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1.
BMC Res Notes ; 15(1): 264, 2022 Jul 27.
Article in English | MEDLINE | ID: mdl-35897027

ABSTRACT

OBJECTIVE: Constantly high glycemia levels might influence outcomes in the management of patients undergoing surgery for diabetic foot infections (DFI). In our center for DFI, we performed a case-control study using a multivariate Cox regression model. Patients developing a new DFI could participate in the study several times. RESULTS: Among 1013 different DFI episodes in 586 individual adult patients (type I diabetes 148 episodes [15%], 882 [87%] with osteomyelitis; median antibiotic therapy of 21 days), professional diabetes counselling was provided by a specialized diabetes nurse in 195 episodes (19%). At admission, blood glucose levels were elevated in 110 episodes (11%). Treatments normalized glycemia on postoperative day 3 in 353 episodes (35%) and on day 7 for 321 (32%) episodes. Glycemia levels entirely normalized for 367 episodes (36%) until the end of hospitalization. Overall, treatment of DFI episodes failed in 255 of 1013 cases (25%), requiring surgical revision. By multivariate analysis, neither the provision of diabetes counseling, nor attaining normalizations of daily glycemic levels at day 3, day 7, or overall, influenced the ultimate incidence of clinical failures. Thus, the rapidity or success of achieving normoglycemia do not appear to influence the risk of treatment failure for operated DFI episodes.

2.
Am J Infect Control ; 50(3): 352-354, 2022 03.
Article in English | MEDLINE | ID: mdl-34718067

ABSTRACT

Use of public transportation could be associated with an increased risk for developing COVID-19. We investigated 376 COVID-19-compatible episodes among our healthcare workers (HCWs), of whom 225 (60%) reported that they used public transportation. In multivariate analyses, HCWs using public transportation had no greater incidence of COVID-19 than those continuously using a private transportation.


Subject(s)
COVID-19 , Pandemics , COVID-19/epidemiology , Health Personnel , Humans , Incidence , SARS-CoV-2 , Switzerland/epidemiology
3.
Endocrinol Diabetes Metab ; 4(2): e00225, 2021 04.
Article in English | MEDLINE | ID: mdl-33855224

ABSTRACT

Introduction: The most frequently prescribed empirical antibiotic agents for mild and moderate diabetic foot infections (DFIs) are amino-penicillins and second-generation cephalosporins that do not cover Pseudomonas spp. Many clinicians believe they can predict the involvement of Pseudomonas in a DFI by visual and/or olfactory clues, but no data support this assertion. Methods: In this prospective observational study, we separately asked 13 experienced (median 11 years) healthcare workers whether they thought the Pseudomonas spp. would be implicated in the DFI. Their predictions were compared with the results of cultures of deep/intraoperative specimens and/or the clinical remission of DFI achieved with antibiotic agents that did not cover Pseudomonas. Results: Among 221 DFI episodes in 88 individual patients, intraoperative tissue cultures grew Pseudomonas in 22 cases (10%, including six bone samples). The presence of Pseudomonas was correctly predicted with a sensitivity of 0.32, specificity of 0.84, positive predictive value of 0.18 and negative predictive value 0.92. Despite two feedbacks of the interim results and a 2-year period, the clinicians' predictive performance did not improve. Conclusion: The combined visual and olfactory performance of experienced clinicians in predicting the presence of Pseudomonas in a DFI was moderate, with better specificity than sensitivity, and did not improve over time. Further investigations are needed to determine whether clinicians should use a negative prediction of the presence of Pseudomonas in a DFI, especially in settings with a high prevalence of pseudomonal DFIs.


Subject(s)
Clinical Competence , Diabetic Foot/microbiology , Osteomyelitis/microbiology , Physicians , Pseudomonas Infections , Pseudomonas aeruginosa/pathogenicity , Smell/physiology , Diabetic Foot/pathology , Diabetic Foot/surgery , Forecasting , Humans , Osteomyelitis/pathology , Osteomyelitis/surgery , Prospective Studies , Pseudomonas aeruginosa/isolation & purification
4.
Aging Clin Exp Res ; 33(3): 703-710, 2021 Mar.
Article in English | MEDLINE | ID: mdl-31494913

ABSTRACT

BACKGROUND: With the increasing number of elderly patients, arthroplasties, fractures and diabetic foot infections, the worldwide number of osteoarticular infections (OAI) among the elderly is concomitantly expected to rise. AIMS: We explore existing scientific knowledge about OAI in the frail elderly population. METHODS: We performed a literature search linking OAIs to geriatric patients and comparing elderly patients (> 65 years) with average adults (range 18-65 years). RESULTS: In this literature, financial aspects, comparison of diverse therapies on quality of life, reimbursement policies, or specific guidelines or nursing recommendations are missing. Age itself was not an independent factor related to particular pathogens, prevention of OAI, nursing care, and outcomes of OAI. However, geriatric patients were significantly more exposed to adverse events of therapy. They had more co-morbidities and more conservative surgery for OAI. CONCLUSION: Available literature regarding OAI management among elderly patients is sparse. In recent evaluations, age itself does not seem an independent factor related to particular epidemiology, pathogens, prevention, nursing care, rehabilitation and therapeutic outcomes of OAI. Future clinical research will concern more conservative surgical indications, but certainly reduce inappropriate antibiotic use.


Subject(s)
Frail Elderly , Quality of Life , Aged , Anti-Bacterial Agents/therapeutic use , Comorbidity , Humans
5.
Trials ; 21(1): 144, 2020 Feb 06.
Article in English | MEDLINE | ID: mdl-32028985

ABSTRACT

BACKGROUND: There are several open scientific questions regarding the optimal antibiotic treatment of spinal infections (SIs) with or without an implant. The duration of postsurgical antibiotic therapy is debated. METHODS: We will perform two unblinded randomized controlled trials (RCTs). We hypothesize that shorter durations of systemic antibiotic therapy after surgery for SI are noninferior (10% margin, 80% power, α = 5%) to existing (long) treatment durations. The RCTs allocate the participants to two arms of 2 × 59 episodes each: 3 vs. 6 weeks of targeted postsurgical systemic antibiotic therapy for implant-free SIs or 6 vs. 12 weeks for implant-related SIs. This equals a total of 236 adult SI episodes (randomization scheme 1:1) with a minimal follow-up of 12 months. All participants receive concomitant multidisciplinary surgical, re-educational, internist, and infectious disease care. We will perform three interim analyses that are evaluated, in a blinded analysis, by an independent study data monitoring committee. Besides the primary outcome of remission, we will also assess adverse events of antibiotic therapy, changes of the patient's nutritional status, the influence of immune suppression, total costs, functional scores, and the timely evolution of the (surgical) wounds. We define infection as the presence of local signs of inflammation (pus, wound discharge, calor, and rubor) together with microbiological evidence of the same pathogen(s) in at least two intraoperative samples, and we define remission as the absence of clinical, laboratory, and/or radiological evidence of (former or new) infection. DISCUSSION: Provided that there is adequate surgical debridement, both RCTs will potentially enable prescription of less antibiotics during the therapy of SI, with potentially less adverse events and reduced overall costs. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04048304. Registered on 5 August 2019. PROTOCOL VERSION: 2, 5 July 2019.


Subject(s)
Anti-Bacterial Agents/administration & dosage , Osteomyelitis/drug therapy , Spinal Diseases/drug therapy , Spinal Fusion/adverse effects , Surgical Wound Infection/drug therapy , Adult , Anti-Bacterial Agents/adverse effects , Drug Administration Schedule , Equivalence Trials as Topic , Follow-Up Studies , Humans , Middle Aged , Osteomyelitis/etiology , Prospective Studies , Spinal Diseases/etiology , Spinal Fusion/instrumentation , Surgical Wound Infection/etiology , Time Factors , Treatment Outcome
6.
Trials ; 21(1): 54, 2020 Jan 08.
Article in English | MEDLINE | ID: mdl-31915048

ABSTRACT

BACKGROUND: Few studies have addressed the appropriate duration of antibiotic therapy for diabetic foot infections (DFI) with or without amputation. We will perform two randomized clinical trials (RCTs) to reduce the antibiotic use and associated adverse events in DFI. METHODS: We hypothesize that shorter durations of postdebridement systemic antibiotic therapy are noninferior (10% margin, 80% power, alpha 5%) to existing (long) durations and we will perform two unblinded RCTs with a total of 400 DFI episodes (randomization 1:1) from 2019 to 2022. The primary outcome for both RCTs is remission of infection after a minimal follow-up of 2 months. The secondary outcomes for both RCTs are the incidence of adverse events and the overall treatment costs. The first RCT will allocate the total therapeutic amputations in two arms of 50 patients each: 1 versus 3 weeks of antibiotic therapy for residual osteomyelitis (positive microbiological samples of the residual bone stump); or 1 versus 4 days for remaining soft tissue infection. The second RCT will randomize the conservative approach (only surgical debridement without in toto amputation) in two arms with 50 patients each: 10 versus 20 days of antibiotic therapy for soft tissue infections; and 3 versus 6 weeks for osteomyelitis. All participants will have professional wound debridement, adequate off-loading, angiology evaluation, and a concomitant surgical, re-educational, podiatric, internist and infectiology care. During the surgeries, we will collect tissues for BioBanking and future laboratory studies. DISCUSSION: Both parallel RCTs will respond to frequent questions regarding the duration of antibiotic use in the both major subsets of DFIs, to ensure the quality of care, and to avoid unnecessary excesses in terms of surgery and antibiotic use. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04081792. Registered on 4 September 2019.


Subject(s)
Anti-Bacterial Agents/administration & dosage , Debridement , Diabetic Foot/therapy , Osteomyelitis/therapy , Soft Tissue Infections/therapy , Adult , Aged , Aged, 80 and over , Amputation, Surgical/statistics & numerical data , Anti-Bacterial Agents/adverse effects , Combined Modality Therapy , Diabetic Foot/complications , Diabetic Foot/microbiology , Drug Administration Schedule , Female , Follow-Up Studies , Humans , Male , Middle Aged , Osteomyelitis/microbiology , Randomized Controlled Trials as Topic , Soft Tissue Infections/microbiology , Time Factors , Treatment Outcome , Wound Healing , Young Adult
7.
PLoS One ; 14(12): e0226674, 2019.
Article in English | MEDLINE | ID: mdl-31851708

ABSTRACT

BACKGROUND: Perioperative antibiotic prophylaxis in non-infected orthopedic surgery is evident, in contrast to prophylaxis during surgery for infection. Epidemiological data are lacking for this particular situation. METHODS AND FINDINGS: It is a single-center cohort on iterative surgical site infections (SSIs) in infected orthopedic patients. We included 2480 first episodes of orthopedic infections (median age 56 years and 833 immune-suppressed): implant-related infections (n = 648), osteoarticular infections (1153), and 1327 soft tissue infections. The median number of debridement was 1 (range, 1-15 interventions). Overall, 1617 infections (65%) were debrided once compared to 862 cases that were operated multiple times (35%). Upon iterative intraoperative tissue sampling, we detected pathogens in 507 cases (507/862; 59%), of which 241 (242/507; 48%) corresponded to the initial species at the first debridement. We witnessed 265 new SSIs (11% of the cohort) that were resistant to current antibiotic therapy in 174 cases (7% of the cohort). In multivariate analysis, iterative surgical debridements that were performed under current antibiotic administration were associated with new SSIs (odds ratio 1.6, 95%CI 1.2-2.2); mostly occurring after the 2nd debridement. However, we failed to define an ideal hypothetic prophylaxis during antibiotic therapy to prevent further SSIs. CONCLUSIONS: Selection of new pathogens resistant to ongoing antibiotic therapy occurs frequently during iterative debridement in orthopedic infections, especially after the 2nd debridement. The new pathogens are however unpredictable. The prevention, if feasible, probably relies on surgical performance and wise indications for re-debridement instead of new maximal prophylactic antibiotic coverage in addition to current therapeutic regimens.


Subject(s)
Antibiotic Prophylaxis/methods , Debridement/methods , Orthopedic Procedures/methods , Perioperative Care/methods , Surgical Wound Infection/prevention & control , Anti-Bacterial Agents/therapeutic use , Cohort Studies , Humans , Middle Aged , Orthopedic Procedures/standards , Retrospective Studies
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