Incidence Of Infectious Complications Research Articles

Limited impact of traumatic brain injury on the post-traumatic inflammatory cellular response.

Trauma triggers a systemic inflammatory cellular response due to tissue damage, potentially leading to a secondary immune deficiency. Trauma severity is quantified by the Injury Severity Score (ISS). Severe Traumatic Brain Injury (TBI) is associated with high ISSs due to high lethality, despite limited tissue damage. Therefore, ISS might overestimate the post-traumatic inflammatory cellular response. This study investigated the effect of TBI on the occurrence of different systemic neutrophil phenotypes as alternative read-out for systemic inflammation. A single-center retrospective cohort study was conducted at a level-1 trauma center. Patients aged ≥ 18 years, admitted between 01-03-2021-01-11-2022 and providing a diagnostic blood sample were included. Four groups were created: isolated TBI, isolated non-TBI, multitrauma TBI and multitrauma non-TBI. Primary outcome was occurrence of different neutrophil phenotypes determined by automated flow cytometry. Secondary outcome was infectious complications. In total, 404 patients were included. TBI and non-TBI patients demonstrated similar occurrences of different neutrophil phenotypes. However, isolated TBI patients had higher ISSs than their isolated non-TBI controls who suffered similar post-traumatic inflammatory cellular responses. Regardless of the type of injury, patients exhibiting higher systemic inflammation had a high infection risk. When TBI is involved, ISS tends to be higher compared to similar patients in the absence of TBI. However, TBI patients did not demonstrate an increased inflammatory cellular response compared to non-TBI patients. Therefore, TBI does not add much to the inflammatory cellular response in trauma patients. The degree of the inflammatory response was related to the incidence of infectious complications.

Low rates of complications and β-lactam resistance in viridans group streptococci bloodstream infection among cancer patients receiving chemotherapy.

Viridans group streptococci (VGS) bloodstream infection (BSI) frequently occurs in cancer patients receiving chemotherapy, and is associated with infective endocarditis (IE) in up to 20% of cases in the general population. In cancer patients receiving chemotherapy with VGS BSI, we aimed to: (i) determine the incidence of infective complications including IE, (ii) assess the utility of echocardiography in this patient population, (iii) determine the duration and type of antimicrobial therapy received for monomicrobial infections, and (iv) determine the evolution of antimicrobial resistance. VGS BSIs (excluding Streptococcus pneumoniae and Streptococcus pseudopneumoniae) in cancer patients receiving chemotherapy were identified from a statewide public pathology database between 2013 and 2022 at our tertiary centre. Medical records were accessed for clinical, microbiological and radiological data. Of 581 patient episodes screened, 183 episodes involving 171 patients met inclusion criteria. Of these, 51% were bone marrow transplantation (BMT) patients, 40% were non-BMT haematology patients, and 8% were solid organ malignancy patients. The median age was 55 years, and 96% were neutropenic at the time of blood culture collection. A transthoracic echocardiogram was performed for 71% of episodes, and one patient met modified Duke's criteria for definite IE, although this diagnosis was not suspected on clinical grounds. Other complications were uncommon. Benzylpenicillin resistance was rare (2.9%) and did not change over time. Most episodes (75%) were treated with piperacillin/tazobactam. For monomicrobial BSIs, the median antibiotic duration was 5 days (IQR 2-7) post-neutropenia resolution. Infective complications and antimicrobial resistance are rare in cancer patients with VGS BSI. This may provide a safe opportunity to limit both investigations (e.g. echocardiogram) and prolonged exposure to broad-spectrum antimicrobials.

Postoperative complications and hernia recurrence after the use of various ventral hernia repair techniques

Prosthetic hernioplasty (HP) for ventral hernias (VH) has a complication rate of up to 27% and a hernia recurrence rate up of to 37%, depending on the chosen technique. The use of laparoscopic HP techniques allows for a shorter hospital stay and a lower risk of wound infection. There is a wide range of data on the superiority of laparoscopy over the open technique in terms of recurrence rates and various types of complications. The results of comparing HP with and without suturing of the hernia defect are controversial. Objective — to study the structure and incidence of postoperative complications, as well as the frequency of hernia recurrences after the use of open and laparoscopic HP for VH. Materials and methods. A multicenter prospective study, which included 482 patients diagnosed with VH, was conducted at the clinical base of the Department of General Surgery No. 2 at Bogomolets National Medical University. A total of 279 (57.9%) patients had primary VH, while 203 (42.1%) had incisional VH. The patients were divided into two groups, comparable in terms of age, sex, and hernia size distribution. Group 1 included 250 (51.9%) patients who underwent open HP with suturing of the hernia defect: subgroup 1a — open sublay (n=243; 50.4%), and subgroup 1b — open intraperitoneal onlay mesh technique (IPOM) (n=7; 1.5%). Group 2 included 232 (48.1%) patients who underwent laparoscopic HP using the IPOM technique: subgroup 2a — IPOM without suturing of the aponeurosis defect (n=81; 16.8%), subgroup 2b — IPOM with suturing of the aponeurosis defect (n=108; 22.4%), and subgroup 2c — IPOM+ with open aponeurosis defect suturing (n=43; 8.9%). Follow‑up evaluations were carried out at intervals of 2 weeks, 1 month, 6 months, and 1 year to assess the presence of complications, recurrence, and satisfaction with the cosmetic effect of the operation. Results. The overall frequency of complications after HP was 15.6%, while after open sublay it was 21.2%, and after laparoscopic IPOM it was 9.9%. All cases of complications belonged to Grades I—IIIb according to the Clavien‑Dindo classification. In both groups, there were no fatalities. In group 1, the frequency of seroma was 11.6% and hematoma was 5.6%, and in group 2, it was 7.3% and 0.9%, respectively. A statistically significant increase in the frequency of hematoma development was observed after open HP techniques compared to laparoscopic ones (p=0.004), while the frequency of seroma detection was comparable (p=0.148). Non‑suturing of the aponeurosis defect after laparoscopic IPOM in patients with VH did not result in an increase in the total number of complications or the percentage of recurrence (p >0.05). Laparoscopic IPOM with hernia suturing demonstrated significantly higher patient satisfaction with the appearance of the anterior abdominal wall compared to other HP techniques (р <0.05). Conclusions. The open sublay and laparoscopic IPOM HP procedures have a comparable recurrence rate of VH (p >0.05). The incidence of infectious complications and hematomas is significantly higher after open operations compared to laparoscopic ones (p=0.041 and p=0.004, respectively).

Prevention of periprosthetic knee joint infections. Experience based on 590 patients treated before and after the introduction of a proprietary protocol

Introduction. Total knee arthroplasty is a widely performed procedure in orthopedics. One of its complications is periprosthetic joint infection. Efforts should be made to reduce their frequency by implementing appropriate preventive protocols. Objective. To assess the incidence of infectious complications and their association with comorbidities and to retrospectively evaluate the effectiveness of a polymodal protocol for preventing periprosthetic infections implemented in 2015. Further the paper aims to evaluate the spectrum of pathogens responsible for these complications. Materials and methods. A total of 590 cases were analyzed, 277 of which were operated on before the preventive protocol was introduced and 313 after its implementation. Results. Eleven cases of periprosthetic joint infections were diagnosed. Prolonged wound healing was observed in older individuals and diabetic patients. Increased risk of periprosthetic infections was found in obese individuals and those with inflammatory arthropathies. The implemented protocol did not impact the overall incidence of infectious complications in the studied population but a reduction in complications was observed in diabetic patients. The most commonly isolated pathogens were coagulase-negative Staphylococcus, followed by Staphylococcus aureus. Conclusions. The implemented protocol was effective in diabetic patients. The identified pathogens corresponded to those typically observed in periprosthetic infections in Europe.

The Outcome of Outpatient Intermediate and High Dose Cytarabine Consolidation Chemotherapy in Patients with Acute Myeloid Leukemia. The Experience of King Fahad Specialist Hospital in Dammam, Saudi Arabia

Background: Adult patients with Acute Myeloid Leukemia (AML) have traditionally been hospitalized for the duration of intensive consolidation chemotherapy until blood count recovery to avoid complications. Recently, there has been a trend to shift the care of AML patients treated with intensive chemotherapy from inpatient to outpatient settings to reduce treatment costs and save beds. Methods and materials: A retrospective study of AML patients who received cytarabine consolidation chemotherapy between the 1st of August 2016 and the 31st of December 2023 at King Fahad Specialist Hospital in Dammam, Saudi Arabia was performed. Results: Over a period of 7 years and 4 months, 62 patients received a total of 127 cycles of intensive consolidation chemotherapy at outpatient setting. At diagnosis: 12 patients had extramedullary disease, and 17 patients had adverse cytogenetic abnormalities. Following the 127 cycles of chemotherapy, 38 episodes of febrile neutropenia were encountered, and 46 hospital admissions were required. No complications were encountered following 62.2% of the cycles of consolidation therapy and no early mortality due to intensive consolidation therapy was reported. Out of 62 patients studied, 36 patients underwent various forms of hematopoietic stem cell transplantation. Disease relapses were encountered in 24 patients and the 5-year incidence of relapse for the entire group of patients was 42%. The 5-year leukemia-free survival for the: entire study patients, transplanted patients, and non-transplanted patients were: 43%, 38%, and 50% respectively. The 5-year overall survival for the: entire study patients, transplanted patients, and non-transplanted patients were: 44%, 34%, and 65% respectively. At the end of follow-up: 37 patients (59.68%) were alive, 24 patients (38.71%) were dead, and the fate of 1 patient (1.61%) was unknown as the patient moved to another hospital. Conclusion: Administration of intensive consolidation chemotherapy for patients with AML at outpatient setting is safe, feasible, and cost-effective. The incidence of infectious complications was relatively low. No early treatment-related mortality due to intensive consolidation therapy was encountered. Outpatient administration of intensive consolidation therapy can save beds, reduce hospital costs, and is associated with short-term and long-term outcomes that are comparable to inpatient administration of consolidation therapy.

Early enteral nutrition support for patients with acute pancreatitis in the inpatient setting: a best practice implementation project.

Acute pancreatitis is a major disease that endangers the health and lives of people. Historically, clinical therapy has recommended. that patients with acute pancreatitis remain nil by mouth. As one of the therapies recommended in recent guidelines, early enteral nutrition support reduces the incidence of infectious complications and reduces the risk of severe conditions. However, early enteral nutrition support has not been optimally implemented within clinical practice for acute pancreatitis inpatients. This evidence implementation project aimed to increase compliance with best practice recommendations for early enteral nutrition support, while standardizing the enteral nutrition support process and reducing the incidence of delayed enteral nutrition. The project was guided by the JBI Evidence Implementation Framework, which is grounded in the audit and feedback process, as well as a seven-stage structured approach to identifying and managing barriers to compliance with recommended practices. In the baseline audit, compliance rates were low for all evidence-based audit criteria. Four of the eight criteria showed 0% compliance. However, after implementation, all eight criteria achieved a minimum compliance rate of 60%, with Site 2 achieving 90% to 100% compliance. In addition, nurses improved their knowledge and skills in early enteral nutrition support. The incidence of delayed enteral nutrition also fell from 86.2% to 20.7% at both study sites. The implementation strategy included a training program, psychological interventions, and financial and human resource support. This project not only significantly improved early enteral nutrition support for acute pancreatitis patients, but also increased nurses' knowledge and practice skills, standardized the process of enteral nutrition support, and reduced the incidence of delayed enteral nutrition. http://links.lww.com/IJEBH/A177.

Antibacterial wound coating based on chitosan and povidone, obtained by 3D printing

The objective of this study was to develop a method for forming an antimicrobial wound coating based on chitosan and polyvinylpyrrolidone using 3D printing technology.
 The properties of the coating were then studied in vitro and in vivo to improve the treatment outcomes of deep burns. The resulting coating was a 4% hydrogel of medium molecular weight chitosan with the addition of 1% povidone iodine and dermal fibroblasts. After transplantation, the coating was covered with “Foliderm” film. The coating was formed using an extrusion 3D bioprinter, with printing parameters determined experimentally. The samples were first studied in vitro. Scanning electron microscopy was used to evaluate the coating’s microarchitecture and its interaction with dermal fibroblasts. A colorimetric test was conducted to assess cell metabolic activity and cytotoxicity, and antimicrobial activity against reference strains of Staphylococcus aureus was analyzed. An experiment was conducted to evaluate the in vivo properties of the coating. Nineteen male Wistar rats were used in the study. An injury was inflicted that resulted in a deep thermal contact burn, affecting all layers of skin and subcutaneous fatty tissue, with an area of approximately 20 cm2. The animals were divided into three groups: experimental (with the application of the developed coating), comparative (using the traditional and widespread method of treatment with Levomekol ointment) and control (without treatment).
 The study lasted for 38 days and found that the developed coating is highly biocompatible, atraumatic, elastic, and adheres well to wounds. Chitosan was used to create a porous structure with channels running parallel to each other. The coating cells are evenly distributed on the surface of the matrix, specifically on the walls of the pores. The inclusion of 1% povidone iodine in the polymer resulted in high antimicrobial activity without significantly affecting the activity of the cells in the composition. The experiment on applying a coating for treating deep thermal burns demonstrated that the developed coating had a positive effect on the wound healing process. This effect was characterized by a higher rate of epithelization and a significantly lower incidence of infectious complications compared to other experimental groups. In the histological study, the experimental group outperformed the control and comparison groups in the quality of the formed granulation tissue, the number of newly formed capillaries, and the severity of the local inflammatory process.

Effect of Different Induction Immunosuppression on the Incidence of Infectious Complications after Kidney Transplantation-Single Center Study.

Background/Objectives: Potent immunosuppression lowers the incidence of acute graft rejection but increases the risk of infections. In order to decrease either infectious complications or acute rejection, it is necessary to identify risk groups of patients profiting from personalized induction immunosuppressive treatment. The aim of our analysis was to find whether there were higher incidences of infectious complications after kidney transplantation (KT) in groups with different induction immunosuppressive treatment and also to find independent risk factors for recurrent infections. Materials: We retrospectively evaluated all patients with induction treatment with basiliximab after kidney transplantation from 2014 to 2019 at our center relative to age- and sex-matched controls of patients with thymoglobulin induction immunosuppression. Results: Our study consisted of two groups: basiliximab (39) and thymoglobulin (39). In the thymoglobulin group we observed an increased incidence of recurrent infection in every observed interval; however, acute rejection was seen more often in the basiliximab group. A history of respiratory diseases and thrombocytopenia were identified as independent risk factors for recurrent bacterial infections from the first to sixth month after KT. Decreased eGFR from the first month, infections caused by multi-drug-resistant bacteria, and severe infections (reflected by the need for hospitalization) were identified as independent risk factors for recurrent bacterial infections from the first to the twelfth month after KT. Conclusions: We found that in the group of patients with thymoglobulin induction immunosuppressive treatment, infectious complications occurred significantly more often during the entire monitored period with decreased incidence of acute humoral and cellular rejection occurred more often.

Стратегия эффективного административного контроля антимикробной терапии в отделении реанимации и интенсивной терапии хирургического профиля: ретроспективное пилотное исследование.

Objective: To evaluate a strategy for effective administrative control of targeted antimicrobial therapy in surgical intensive care unit (ICU) patients. Materials and methods. The study included 3522 patients who were treated in ICU No. 1 in the period 2022 to 2023. The first group (control), treatment period 2022, included 1764 patients. The second group (research), treatment period 2023, included 1758 patients. In both groups, the use of antimicrobial drugs (AMP) was carried out in accordance with the antibacterial therapy control strategy (ASCT); in group 2, systemic administrative control was additionally carried out in the form of the use of the “Effective Hospital” program and a developed analytical system with monitoring the financial stability of the unit, aimed at daily monitoring of operating activities. A comparative analysis of the frequency of use of various classes of antimicrobial agents, the incidence of infectious complications, mortality rates and financial costs between groups was performed. Results. There was a significant decrease in the consumption of AMPs of the carbapenem group from 8194 vials in 2022 to 6577 vials in 2023, which was a decrease of 19.7%; a decrease in the consumption of tetracycline group AMPs in 2023 compared to 2022, from 2338 bottles to 1581 bottles, which amounted to 32.4%; reduction in the consumption of vancomycin and linezolid in 2023 compared to 2022 from 562 vials to 313 vials, which amounted to 44.3%. There was a decrease in the incidence of VAP from 59.3 (57.6; 62.9) in 2022 to 48.1 (38.65; 61.9) units in 2023, which amounted to 10.8% (p = 0.053). The increase in the frequency of deaths from 10.9% (9.1; 12.4) in 2022 to 11.5% (10.5; 12.7) in 2023 did not have significant differences (p = 0.67). The total expenditure on AMP in 2023 significantly decreased by 22.3%, which allowed saving 1,477,205.53 rubles (p = 0.012). Conclusion. The use of a daily strategy of administrative control of operational activities and the use of antimicrobial therapy in the ICU can reduce the costs of expensive antimicrobial agents, reduce the incidence of nosocomial infectious and inflammatory complications without changing overall mortality.

Prospective Evaluation of Risk Factors Responsible for Infection Following Retrograde Intrarenal Surgery.

The study aimed to identify the various risk factors for infective complications following retrograde intrarenal surgery (RIRS). The study was conducted over one year, and the incidence of infectious complications after RIRS was calculated. Patients were divided into two groups based on the presence and absence of infective complications and were compared in terms of preoperative and operative characteristics. The complications were assessed and graded according to the Modified Clavien classification system (MCCS). The Fisher's exact test, Student's t-test, and Mann-Whitney U test were used for univariate analysis. Multivariate logistic regression analysis was used to identify independent risk factors for postoperative urinary tract infection (UTI). Out of 165 patients in the study, 27 (16.7%) patients developed UTI within one month of undergoing RIRS. The most frequent complication was fever, which occurred in 13 (7.8%) patients. When stratified by MCCS, 13 were grade I, nine were grade II, four were grade III, and one was a grade IV complication. High stone burden, concomitant diabetes mellitus, and multiple renal stones were identified as substantial risk factors for postoperative UTI in univariate analysis. On multivariate analysis, preoperative UTI and prolonged operative time were found to have a significant association with postoperative UTI. The present study demonstrated that preoperative UTI and prolonged operative time are independent factors responsible for postoperative UTI. Large stone burden, stone multiplicity, and diabetes mellitus contribute to a higher risk for UTI following RIRS.

Prophylactic antibiotic use in transrectal prostatic needle biopsy; a randomized control trial of Targeted versus Empirical antibiotic prophylaxis

Background: Prostate biopsy is one of the most performed urological procedures. It is a generally safe procedure, however, there has been increasing incidence of life-threatening infective complications such as sepsis due to a global rise in antibiotic resistance.
 Methodology: This study aimed to determine whether targeted antibiotic prophylaxis using rectal swab MCS-directed antibiotics is more effective than empirical antibiotic prophylaxis in preventing infective complications after transrectal prostatic needle biopsy at a Nigerian Teaching Hospital. Ninety-two consenting patients were prospectively randomized into 2 equal arms using a computer-generated random sequence. Forty-six patients received targeted antibiotic prophylaxis based on rectal swab MCS, while the remainder received empirical antibiotic prophylaxis as per local protocol. All patients underwent sextant transrectal prostatic needle biopsy and were subsequently followed up for 1months to assess for infective complications. The data were analyzed using SPSS version 21. Statistical significance was set at P ≤0.05.
 Results: The average age of the patients studied was 68.3yrs (48-91±8.3yrs). Both groups were comparable at baseline. Overall, there were 7(7.6%) cases of infectious complications. Most of these complications occurred in the empirical prophylaxis group (6 (13 %) vs. 1 (2 %), P– 0.049). These were also more severe than those in the targeted arm.
 Conclusions: Targeted antibiotic prophylaxis was associated with a significant decrease in the incidence of infectious complications compared with empirical antibiotic prophylaxis after transrectal prostate needle biopsy. This method should be considered in patients at a high risk of infective complications.

Antimicrobial prophylaxis protocol based on rectal swab culture before prostate biopsy to prevent infectious complications: a prospective randomized comparative study.

To evaluate the benefit of targeted antibiotic prophylaxis (TAP) based on rectal swab culture in comparison with standard empiric antimicrobial prophylaxis in patients undergoing transrectal ultrasound-guided needle biopsy of the prostate (TRUS-BP), as well as to assess rate of fecal carriage of Fluoroquinolone-resistant Enterobacterales FQRE. We prospectively analyzed data that randomized 157 patients within two groups: (G1) TAP according to rectal swab performed 10days before PB; (G2): empirical antibiotic prophylaxis with ciprofloxacin. Prevalence of FQRE digestive carriage and risk factors were investigated. Incidence of infectious complications after (TRUS-BP) in each group was compared. G2 included 80 patients versus 77 in G1. There was no difference between the two groups regarding age, diabetes, prostate volume, PSA, number of biopsy cores, and risk factors for FQRE. In G2, the prevalence of FQRE digestive carriage was 56.3% all related to E. coli species. In the case of digestive carriage of FQRE, TAP according to the rectal swab culture with third-generation cephalosporins was performed in 73.3%. Patients with FQRE had history of FQ use within the last 6months in 17.8% (p = 0.03). Rate of febrile urinary tract infection after PB was 13% in G1 and 3.8% in G2 (p = 0.02). Incidence of FQ resistance in the intestinal flora of our local population was prevalent. Risk factor for resistance was the use of FQ within the last 6months. TAP adapted to rectal swab, mainly with third-generation cephalosporins, significantly reduced the rate of infectious complications after (TRUS-BP).

Risk Factors for Infectious Complications following Endoscopic Retrograde Cholangiopancreatography in Liver Transplant Patients: A Single-Center Study.

Background: Liver transplant recipients often require endoscopic retrograde cholangiopancreatography (ERCP) for biliary complications, which can lead to infections. This retrospective single-center study aimed to identify risk factors for infectious complications following ERCP in liver transplant patients. Methods: A retrospective analysis was conducted on 285 elective ERCP interventions performed in 88 liver transplant patients at a tertiary care center. The primary endpoint was the occurrence of an infection following ERCP. Univariable and multivariable regression analyses, Cox regression, and log-rank tests were employed to assess the influence of various factors on the incidence of infectious complications. Results: Among the 285 ERCP interventions, isolated anastomotic stenosis was found in 175 cases, ischemic type biliary lesion (ITBL) in 103 cases, and choledocholithiasis in seven cases. Bile duct interventions were performed in 96.9% of all ERCPs. Infections after ERCP occurred in 46 cases (16.1%). Independent risk factors for infection included male sex (OR 24.19), prednisolone therapy (OR 4.5), ITBL (OR 4.51), sphincterotomy (OR 2.44), cholangioscopy (OR 3.22), dilatation therapy of the bile ducts (OR 9.48), and delayed prophylactic antibiotic therapy (>1 h after ERCP) (OR 2.93). Additionally, infections following previous ERCP interventions were associated with an increased incidence of infections following future ERCP interventions (p < 0.0001). Conclusion: In liver transplant patients undergoing ERCP, male sex, prednisolone therapy, and complex bile duct interventions independently raised infection risks. Delayed antibiotic treatment further increased this risk. Patients with ITBL were notably susceptible due to incomplete drainage. Additionally, a history of post-ERCP infections signaled higher future risks, necessitating close monitoring and timely antibiotic prophylaxis.

Etiology of Total Knee Arthroplasty Revisions: A Two-Decade Institutional Perspective.

Total knee arthroplasty (TKA) implant survival time is determined by various patient and implant-related factors and varies significantly in recent worldwide reports. In our study, we have included 247 TKA revisions in 203 patients performed in our hospital over the last 20 years. Multiple etiologies of revisions were identified and classified into 10 categories. Time to failure was analyzed with regard to etiology, patient demographics, and other relevant data. The overall average time to revision was 44.08 months (95% confidence interval (CI) between 33.34 and 49.82 months). Age at primary implant was negatively correlated with time to revision (hazard ratio (HR) = 1.0521 and 95% CI of HR = 1.0359 to 1.0685) and female patients showed a 1.59 times higher risk of implant failure than males. Periprosthetic joint infection was the cause of 46.56% (n=115) of revisions (out of which 12.55% (n=31) were early infections, diagnosed within the first three months), while aseptic loosening was found in 31.98% (n=79) of cases. Infection correlated with a shorter time to revision compared to aseptic loosening (p<0.05). These findings emphasize the need to intensify efforts to deliver the best patient care, select the best antibiotic regimen, and improve surgical techniques to decrease the incidence of infectious complications.

ЗНАЧЕНИЕ ИММУНОЛОГИЧЕСКОГО СКРИНИНГА В ПРОГНОЗИРОВАНИИ ИНФЕКЦИОННЫХ ОСЛОЖНЕНИЙ КАРДИОХИРУРГИИ

Incidence of infectious complications in children with congenital heart disease, especially with cyanotic and complex defects, is higher than in the population, which is associated with both hemodynamic and immune disorders. Various types of primary immunodeficiencies in congenital heart disease and the dependence of immune disorders on the morphology of the defect, the severity of circulatory failure and arterial hypoxemia are described. The importance of diagnosing immunological disorders is emphasized to reduce the risk of infectious complications of cardiac surgery, reduce mortality and improve the outcomes of surgical interventions for congenital heart disease. The prognostic value of immune disorders identified by the TREC/KREC method for infectious complications of cardiac surgery has not been studied. The purpose of this research was to assess the possibility of predicting infectious complications of cardiac surgery in children with congenital heart disease based on screening using the TREC/KREC method. Material and methods used: preoperatively, 200 children with congenital heart disease aged 3 days to 12 months old were examined. Instrumental and laboratory methods were used including immunological screening for TREC/KREC DNA. Results: 123 (62.4%) were diagnosed with “acyanotic” congenital heart disease, 74 (37.5%) with various cyanotic congenital heart diseases and 10 (5%) with congenital heart diseases with Down syndrome, Di George syndrome, Williams syndrome or multiple malformations. 184 (92%) underwent various cardiac surgical interventions. Violations of T-cell immunity according to preoperative TREC/KREC screening were observed in 23.5% of cases including in all children with syndromic forms of congenital heart disease, multiple malformations, and significantly more often in cyanotic congenital heart disease, conotruncal defects, and those admitted in critical conditions. Infectious complications of cardiac surgery were observed significantly more often in this group than in children with normal T-cell immunity (in 36% and 3.6%, respectively). Conclusion: the prognostic value of TREC/KREC screening for targeted preparation and postoperative management in order to prevent infectious complications of cardiac surgery has been confirmed.

Risk factors in emergency abdominal surgery

The urgent nature of the surgical disease causes a high incidence of infectious complications. Surgical site infections account for 20% of all nosocomial infections and contribute to dramatically increased costs and higher readmission rates. About 38% of deaths in this category of patients are associated with infection.Goal of the work. To identify possible risk factors in emergency abdominal surgery.Results. Univariate analysis showed that risk factors such as diabetes had a significantly significant effect on the occurrence of surgical site infection in the study group (odds ratio [OR] = 4.27; 95% confidence interval [CI]: 1.67–14.19), arterial hypertension (OR = 3.80; 95% CI: 1.11–9.55), coronary heart disease (OR = 1.32; 95% CI: 1.23–10.13), duration hospital stay (OR = 1.78; 95% CI: 1.17–1.40).

Comparison of different regimens of short-term antibiotic prophylaxis in transrectal prostate biopsy

Prostate cancer is the most common malignant solid tumour in men aged >70 years and is the second most common cause of death from oncological circumstances. To evaluate the effect of different short-term prophylactic antibiotic regimens in transrectal prostate biopsy (PB) on the incidence of infectious complications. Patients who underwent transrectal ultrasound-guided PB between January 2021 and December 2022 were included in the prospective randomized study. According to the regimen of prophylaxis, patients were randomized into three groups: (1) fosfomycin trometamol 3g, 3h before the procedure+ ciprofloxacin 500mg, 2h before the procedure; (2) fosfomycin trometamol 3g, 3h before and 24h after the procedure; (3) ciprofloxacin 500mg 12, 2h before the procedure, and 12h after the procedure. A rectal swab was performed 1-2 weeks before PB to evaluate the culture findings. Complications were evaluated during follow-up visits within one month after PB. In the monitored period, 605PBs were performed, and 544 patients met the inclusion criteria (184, 161, and 199 in groups 1, 2, and 3). Infectious complications occurred in 10 cases (1.83%), namely 3, 4, and 3 according to patient groups. There was no statistically significant difference between the individual groups. None of the patients required hospitalization and all were free of symptoms of sepsis. Short-term antibiotic prophylaxis in PB using fosfomycin trometamol, ciprofloxacin, or their combination appears to be effective. Fosfomycin trometamol is a suitable alternative to fluoroquinolone antibiotics.

Extracorporeal shock wave lithotripsy, ureterolithotripsy, and percutaneous nephrolithotripsy challenges in managing spinal cord neuropathy patients. Lessons learned from a scoping review.

We aim to review the outcomes of shock wave lithotripsy (SWL), ureteroscopy, and percutaneous nephrolithotripsy (PCNL) for renal and ureteral stones in spinal cord neuropathy patients (SNP). A literature search was performed on 8th March 2023 using PubMed, EMBASE, and Google Scholar with no date limit. Preclinical/animal studies, reviews, letters to the editor, case reports, and meeting abstracts were excluded. Only English papers were accepted. Thirty-five articles were accepted. Five studies focused on SWL, 17 on PCNL, and 6 on ureteroscopy. The remaining articles employed more than one procedure. Stone composition has shifted from struvite to the more common calcium phosphate. SWL showed a very poor stone-free rate (SFR) likely due to challenges in patient positioning, stone visualization, localization, and inability to pass fragments spontaneously. Flexible ureteroscopy and PCNL were associated with a high incidence of infectious complications, long hospital stays, high blood transfusion rate, and intensive care admissions. There were also cases of death. Both procedures were challenging due to genitourinary reconstruction, scoliosis and kyphosis, rib-cage deformity, lower limb contractures, and severe comorbidity which also affected anesthesia. SFR was lower than in non-neurological patients. SWL, ureterolithotripsy, and PCNL should be considered challenging procedures in SNP due to positioning issues, an increased risk of intra and peri-operative morbidity, and even mortality. Computed tomography should be recommended to assess residual fragments as it becomes imperative to minimize a re-intervention in SNP who should be preferably treated in referral centers.

Efficacy and safety of rituximab in elderly patients with membranous nephropathy.

Objectives: Advancing age is a risk factor for treatment-related side effects and mortality in membranous nephropathy (MN) patients treated with traditional immunosuppressive regimens. This study aimed to determine the efficacy and safety of rituximab (RTX) in the treatment of elderly patients with MN. Methods: We performed a single center retrospective review of 37 consecutive MN patients aged 70 and older at the time of RTX infusion. We also enrolled 76 young patients (<70years old) with MN as the control group. We assessed clinical and laboratory indices, remission rates, and adverse events at RTX infusion, 3months, and last visit. Results: A total of 37 elderly patients with MN were included, with a median follow-up period of 15.50 (10.00, 24.40) months. Of the 37 patients, 75.68% were male, and mean age was 71.89 ± 2.47years. At last visit, 7 (18.92%) patients achieved complete remission, and 26 (70.27%) patients achieved complete or partial remission. There were no differences in the complete remission rate and complete or partial remission rate at last visit compared to young patients (26.32% vs. 18.92%, p = 0.387; 85.53% vs. 70.27%, p = 0.055). After RTX treatment, three of 6 elderly patients with pneumonia died due to ineffective treatment of the infection in RTX therapy courses. The results of multivariant regression analysis showed that elderly patients have an increased risk of serious infection, compared with patients younger than 70years (OR = 32.874, 95% CI 1.300-831.490, p = 0.034). For each increase of 1g/L in serum albumin, the risk of serious infection would decrease by 43.2% (OR = 0.568, 95% CI 0.334-0.969, p = 0.038). Conclusion: This study demonstrates that RTX is effective in the treatment of elderly patients with MN. However, we also observed a high incidence of infectious complications. Our experience was limited by its retrospective design and relatively small sample size, and further randomized controlled studies with large sample size are needed to confirm our preliminary findings.

Efficacy of fosfomycin compared to second generation cephalosporin flumarin as antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: a single center retrospective study

BackgroundFluoroquinolone has been the historic choice of antimicrobial prophylaxis for transrectal ultrasound (TRUS) guided prostate biopsy. However, increased fluoroquinolone resistance and recent restrictions of its use for antimicrobial prophylaxis has led to the emergence of alternative agents for antimicrobial prophylaxis for TRUS guided prostate biopsy including fosfomycin and cephalosporins. This study aimed to compare the efficacy of fosfomycin and a second-generation cephalosporin flumarin as alternative antimicrobials for TRUS-guided prostate biopsy in terms of the incidence of infectious complications after TRUS-guided prostate biopsy.MethodsA retrospective chart review of all patients who underwent TRUS-guided prostate biopsy between November 2009 to January 2023 was undertaken. Comparison of baseline characteristics and the incidence of infectious complications was done between those who received fosfomycin as antimicrobial prophylaxis for TRUS-guided prostate biopsy and those who received flumarin. Multivariate logistic regression analysis was conducted to identify risk factors for infectious complications after TRUS-guided prostate biopsy.ResultsOf 2,900 patients identified as eligible candidates for analysis, 333 (11.5%) received fosfomycin and 2,567 (88.5%) received flumarin. The overall rate of infectious complications was approximately 3% lower in patients who received fosfomycin, although such difference did not reach statistical significance (5.7% vs. 8.6%, p = 0.074). Multivariate logistic regression analysis showed that history of operation done under general anaesthesia within six months of the biopsy (odds ratio [OR]: 2.216; 95% confidence interval [CI]: 1.042–4.713; p = 0.039) and history of prior antimicrobial use within six months (OR: 1.457; 95% CI: 1.049–2.024; p = 0.025) were significant risk factors for infectious complications after TRUS-guided prostate biopsy.ConclusionFosfomycin was comparable to second-generation cephalosporin flumarin in preventing infectious complications after TRUS-guided prostate biopsy. Coupled with its properties such as ease of administration, low adverse effects, low resistance rate, and low collateral damage, fosfomycin might be an attractive alternative antimicrobial prophylaxis for TRUS-guided prostate biopsy.