Related Infectious Complications Research Articles

Artificial Intelligence-Based Assessment of Preoperative Body Composition Is Associated With Early Complications After Radical Cystectomy.

We aimed to use a validated artificial intelligence (AI) algorithm to extract muscle and adipose areas from CT images before radical cystectomy (RCx) and then correlate these measures with 90-day post-RCx complications. A tertiary referral center's cystectomy registry was queried for patients who underwent RCx between 2009 and 2017 for bladder cancer. Eight hundred forty-three RCx patients with CT imaging within 90 days of preceding surgery were included, to allow for extraction of body composition parameters by AI. We assessed complications within 90 days of surgery including wound, infectious, and major complications; readmission; and death. Multivariable logistic regressions associated pre-RCx measures with post-RCx complications. Increasing subcutaneous adipose tissue was associated with more wound complications, while patients with increasing visceral adipose tissue had greater odds of infectious-related complications. After adjusting for patient characteristics, every 10 cm2 increases in fat mass index were associated with more infectious (odds ratio [OR], 1.04; P = .002) and wound (OR, 1.06; P < .001) complications. On multivariable analysis, a higher preoperative skeletal muscle index was associated with lower odds of major complications (OR, 0.75 for every 10 cm2; P = .008), while higher intramuscular adipose was associated with higher odds of major complications (OR, 1.93; P = .008). Automated AI body composition measurements preoperatively are associated with post-RCx complications. These measurements, in addition to patient (Eastern Cooperative Oncology Group performance status and smoking status) and surgical (robotic approach and continent diversion) characteristics, can then be used to individualize patient counseling and facilitate triage of nutritional and rehabilitation efforts.

Safety of Adjuvanted Recombinant Herpes Zoster Virus Vaccination in Fragile Populations: An Observational Real-Life Study.

Vaccination is the most effective strategy for preventing infectious diseases and related complications, and proving its efficacy is crucial for its success and adherence, especially for newly introduced vaccines, such as adjuvanted recombinant herpes zoster virus vaccination (RZV). In this observational real-life study, we recorded adverse effects following immunization (AEFIs) after RZV administration in frail populations. A total of 271 subjects underwent RZV at Vaccination Center, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy. Most subjects were solid organ transplant recipients (kidney, 77.1%; liver, 4.8%). Demographics, clinical data, and AEFIs (type, duration, and medications used) were recorded. Overall, 37% of participants reported at least one AEFI following the first dose, predominantly pain at the injection site (60%), while 41% did so after the second dose (pain at the injection site in 62% of cases). Medications were more frequently used for AEFI treatment after the second dose (28%) rather than after the first dose (13%) (p = 0.01). After stratification by sex, females experienced AEFIs more frequently than males, particularly local skin reactions. Our study added evidence of safety and tolerability of the adjuvanted recombinant RZV in frail adults.

Lumbar Fusions in Patients with Sickle Cell Disease: A Propensity-Matched Analysis of Postoperative Complications

ObjectiveThe present study compares postoperative outcomes between patients with and without sickle cell disease (SCD) undergoing one- to three-level lumbar spinal fusion for degenerative pathologies. MethodsPatients who underwent one- to three-level lumbar spinal fusion for degenerative pathologies from 2010–2021 were identified using the PearlDiver database. Patients were separated into 1) SCD and 2) non-SCD groups and were propensity-matched 1:1 for age, sex, Elixhauser Comorbidity Index (ECI), surgical approach, and various comorbidities. Complications were separately analyzed by single- and multi-level procedures using chi-squared and Mann-Whitney U testing. ResultsPropensity-score matching identified 1,934 SCD and non-SCD patients who underwent single-level fusion and 2,094 SCD and non-SCD patients who underwent multi-level fusion. Across single-level fusions, those with SCD had a significantly higher risk of neurovascular compromise (p < 0.001), venous thromboembolism (p = 0.004), pneumonia (p = 0.032), urinary tract infections (UTI) (p = 0.001), and greater postoperative opioid usage out to twelve months (p = 0.018). Across multi-level fusions, SCD carried higher risk for neurovascular compromise (p < 0.001), pneumonia (p = 0.010), and UTI (p < 0.001). All SCD patients had significantly higher opioid use at one month (p = 0.001) and at six months (p = 0.009) postoperatively. ConclusionsPatients with SCD undergoing lumbar spinal fusion demonstrate higher risks for coagulopathic, ischemic, and infectious-related complications, as well as long-term postoperative opioid use. Awareness of the unique complication profile in SCD patients may help guide surgeons in refining perioperative management strategies to optimize outcomes in patients with SCD.

Chronic Oral Corticosteroid Use and 10-Year Incidence of Major Complications Following Total Knee Arthroplasty

BackgroundOral corticosteroids are the primary treatment for several autoimmune conditions. The risk of long-term implant, bone health, and infectious-related complications in patients taking chronic oral corticosteroids before total knee arthroplasty (TKA) is unknown. We compared the 10-year cumulative incidence of revision, periprosthetic joint infection (PJI), fragility fracture (FF), and periprosthetic fracture following TKA in patients who had and did not have preoperative chronic oral corticosteroid use. MethodsA retrospective cohort analysis was conducted using a national database. Primary TKA patients who had chronic preoperative oral corticosteroid use were identified using Current Procedural Terminology and International Classification of Disease 9 and 10 codes. Exclusion criteria included malignancy, osteoporosis treatment, trauma, and < 2-year follow-up. Primary outcomes were 10-year cumulative incidence and hazard ratios (HRs) of all-cause revision (ACR), aseptic revision, PJI, FF, and periprosthetic fracture. A Kaplan-Meier analysis and a multivariable Cox proportional hazards model were utilized. Overall, 611,596 patients were identified, and 5,217 (0.85%) were prescribed chronic corticosteroids. There were 10,000 control patients randomly sampled for analysis. ResultsCorticosteroid patients had significantly higher 10-year HR of FF (HR; 95% confidence interval); P value (1.47; 1.34 to 1.62; P < .001)], ACR (1.21; 1.05 to 1.40; P = .009), and PJI (1.30; 1.01 to 1.69; P = .045) when compared to the control. ConclusionsPatients prescribed preoperative chronic oral corticosteroids had higher risks of ACR, PJI, and FF within 10 years following TKA compared to patients not taking corticosteroids. This information can be used by surgeons during preoperative counseling to educate this high-risk patient population about their increased risk of postoperative complications.

Vaccinations in Pregnancy. A Comprehensive Overview

Introduction and purpose&#x0D; Pregnancy is associated with many changes in the mother's body, allowing for the proper development of the fetus, but unfortunately it also predisposes many potentially harmless infections to become much more severe during pregnancy. Therefore, vaccinations during pregnancy play a very important protective role both for the mother, her unborn child and to the child immediately after birth. Immunization during pregnancy and in the preconception period protects against many infectious diseases and related complications. By receiving the vaccine, specific antibodies are synthesized and transported across the placenta to the fetus. They protect the baby during the first months of life, when the baby cannot receive vaccinations due to its age yet. Vaccinations during pregnancy can be divided into necessary, possible and recommended. Recommended vaccinations include against diphtheria, tetanus, pertussis, influenza, Covid19 and RSV. They are especially recommended for every pregnant woman who has no permanent or temporary contraindications. A special group of vaccinations are those necessary to perform, which play the main role as post-exposure prophylaxis and must be administered immediately after exposure to the agent causing the infection. These include mainly vaccination against tetanus and rabies. The vaccinations that can be performed include those targeted at a specific group of patients with various chronic diseases who are at risk or traveling to countries where there is an increased risk of illness. During a doctor's visit to a woman planning a pregnancy, it is important to collect a detailed interview regarding vaccination history, past infectious infections and chronic diseases. This allows us to prepare an individualized vaccination schedule recommended both before and during pregnancy.

Position statement on infection screening, prophylaxis, and vaccination of pediatric patients with rheumatic diseases and immunosuppressive therapies, part 3: precautions in situations of surgery, fever, and opportunistic infections

The objective of this study is to provide practical recommendations on the management of pediatric patients with immune-mediated rheumatic diseases receiving immunosuppressive therapies. The recommendations specifically address the cases of surgery, fever, and opportunistic infections (varicella, herpes-zoster, tuberculosis, invasive fungal disease). A qualitative approach was applied. A narrative literature review was performed via Medline. Primary searches were conducted using MeSH terms and free text to identify publications on infections and vaccinations in pediatric patients with immune-mediated rheumatic diseases receiving immunosuppressive therapies. The results were presented and discussed in a nominal group meeting, comprising a committee of 12 pediatric rheumatologists from the Infection Prevention and Treatment Working Group of the Spanish Society of Pediatric Rheumatology. Several recommendations were generated. A consensus procedure was implemented via a Delphi process; this was extended to members of the Spanish Society of Pediatric Rheumatology and Spanish Society of Pediatric Infectious Disease of the Spanish Association of Pediatrics. Participants produced a score ranging from 0 (totally disagree) to 10 (totally agree). Agreement was defined as a vote ≥ 7 by at least 70% of participants. The literature review included more than 400 articles. Overall, 63 recommendations (19 on surgery, fever, and opportunistic infections) were generated and voted by 59 pediatric rheumatologists and other pediatric specialists. Agreement was reached for all 63 recommendations. The recommendations on special situations cover management in cases of surgery, fever, and opportunistic infections (varicella, herpes-zoster, tuberculosis, and invasive fungal disease). Conclusions: Hereby, we provided consensus and updated of recommendations about the management of special situations such as surgery, fever, and opportunistic in children with immune-mediated rheumatic diseases receiving immunosuppressive therapies. Several of the recommendations depend largely on clinical judgement and specific balance between risk and benefit for each individual and situation. To assess this risk, the clinician should have knowledge of the drugs, the patient’s previous situation as well as the current infectious disease, in addition to experience.What is Known:• Infectious diseases and related complications are a major cause of morbidity and mortality in patients with immune-mediated rheumatic diseases.• Information on how to manage the treatment in situations of fever, opportunistic infections, and surgery in children is limited, and guidelines for action are often extrapolated from adults.What is New:• In the absence of strong evidence, a literature review and a Delphi survey were conducted to establish a series of expert recommendations that could support the clinical practice, providing a practical and simple day-to-day approach to be used by pediatric rheumatologists.

Heterogeneity in Access and Toxicity Management of Commercially Available BCMA-Directed CAR-T and Bispecific T-Cell Engager Therapy Among the International Myeloma Community

Introduction: BCMA-directed CAR-T and Bispecific T-cell engager (BiTE) therapies have shown remarkable overall response rates in heavily pretreated patients with relapsed/refractory multiple myeloma (RRMM). This has led to the approval of idecabtagene vicleucel, ciltacabtagene autoleucel and teclistamab by the FDA, EMA and other regulatory agencies. We performed a global survey on accessibility, practice patterns, and toxicity management of commercially available CAR-T and BiTE therapies. Methods: An online survey was completed by clinicians attending the International Myeloma Society's Immune Effector Cell Therapies in Multiple Myeloma Workshop, in-person or virtually, made available for 30 days after the meeting held in March 2023, Boston, MA. Results: 87 clinicians from 16 countries completed the survey, most practicing in an academic practice (86%) and in an urban environment (89%). Sixty-four percent of the respondents practice in North America followed by Europe (25.3%) including Germany, United Kingdom, Ireland, Italy, Netherlands, Spain, France, Greece, and Cyprus, and 6.9% from Asia and 3.4% from Australia. Seventy-seven percent reported CAR-T cell therapy was approved in their country with 44.8% treating 1-5 patients and 14.9% treating &amp;gt;5 patients per month; 67% reported BiTE therapy was approved in their country with 14.9% treating &amp;gt;5 patients per month. Of evaluable responses (n = 40), 62% administered CAR-T therapy inpatient and 15% administered CAR-T therapy outpatient ≥ 50% of the time. Length of time between decision to treat with CAR-T therapy to infusion was 6-12 weeks for 42% of responders and &amp;lt;6 weeks for only 20%. Most (75%) reported inpatient administration of BiTE therapy step-up dosing; 17.5% reported outpatient step-up dosing administered ≥ 50% of the time. Use of institutional or practice SOPs for CAR-T and BiTE therapy patient selection was reported by 85% and 58%, respectively, with the factors influencing SOP outlined in Table 1. Of available CAR-T therapies, 53% prefer cilta-cel and 23% reported CAR-T therapy preference depended most on patients' co-morbidities/frailty (89%), timing of next available apheresis (67%), age (56%), CNS disease (44%) and other factors. Maintenance therapy after CAR-T therapy was reportedly used by 25% and 5% of respondents in 1-10% and 11-50% of their patients, respectively, to “maintain level of response achieved” (50%) or “achieve a deeper level of response” (25%). About half (43%) of the respondents reported using an SOP or particular criteria for secondary Hemophagocytic Lympho-Histiocytosis/Macrophage Activation Syndrome/CAR-related-HLH (sHLH/MAS/CarHLH) management that varied between the use of ASTCT Working Group IEC associated HLH-like syndrome Criteria (47%) (Hines 2023), CARTOX HLH Criteria (24%) (Neelapu 2017) and HLH-2004 criteria (6%). Tocilizumab was used as cytokine release syndrome (CRS) prophylaxis only by one responder. Keppra neurologic prophylaxis was used by 47.5% and 15% of responders for CAR-T and BiTE therapy, respectively. Delayed neurotoxicity with CAR-T was reported in 1-5% of patients by 57.5% of responders and 6-10% of patients by 15% of responders; most common manifestations were other movement/neuromuscular disorder (62%), nerve palsy (55%), and Parkinsonism (45%). Infectious prophylaxis was used to protect against HSV (92.5%), PJP (90%), bacterial pathogens (55%), fungal pathogens (60%), and IVIG (77.5%). However, criteria for infectious prophylaxis use varies widely incorporating IgG levels, infectious history, CD4+ count, B-cell aplasia and cytopenias (48.1 - 88.9%). Most respondents (46.3 - 86.5%) reported completing an infectious work-up including CMV, EBV, Hep B/C, and HIV ( Table 2). Conclusions: Trends of CAR-T and BiTE therapy use and patterns of concurrent prophylactic and supportive care in MM vary widely among academic centers across the globe, demonstrating a need for further understanding of toxicity pathogenesis, toxicity management and consistent guidelines. This survey also demonstrates the great unmet need for access beyond urban centers among the international myeloma community. Prospective studies and claims data analysis should be utilized to evaluate the longitudinal cost of care, quality of life, duration of response and management of infectious disease, neurological or related complications of CAR-T and bispecific TCE therapies.

Clinical and economic burden of surgical complications during hospitalization for digestive cancer surgery in France.

Surgical complications and particularly infections after digestive cancer surgery remain a major health and economic problem and its burden in France is not well documented. The aim of this study was to analyse recent data regarding surgical complications in patients undergoing major digestive cancer surgery, and to estimate its burden for the French society. Using the 2018 French hospital discharge database and 2017 National CostStudy we studied hospital stays for surgical resection in patients withdigestive cancer. The population was divided into three groups based onpostoperative outcomes: no complications (NC), related infectious complications (RIC) and other complications. The main analysis compared the length and cost per stay between RIC and NC. Forty-Four thousand one hundred and twenty-three stays following a digestive cancer resection were identified. Lower gastro-intestinal cancers were the most prevalent representing 74.8% of stays, the rate of malnutrition was 32.8% and 15.8% of patients presented RIC. Mean (SD) length of stay varied from 11,7 (9.0) days for NC to 25,5 days (19.5) for RIC (p < 0.01). The mean cost per patients' stay (SD) varied from €10 641 (€ 5897) for the NC to €18 720 (€7905) for RIC (p < .01). The risk of RIC after digestive cancer resection remains high (>15%) and was associated with significantly longer length of stay and higher cost per stay. Although important prevention plans have been implemented in recent years, care strategies are still needed to alleviate the burden on patients and the healthcare system.

MP56-18 STENT VS STENT-LESS ILEAL CONDUITS AFTER RADICAL CYSTECTOMIES: IS THERE DIFFERENCE IN EARLY POSTOPERATIVE OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023MP56-18 STENT VS STENT-LESS ILEAL CONDUITS AFTER RADICAL CYSTECTOMIES: IS THERE DIFFERENCE IN EARLY POSTOPERATIVE OUTCOMES Rishabh Simhal, Yash Shah, Kerith Wang, Daniel Simon, James Mark, Zachary Prebay, Costas Lallas, Leonard Gomella, and Mihir Shah Rishabh SimhalRishabh Simhal More articles by this author , Yash ShahYash Shah More articles by this author , Kerith WangKerith Wang More articles by this author , Daniel SimonDaniel Simon More articles by this author , James MarkJames Mark More articles by this author , Zachary PrebayZachary Prebay More articles by this author , Costas LallasCostas Lallas More articles by this author , Leonard GomellaLeonard Gomella More articles by this author , and Mihir ShahMihir Shah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003309.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Placing stents at the ureteroileal anastomosis for radical cystectomy with ileal conduit (RCIC) diversion has been common practice for the vast majority of urologists. Recently, the practice has been called into question, as some institutions have shifted to not stenting their ileal conduits for patient comfort and convenience. In this study, we aim to investigate the difference in 30-day outcomes between patients who did and did not receive ureteroileal stents after RCIC. METHODS: RCs performed between 2019-2020 were identified in NSQIP and the corresponding cystectomy-targeted database. Baseline demographics, comorbidities, and operative parameters were compared via Pearson’s chi-square and t-tests between stented and stent-less RCICs. Outcomes of interest included rates of urinary tract infections (UTIs), acute kidney injury (AKI), renal failure requiring dialysis, anastomotic leaks, ureteral obstruction, ureteral fistula formation, need for reoperation, and 30-day hospital readmissions. Outcomes were compared using Pearson’s chi-square. All statistical tests were two tailed, p<0.05 considered significant. RESULTS: 3,865 RCICs were identified, of which 446 (11.5%) were stent-less. There was no difference in baseline demographics, comorbidities, or operative parameters between the stented and stent-less group, with the notable exceptions that significantly more stent-less patients had robotic-assisted instead of open RCs compared to the stented group (33% vs 21%, p<0.001), and significantly more stent-less patients were preoperatively on dialysis compared to the stented group (4.9% vs 0.5%, p<0.001). There was no significant difference in 30-day rates of UTIs, AKIs, renal failure, anastomotic leaks, ureteral obstruction, ureteral fistula formation, need for reoperation, and readmissions between the stented and stent-less cohorts. CONCLUSIONS: Stent-less ileal conduits have recently emerged in popularity. This study represents the largest multi-institutional analysis comparing outcomes between traditionally stented and stent-less RCICs, and shows that there is no significant difference in outcomes. This study shows no difference in significant perioperative complications in patients without stents compared to those with stents. Therefore this needs to be investigated further given the overall cost, patient discomfort and concern for stent related infectious complications. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e782 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rishabh Simhal More articles by this author Yash Shah More articles by this author Kerith Wang More articles by this author Daniel Simon More articles by this author James Mark More articles by this author Zachary Prebay More articles by this author Costas Lallas More articles by this author Leonard Gomella More articles by this author Mihir Shah More articles by this author Expand All Advertisement PDF downloadLoading ...

No role of antibiotics in patients with chest trauma requiring inter-costal drain: a pilot randomized controlled trial.

To study the role of prolonged prophylactic antibiotic therapy (PAT) in the prevention of Inter-costal drain (ICD) related infectious complications in patients with Blunt Trauma Chest (BTC). Patients of age 15years and above with BTC requiring ICD were included. Patients with penetrating chest injuries, associated injuries/illnesses requiring antibiotic administration, need for mechanical ventilation, known pulmonary disease or immuno-compromised status and need for open thoracotomy were excluded. 120 patients were randomized equally to two groups; no prolonged PAT group (Group A) and prolonged PAT group (group B). Both group patients received one shot of injectable antibiotic prior to ICD insertion. Primary outcome measure was comparison of ICD related infectious complications (pneumonia, empyema and SSI) and secondary outcome measures included the duration of ICD, Length of Hospital stay (LOS) and in-hospital mortality in both the groups. Infectious complications (pneumonia, empyema and SSI) were seen in only one patient in antibiotic group, and none in no antibiotic group (p value = 0.500). Other complications such as post ICD pain scores, respiratory failure requiring ventilatory support, retained hemothorax or recurrent pneumothorax, did not show any statistical difference between both groups. Also, no significant difference was seen in both the groups in terms of mean duration of ICD (p value = 0.600) and LOS (p value = 0.259).m CONCLUSION: Overall prevalence of ICD related infectious complications are low in BTC patients. Definitive role of prolonged prophylactic antibiotics in reducing infectious complications and other associated co morbidities in BTC patients with ICDs could not be established. Clinical Trial Registry, India (Trial registered at ctri.nic.in/clinical trials/login.php, number REF/2019/021704 dated 18/10/2019).

Conventional single-chamber pacemakers versus transcatheter pacing systems at long-term follow-up

Abstract Background Leadless pacemakers systems (LPM), have demonstrated safety and efficacy at mid-long term follow-up. There are still issues that cannot be completely avoided with conventional transvenous pacemaker (VVI) such as infectious or pocket related complications in which LPM are clearly superior. Purpose The aim of the study was to compare the clinical and device performance between LPM and VVI in a one-center long-term follow-up. Methods This was a prospective, observational, one-center study. We include all patients with a single chamber pacemaker implantation from June 1 2015 to March 1 2022 to complete a long-term follow-up. All clinical, electrical and echocardiographic characteristics, including electrical parameters, complications and mortality, were described. Results We included 245 patients with VVI pacemakers and 315 LPM. Mean age was 79.6±6.6 in LPM and 83.5±8.9 y/o in VVI pacemakers. All clinical, electrical and echocardiographic characteristics are described in Table 1. Electrical parameters of LPM were stable at long-term follow-up. There were a total of 7 complications in LPM and 17 in VVI pacemakers (p=0.006). There were no significant differences between major complications but there were in minor complications as shown in Table 2. There were no significant differences in mortality between both groups, but there was one death related to endocarditis in a VVI pacemaker patient during the follow-up (40,3±10 months). Conclusions In our study, there were no significant differences in terms of mortality and major complications between LMP and VVI at long-term follow-up. We consider our study supports the results in favor of the safety and effectiveness of LPM in the long-term. Funding Acknowledgement Type of funding sources: None.

PD41-03 ANTIBIOTIC-FREE TRANSPERINEAL PROSTATE BIOPSY: UROLOGY’S CONTRIBUTION TO RESPONSIBLE ANTIMICROBIAL STEWARDSHIP

PD41-03 ANTIBIOTIC-FREE TRANSPERINEAL PROSTATE BIOPSY: UROLOGY’S CONTRIBUTION TO RESPONSIBLE ANTIMICROBIAL STEWARDSHIP

Associations between omega-3 polyunsaturated fatty acids supplementation and surgical prognosis in patients with gastrointestinal cancer: A systematic review and meta-analysis

BackgroundSurgical resection remains the primary treatment for gastrointestinal (GI) cancer, omega-3 polyunsaturated fatty acids (n-3 PUFAs) have been reported to improve the prognosis of patients undergoing gastrointestinal tumor surgery. This meta-analysis aims to explore the efficacy of n-3 PUFAs on GI cancer patients undergoing surgery. MethodsA systematic search of PubMed, Cochrane Library databases, EMBASE (until December 2021) was conducted. PRISMA checklist was followed. The data were analyzed by RevMan v5.3.0. ResultsA total of ten RCTs articles including 663 patients were studied. The analysis demonstrated that the n-3 PUFAs group significantly reduced levels of interleukin-6 (IL-6) (P = 0.001), C-reactive protein (CRP) (P < 0.00001), tumor necrosis factor-ɑ (TNF-α) (P = 0.0003) compared with the control group. and higher levels of CD4+T cells (P = 0.03), CD8+T cells (P = 0.02) and CD4+/CD8+ratio (P = 0.03) compared with the control group. but there was no significant difference in infection complications rate (P = 0.50) and the level of prealbumin (P = 0.80), albumin (P = 0.21), retinol-binding protein(P = 0.80) between the two groups. In addition, the n-3 PUFAs group significantly reduced the length of hospital stay (P = 0.007). ConclusionOur meta-analysis shows that n-3 PUFAs can effectively improve the immune function of patients undergoing gastrointestinal cancer surgery, reduce inflammatory response and reduce the length of hospital stay, But it has no significant impact on the incidence of infectious-related complications and the level of nutrient protein.

Position statement of the Spanish Society of Pediatric Rheumatology on infection screening, prophylaxis, and vaccination of pediatric patients with rheumatic diseases and immunosuppressive therapies: Part 1 (screening)

This study provides practical recommendations on infection screening in pediatric patients with immune-mediated rheumatic diseases and immunosuppressive therapies. For this reason, a qualitative approach was applied. A narrative literature review was performed via Medline. Primary searches were conducted using Mesh and free texts to identify articles that analyzed data on infections and vaccinations in pediatric patients with immune-mediated rheumatic diseases and immunosuppressive therapies. The results were presented and discussed in a nominal group meeting, comprising a committee of 12 pediatric rheumatologists from the infections prevention and treatment working group of the Spanish Society of Pediatric Rheumatology. Several recommendations were generated. A consensus procedure was implemented via a Delphi process that was extended to members of the Spanish Society of Pediatric Rheumatology and Vaccine Advisory Committee of the Spanish Association of Pediatrics. Participants to the process produced a score ranging from 0 = totally disagree to 10 = totally agree. Agreement was considered if at least 70% of participants voted ≥ 7. The literature review included more than 400 articles. Overall, 63 recommendations were generated (21 on infection screening) voted by 59 pediatric rheumatologists and other pediatric specialists, all of them achieving the pre-established agreement level. The recommendations on screening cover all the procedures (serology, assessment of risk factors, and other clinical activities) connected with the screening for infections including tuberculosis; hepatitis A, B, and C viruses; measles; mumps; rubella; diphtheria; and other infections. Conclusion: Screening for infections is an essential part of risk management in pediatric patients with immune-mediated rheumatic diseases and immunosuppressive therapies.What is Known:• Infectious diseases and related complications are a major cause of morbidity and mortality in patients with immune-mediated rheumatic diseases.• At present, practical information on infectious prophylaxis in children with rheumatic diseases is limited, and often extrapolated from children with cancer.What is New:• In the absence of evidence, a literature review and a Delphi survey were conducted to establish a series of expert recommendations that would be useful in clinical practice, providing a practical and simple day-to-day approach to be used by pediatric rheumatologists.

Infectious outcomes of fibrin sheath disruption in tunneled dialysis catheters.

Fibrin sheath (FS) formation around tunneled central venous catheters (CVC) increases the risk of catheter-related bloodstream infections due to bacterial adherence to a biofilm. We sought to investigate whether FS disruption (FSD) at the time of CVC removal or exchange affects infectious outcomes in patients with CVC-related infections. Retrospective cohort study of 307 adult maintenance hemodialysis patients aged 18 years or older at a single center academic-based hemodialysis program (UHN, Toronto) who developed CVC-related infections requiring CVC removal or exchange between January 2000 and January 2019. Exposure was FSD at the time of CVC removal or exchange. Outcomes were infectious metastatic complications, recurrent infection with the same organism within 1 year, or death due to infection. We created a Markov Multi-State Model (MMSM) to assess patients' trajectories through time as they transitioned between states. A time-to-event analysis was performed, adjusted for clinically relevant factors. There was no significant relationship between FSD status at the time of CVC removal, the development of infectious complications in the multivariable model (adjusted HR = 0.71, 95% CI 0.09-5.80, p = 0.76), or mortality from infection (HR = 0.84, 95% CI 0.34-2.11, p = 0.73). FSD at the time of CVC removal was not associated with increased risk of infectious complications or death due to infection. Further prospective study is needed to determine whether FSD contributes to reducing CVC infectious related complications.

Early Antibiotic Administration is Independently Associated with Improved Survival in Traumatic Brain Injury

Central and systemic immune dysfunction after traumatic brain injury (TBI) can lead to infectious-related complications, which may result in delayed mortality. The role of early empiric antibiotics after TBI has not been characterized to date, but is recommended in select cases to decrease complications. We aimed to determine the relationship between early antibiotic use and in-hospital mortality in TBI patients. A retrospective review was conducted of TBI patients requiring ICU admission at an urban, academic, Level I trauma center from 01/2014 to 08/2016. Data collection included demographics, injury characteristics, details regarding antibiotic use, and outcomes. Early antibiotic administration was defined as any antibiotic given within 48 hs from admission. Patients given early antibiotics (EARLY) were compared to those who received their first dose later or did not receive any antibiotics (non-EARLY). Of the 488 TBI patients meeting inclusion criteria, 189 (38.7%) received early antibiotics. EARLY patients were younger (EARLY 54.2 versus non-EARLY 61.5 ys, P <0.01) and more likely to be male (71.4% versus 60.9%, P=0.02). Injury severity scores (23.6 versus 17.2, P <0.01) and regional head abbreviated injury scale scores (3.9 versus 3.7, P <0.01) were significantly higher in patients who received early antibiotics. Unadjusted in-hospital mortality rates were similar, however EARLY was associated with a lower mortality rate (AOR 0.17, 95% CI: 0.07 - 0.43, adjusted P <0.01) after adjusting for confounders. Despite presenting with a higher injury burden, TBI patients who received early antibiotics had a lower associated mortality rate compared to their counterparts. Future investigations are necessary to understand the underlying mechanisms that result in this potential survival benefit.

Complications associated with peripherally inserted central catheters and Hickman™ in patients with advanced pulmonary hypertension treated with intravenous prostanoids

BackgroundEpoprostenol requires continuous infusion and may lead to catheter-related complications. Evidence regarding the comparison between peripherally inserted central catheters (PICC) or tunneled central catheters in Pulmonary Hypertension (PH) is scarce. We sought to study the incidence of mechanical and infectious complications associated with PICC and Hickman catheters in patients with PH under epoprostenol treatment. MethodsThis is a single-center retrospective study of patients with PH who received continuous treatment with intravenous epoprostenol for at least 24 h between January 2010 and July 2020. Mechanical and infectious complications were analyzed according to the catheter type: PICC and Hickman. The incidence of catheter-related complications was calculated per 1000 exposure-days of risk. Results175 catheters were implanted in 109 patients, of which 100 (57.1%) were Hickman and 75 (42.9%) were PICC. After a median follow-up of 334 [130–798] days, there were no differences in the rates of local (0.22 vs 0.21; p = 0.904) or blood-stream infections (0.13 vs 0.21; p = 0.405). Mechanical complications were more frequent in the PICC group (0.98 vs 0.23 p=<0.001), including venous thrombosis (0.16 vs 0.00 p = 0.003) and catheter occlusion (0.66 vs 0.04 p=<0.001). These complications were associated with a greater need for hospitalization (1.48 vs 0.50; p=<0.001), without differences in mortality during follow-up (0.33 vs 0.21; p = 0.288). ConclusionIn patients with PH treated with intravenous epoprostenol, both Hickman and PICC catheters were associated with high rate of complications. Although there were no differences in the frequency of infectious-related complications, PICC was associated with a higher frequency of catheter occlusion and deep venous thrombosis.

A novel enema method can prevent infectious complications of transrectal ultrasound‐guided prostate biopsy: A single‐centre experience

TRUS biopsy is the preferred method for diagnosing prostate cancer, but it can cause infectious complications that arise with the contribution of fluoroquinolone resistance. We aimed to explore the potential protective effect of a second rectal enema before biopsy. From January 2015 to December 2020, 419 patients were assessed retrospectively. Patients with a history of anticoagulant use, uncontrolled diabetes, urological surgery, prostate biopsy or recent hospitalisation or overseas travel, as well as those with the previous prostatitis, were excluded from the study. The patients were subsequently divided into two groups: Group 1 (n=223) had received one enema, on the morning of the biopsy and Group 2 (n=196) had received two, with the additional enema administered half an hour before the procedure. There was no significant difference between the groups in terms of age(P=.076), BMI (P=.489), diabetes (P=.265), prostate-specific antigen (PSA) level (P=.193), free/total PSA (f/t PSA) ratio (P=.518) and prostate size (P=.661) or in relation to cancer detection (P=.428). The median hospitalisation date was significantly higher in Group 1 (P=.003) as was urinary tract infection (UTI) development (P=.004). However, there was no significant difference in terms of fever and sepsis (P=.524 and P=.548, respectively). Additionally, subgroup analysis demonstrated that UTI was significantly lower in patients with diabetes mellitus who had received a second enema (P=.004), though there was no significant difference in UTI between the groups in those without diabetes mellitus (P=.215). Multivariable analysis showed that age and diabetes were significant risk factors for the development of UTI (OR: 1.074, 95% CI: 1.027-1.130, P=.002 and OR: 1.220, 95% CI: 0.131-0.665, P=.003, respectively). Furthermore, the second enema was a significant protective factor for preventing UTI (OR: -1.794, 95% CI: 2.208-16.389, P<.001). Older age and the presence of diabetes mellitus are independent risk factors for UTI after prostate biopsy. A second enema procedure before biopsy may protect patients from related infectious complications and could therefore be used as an alternative preventative method.

A Randomized Controlled Trial of Preoperative Prophylactic Antibiotics for Percutaneous Nephrolithotomy in Moderate to High Infectious Risk Population: A Report from the EDGE Consortium.

Postoperative infectious related complications are not uncommon after percutaneous nephrolithotomy. Previously, we noted that 7 days of antibiotics did not decrease sepsis rates compared to just perioperative antibiotics in a low risk percutaneous nephrolithotomy population. This study aimed to compare the same regimens in individuals at moderate to high risk for sepsis undergoing percutaneous nephrolithotomy. Patients were prospectively randomized in this multi-institutional study to either 2 days or 7 days of preoperative antibiotics. Enrolled patients had stones requiring percutaneous nephrolithotomy and had either a positive preoperative urine culture or existing indwelling urinary drainage tube. Primary outcome was difference in sepsis rates between the groups. Secondary outcomes included rate of nonseptic bacteriuria, stone-free rate and length of stay. A total of 123 patients at 7 institutions were analyzed. There was no difference in sepsis rates between groups on univariate analysis. Similarly, there were no differences in nonseptic bacteriuria, stone-free rate and length of stay. On multivariate analysis, 2 days of antibiotics increased the risk of sepsis compared to 7 days of antibiotics (OR 3.1, 95% CI 1.1-8.9, p=0.031). Patients receiving antibiotics for 2 days had higher rates of staghorn calculus than the 7-day group (58% vs 32%, p=0.006) but post hoc subanalysis did not demonstrate increased sepsis in the staghorn only group. Giving 7 days of preoperative antibiotics vs 2 days decreases the risk of sepsis in moderate to high risk percutaneous nephrolithotomy patients. Future guidelines should consider infectious risk stratification for percutaneous nephrolithotomy antibiotic recommendations.

Spinal fusion in pediatric patients with marfan syndrome: a nationwide assessment on short-term outcomes and readmission risk.

The purpose of this study was to utilize the National Readmission Database (NRD) to determine estimates for complication rates, 90-day readmission rates, and hospital costs associated with spinal fusion in pediatric patients with Marfan syndrome. The 2012-2015 NRD databases were queried for all pediatric (< 19years old) patients diagnosed with Marfan syndrome undergoing spinal fusion surgery. The primary outcome variables in this study were index admission complications and 90-day readmissions. A total of 249 patients with Marfan syndrome underwent spinal fusion surgery between 2012 and 2015 (mean age ± standard deviation at the time of surgery: 14 ± 2.0, 132 (53%) female). 25 (10.1%) were readmitted within 90days of the index hospital discharge date. Overall, 59.7% of patients experienced at least one complication during the index admission. Unplanned 90-day readmission could be predicted by older age (odds ratio 2.3, 95% confidence interval 1.3-4.2, p = 0.006), Medicaid insurance status (56.0, 3.8-820.0, p = 0.003), and experiencing an inpatient medical complication (42.9, 4.6-398.7, p = 0.001). Patients were readmitted for wound dehiscence (8 patients, 3.2%), nervous system related complications (3 patients, 1.2%), and postoperative infectious related complications (4 patients, 1.6%). This study is the first to demonstrate on a national level the complications and potential risk factors for 90-day hospital readmission for patients with Marfan syndrome undergoing spinal fusion. Patients with Marfan syndrome undergoing spinal fusion often present with multiple medical comorbidities that must be managed carefully perioperatively to reduce inpatient complications and early hospital readmissions.