Prolonged Hospital Research Articles

Effect of kangaroo mother care in low-birth-weight babies in reference to breastfeeding in NICU at a tertiary care centre - An observational study

Background: Kangaroo mother care (KMC) is described by the WHO as early, ongoing, and prolonged skin-to-skin contact between a mother and her preterm infants. Aims and Objectives: (1) The aim of the study was to study the effect of KMC in growth of newborn and (2) to study the effect of KMC in prevention of hypothermia, apnea, and requirement of prolonged hospital stay. Materials and Methods: In this prospective, hospital based, observational study, 241 neonates who were hospitalized to the neonatal intensive care unit in Gauhati Medical College and Hospital, Guwahati between April 2023 and March 2024 were assessed. Every potential mother was trained for KMC and given exclusive breastfeeds, and contrasted with a control/(conventional method of care) group of mothers. Results: The KMC babies had better breastfeeding rates as compared to the control group (76% vs. 53.8%). The weight gain (14.9±4.7 vs. 10.5±4.1 g/day), increase in length (0.97±0.67 vs. 0.69±0.63 cm/week), chest circumference (0.73±0.35 vs. 0.49±0.19 G/week), and head circumference (0.74±0.52 vs. 0.50±0.31 g/week), was also better in the KMC group. The incidence of apnea and hypothermia was significantly less in the KMC group, and the duration of stay in hospital was less in the KMC group than the control group (10±5 vs. 16±8 days). Conclusions: KMC improves breastfeeding rates, improves growth, reduces morbidities, and decreases duration of hospital stay.

Characterizing the role of left ventricular indices and biventricular interaction in bronchopulmonary dysplasia-associated pulmonary hypertension in extreme prematurity.

Bronchopulmonary dysplasia (BPD) is a common respiratory morbidity in preterm infants. The onset of pulmonary hypertension leads to worse respiratory outcomes. The contribution of left ventricular diastolic dysfunction in BPD-PH is well reported. We evaluated the serial left ventricular (LV) function and possible ventricular interdependence among BPD-PH. Single-centre, prospective observational study. Infants <28 weeks of gestation included. 80 infants were enrolled. The incidence of BPD-PH was 23%. The BPD-PH group had a high incidence of hemodynamically significant ductus arteriosus (83% vs 56%,p <0.018), longer oxygen days (96.2±68.1 vs 59.35±52,p< 0.008), and prolonged hospital stay (133.8±46 vs 106.5±38 days,p<0.005). Serial tissue Doppler imaging showed prolonged left ventricle (LV) isovolumetric contraction time (IVCT)(31.05±3.3 vs 26.8±4.4ms,p<0.001), and myocardial performance index (MPI) (0.43±0.03 vs 0.37±0.04,p<0.001) from 33 weeks. The changes in IVCT (35.9±6.7 vs 27.9±4.5ms, p<0.001), isovolumetric relaxation time (IVRT) (50±6.5 vs 39.9±5.8ms,p <0.001), and MPI (0.48±0.05 vs 0.36±0.03,p <0.001) persisted at 36 weeks. The receiver operator characteristic curve showed LV MPI >40 has 83% sensitivity and 65% specificity (AUC 0.77, p<0.001) in the diagnosis of PH. The BPD-PH group had a higher LV E/E' ratio (13.1±4.4 vs 11.4±3.4, p <0.02). Pearson correlation test showed a moderate positive correlation between RV MPI and LV MPI (r= 0.585, p <0.001). Significant LV diastolic dysfunction was observed in BPD-PH. This is the first study to show biventricular strain and possible ventricular interdependence in BPD-PH. The prolonged LV IVRT and MPI may be a novel echocardiographic indicator of BPD-PH.

Impact of HIV exposure without infection on hospital course and mortality among young children in sub-Saharan Africa: a multi-site cohort study

BackgroundAlthough mortality risk associated with HIV is well described, HIV-exposed uninfected (HEU) young children are also at increased risk of hospitalization and death as compared to HIV-unexposed uninfected (HUU) children. The drivers of poor outcomes among HEU children remain unknown, limiting the development of interventions to support this vulnerable population.MethodsWe performed a secondary analysis of data from a large multi-country prospective cohort [Childhood Acute Illness and Nutrition (CHAIN) Network] study. Data from 5 sites in Uganda, Kenya, and Malawi were included. Hospitalized children aged 2–23 months were followed from an index admission for 6 months after discharge to determine acute and long-term outcomes. Using perinatal HIV exposure (HEU and HUU) as the primary exposure and adjusting for child, caregiver, and household characteristics, we compared inpatient and 30-day survival outcomes, nutritional status, hospital length of stay, illness severity, and utilization of inpatient resources.ResultsWe included 1486 children: 217 HEU and 1269 HUU. HEU children had an increased risk of mortality both during hospitalization [adjusted OR 1.96, 95% CI (1.14–3.37)] and in the 30 days following hospital admission [adjusted hazard ratio 2.20, 95% CI (1.10–4.42)]. Wasting and stunting were more frequent in HEU than HUU children, with adjusted OR 1.41, 95% CI (1.03–1.95) and adjusted OR 1.91, 95% CI (1.34–2.70), respectively. HEU children were also more likely to have a prolonged hospital stay compared to HUU children [adjusted OR 1.58, 95% CI (1.08–2.29)], although admission diagnoses, illness severity at admission, and use of inpatient resources (supplemental oxygen, nasogastric tube, and second-line antibiotics) did not differ significantly between groups.ConclusionsHEU children are more likely to die during hospitalization and within 30 days of admission, to be wasted and stunted upon hospital admission, and to require a prolonged hospital stay, as compared to HUU children. Hospitals in settings with a high prevalence of women-living-with-HIV should ensure that maternal HIV status is established among children requiring admission and build capacity to provide additional hospital monitoring and early post-discharge support for HEU children.

Intensive care nurses’ knowledge of pressure injury prevention

BackgroundPressure injuries (PIs) remain a significant public health concern due to their high prevalence among critically ill patients admitted to intensive care units (ICUs). Despite advancements in science and technology related to PI prevention, the prevalence continues to rise. A key factor contributing to this rise is inadequate knowledge and limited use of evidence-based practices by nurses, resulting in prolonged hospital stays and poor patient outcomes. This study aimed to determine the knowledge of intensive care nurses regarding pressure injury prevention.MethodsA descriptive cross-sectional design was used to collect data from 101 nurses working in four ICUs at an academic hospital in Gauteng Province, South Africa. The revised Pressure Ulcer Knowledge Assessment Tool (PUKAT 2.0) was utilized to gather data from a convenience sample of intensive care nurses. Descriptive and inferential statistics were employed to analyze the data, with statistical tests including the Shapiro-Wilk test, univariate and multivariate linear regression, and Cronbach’s alpha coefficient tests. A p-value of less than 0.05 was considered statistically significant.ResultsThe mean knowledge score of the nurses (N = 101) was 42.16% (SD 12.09), indicating poor knowledge of PI prevention. The lowest scores were observed in the areas of “prevention of pressure injuries” (25%) and “classification and observation” (39.5%). Higher levels of education (14.00; 95% CI 2.90–25.11; p = 0.014), seniority (15.58; 95% CI 2.92–28.24; p = 0.016), and years of experience (6.38; 95% CI 9.70–5.45; p = 0.039) were statistically significant predictors of better prevention and management of PI.ConclusionThe findings of this study demonstrate that intensive care nurses have poor knowledge of prevention measures, classification, and observation of stages. This may hinder their ability to effectively utilize risk assessment tools in clinical practice. Improving training and providing intensive care nurses with adequate information about evidence-based practices to prevent PI could strengthen their contribution to patient safety. These findings underscore the need for continuous, mandatory training programs for intensive care nurses to stay updated with the latest evidence and practices in PI prevention.

Intraperitoneal immunotherapy with denileukin diftitox (ONTAK) in recurrent refractory ovarian cancer

BackgroundDenileukin diftitox (ONTAK) is a diphtheria/IL-2R fusion protein able to deplete regulatory T cells in peripheral blood. Regulatory T cells in the local immune microenvironment have been shown to be associated with poor prognosis in ovarian cancer. This study examined whether denileukin diftitox (ONTAK) could be safely administered intraperitoneal in patients with advanced refractory ovarian cancer and assessed its effects on regulatory T cells and tumor associated cytokines in ascites and peripheral blood. Patients and methodsA phase I dose escalation study of intraperitoneal denileukin diftitox (ONTAK) enrolled 10 patients with advanced, refractory ovarian carcinoma at 3 doses (5 μg/kg, 15 μg/kg, and 25 μg/kg). Serial CA-125 measurements assessed clinical response. Regulatory T cells were quantified using RT-PCR and cytokine levels measured by Luminex. ResultsThe maximum tolerated dose was 15 μg/kg with a dose limiting toxicity observed in 1 out of 6 patients in the expansion group. The majority of adverse events were transient grades 1–2. One patient treated at the 25 μg/kg dose experienced cytokine storm with prolonged hospitalization. 3 patients had decreases in CA-125 after treatment but none met criteria for partial response. Treatment with denileukin diftitox (ONTAK) decreased regulatory T cells in peripheral blood and ascites. Treated patients did not show any significant changes in IL-8, TGF-β, sIL2Ra in ascites or peripheral blood. ConclusionsDenileukin diftitox (ONTAK) can be safely administered intraperitoneally to recurrent refractory ovarian cancer patients. Regulatory T cells were reduced in ascites and peripheral blood, but there were no significant changes in cytokine levels.Clinical Trial Registration:ClinicalTrials.gov # NCT00357448

The impact of the COVID-19 pandemic on hospital admissions in a psychiatric ward in a general hospital in Greece.

The negative consequences of the COVID-19 pandemic and the subsequent restrictive measures on the mental health and well-being of the population and psychiatric patients have been widely recognized. Patients' treatment attendance and engagement with mental health services had been negatively affected by the pandemic, whereas patients were less likely to receive timely outpatient care. The pandemic also impacted the use of inpatient services. The aim of the present study was to explore the variability of attendance and admissions to a general hospital psychiatric ward over a 12-month interval after the onset of the pandemic (March 2020), compared to the respective 12-month pre-pandemic interval. A retrospective, observational pre/post study was performed, involving a general hospital psychiatric ward in Corfu, Northwest Greece, which serves an insular catchment area of approximately 100,000 inhabitants. For data analysis, c- and u-charts of statistical process control charts were employed, using monthly data (March 2019 to February 2021). Overall, a significant decline in attendance rates was observed, mostly accounted for by a 26.5% reduction in voluntary attendance rates (1516 patients prior vs. 1114 patients after the onset of the pandemic). The involuntary commitment of patients did not differ between the two periods (106 prior vs. 100 after the onset of the pandemic). Admission rates did not change significantly between the two periods. Diagnoses that exhibited significant variance in examinations between the two study periods were mood disorders and personality disorders, whereas there was no significant variation in the number of admissions across different diagnoses. Length of hospital stay increased significantly by 13.2% over the first year of the pandemic, from 25.57 days (Md= 13, IQR= 22) during the pre-COVID-19 period to 28.95 days (Md= 22, IQR= 28) during the COVID-19 period. Patients with schizophrenia and related disorders (Mean= 34.25 days, SD= 43.19) and mood disorders (Mean= 26.26, SD= 33.48) had prolonged hospital stays compared to other diagnoses. These findings highlight significant shifts in psychiatric care delivery during the pandemic and underscore the need for targeted interventions to address the evolving demands on mental health services during public health crises.

Nurses, Knowledge Regarding Pressure Ulcer At Tertiary Level Hospital In Dhaka, Bangladesh

Background: Pressure Ulcer is one of the chief complications of prolonged hospitalization patients, it occurs when localized tissue gets deprived of circulation due to soft tissue compressed between external surfaces and bony prominence for a prolonged time. Aim: The aim of this study was to assess the level of nurses’ knowledge regarding pressure ulcer at tertiary level hospital in Dhaka, Bangladesh. Method: A descriptive type of cross-sectional study was conducted from July 2023 to June 2024 among 50 senior staff nurses who were selected by convenient sampling technique. Data was collected by a structured knowledgebased questionnaire regarding Pressure Ulcer. Data were analyzed using descriptive statistics (frequencies, percentages and mean). Results: The mean age of respondents was 35 years. The overall nurses’ knowledge was very good 82.4%, 4% had below average knowledge, 4% had average knowledge, 18% had excellent knowledge, 26% had good knowledge regarding pressure ulcer among nurses. Higher professional qualifications significantly influenced the knowledge of respondents on pressure ulcer. The level of total knowledge score of B.Sc. in Nursing and B.Sc. in Public Health Nursing (Post Basic) respondents was 82.75% whereas Diploma in Nursing Science and Midwifery was 82.5%. Conclusion: On the basis of findings, the study provides suggestions to prioritize training programs in raising the level of nurses’ knowledge regarding pressure ulcer prevention in terms of providing quality care to manage and prevent pressure ulcer.

Development of a risk of bias assessment tool specifically for meta-analysis of trials for surgical site infection

Background: Surgical site infections (SSIs) significantly impact patient outcomes, with rates reaching up to 20% after surgery, leading to higher morbidity, prolonged hospital stays, and increased costs. The assessment of randomized controlled trials (RCTs) related to SSIs has been challenging due to the lack of a specialized Risk of Bias (RoB) tool, as existing tools like the RoB-2 are not surgery-specific. To address this gap, we developed an adapted SSI-specific RoB-2 tool. Methods: This tool was created through a four-stage consensus process involving surgeons, trial statisticians, and methodologists with extensive experience in international SSI trials. Results: The process identified ten critical domains relevant to assessing RCTs on SSI interventions. Of these, eight domains were prioritized as essential for the final tool, while two were considered desirable but less critical due to the challenges of blinding in surgical contexts. Conclusion: The adapted RoB-2 tool is tailored to the unique aspects of SSI trials, offering a more focused and practical means of evaluating RCT quality. It not only improves the assessment of existing studies but also guides the design of future RCTs, enhancing the quality of evidence in SSI research. The tool's application in meta-analyses will likely lead to more reliable and generalizable results, informing clinical practice and policy decisions related to SSI prevention and management.

Impact of time to antibiotics on clinical outcome in paediatric febrile neutropenia: a target trial emulation of 1685 episodes

Prompt antibiotic administration for febrile neutropenia (FN) is standard of care, and targets of time to antibiotics (TTA)<60min are common. We sought to determine the effect of TTA ≥60 versus <60min on adverse outcomes (intensive care unit (ICU) admission or death) in children with cancer and FN. Effect modification by a decision rule that predicts infection (AUS-rule) and bacteraemia were also investigated. The prospective, multi-centre (n=8), Australian PICNICC study dataset was analysed. To control for confounding, we used outcome regression adjusted for propensity score modelled as restricted cubic spline with two degrees of freedom. The propensity score was estimated from a logistic regression model for the exposure on the confounders, identified a priori (age, sex, severely unwell, disease, chemotherapy intensity and site). TTA was defined as time from from emergency triage to first antibiotic dose. 1685 FN episodes in 976 patients were included. Median TTA was 53min (IQR 37-77min, 1542 (92%) <120min). An adverse outcome occurred in 43 (2.6%) episodes (39 ICU; 5 deaths). The confounder-adjusted point estimate suggested a lower risk for adverse outcome associated with TTA ≥60min (RR 0.62, 95% CI 0.32-1.21), but the wide 95% CI precluded definitive judgement about strength and direction of the effect (unadjusted RR 0.52; 95% CI 0.26, 1.05). Similarly, although the point estimates were suggestive of a null association or reduced risk for adverse outcome associated with TTA ≥60min for all comparisons across bacteraemia or AUS-rule strata, the 95% CIs were imprecise. For children with FN, there was no definite evidence that TTA ≥60min from hospital triage (but within 2h), increased risk of adverse outcome or prolonged hospital admission. This study has important implications for FN TTA mandates, suggesting a more nuanced approach is required. National Health and Medical Research Council and Medical Research Future Fund.

A Day Saved is a Life Saved: Direct Antimicrobial Susceptibility Testing from Positively Flagged Blood Culture Bottles and their Concordance with the Routine Method.

Sepsis is a major health problem worldwide and is associated with high morbidity and mortality with every hour delay in initiation of therapy. A conventional method of blood culture and Antimicrobial Susceptibility Testing (AST) takes around 48-72 hours. Empirical antibiotics need to be administered until the sensitivity report is made available. It has been estimated that 20-50% of the empirical antibiotics are inappropriate, resulting in prolonged hospital stays, adverse effects, and emergence of drug resistance. Additionally, this also puts an extra financial burden on both the patients and healthcare settings. Performing direct Antimicrobial Sensitivity Testing (dAST) is an important tool to reduce turn-around time (TAT) by at least 18-24 hours, thus reducing morbidity and mortality among critically ill patients. Direct AST (dAST) was performed from the positively flagged blood culture bottles received between December, 2021 to May, 2022 from Intensive Care Units (ICUs) on Mueller- Hinton Agar (MHA) using four drops of withdrawn blood. dAST was performed for six drugs: Ceftriaxone-30 μg (CTR), Piperacillin/Tazobactam-100/10 μg (PIT), Meropenem-10 μg (MRP), Ciprofloxacin-5 μg (CIP), Aztreonam-30 μg (AT), and Colistin (CL). The zone of inhibition was interpreted as per CLSI M100 ed32, 2022 guidelines. A parallel conventional method was also performed to examine for categorical agreement and disagreement. Identification was carried out using MALDI-TOF MS from the colonies that appeared on the dAST plate on the subsequent day. A total of 162 positively flagged blood culture bottles were included in the study. The majority of the Gram-negative organisms were from Enterobacterales (n=109), followed by Acinetobacter spp. (n=28) and Pseudomonas aeruginosa (n=25). Out of the 972 isolate-antimicrobial combinations, overall Categorical Agreement (CA) was seen in 936 (96.3%), whereas disagreement was observed in 36 with minor error (mE) in 21 (2.2%), major error (ME) in 7 (0.7%), and very major error (VME) in 8 (0.8%) when compared to the routine method. Categorical agreement (CA) of > 99% was seen in ceftriaxone (CTR) and ciprofloxacin (CIP). In comparison, the lowest CA was observed with meropenem (MRP) at 92%. Colistin dAST was performed using the E-strip method, and the result obtained was highly convincing, with an overall disagreement of only 1.2%. Rapid dAST from positively flagged blood culture bottles proved to significantly reduce the TAT from the time of sample collection to the first availability of antimicrobial susceptibility report with excellent categorical agreement of > 95% using the conventional disc diffusion method. Results obtained were within the acceptance criteria set by U. S. Food and Drug Administration (FDA) guidelines of > 90% categorical agreement for a new method. We were able to obtain excellent concordance for colistin using the E-strip method. Performing dAST not only saves a "day", but its proper implementation would save a "life".

Oxidised cellulose in musculoskeletal oncology procedure: Does it reduce postoperative blood loss?

Major musculoskeletal oncology procedures often result in perioperative bleeding. This exposes patients to allogeneic red blood cell transfusion and its potential complications, thus increasing the risk of surgical wound infection and prolonged hospital stay. This study aimed to investigate the efficacy of oxidised cellulose, a topical haemostatic agent, in reducing postoperative blood loss and its subsequent risks. In this randomised controlled trial, 40 patients undergoing major musculoskeletal oncology procedures were assigned to control and intervention groups. Oxidised cellulose was inserted into the surgical wound after the resection's conclusion before the wound's closure to reduce postoperative bleeding for patients in the intervention group. Postoperative closed suction drain system (Redivac TM) volume, drop in haemoglobin level, allogeneic red blood cell transfusion rate, duration of surgery, and length of hospital stay were compared between the two groups. The postoperative Redivac volume (Control: 432 MLS vs. Intervention: 431.75 MLS), drop in haemoglobin level (Control: 3.12g/dL vs. Intervention: 3.06g/dL), duration of surgery (Control: 134 vs. Intervention: 156min), and allogeneic red blood cell transfusion were lower in the intervention group (Control: 204 MLS vs. Intervention: 170 MLS), but they were not statistically significant (p > 0.05) (Control: 134 vs. Intervention: 156min). Mean hospital stay was similar in both groups (Control: 5.45days vs. Intervention: 5.85days). Oxidised cellulose use does not significantly affect postoperative blood loss, the rate of allogeneic blood transfusion, and hospital stay. However, we believe its use contributes positively but not considerably towards lower postoperative blood loss in musculoskeletal oncology surgeries.

Advancing personalised care in atrial fibrillation and stroke: The potential impact of AI from prevention to rehabilitation.

Atrial fibrillation (AF) is a complex condition caused by various underlying pathophysiological disorders and is the most common heart arrhythmia worldwide, affecting 2 % of the European population. This prevalence increases with age, imposing significant financial, economic, and human burdens. In Europe, stroke is the second leading cause of death and the primary cause of disability, with numbers expected to rise due to ageing and improved survival rates. Functional recovery from AF-related stroke is often unsatisfactory, leading to prolonged hospital stays, severe disability, and high mortality. Despite advances in AF and stroke research, the full pathophysiological and management issues between AF and stroke increasingly need innovative approaches such as artificial intelligence (AI) and machine learning (ML). Current risk assessment tools focus on static risk factors, neglecting the dynamic nature of risk influenced by acute illness, ageing, and comorbidities. Incorporating biomarkers and automated ECG analysis could enhance pathophysiological understanding. This paper highlights the need for personalised, integrative approaches in AF and stroke management, emphasising the potential of AI and ML to improve risk prediction, treatment personalisation, and rehabilitation outcomes. Further research is essential to optimise care and reduce the burden of AF and stroke on patients and healthcare systems.

Diagnostic stewardship and dermatology consultation in cellulitis management: a systematic literature review and meta-analysis.

Cellulitis is a common skin infection often requiring antibiotic treatment. However, misdiagnosis and inappropriate antibiotic use contribute to antibiotic resistance and healthcare costs. We aimed to evaluate the impact of dermatology consultation on treatment modification in patients with suspected cellulitis and to determine whether dermatologists' evaluation can be used as a reference to diagnose suspected cellulitis. We explored MedLine (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane CENTRAL, Web of Science, and Scopus and Embase, including publications from database inception to July 25, 2023. Studies were included if they evaluated treatment modifications involving the use of antibiotics for patients with suspected cellulitis with and without dermatology consultation. We excluded comments or reviews, pilot studies, and studies without a non-dermatology control group, treatment modifications, the use of antibiotics, or patients with cellulitis. Of the 49 full-text articles, 14 studies met the selection criteria.This systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Of five independent reviewers (GYC, IP, MG, MKH, and AMRP), two abstracted data for each article using a standardized abstraction form. We used the Downs and Black scale to evaluate study quality. Subgroup analysis was conducted regarding readmission rate within 30 days for two independent populations seen by a non-dermatologist physician or a dermatologist. We employed random-effects models to obtain pooled mean differences. Heterogeneity was assessed using the I-squared value. The impact of dermatology consultation on treatment modification involving antibiotics in patients with suspected cellulitis and readmission rates in 30 days. Dermatology consultation changed initial treatment plans involving antibiotics from 47 to 96% of the time, improving diagnostic accuracy and, consequently, antibiotic stewardship of cellulitis. Dermatology consultation was not significantly associated with lower readmission rates in 30 days (pooled OR = 0.56, 95% CI: 0.25 to 1.25, I2 = 0%). Dermatology consultation in patients with suspected cellulitis may improve diagnosis and management, thereby reducing antibiotic misuse, unnecessary tests, and prolonged hospitalizations.

Role of secretomes in chronic wound treatment: a review

Living with a chronic wound may prove to be devastating to patients both physically and psychologically. Wound increases economic and society burden due to low healing rate, prolonged hospital treatment, and increased epidemiology worldwide. Therefore, application wound treatment modalities are necessary for patient recovery. However, each modality has their own advantage and limitation. As a newly-founded modality, secretome, which originated from Mesenchymal stem cells (MSCs) plays an important role in chronic wound healing due to its ability in promoting tissue regeneration and self-renewal that supports cell proliferation and migration. However, different therapeutic potentials can arise according to each source of stem cells. This review highlights the importance of secretome as a modality in treating chronic wounds. Secretome types, stem cell origin, and results when applied in vitro and in vivo will also be comprehensively reviewed.

The Epidemiology, Clinical, and Economic Burdens of Respiratory Syncytial Virus Infections Amongst Hospitalized Children Under 5 Years of Age in Jordan: A National Multi-Center Cross-Sectional Study

Respiratory syncytial virus (RSV) has been recognized as a highly important cause of morbidity and mortality among children and adults. A cross-sectional study at representative sites in Jordan was undertaken to provide an assessment of the epidemiology and health and economic burdens of RSV and influenza infections in Jordan amongst hospitalized children under 5 years old for the period between 15 November 2022 and 14 April 2023. This study involved 1000 patients with a mean age of 17.10 (SD: 16.57) months. Of these, half (n = 506, 50.6%) had positive results for RSV. Furthermore, 33% and 17.4% of the participants had positive results for RSV-B and RSV-A, respectively. The findings underscore the severity of RSV infections, where a significant proportion of the children experienced severe respiratory distress, which led to bronchiolitis and pneumonia. This study meticulously documented the clinical outcomes, including the need for intensive care, mechanical ventilation, and prolonged hospital stays. There was no statistically significant difference in the financial burdens between the RSV-positive and RSV-negative patients. This study revealed the urgent need for preventive measures to control the substantial burden of RSV among children under 5 years old in Jordan.

RISK FACTORS FOR SURGICAL SITE INFECTION FOLLOWING CESAREAN SECTION

Surgical site infections (SSIs) following cesarean sections (CS) are significant contributors to maternal morbidity and healthcare burdens worldwide. Despite adherence to preoperative guidelines, certain risk factors remain associated with increased SSI rates. Identifying and addressing these factors is essential for improving patient outcomes. Objective: To identify and evaluate the risk factors associated with surgical site infection (SSI) following cesarean section (CS) based on the World Health Organization’s recommended preoperative measures in a tertiary care hospital in Mirpur, AJ &amp; K. Methods: A prospective cohort study was conducted from January 2022 to December 2023 at a tertiary care hospital in Mirpur, AJ&amp;K. A total of 1,500 patients undergoing cesarean sections were enrolled and followed for 30 days post-surgery to monitor for the occurrence of SSI. Data on potential risk factors, such as body mass index (BMI), diabetes, hypertension, preoperative antibiotic use, duration of surgery, type of cesarean section (elective vs. emergency), anemia, and personal hygiene practices, were collected at baseline. The primary outcome was the incidence of SSI, diagnosed according to the Centers for Disease Control and Prevention (CDC) criteria. Risk factors were compared between patients who developed SSI (cases) and those who did not (controls). Statistical analyses, including Chi-squared and Fisher’s Exact tests, were performed to identify significant risk factors. Multivariate logistic regression was used to control for confounding factors. Results: Out of the 1,500 patients, 18% (n=270) developed SSI within 30 days of surgery. Significant risk factors for SSI included obesity (BMI &gt;30), which increased the odds of SSI by 2.5 times (p=0.001); prolonged hospital stay of more than 5 days, associated with a 1.8-fold increase in SSI risk (p=0.004); emergency cesarean sections, which raised the risk by 2.1 times compared to elective procedures (p=0.002); and anemia (hemoglobin &lt;10 g/dL), which increased SSI risk by 1.9 times (p=0.005). Poor personal hygiene practices were also significantly associated with a higher incidence of SSI (p=0.003). On the other hand, the use of preoperative prophylactic antibiotics was protective, reducing the incidence of SSI by 3.2-fold (p=0.0001). No significant associations were observed between the duration of surgery (p=0.21) or patient age (p=0.15) and the occurrence of SSI. Conclusions: This prospective cohort study identified obesity, prolonged hospital stay, emergency cesarean section, anemia, and personal hygiene practices as significant risk factors for the development of SSI following cesarean section, consistent with the World Health Organization’s preoperative guidelines. The use of preoperative prophylactic antibiotics was shown to be an effective intervention in reducing SSI risk. These findings underscore the importance of targeted preventive measures, including weight management, prompt hospital discharge, enhanced personal hygiene education, and the routine use of prophylactic antibiotics, in reducing the burden of SSIs in cesarean sections.

COMPARISON OF VACUUM-ASSISTED CLOSURE (VAC) THERAPY AND CONVENTIONAL THERAPY FOR DEEP STERNAL WOUND INFECTIONS (DSWI) POST-OPEN HEART SURGERY

Deep sternal wound infections (DSWI) represent a serious postoperative complication in cardiothoracic surgery, leading to significant morbidity, prolonged hospital stays, and increased mortality. Traditionally, DSWI has been managed through debridement, antibiotic regimens, and conventional wound care methods, but Vacuum-Assisted Closure (VAC) therapy has recently emerged as an alternative approach. This article compares VAC therapy with conventional therapy, assessing their respective impacts on wound healing time, infection rates, and overall patient outcomes. Findings suggest that VAC therapy offers promising advantages over traditional methods in DSWI management.

INHALED ANTIBIOTICS FOR TREATING PNEUMONIA IN INVASIVELY VENTILATED PATIENTS IN THE INTENSIVE CARE UNIT

Pneumonia in invasively ventilated patients is a significant concern in the intensive care unit (ICU), often associated with increased morbidity, prolonged hospital stays, and high mortality rates. The emergence of multidrug-resistant (MDR) pathogens further complicates management. Inhaled antibiotics (IABs) have gained attention as an adjunctive or alternative treatment modality to systemic antibiotics, offering direct drug delivery to the lungs with potentially enhanced efficacy and reduced systemic toxicity. This review explores the role of inhaled antibiotics in treating pneumonia in invasively ventilated patients, focusing on pharmacological considerations, clinical efficacy, safety profiles, and limitations. Relevant evidence is derived from databases such as PubMed, Scopus, Web of Science, and Google Scholar, incorporating the latest studies and clinical trials to provide a comprehensive understanding.

Stenotrophomonas maltophilia bacteremia in adult patients with hematological diseases: clinical characteristics and risk factors for 28-day mortality.

Patients with hematological diseases are at high risk for Stenotrophomonas maltophilia (SM) bacteremia. This study retrospectively analyzed the clinical characteristics and risk factors for 28-day mortality among 140 adult hematological patients diagnosed with SM bacteremia from January 2012 to July 2023. he overall 28-day mortality was 31.43% (44/140), with a median age of 44 years. The median hospital stay before SM bacteremia onset was 25 days, and 69.29% of patients had unresolved neutropenia. All patients had received broad-spectrum antibiotics in the past month, and 69.29% developed breakthrough bacteremia during carbapenem therapy. Independent risk factors for mortality included a Sequential Organ Failure Assessment (SOFA) score ≥5, tigecycline exposure, age ≥60, and pulmonary infection. Patients with ≥2 risk factors were stratified into the high-risk group, with a significantly higher 28-day mortality compared with the low-risk group (56.52% vs 7.04%, P < 0.001). Treatment with trimethoprim-sulfamethoxazole (TMP/SMX) (P = 0.008) or TMP/SMX combined with cefoperazone/sulbactam (CSL) (P = 0.005) was associated with survival benefits among high-risk patients. Overall, SM bacteremia usually occurs in hematological patients with prolonged hospitalization, unresolved neutropenia, and extensive use of broad-spectrum antibiotics, especially carbapenems. Patients with high SOFA scores, advanced age, pulmonary infection, or recent tigecycline exposure are at higher risk of mortality. The preferred treatment is TMP/SMX rather than fluoroquinolones, with combination therapy of TMP/SMX and CSL considered a feasible treatment option.IMPORTANCEThis study, representing the largest cohort of adult hematological patients with SM bacteremia to date, strengthens the validity of existing findings and provides new insights into its clinical management. We identify risk factors for 28-day mortality, revealing that patients with two or more risk factors experience particularly high mortality rates. This highlights the importance of early identification and targeted management of high-risk individuals. Our findings also demonstrate that TMP/SMX is superior to fluoroquinolones and suggest that combining TMP/SMX with CSL may offer additional survival benefits.

Does prophylactic tamsulosin use with ERAS protocol provide improvement after colorectal surgery?

IntroductionEarly urinary catheter removal has been incorporated into Enhanced Recovery After Surgery (ERAS) pathways to aid faster recovery and minimize urinary tract infection. However, early catheter removal can result in urinary retention, which may lead to catheter reinsertion and a prolonged hospital stay. Tamsulosin, an alpha-blocking medication, effectively treats urinary retention in both men and women. Our study aims to compare urinary retention rates and short-term outcomes between patients treated with tamsulosin and those who were not. MethodsThis retrospective cohort study included patients who underwent elective abdominopelvic colorectal procedures using the ERAS protocol between September 2020 and October 2023. After April 2022, postoperative 0.4 ​mg tamsulosin treatment was added to the ERAS protocol. Univariate analysis was used to compare demographics and perioperative treatment history. The control and tamsulosin groups were matched in a 2:1 ratio, using propensity scores. The primary outcomes were urinary retention and the length of hospital stay. ResultsThe study included 2072 patients (1215 female, 58.6 ​%), with a mean age of 53.1 (±17.1) years. The initial univariate analysis was followed by propensity score matching, resulting in 344 patients in the tamsulosin group and 688 in the control group. The urinary retention rate was notably lower in patients who received tamsulosin during hospitalization (9.2 ​% vs. 4.7 ​%, p ​= ​0.01). Furthermore, the length of hospital stay was shorter in patients treated with tamsulosin (5 vs. 4.2 p ​< ​0.01). ConclusionPostoperative prophylactic tamsulosin use decreases urinary retention rates and length of stay after colorectal surgery and should be considered complementary to ERAS protocols for improved recovery.