Antibiotic Research Articles

Chalazia: A Scoping Review to Identify the Evidence Behind Treatments.

Current treatment approaches aimed at resolving a chalazion vary greatly among practice settings and practitioners. Our objective is to provide a review of existing literature on treatment modalities aimed at resolving a chalazion. We conducted a review of existing peer-reviewed publications that described treatment methods aimed at resolving chalazia in patients of any age. Literature searches were conducted using PubMed, Embase, and Cochrane. A 3-stage review process was conducted by 2 trained reviewers, including an initial screening, a full-text review, and data extraction. Articles were assessed for baseline study identifiers, study design, country of origin, number of patients, demographic characteristics, types and number of treatments administered, and resolution rates. Publications were graded using the Oxford Centre for Evidence-Based Medicine levels of evidence table. A total of 2814 articles were initially identified based on database queries; 39 studies met inclusion criteria for full-text review. The most represented study design was case series (15), followed by randomized controlled trials (14). Twenty-five publications discussed intralesional corticosteroid injections, 18 discussed incision or excision and curettage, 5 discussed conservative treatments, and 8 discussed topical antibiotic±steroid treatments. Both the definition of chalazion resolution and resolution rates for each treatment modality varied widely between publications. Procedural management of chalazia, including corticosteroid injections and surgical management, is most often studied in the literature. Fewer publications exist on the efficacy of conservative and topical treatments.

Topical mupirocin treatment reduces interferon and myeloid signatures in cutaneous lupus erythematous lesions through targeting of Staphylococcus species.

Cutaneous lupus erythematosus (CLE) is an inflammatory skin manifestation of systemic lupus erythematosus (SLE). Type I interferons (IFNs) promote inflammatory responses and are elevated in CLE lesions. We recently reported that CLE lesions are frequently colonized with Staphylococcus aureus (S. aureus). Here, we follow up in a proof-of-concept study to investigate whether type I IFN and inflammatory gene signatures in CLE lesions can be modulated with mupirocin, a topical antibiotic treatment against S. aureus-mediated skin infections. Participants with active CLE lesions (n=12) were recruited and randomized into a week of topical treatment with either 2% mupirocin or petroleum jelly vehicle. Paired samples were collected before and after 7 days of treatment to assess microbial lesional skin responses. Microbial samples from nares and lesional skin were used to determine baseline and post-treatment Staphylococcus abundance and microbial community profiles by 16S rRNA gene sequencing. Inflammatory responses were evaluated by bulk RNA sequencing of lesional skin biopsies. We identified 173 differentially expressed genes in CLE lesions after topical mupirocin treatment. Decreased lesional Staphylococcus burden correlated with decreased IFN pathway signaling and inflammatory gene expression and barrier dysfunction. Interestingly, mupirocin treatment lowered skin monocyte levels, and this mupirocin-associated depletion of monocytes correlated with decreased inflammatory gene expression. Mupirocin treatment decreased lesional Staphylococcus, and this correlated with decreased IFN signaling and inflammatory gene expression. This study suggests a topical antibiotic could be employed to decrease lupus skin inflammation and type I IFN responses by reducing Staphylococcus colonization.

Calcifediol and paricalcitol as adjunctive therapies for HSV-1 keratitis and corneal perforation: A case report.

Herpes simplex virus 1 establishes a latent infection in trigeminal ganglia. Reactivation causes cold sores, as well as viral keratitis. The purpose of this study was to report potential benefits of using active vitamin D receptor ligands (VDR-agonists) as adjunctive therapies for the treatment of infectious corneal perforations, and prevention of HSV recurrence. A 57-year-old female with a past history of episodic, poorly-healing, corneal erosions, recurring orolabial herpetic lesions, as well as PCR-confirmed recurrences of herpes simplex keratitis presented with a burning sensation and slight pain in the right eye. Examination indicated HSV keratitis. Topical antibiotic and oral antiviral treatments were prescribed. Despite these standard-of-care treatments, a perforated corneal ulcer ensued. Corneal perforation associated with HSV-1 keratitis recurrence, later confirmed by PCR analysis of corneal scrapings. Corneal perforation was treated with a human fibrin glue, fortified with multilayered amniotic membrane transplant, as well as a therapeutical contact lens. Following surgery, calcifediol and paricalcitol were started as oral adjunctive therapies in an attempt to boost tissue regeneration and innate-immunity within the slow-healing cornea. Anterior segment optical-coherence tomography was used to measure corneal thickness. Frequent follow-ups with various specialists allowed for comprehensive patient evaluation, and meticulous screening for any signs indicating potential HSV-1 recurrence. Following calcifediol-paricalcitol therapy corneal thickening, and re-epithelization ensued. During combined calcifediol-paricalcitol therapy, the patient has had no recurrence of herpes simplex keratitis, or orolabial herpes lesions. Corneal stabilization avoided a high-risk, full-thickness corneal transplantation, facilitating future cataract surgery, and allowing for some degree of visual recovery in this eye.

Endothermal pupilloplasty : Aminimally traumatic technique for centering the pupil in patients with corectopia. Video article

The aim of endothermal pupilloplasty (EP) is to optimize centering of the pupil, contour, or size. The EP is performed in patients with congenital or acquired corectopia or an irregular pupil shape. In individual cases the technique has also been used to tighten the iris in floppy iris syndrome and to adapt iris tissue edges in patients with sectoral iris defects or iridodialysis. In patients with pronounced iris stromal atrophy or major iris tissue defects, e.g., congenital or posttraumatic, EP could be indicated after careful consideration. Viscoelastic substances are injected into the anterior chamber via a23-gauge paracentesis. Using the blunt tip of abipolar endodiathermy probe, the iris tissue is selectively cauterized at several points, stretching the pupil in the direction to which cauterization is applied. The higher the energy level applied and the closer the cauterization is to the pupil margin, the more effect is achieved. The viscoelastic agents are suctioned off and the paracentesis is sealed by hydration (and additionally sewn in children). Avideo of the operation, which is available online, shows the surgical technique in detail. Control examinations are recommended after 1 day, 1 week and 1-3 months post-EP. Acombination of topical steroids and antibiotics, e.g., dexamethasone and gentamicin eye drops, should be applied 5 times daily for 1 week and 3 times daily for another week. To date, isolated positive retrospective case reports on EP have been published. There is alack of prospective studies, reviews or meta-analyses.

C-reactive protein (CRP) and otorrhoea as prognosticate markers for necrotising otitis externa treatment response: based on a retrospective cohort study of 62 patients

Background Recurrence rate of necrotising otitis externa (NOE) after treatment is 15-20%. This is mainly due to a lack of reliable clinical indicator for the resolution of disease. Aims We aim to assess the predictability of the otalgia, otorrhoea and C-reactive protein (CRP) levels in a large cohort of sixty-two patients for treatment outcome. Methods Consecutive patients treated for NOE in our Nottingham tertiary ENT referral unit were retrospectively reviewed from January 2017 to June 2020. Diagnoses were made based on clinical findings and imaging. Good response to treatment was defined as those who required treatment of not longer than the standard six weeks of systemic antibiotics. Results Average age at presentation was 78.4 years. 75.8% of patients were male. 62.9% had diabetes. Ten patients received more than the standard six weeks of systemic antibiotics. Complications from disease progression included cranial nerve neuropathies (14.5%), meningitis (3.2%), and sigmoid sinus thrombosis (3.2%). Two patients had recurrent or persistent NOE and died while on treatment. Delays in normalization of CRP (p = 0.015) and resolution of otorrhoea (p = 0.014) were associated with an increased need for prolonged antibiotic treatment. Conclusion Normalisation of CRP and resolution of otorrhea can assist in identifying patients who will likely benefit from a prolonged course of systemic antibiotics.

A randomized double-blind noninferiority clinical multicenter trial on oral moxifloxacin versus placebo in the outpatient treatment of uncomplicated acute appendicitis: APPAC IV study protocol.

Antibiotic therapy is currently considered a safe and effective treatment alternative for computed tomography (CT)-confirmed uncomplicated acute appendicitis with recent studies reporting good results on both oral antibiotics only and outpatient management. Furthermore, there are promising pilot results on uncomplicated acute appendicitis management with symptomatic treatment (placebo). This trial aims to assess whether both antibiotics and hospitalization can be safely omitted from the treatment of uncomplicated acute appendicitis. The APPAC IV (APPendicitis Acuta IV) trial is a randomized, double-blind, multicenter noninferiority clinical trial comparing oral moxifloxacin with oral placebo in an outpatient setting with a discharge directly from the emergency room (ER). Adult patients (18-60 years) with CT-confirmed uncomplicated acute appendicitis (absence of appendicolith, abscess, perforation, tumor, appendiceal diameter ⩾15 mm on CT, or body temperature >38 °C) will be enrolled in nine Finnish hospitals. Primary outcome is treatment success at 30 days, that is, the resolution of acute appendicitis resulting in discharge from the hospital without appendectomy during the 30-day follow-up evaluated using a noninferiority design with a noninferiority margin of 6 percentage points. Noninferiority will be evaluated using one-sided 95% confidence interval of proportion difference between groups. Secondary endpoints include postintervention complications, recurrent appendicitis after the 30-day follow-up, duration of hospital stay, admission to hospital and reason for admission, readmissions to emergency department or hospitalization, VAS pain scores, quality of life, sick leave, and treatment costs. The follow-up after discharge from the ER includes a phone call at day 1, and at 3-4 days, 30 days, and 1, 3, 5, 10, and 20 years. Those eligible patients, who decline to undergo randomization, will be invited to participate in a concurrent observational cohort study with follow-up at 30 days, and 1 and 5 years. To our knowledge, APPAC IV trial is the first large randomized, double-blind, noninferiority multicenter clinical trial aiming to compare oral antibiotics and placebo for CT-diagnosed uncomplicated acute appendicitis in an outpatient setting. The study aims to bridge the major knowledge gap on whether antibiotics and hospitalization or both can be omitted in the treatment of uncomplicated acute appendicitis. The study protocol has been approved by the Clinical Trials Information System (CTIS) of the European Medicines Agency (EMA), study number: 2023-506213-21-00 and the trial has been registered in ClinicalTrials.gov, NCT06210269.

Efficacy of adjunctive systemic or local antibiotic therapy in peri-implantitis: a systematic review and meta-analysis of randomized controlled clinical trials.

This systematic review and meta-analysis considered the results of randomized controlled clinical trials (RCTs) to evaluate the efficacy of systemic or local antibiotic therapy in peri-implantitis. Two independent authors screened publications from three electronic databases to include RCTs meeting all the inclusion and exclusion criteria. A meta-analysis was performed to evaluate the weighted mean differences in survival rate (SR) and changes in pocket probing depth (PPD), bone level (BL), and clinical attachment level (CAL). The study cohorts were defined as antibiotic and control groups with subgroups for analysis. Seven studies including 309 patients (390 implants) were considered. Within the limitations of this review, patients in the antibiotic groups exhibited significant improvements in PPD. Subgroup analysis indicated that the administration of systemic antibiotics or the use of antibiotics in non-surgical treatments did not result in a significant alteration in BL. It was established that the addition of antibiotics can ameliorate PPD and SR in the treatment of peri-implantitis, whether through surgical or non-surgical approaches, and also shows moderate performance regarding BL and CAL. Considering the lack of application of new technologies in the control group and the hardship of assessing the potential risks of antibiotics, careful clinical judgment is still necessary.

Antibiotic Choice and Outcomes for Respiratory Infections in Children With Tracheostomies.

Respiratory infections are a major cause of hospitalization in children with tracheostomies, contributing significantly to hospital expenses. Limited data exist to describe optimal diagnostic strategies or management recommendations for these infections. This study aimed to explore factors associated with antibiotic therapy, including usage, administration route, duration, variables influencing the decision to prescribe antibiotics, and outcomes in children with tracheostomies experiencing episodes of respiratory infection other than pneumonia (tracheobronchitis and nonspecific respiratory episodes [NSRE]). We conducted a retrospective cohort study using the medical records of 83 children who underwent tracheostomy and received treatment at a tertiary hospital from 2010 to 2021. A total of 164 episodes of tracheobronchitis and 98 episodes of NSRE were analyzed. Children with tracheobronchitis were more frequently treated with antibiotics: 75% in nonhospitalized cases and 76% in hospitalized cases. In NSRE, antibiotic prescription dropped to 40% and 29%, respectively. Out of 51 tracheobronchitis and 15 NSRE initially treated with oral antibiotics, a switch to intravenous administration was deemed necessary in only 7 tracheobronchitis cases (14%). Fever was significantly associated with antibiotic prescription in tracheobronchitis and NSRE, regardless of hospitalization status. Two children died within the 28-day period following the onset of tracheobronchitis symptoms. Many cases identified as tracheobronchitis, along with a greater number of NSRE cases, resolved without requiring antibiotics. Although fever was associated with increased antibiotic prescription, it does not necessarily indicate severity. Therefore, careful consideration should be given before prescribing antibiotics, especially in febrile cases, to avoid unnecessary treatments.

Length of Hospital Stay for Endocarditis Before and After the Partial Oral Treatment of Endocarditis Trial

BackgroundThe results from the POET (Partial Oral Treatment of left-sided Endocarditis) trial were published in August 2018 and established noninferiority of oral step-down antibiotic treatment in stabilized patients with infective endocarditis (IE). Data on length of hospital stay (LOS) and safety following the POET trial are warranted. ObjectivesThe goal of this study was to examine changes in LOS and safety (mortality and relapse of bacteremia) before and after POET publication. MethodsUsing Danish nationwide registries, patients with first-time IE caused by Streptococcus spp., Enterococcus faecalis, Staphylococcus aureus, or coagulase-negative staphylococci from 2012 to 2021 were identified. Median LOS was examined according to publication date (before and after September 2018). Mortality and relapse of bacteremia at 180 days of follow-up were examined. ResultsWe identified 3,008 patients before POET publication (median age 72.8 years) and 1,740 after publication (median age 75.2 years) (P < 0.0001). The median LOS decreased by 8 days: 41 days (Q1-Q3: 29-49 days) before POET publication and 33 days (Q1-Q3: 21-44 days) after POET publication (P < 0.0001). Similar reductions in LOS were seen across microbiological etiologies and age groups. Reduction in LOS was most pronounced in nonsurgically treated patients. Mortality from IE admission to a maximum of 180 days’ follow-up was 27.5% before POET publication and 28.3% after publication (P = 0.41). The bacteremia relapse rate within 180 days was 3.5% before POET publication and 1.6% after publication (P = 0.0002). ConclusionsFollowing the POET trial, we found a reduction in median LOS of 8 days with no change in mortality and an associated lower rate of relapse of bacteremia.

Optimizing Surgical Site Infection Prevention in Dermatologic Surgery.

We aim to review modifiable risk factors and practices for surgical site infections (SSIs) reduction in cutaneous surgeries. The existing norms are assessed with the latest evidence, with the aim of enhancing and optimizing intra and postoperative strategies. This review seeks to offer an updated summary of the results of evidence for SSI reduction strategies tailored for practicing general dermatologists. Searches were conducted for "cutaneous surgery surgical site infection complications" using PubMed Central® and DynaMed®. Articles with pragmatic guideline recommendations were selected. We found evidence for intraoperative factors such as non-sterile gloves, brushless hand scrubbing/simple hand washing, sterile materials, and chlorhexidine gluconate as a skin antiseptic. For postoperative factors, there is a lack of evidence to support the use of topical antibiotic ointments, dressings, or waiting 48 hours before wetting to prevent SSI. Several intra/postoperative factors not specific to dermatologic procedures are briefly discussed for additional context. Several SSI risk factors are inherent to patients or necessary procedures; however, dermatologists have identified modifiable risk factors and developed protocols to mitigate SSI risks intraoperatively and postoperatively. By questioning established practices in cutaneous surgery aimed at preventing SSIs, we can work towards the optimal utilization of resources. This dual-focused approach not only enhances the efficiency of the healthcare system but also diminishes the risks associated with SSIs. It is important to acknowledge that this review does not encompass all factors essential for consideration in these recommendations. Nonetheless, it will approach these factors with an evidence-based lens, placing SSI prevention at the forefront.

Hypertrophic nonunion management with distraction osteogenesis: a scoping review of the literature

Abstract Introduction: Traditionally, stiff hypertrophic nonunions have been managed with open preparation of the nonunion site, which is then secured with internal fixation. Alternative surgical options are available including distraction osteogenesis with an external fixator. There is currently a limited amount of literature pertaining to the use of distraction osteogenesis in the management of hypertrophic nonunion. The aim of this systematic review was to collate and assess the effectiveness of distraction osteogenesis (DO) in the management of hypertrophic nonunions and to evaluate the complications that are commonly reported in the literature. Methods: We searched for articles pertaining to the treatment of hypertrophic nonunion using distraction osteogenesis. Several electronic bibliographic databases and clinical trial registries were searched using the MeSH terms “hypertrophic non-union,” “distraction osteogenesis,” “stiff non-union,” and “External Fixation” in various combinations to return the maximal number of studies for review. We performed a systematic review and identified a total of 11 studies eligible for review. Results: The review of the literature demonstrated that this technique is highly effective in achieving bony union with minimal complications. The most common complication is mild superficial pin site infections, usually managed with oral antibiotics and effective wound hygiene. Other complications reported were deep pin tract infections, broken hardware, and deformity recurrence due to collapse of regenerate bone. Conclusion: The use of distraction osteogenesis with external fixator devices is an effective and safe method for producing bony union in hypertrophic nonunions. There were minimal associated complications.

Timing of radiographic healing for distal femur fractures treated with intramedullary nails.

This study aimed to profile modified Radiographic Union Scale for Tibia (mRUST) scores over time in distal femur fractures treated with intramedullary nails and identify predictors of radiographic union timing and delayed progression. Design: Multicenter retrospective cohort study. Ten Level I Trauma Centers. The inclusion criteria were patients with distal femur fractures (OTA/AO 33A and 33C) treated with intramedullary nails, with a minimum follow-up of one year or until radiographic union or reoperation. The exclusion criteria were fractures treated with combination nail-plate constructs, pathologic fractures, and patients under 18 years old.Outcome Measures and Comparisons: The primary outcome was the mRUST score at 3, 6, and 12 months post-operatively. Receiver operating characteristic (ROC) curve analysis identified the optimal 3-month mRUST score predicting reoperation. Multivariable models were used to identify predictors of radiographic union timing and delayed progression. The study included 155 fractures in 152 patients, with a mean patient age of 51 and a mean follow-up of 17 months. A 3-month mRUST score of ≤8 predicted reoperation with a PPV of 25%, and a NPV of 99%. The timing of radiographic union was associated with tobacco use (1.2 months later; p = 0.04), open fracture (1.4 months later; p = 0.04), and the use of topical antibiotics (2.1 months longer; 95% CI: 0.33 - 3.84; p = 0.02), however topical antibiotics was at high risk of being confounded by injury severity. Delayed progression to fracture healing, wherein the most rapid radiographic healing occurs more than 3 months post-operatively, was predicted by chronic kidney disease (p < 0.01). A 3-month mRUST score >8 suggests a very high likelihood of avoiding reoperation for nonunion.Tobacco use and open fractures were associated with a longer time to radiographic union. Chronic kidney disease is associated with a delayed radiographic progression, suggesting a need for adjusted expectations and management strategies in these patients. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Preliminary clinical evaluation of the treatment efficacy of a temperature-adjustable cryotherapy device for chronic, recurrent blepharitis in dogs.

To preliminarily evaluate the treatment efficacy of a temperature-adjustable cryotherapy device for chronic, recurrent blepharitis in dogs. Five dogs (eight eyes) of different breeds with blepharitis, which was unresponsive to systemic steroids. The dogs were subjected to ophthalmic examination, including Schirmer tear test-1 (STT-1), tear film break-up time (TFBUT) test, and slit-lamp biomicroscope examination. Cryotherapy was performed using a device featuring precise low-temperature control. A bandage lens and ointment (2% hypromellose) were applied before cryotherapy to protect the cornea. Carbon dioxide gas at 0°C was sprayed on the lesion for 10 s. In all patients, only topical antibiotics and corticosteroid were applied twice a day; systemic corticosteroids were not used. Pruritus and ocular discharge were scored based on the visual analog scale (VAS) before and 3 weeks after cryotherapy. Qualitative changes in tear film were measured using STT-1 and a TFBUT test. The effects on erythema and swelling were evaluated by ophthalmic examination. Pruritus improvement was confirmed in all eight eyes (five dogs). After cryotherapy, the average VAS score of pruritus significantly decreased from 4.12 ± 2.64 to 0.37 ± 0.51 (p < .001), and the average TFBUT significantly increased from 5.75 ± 4.80 to 13.75 ± 4.43 (p = .010). STT-1 and the VAS score of ocular discharge did not significantly differ. Erythema and swelling were improved in three out of eight eyes. Cryotherapy is effective in treating blepharitis with pruritus and may become a new treatment option in patients in whom systemic corticosteroids are difficult to administer.

Topical antibiotics for the treatment of upper respiratory tract diseases

Actuality. Antibiotic resistance includes the unjustified use of topical antibacterial agents.Objective. To study the frequency of topical and systemic antibacterial drugs among adults with symptoms of otorhinolaryngological diseases over the past 6 months and the role of physicians in prescribing antibacterial drugs.Methods: online questioning of adults. The data from a survey of 111 respondents aged over 18 years were analyzed. A group (61 out of 111) of respondents (54.96%) experiencing symptoms of otorhinolaryngological diseases and using medications 6 months before the survey was conducted was identified.Results: 31.15% of respondents took systemic antibiotics. Of all respondents who received a systemic antibacterial drug, only 14 out of 19 (73.68%) took it as prescribed by a physician and 1 (2.38%) was prescribed by a pharmacist. At the same time, the respondents used all topical antibacterial drugs — 4 cases (6.6%) without the recommendation of a physician or pharmacist.Conclusion. The prevalence of topical antibacterial drugs for the treatment of upper respiratory tract diseases among the study population was low, but the frequency of their use without the appointment of a specialist was high.

On Algorithms and Approximations for Progressively Type‐I Censoring Schemes

ABSTRACTThis research aims to study the estimation of parameters for a Burr‐XII distribution and to investigate optimal sampling plans under progressive Type‐I censoring (PTIC). For point estimation, we employed the maximum‐likelihood estimation (MLE) method using two numerical approaches: Newton–Raphson and the Expectation–Maximization algorithm. We also utilized Bayesian estimation with squared error loss and linear exponential loss functions. Specifically, two approximate Bayesian methods, the Lindley and Tierney‐Kadane methods were examined. Additionally, Bayesian numerical estimation was performed using Markov Chain Monte Carlo with the Metropolis‐Hastings (MH) algorithm. For interval estimation, we constructed asymptotic confidence intervals for MLE and the highest posterior density method within the Bayesian framework. The practical study involved Monte Carlo simulations to assess the efficiency and accuracy of the proposed estimation methods across different PTIC schemes. A real data analysis is also provided to illustrate the practical application of these methodologies in analyzing a clinical trial dataset. Data from a clinical trial using a PTIC scheme reveals patterns in pain relief, aiding in evaluating the antibiotic ointment's effectiveness. The study further investigates optimal sampling plans for the Burr‐XII distribution under PTIC.

Necrotizing pneumonia-a rare but complex complication in bronchiectasis patients.

Pneumonia occurs commonly in bronchiectasis patients with exacerbation, though necrotizing pneumonia remains rare. This report presents two cases of bronchiectasis complicated by necrotizing pneumonia. The first case involves a 39-year-old female with bronchiectasis due to primary ciliary dyskinesia. She presented with severe chest pain and persistent fever unresponsive to oral antibiotics. Chest computed tomography (CT) revealed necrotizing pneumonia with associated empyema, necessitating prolonged antibiotic therapy, pleural drainage and ultimately surgical decortication. The second case is a 39-year-old male with bronchiectasis following ammonia inhalation injury, presenting with pleuritic chest pain and productive cough, with a CT scan showing consolidation with low attenuation areas. Intensive antibiotic treatment was required, alongside corticosteroids and inhaled antibiotics afterward. These cases demonstrate the importance of identifying risk factors for necrotizing pneumonia in bronchiectasis patients. Tailoring treatment strategies, including extending antibiotic regimens, using inhaled antibiotics, and administering corticosteroids, is essential to mitigate poor outcomes.

Using artificial intelligence to determine best time to switch intravenous to oral antibiotics in pediatrics.

Using artificial intelligence to determine best time to switch intravenous to oral antibiotics in pediatrics.

Clinical and functional outcomes of utilising nail cement spacer as a frugal method of reconstruction for tumours of the proximal humerus

BackgroundThe shoulder girdle and proximal humerus are common sites for neoplastic lesions be it benign or malignant. We aimed to evaluate the outcomes of a frugal method of reconstruction of the proximal humerus for neoplastic lesions at short to medium term follow-up. MethodsData for this retrospective case series was collected from an electronic data base held at the primary authors institution. All patients who had resection of the proximal humerus for any neoplastic lesion and reconstructed with a nail cement spacer were included in the study from January 2016 to January 2023. The functional outcomes were measured by Musculoskeletal tumour society score (MSTS) and the Toronto extremity salvage score (TESS). The survivorship and post-operative complications were also reported. ResultsTwenty-two patients were available at final follow up with a mean follow-up time of 37 ±18 months (range 12-81 months) with Ewing’s sarcoma, giant cell tumour, osteosarcoma and metastatic disease as the commonest indications for surgery with a mean age of 29 ± 17 years. The Kaplan–Meier estimates indicated that the survival rate for 22 patients with endpoint (event) taken as death was 63.6% and for endpoint taken (event) as implant failure was 95.5% with mean survival time of 58.1 and 77 months respectively. At final follow up, the mean MSTS score was 23.6 ± 2.9 (78.7%). One patient had superficial infection which settled with a short course of oral antibiotics and one patient had breakage of nail, which was revised. ConclusionThese results prove that this frugal method of reconstruction is comparable with endoprosthesis when considering clinical and functional outcomes but significantly cost effective and should be considered for the individual patient.

Pharmacokinetics of PP353, a formulation of linezolid for intervertebral disc administration, in patients with chronic low back pain and Modic change Type 1: A first-in-human, Phase 1b, open-label, single-dose study.

Bacterial infection of the intervertebral disc is difficult to treat because the tissue is usually not vascularized and systemic antibiotic therapy may not reach optimal antibacterial exposure. Here we characterize the safety, tolerability, and pharmacokinetics of PP353, a suspension of micronized linezolid, formulated for direct intervertebral disc administration. The safety, tolerability, and pharmacokinetics of an intradiscal administration of PP353, was assessed in Part A of a Phase 1b study and consisted of a single injection of study drug (3 mL of PP353 and 150 mg linezolid). Clinical assessment included initial safety and tolerability of PP353 with continued follow-up for 12 months. Assessment of linezolid concentration in plasma samples enabled characterization of the pharmacokinetics. Deconvolution of systemic linezolid was used to estimate intervertebral disc linezolid concentration. Intradiscal administration of 3 mL of PP353 (linezolid 50 mg/mL) to the nucleus pulposus was well tolerated with no reported study treatment-related severe or serious adverse events and resulted in an average geometric mean linezolid plasma C max of 1300 ng/mL at 7.27 h post-administration. The linezolid plasma C max observed with intradiscal PP353 is approximately 10% that observed with a standard oral or iv administration of 600 mg linezolid. Pharmacokinetic deconvolution estimated that a single dose of PP353 (150 mg linezolid) provided intradiscal bactericidal concentration of linezolid for 96 h and bacteriostatic exposure for up to 120 h after dosing. Intradiscal administration of 3 mL of PP353 is well-tolerated and based on the pharmacokinetics following a single injection, a two-dose regimen of PP353 (150 mg linezolid) on Day 1 and Day 5 ± 1 was selected to explore safety, tolerability, pharmacokinetics, and efficacy in Part B of the Persica 002 study.

Pharmacoepidemiology of antibacterials use for nosocomial infections

Introduction. Antibacterial resistance of nosocomial infectious agents is a serious problem. It makes a choice of therapy complicated and worsens the prognosis of the disease significantly. Purpose of the study. The purpose of the study was the pharmacoepidemiological analysis of antibacterial use as a treatment for infections caused by multidrug-resistant pathogens. Material and methods. A retrospective study of medical records was conducted for hospitalized patients at the State Budgetary Institution “City Clinical Hospital named after S.S. Yudin DZM” in 2019–2021. Antibacterial therapy in hospital settings against pathogens of the ESKAPE group was analyzed and the resistance of the detected pathogens was determined. Results. 226 confirmed clinical cases of infection were analyzed. Results of 1422 microbiological studies were studied to determine the resistance of the detected pathogens. The structure of 562 prescriptions of drugs of the group J01 “Antibacterial drugs for systemic use” was studied. In 2020 the total volume of consumption of systemic antibacterials amounted for 85594 DDD. The DU-90% segment by the number of DDDs made up five drugs – meropenem, polymyxin B, tigecycline, amikacin and ampicillin/sulbactam. The intensity of drug consumption was also expressed in DDD/100 bed days. The most prescribed empirically systemic antibiotics for infections treatment have become the group of β-lactam drugs in combination with β-lactamase inhibitors and carbapenems. Tigecycline, polymyxin B and carbapenems are the main drugs for targeted treatment of nosocomial infections at the multidisciplinary hospital of the State Budgetary Institution “City Clinical Hospital named after S.S. Yudin DZM”.