Preventive strategies in paediatric cardiovascular surgery: impact on surgical site infections and beyond.

BACKGROUND: Surgical management of congenital heart disease (CHD) has increased worldwide, but healthcare-associated infections (HAIs) can threaten these efforts. AIM: To analyse the incidence of HAI, the impact of preventive interventions, and microbiological profiles in a paediatric cardiovascular surgery programme. METHODS: Cohort study including children aged <12 years with CHD who underwent cardiovascular surgery between 2010 and 2021 in Medellín, Colombia (a middle-income setting). Data were collected from medical and laboratory records and infection control programme databases. Impact of various preventive interventions was assessed using a Poisson model. P < 0.05 was considered statistically significant. FINDINGS: A total of 2512 surgeries were analysed. Incidence of surgical site infection (SSI) was 5.9%, followed by central line-associated bloodstream infection (CLABSI; 4.7%), catheter-associated urinary tract infection (CAUTI; 2.2%), and ventilator-associated pneumonia (VAP; 1.4%). Most of the strategies focused on preventing SSI, resulting in a reduction from 9.5% in 2010 to 3.0% in 2021 (P = 0.030). Antibiotic prophylaxis based on patient weight and continuous infusion had an impact on reducing SSI (RR: 0.56; 95% CI: 0.32-0.99). Vacuum-assisted closure (VAC) in clean wounds reduced 100% of infections. No significant risk reduction was observed for other HAI with the implemented interventions. CONCLUSION: Preventive strategies effectively reduced SSI but no other infections, emphasizing the need for targeted approaches to address a broader spectrum of HAI successfully.

Triggered electromyography (tEMG) in the lumbar spine It́s reliable? Correlation of tEMG with postoperative CT images in lumbar instrumentation. / Electromiografía evocada (tEMG) en la columna lumbar. ¿Es confiable? Correlación de tEMG con imágenes de TC posoperatorias en la instrumentación lumbar.

INTRODUCTION: Instrumentation with pedicle screws (PS) can compromise the adjacent neural structures. Triggered electromyography (tEMG) is a modality of intraoperative neuromonitoring, used to assist in the placement of these. The objective of the present study is to evaluate the reliability of this tool. METHOD: Retrospective review of patients underwent posterior lumbar fusions from January 2017 to December 2019, correlating postoperative CT images (postop CT) with tEMG results for each PS with a threshold of 10mA, establishing sensitivity and specificity of this tool. Diagnostic test and receiver operating characteristic curve were performed to evaluate the area under the curve. RESULT: A total of 275 PS were evaluated between L1 to S1; 5 PS showed concordance for an inadequate trajectory, while 10PS, with tEMG <10mA, were correctly positioned. The postoperative CT identified 17 pedicle gaps not noticed by the tEMG. Sensitivity and specificity were 23% (95% CI: 8-45) and 96% (95% CI: 93-98), respectively, with a PPV of 33.3% and a NPV of 93.6%. The area under the curve was 0.74 (95% CI: 0.62-0.86) with a cut-off point of 24mA, showing a sensitivity of 77% (95% CI: 0.55-0.92) and specificity of 69% (95% CI: 0.63-0.75). CONCLUSION: Given its low sensitivity, we do not recommend tEMG as the sole test in the verification of PS. We recommend using a cut-off point ≤8mA as it demonstrated the highest levels of sensitivity and specificity. We do not recommend using high thresholds to increase sensitivity.

Electromiografía evocada (tEMG) en la columna lumbar. ¿Es confiable? Correlación de tEMG con imágenes de TC posoperatorias en la instrumentación lumbar / Triggered electromyography (tEMG) in the lumbar spine Its reliable? Correlation of tEMG with postoperative CT images in lumbar instrumentation

Introducción: La instrumentación con tornillos pediculares (TP) puede comprometer las estructuras neurales adyacentes. La electromiografía evocada (tEMG) es una modalidad del neuromonitoreo intraoperatorio utilizada para asistir la colocación de estos. El objetivo del presente estudio es evaluar la confiabilidad de esta herramienta. Método: Revisión retrospectiva de pacientes intervenidos de artrodesis lumbar posterolateral instrumentada desde enero del 2017 hasta diciembre del 2019. Se correlacionaron las imágenes de TC postoperatorias (TC-postop) con los resultados de la tEMG para cada TP con un umbral de 10mA, y se establecieron la sensibilidad y especificidad de esta herramienta. Se realizó test diagnóstico y la curva característica operativa del receptor para evaluar el área bajo la curva. Resultado: Se evaluaron 275 TP entre L1 y S1; 5 TP presentaban concordancia para una trayectoria inadecuada, mientras que 10TP, con tEMG <10mA, se encontraban correctamente posicionados. La TC-postop identificó 17 brechas pediculares no advertidas por la tEMG. La sensibilidad y la especificidad fue del 23% (IC 95%: 8-45) y 96% (IC 95%: 93-98), respectivamente, con un VPP del 33,3% y un VPN del 93,6%. El área bajo la curva fue de 0,74 (IC 95%: 0,62-0,86) con punto de corte de 24mA, que mostró una sensibilidad del 77% (IC 95%: 0,55-0,92) y una especificidad del 69% (IC 95%: 0,63-0,75). Conclusión: Dada su baja sensibilidad, no aconsejamos la tEMG como prueba única en la verificación de TP. Recomendamos la utilización de un punto de corte ≤8mA, ya que ha demostrado los niveles más altos de sensibilidad y especificidad. No recomendamos el uso de umbrales elevados para aumentar la sensibilidad.(AU)

Introduction: Instrumentation with pedicle screws (PS) can compromise the adjacent neural structures. Triggered electromyography (tEMG) is a modality of intraoperative neuromonitoring, used to assist in the placement of these. The objective of the present study is to evaluate the reliability of this tool. Method: Retrospective review of patients underwent posterior lumbar fusions from January 2017 to December 2019, correlating postoperative CT images (postop CT) with tEMG results for each PS with a threshold of 10mA, establishing sensitivity and specificity of this tool. Diagnostic test and receiver operating characteristic curve were performed to evaluate the area under the curve. Result: A total of 275 PS were evaluated between L1 to S1; 5 PS showed concordance for an inadequate trajectory, while 10PS, with tEMG <10mA, were correctly positioned. The postoperative CT identified 17 pedicle gaps not noticed by the tEMG. Sensitivity and specificity were 23% (95% CI: 8-45) and 96% (95% CI: 93-98), respectively, with a PPV of 33.3% and a NPV of 93.6%. The area under the curve was 0.74 (95% CI: 0.62-0.86) with a cut-off point of 24mA, showing a sensitivity of 77% (95% CI: 0.55-0.92) and specificity of 69% (95% CI: 0.63-0.75). Conclusion: Given its low sensitivity, we do not recommend tEMG as the sole test in the verification of PS. We recommend using a cut-off point ≤8mA as it demonstrated the highest levels of sensitivity and specificity. We do not recommend using high thresholds to increase sensitivity.(AU)

Triggered electromyography (tEMG) in the lumbar spine it's reliable? Correlation of tEMG with postoperative CT images in lumbar instrumentation / Electromiografía evocada (tEMG) en la columna lumbar. ¿Es confiable? Correlación de tEMG con imágenes de TC posoperatorias en la instrumentación lumbar

Introduction: Instrumentation with pedicle screws (PS) can compromise the adjacent neural structures. Triggered electromyography (tEMG) is a modality of intraoperative neuromonitoring, used to assist in the placement of these. The objective of the present study is to evaluate the reliability of this tool. Method: Retrospective review of patients underwent posterior lumbar fusions from January 2017 to December 2019, correlating postoperative CT images (postop CT) with tEMG results for each PS with a threshold of 10mA, establishing sensitivity and specificity of this tool. Diagnostic test and receiver operating characteristic curve were performed to evaluate the area under the curve. Result: A total of 275 PS were evaluated between L1 to S1; 5 PS showed concordance for an inadequate trajectory, while 10PS, with tEMG <10mA, were correctly positioned. The postoperative CT identified 17 pedicle gaps not noticed by the tEMG. Sensitivity and specificity were 23% (95% CI: 8-45) and 96% (95% CI: 93-98), respectively, with a PPV of 33.3% and a NPV of 93.6%. The area under the curve was 0.74 (95% CI: 0.62-0.86) with a cut-off point of 24mA, showing a sensitivity of 77% (95% CI: 0.55-0.92) and specificity of 69% (95% CI: 0.63-0.75). Conclusion: Given its low sensitivity, we do not recommend tEMG as the sole test in the verification of PS. We recommend using a cut-off point ≤8mA as it demonstrated the highest levels of sensitivity and specificity. We do not recommend using high thresholds to increase sensitivity.(AU)

Introducción: La instrumentación con tornillos pediculares (TP) puede comprometer las estructuras neurales adyacentes. La electromiografía evocada (tEMG) es una modalidad del neuromonitoreo intraoperatorio utilizada para asistir la colocación de estos. El objetivo del presente estudio es evaluar la confiabilidad de esta herramienta. Método: Revisión retrospectiva de pacientes intervenidos de artrodesis lumbar posterolateral instrumentada desde enero del 2017 hasta diciembre del 2019. Se correlacionaron las imágenes de TC postoperatorias (TC-postop) con los resultados de la tEMG para cada TP con un umbral de 10mA, y se establecieron la sensibilidad y especificidad de esta herramienta. Se realizó test diagnóstico y la curva característica operativa del receptor para evaluar el área bajo la curva. Resultado: Se evaluaron 275 TP entre L1 y S1; 5 TP presentaban concordancia para una trayectoria inadecuada, mientras que 10TP, con tEMG <10mA, se encontraban correctamente posicionados. La TC-postop identificó 17 brechas pediculares no advertidas por la tEMG. La sensibilidad y la especificidad fue del 23% (IC 95%: 8-45) y 96% (IC 95%: 93-98), respectivamente, con un VPP del 33,3% y un VPN del 93,6%. El área bajo la curva fue de 0,74 (IC 95%: 0,62-0,86) con punto de corte de 24mA, que mostró una sensibilidad del 77% (IC 95%: 0,55-0,92) y una especificidad del 69% (IC 95%: 0,63-0,75). Conclusión: Dada su baja sensibilidad, no aconsejamos la tEMG como prueba única en la verificación de TP. Recomendamos la utilización de un punto de corte ≤8mA, ya que ha demostrado los niveles más altos de sensibilidad y especificidad. No recomendamos el uso de umbrales elevados para aumentar la sensibilidad.(AU)

Evaluation of the Induction of Cell-Mediated Immunity Against Candida albicans in a Model of Cutaneous Infection in Newborn 0-Day-Old Mice.

Candida albicans is a commensal fungus of the skin and mucous membranes in humans, but it is also responsible for mucocutaneous and systemic infections in immunocompromised patients like low birth weight neonates and premature newborns. The epicutaneous application of C. albicans is widely used to study the immune response against this pathogen in adult mice models. However, the immune response of newborns against infections caused by the genus Candida is poorly understood. In order to mimic premature human infection, we developed a model of C. albicans epicutaneous infection in newborn mice. We found that yeasts were able to colonize while the pseudohyphae invaded the epidermis. Recruitment of polymorphonuclear and mononuclear cells at the infection zone was observed. Fungal invasion, fungal burden and cellular infiltration displayed a time- and dose-dependent response. Interestingly, newborn mice were able to control C. albicans primary infection. Finally, we showed that the epicutaneous infection of C. albicans in newborn mice at birth results in the induction of cell-mediated immunity as evinced by delayed-type hypersensitivity assays.