. The most common diagnoses reported were acute otitis media (48.96%), pharyngitis (25.09%), and skin and soft tissue infections (7.29%). In this sample of pediatric UC encounters, only 5% of diagnoses receiving antibiotic prescriptions were made up of tier 3 diagnoses, determined to almost never require antibiotics. While viral respiratory infections have been reported to frequently be treated with antibiotics in general UC centers, our study of pediatric UC centers showed that this was infrequent. However, otitis media with effusion and otalgia should be further investigated. With most antibiotic prescriptions being tier 2 diagnoses, pediatric UC providers can use evidence-based prescribing practices, shared decision making, and contingency plans to reduce unnecessary antibiotic exposure.

Contemporary nutrition-based interventions to reduce risk of infection among elderly long-term care residents: A scoping review.

BackgroundElderly long-term care residents (ELTCRs) face considerable burden of infection, especially evident during the COVID-19 pandemic. The nutritional status of the host can influence susceptibility to infection by altering immune system integrity, therefore, nutrition-based interventions may be a viable complement to existing infection prevention measures.ObjectiveThis scoping review sought to identify nutritional interventions and factors that have the strongest evidence to benefit ELTCRs, and thus best poised for rigorous clinical trial evaluation and subsequent implementation.MethodsA database search of OVID-Medline, OVID-Embase, and Web of Science was performed from 2011 to 2021 to identify nutritional intervention studies which attribute to changes in infection in contemporary ELTCR settings. Articles were screened in duplicate and data extraction completed by a single reviewer, while a second reviewer verified the data which was fitted to identify evidence for nutritional interventions related to reducing rates of infection among ELTCRs.ResultsThe search identified 1018 studies, of which 11 (nine clinical trials and two observational cohort studies) satisfied screening criteria. Interventions that significantly reduced risk of infection included whey protein (any infection), Black Chokeberry (urinary tract infection), and vitamin D (acute respiratory tract infection, skin and soft tissue infection). Both zinc and a dedicated meal-plan significantly improved lymphocyte parameters. Vitamin D deficiency was associated with the development of respiratory tract infections. Probiotic and soy-based protein interventions did not significantly affect risk of infection or lymphocyte parameters, respectively.ConclusionThe current scoping review was effective in identifying the use of nutrition-based interventions for infection prevention among ELTCRs. In this study, some nutrition-based interventions were observed to significantly influence the risk of infection among ELTCRs. Nutritional interventions such as vitamin D (preventing deficiency/insufficiency), Black Chokeberry juice, zinc gluconate, whey protein, and varied and nutrient dense meal plans may be suitable for future rigorous clinical trial evaluation.

Impact of outpatient antimicrobial stewardship guideline implementation in an urgent care setting

BackgroundUrgent care medicine is a rapidly growing health care sector where patients are commonly treated for acute infectious diseases–related conditions. However, there are few antimicrobial stewardship interventions described in these settings. ObjectiveThe objective of this study is to determine whether implementing outpatient antimicrobial stewardship guidelines would improve antibiotic prescribing for acute upper respiratory tract infections (ARTIs), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) at a single urgent care site. MethodsThis was a pre-post interventional study comparing antibiotic prescribing patterns for ARTI, SSTI, and UTI at a single urgent care site in the preintervention group (November 2019 to January 2020) with the postintervention group (November 2020 to January 2021) after implementation of outpatient stewardship guidelines. A second urgent care site that did not receive any interventions served as a control. The outpatient stewardship guidelines were implemented in October 2020 via didactic provider education and pocket guide distribution. The primary end point was the rate of total guideline-concordant antibiotic prescribing. Secondary end points included the rates of guideline concordance of each component of the prescription, including antibiotic selection, duration, dose, therapy indication, and patient safety outcomes. ResultsThe primary outcome of total guideline-concordant antibiotic prescribing significantly improved after implementation of outpatient antimicrobial stewardship guidelines at the study site (50% vs. 70%, P < 0.001), which was also reflected when comparing postintervention study site with postperiod control site (70% vs. 48%, P < 0.001). There was a statistically significant improvement in guideline-concordant duration of antibiotic therapy (43% vs. 61%, P = 0.001), driven by a reduction in antibiotic duration for UTI (7 [interquartile range (IQR) 5–7] vs. 5 [IQR 5–7] days, P = 0.007), which was also observed when comparing the postintervention study site with the postperiod control site (61% vs. 48%, P = 0.02). Patient safety outcomes were similar between groups. ConclusionAn antimicrobial stewardship intervention comprising institutional outpatient guideline implementation and provider education significantly improved total guideline-concordant antibiotic prescribing by 20% for ARTI, UTI, and SSTI in an urgent care site.

New Perspectives on Antimicrobial Agents: Long-Acting Lipoglycopeptides.

The long-acting lipoglycopeptides (LGPs) dalbavancin and oritavancin are semisynthetic antimicrobials with broad and potent activity against Gram-positive bacterial pathogens. While they are approved by the Food and Drug Administration for acute bacterial skin and soft tissue infections, their pharmacological properties suggest a potential role of these agents for the treatment of deep-seated and severe infections, such as bloodstream and bone and joint infections. The use of these antimicrobials is particularly appealing when prolonged therapy, early discharge, and avoidance of long-term intravascular catheter access are desirable or when multidrug-resistant bacteria are suspected. This review describes the current evidence for the use of oritavancin and dalbavancin in the treatment of invasive infections, as well as the hurdles that are preventing their optimal use. Moreover, this review discusses the current knowledge gaps that need to be filled to understand the potential role of LGPs in highly needed clinical scenarios and the ongoing clinical studies that aim to address these voids in the upcoming years.

757 A Patient Inclusion Criteria Algorithm for New Burn Centers Seeking to Implement a Burn Registry

IntroductionData submissions to the NBR are based upon the standardized medical definitions and generalized guidance on patient inclusion criteria found in the ABA Burn Care Quality Data Dictionary. The guidance is complex, often leading to confusion in determining proper patient identification. This is most problematic for new burn centers seeking to implement a burn registry. Therefore, at our burn center, we designed and implemented an algorithm based on a thorough literature review and ABA guidance to improve the accuracy and efficiency of patient identification.MethodsA review of the literature was conducted using the PubMed database. In addition, utilizing the ABA’s multitude of resources including, the Burn Care & Quality Platform (BCQP) Data Dictionary 2020 version 1.1 patient inclusion criteria statements, a BCQP Q&A session on admission information, and Quality & Registry Community discussion boards, the following algorithm was developed by the compilation and simplification of the definitions provided for burn and non-burn injury patient inclusion criteria.ResultsA thorough literature review produced no articles that address NBR inclusion criteria. According to these documents, all patients admitted to the hospital for treatment of an acute burn or soft tissue wound should be included in the burn registry; however, a BCQP Q&A session expressed the Burn Service must provide medical care in order for a patient to be included in the registry. Furthermore, the BCQP Data Dictionary outlines patient inclusion based on a hospital length of stay >24 hours, a surgical operation, or expire at a hospital facility for registry inclusion. Observation patients and non-burn patient consults are excluded from the NBR. The ABA community discussion board revealed many centers only count and track non-burn injury admissions to the burn center service line. The compilation of information resulted in the development of a standardized algorithm defining a patient for registry inclusion.ConclusionsA comprehensive review of the ABA resource documents was compiled to clarify the patient inclusion criteria for data submission to the NBR. The BCQP Data Dictionary 2020 version 1.1 patient inclusion criteria statements, the collaborative Ameriburn communities, and the BCQP Q&A session influenced the design of the clarification algorithm for patient identification to assist burn centers seeking to accurately and most efficiently implement a burn registry. Further research should be conducted on the utilization of the algorithm in comparison to other burn centers.

Antimicrobial Random Peptide Mixtures Eradicate Acinetobacter baumannii Biofilms and Inhibit Mouse Models of Infection.

Antibiotic resistance is one of the greatest crises in human medicine. Increased incidents of antibiotic resistance are linked to clinical overuse and overreliance on antibiotics. Among the ESKAPE pathogens, Acinetobacter baumannii, especially carbapenem-resistant isolates, has emerged as a significant threat in the context of blood, urinary tract, lung, and wound infections. Therefore, new approaches that limit the emergence of antibiotic resistant A. baumannii are urgently needed. Recently, we have shown that random peptide mixtures (RPMs) are an attractive alternative class of drugs to antibiotics with strong safety and pharmacokinetic profiles. RPMs are antimicrobial peptide mixtures produced by incorporating two amino acids at each coupling step, rendering them extremely diverse but still defined in their overall composition, chain length, and stereochemistry. The extreme diversity of RPMs may prevent bacteria from evolving resistance rapidly. Here, we demonstrated that RPMs rapidly and efficiently kill different strains of A. baumannii, inhibit biofilm formation, and disrupt mature biofilms. Importantly, RPMs attenuated bacterial burden in mouse models of acute pneumonia and soft tissue infection and significantly reduced mouse mortality during sepsis. Collectively, our results demonstrate RPMs have the potential to be used as powerful therapeutics against antibiotic-resistant A. baumannii.

Mechanism of Olibanum and Myrrha for the Acute Soft Tissue Injury Based on Network Pharmacology

Abstract Objective The objective of this study was to screen the therapeutic target of olibanum and myrrha on acute soft tissue injury (ASTI) by network pharmacology and to clarify their mechanisms. Methods The main chemical constituents and the targets of olibanum and myrrha were obtained by using traditional Chinese medicine systems pharmacology database and analysis platform database. The disease targets of ASTI were searched by GeneCards. The intersection targets of herbs and diseases were selected for protein interaction analysis, protein–protein interaction network was constructed, and potential protein functional modules in the network were explored. A compound–target–disease network was constructed using Cytoscape3.8.2 software. The targets were analyzed by gene ontology analysis and Kyoto Encyclopedia of Genes and Genomes enrichment analysis based on the Metascape database. Results The core active components of olibanum and myrrha were quercetin, β-sitosterol, and stigmasterol. The core targets were PGR, NCOA2, PTGS2, PRKCA, and NR3C2. Pathways in cancer, AGE-RAGE signaling pathway in diabetic complications might play a potential role in olibanum and myrrha in the treatment of ASTI. Conclusion Olibanum and myrrha have the characteristics of multiple components, multiple targets, and overall regulation in the treatment of ASTI.

A novel synergistic device for joint inflammation – efficacy on ankle sprain cases

Joint inflammation results from soft-tissue injuries and cartilage damage. PRICE is the standard treatment approach for acute soft tissue injuries like ankle sprain. Electrical stimulation, application of orthotic braces, etc. is also effective for this. In a synergistic device all these components are combined and applied simultaneously. This device was developed for joint inflammation and tested for grade I & II acute ankle joint sprain. To test a synergistic – semirigid device, combining PRICE & electrical stimulation for acute ankle sprains of grades I & II for pain, range of motion and swelling is a case series was the objective. Device was developed using novel concept of synergistic applications of PRICE with electrical stimulation. The joint contour of ankle and specific biomechanical bony surface landmarks were considered. Ethical approval was taken from NTCC committee, AIPT. Recordings were taken from eight patients of acute ankle sprain with – in two days of injury, after getting ethical approval. Elevation to the ankle was provided by keeping the part over the pillow and data was recorded with the help of: 1.VAS scale for pain; 2. Measuring tape; 3. Goniometry. t-test was used to find out the significant difference pre and post the application of device. There was a significant reduction in pain (p = 0.006), edema (p = 0.011), dorsi-flexion (p = 0.015), and plantar flexion (p =0.008). The synegistic device has been effective for acute ankle inflammation - grade I & II ankle sprains in 5 sessions; sufficient for the return of function.

A Descriptive Study of the Clinical Presentation, Management, and Outcome of Horses with Acute Soft Tissue Trauma of the Tarsus and the Association with Synovial Involvement.

Simple SummaryThe hock is commonly involved in traumatic injuries in horses and due to the large number of synovial structures located in the region, this frequently results in synovial infection which is a major and potentially life-threatening complication in horses. The aim of this retrospective study was to describe the clinical presentation, diagnostic procedures, management, and outcome of cases with acute soft tissue trauma to the hock and to identify the clinical features that were associated with synovial infection in these cases. This study found that increased synovial effusion, severe lameness on admission, and the persistence of lameness as well as certain wound locations were more commonly associated with a diagnosis of synovial infection. Advanced diagnostic modalities such as radiographs, ultrasonography, and measurements of inflammatory markers aided in establishing the correct diagnosis. The duration of systemic antimicrobial treatment was shorter than previously reported and many cases received local antimicrobial treatment at the site of injury, which may have improved its efficacy. At the time of discharge, while lameness was still present in some cases, the overall survival was excellent. This study describes the clinical features and treatment of these commonly encountered injuries, and this knowledge may benefit clinicians in the future.The tarsus is one of the most common areas of traumatic injury with associated synovial involvement (SI) in horses. The aim of this retrospective study was to describe the clinical presentation, diagnostic procedures, management (emphasizing the type, duration, and route of antimicrobial administration), and outcome of cases with acute soft tissue trauma to the tarsal region. The presenting clinical features, the results of diagnostic modalities, and the initial response to therapy were assessed for their usefulness to predict SI. Medical records of 72 cases were included and SI was diagnosed in 34 cases (47.2%). Increased synovial effusion, lameness on admission (OR = 4.1; 95%CI 1.0–16.4), persistent lameness (OR = 5.7; 95%CI 1.8–17.9), increased blood SAA values (≥200 mg/L) from initial to second measurement (OR = 4.3; 95%CI 1.2–15.5), and wound location on the plantar/plantarolateral/plantaromedial compared to the lateral aspect of the tarsus (OR = 7.0; 95%CI 1.6–30.9) were associated with SI. Radiographs, ultrasonography, and the use of pressure testing when a wound was present proved to be useful in correctly diagnosing SI. The median duration of systemic antimicrobial administration was 8 (IQR: 5 to 9) days and most horses received local antimicrobial therapy. This study highlights several relevant clinical features and their association with SI and emphasizes the usefulness of local antimicrobial therapy in these cases.

Panton-Valentine Leucocidin-Positive Staphylococcus Aureus Gonarthritis in a Healthy Adult Leads To Fulminant Sepsis with Multiple Metastatic Soft Tissue Infection and Necessity of Extracorporeal Membrane Oxygenation

Background: Infections with Panton-Valentine leucocidin (PVL) positive Staphylococcus aureus ( S. aureus ) are often complicated by necrotizing pneumonia, myositis and osteomyelitis. Case Description: We describe a 50 years old, previously healthy male which presented a severe infection with PVL-positive, methicillin- susceptible S. aureus (MSSA) in his left knee after returning from China. He developed a fulminant sepsis with necrotizing pneumonia, acute respiratory distress syndrome (ARDS), acute renal failure and multiple soft tissue abscesses. Extra-corporeal membrane oxygenation (ECMO) was needed for five days. The patient recovered after multiple surgical interventions and long-term antibiotic treatment and eventually returned to work five months after initial admission. Conclusion: While most staphylococcal skin and soft tissue infections (SSTI) show a favorable outcome, SSTI caused by PVL- positive bacteria can lead to fulminant and fatal disease manifestations. Immunocompetent individuals are equally affected as immunocompromised ones. Early suspicion, surgical intervention with debridement and drainage of abscess formations are of key importance in concert with appropriate antibiotic therapy without delay. Imaging should be done to identify clinically silent foci.

The Efficacy in the Treatment of Acute Closed Soft Tissue Injury by Using Acupuncture and Diclofenac in Football Players

This study was aim to investigate the clinical treatment of acupuncture combined with diclofenac in the treatment of acute soft tissue injury in football players. This paperdivided100 patients with acute closed soft tissue injury caused by football into control group and treatment group randomly, 50 cases in each group. The control group was usually treated with PRICE, and the treatment group use PRICE combined with acupuncture and diclofenac to cure. One course for two weeks, treatment requires two courses. Before and after the patient was included in the study, record the scores of dynamic pain intensity, static pain intensity, local pain intensity and local sensitivity, and local swelling assessment. Improve clinical outcomes and record the treatment results after 3 days, 8 days, and 15 days. The results showed that there was a significant difference in the degree of symptomatic relief between the control group and the treatment group on days 3, 8 and 15 after treatment (P < 0.05). The difference between the two groups has statistically significant. The good rate and effective indicators of the treatment group were 65.6% and 92.1%, which was better than the control group (P <0.05) significantly. The results showed that acupuncture combined with diclofenac treatment can improve the pain symptoms of patients with soft tissue injury significantly, and its clinical superiority and overall efficacy are better than conventional PRICE treatment.

Use of subdermal hyaluronic acid injections and a free labial mucocutaneous graft for the repair of feline eyelid agenesis.

To describe a technique to repair feline eyelid agenesis using a hyaluronic acid (HA) subdermal filler injection to allow for acute soft tissue expansion, followed by a free labial mucocutaneous graft. Thirty-nine colobomatous eyelids in 24 feline patients with secondary keratitis were recruited to the study group. Keratitis and trichiasis were markedly resolved in 27/39 (69.2%) eyelids after a single procedure. Post-operative HA subdermal filler injections were required to resolve 5/39 (12.8%) eyelids that had mild post-operative trichiasis, and 1/39 (2.5%) eyelids that had post-operative lateral canthal collapse. Complications occurred in 6/39 (15.4%) cases, consisting of distal graft necrosis (n=2 eyes), suture rubbing the cornea (n=2 eyes), moderate trichiasis (n=1 eye) and graft adherence to the episclera (n=1 eye). The technique was successful in enhancing corneal protection, cosmesis and eyelid function and should be considered as a surgical option for any degree of eyelid agenesis in feline patients.

108. Evaluation of the Impact of Dalbavancin Usage on Clinical Outcomes, Cost-Savings, and Adherence at a Large Safety Net Hospital

BackgroundDalbavancin is a long-acting second-generation lipoglycopeptide antibiotic with potent activity against Gram-positive organisms. Dalbavancin is currently FDA approved for acute bacterial skin and soft tissue infections (ABSSTIs). Growing evidence suggests that patients can be successfully treated with dalbavancin for indications outside of skin and soft tissue infections which include bacteremia and osteomyelitis (OM) with significant cost savings and reduced length of stay. We developed a protocol for the use of dalbavancin in patients who required intravenous antibiotics for serious bacterial infections but did not qualify for outpatient parenteral antibiotic therapy (OPAT). During the COVID-19 pandemic, we expanded the protocol to reduce the amount of clinical contact required for all patients.MethodsIn this retrospective observational study, we reviewed all patients that received at least one dose of dalbavancin in either inpatient or outpatient setting at Parkland Hospital from July 2019 through February 2021. Patient demographics, type of infection, and rationale for dalbavancin were collected at baseline. Clinical response was measured by avoidance of Emergency Department (ED) visits or hospital readmission at 30, 60, and 90 days. In addition, a separate analysis was conducted to estimate hospital, rehabilitation, or nursing home days saved based on their diagnosis and projected length of treatment. ResultsTwenty-eight patients (24 inpatient, 4 outpatient) were included in the study. The majority were uninsured (89%), homeless (64%), or had active intravenous drug use (IDU) (60%). Indications for use included SSTI (42.9%), bacteremia (64.3%), and OM (42.6%). Clinical failure was observed in 4 (14%), 1 (3.5%), and 2 (7.1%) patients at 30, 60, or 90 days (respectively). Nonadherence to medical recommendations, lack of source control, and ongoing IDU increased risk of returning to the hospital. Dalbavancin use saved a total of 381 days of inpatient/rehab/facility stay. Baseline Characteristics of Patients Types of Infections and Microbiology ED Visit or Readmissions at 30, 60, or 90 DaysConclusionDalbavancin showed similar rates of success with improved length of stay and cost savings. The use of long acting lipoglycopeptides are desirable alternatives to traditional OPAT for patients that otherwise would not qualify for OPAT or desire less hospital contact.Disclosures All Authors: No reported disclosures

613. Clinical Outcomes Following Dalbavancin Administration during Outpatient Parenteral Antimicrobial Therapy

BackgroundDalbavancin, a lipoglycopeptide with prolonged half-life targeting Gram-positive organisms, is approved for treatment of acute bacterial skin and soft tissue infection. It reduces hospital duration in patients with barriers to short-term rehabilitation or outpatient parenteral antimicrobial therapy (OPAT). Increasing evidence supports the off-label use of dalbavancin to treat other types of infection. We conducted a quality improvement study to evaluate outcomes following dalbavancin administration.MethodsWe performed a cohort study of recipients of ≥1 dose of dalbavancin from 1/31/2016-1/31/2021 at the Veterans Affairs Connecticut Healthcare System. Demographic, comorbidity, microbiological, antibiotic duration prior to dalbavancin, indication for dalbavancin, and type of infection data were collected. Outcomes included 1) lab abnormalities: hepatotoxicity within 2 weeks of dalbavancin; 2) clinical cure: resolution of symptoms of infection within 90 days; 3) all-cause readmission within 90 days; and 4) all-cause mortality within 90 days.Results42 patients met criteria. Median age was 69 years (range, 32-91), 100% were male, 55% (n=23) had diabetes, 31% (n=13) had liver disease, 36% (n=15) had other immunosuppressive conditions, and 12% (n=5) had substance use disorder (SUD). All received their first dose as inpatients. Median hospital duration was 8 days (range, 1-32). 4 (10%) required critical care. Median antibiotic duration prior to dalbavancin was 7 days (range, 1-42). Indications included ineligibility for OPAT (n=21, 50%), pharmacologic reasons (n=10, 24%), ineligibility for peripherally inserted central catheter (n=6, 14%), or SUD (n=5, 12%). Common microorganisms were Staphylococcus spp. (n=22, 52%), polymicrobial (n=13, 31%), and Corynebacterium spp. (n=10, 24%). 93% (n=39) had clinical cure of infection; readmissions and mortality were rare (Table 1). ConclusionDalbavancin was associated with clinical cure for diverse infections with low rates of adverse events, readmission and mortality in patients ineligible for traditional OPAT. Although confirmatory data are needed from larger studies, dalbavancin appears to be a versatile therapeutic agent for Gram-positive infections.Disclosures All Authors: No reported disclosures