ABSTRACT
Susceptibility to infection and increased antibiotic resistance place burn patients at risk of infection caused by multidrug-resistant organisms (MDRO). This condition can progress to sepsis, which can increase morbidity and mortality. A retrospective cohort study using medical record data of patients treated at RSUPN dr. Cipto Mangunkusumo in the period January 2020 to June 2022 was conducted. Of a total 160 subjects in the study period, 82.5% were aged <60 years, 16.88% had comorbidities, the most common cause of burns was fire (86.25%), the use of medical devices was 90.63%, with a median length of stay of 14 days. The most common Gram-negative MDRO pathogens were K. pneumoniae (29.91%), Enterobacter sp (22.32%) and Acinetobacter (20.54%): 45% of MDRO infected patients died. Bivariate analysis was conducted to find the effect of MDRO infection on burn patient mortality (RR 1,103; 95% CI 1,004-1,211, p=0.046). After adjusting for the role variables, namely: age, comorbidities, TBSA, use of medical devices, length of stay and multivariate analysis, it was found that the variables that had an effect on MDRO infection mortality were length of stay and age. MDRO infection has an effect on the mortality rate of burn patients. Mortality of burn patients due to MDRO infection is greater (45%) compared to non MDRO (21.43%). The most common Gram-negative MDRO pathogen is K. pneumoniae.
Leur sensibilité aux infections et l'augmentation globale de la résistance bactérienne font des brûlés des patients particulièrement à risque d'infections par BMR, pouvant déclencher sepsis/choc septique, qui augmentent morbidité et mortalité. Nous avons revu rétrospectivement les dossiers de 160 patients hospitalisés dans l'hôpital national Dr Cipto Mangunkusumo entre janvier et juin 2022. Parmi eux, 82,5% avaient moins de 60 ans ; 16,88% étaient comorbides ; 86,25% avaient été brûlés par flamme ; 90,63% avaient besoin de matériel invasif. La durée médiane de séjour était de 14 j. Les BGN BMR les plus fréquents étaient K. pneumoniæ (29,91%), Enterobacter (22,32%) et Acinetobacter (20,5%). La mortalité des patients infectés à BMR était de 45% (21,43% pour les non-BMR), avec une association significative BMR-mortalité (OR 1,103 ; IC95 1,004-1,211 ; p= 0,046). En explorant en analyse multivariée les variables classiquement associées à la mortalité (âge, comorbidités, surface brûlée, matériel invasif et durée de séjour), âge et durée de séjour contribuaient à la mortalité par BMR.
ABSTRACT
OBJECTIVE: The definition of neuromuscular taping (NMT) has yet to be clearly analysed as a possible treatment for diabetic foot. Case studies, theoretical analysis and results of existing research may lead to varying perceptions on the definition of NMT and its possible effects on diabetic foot. This article aims to analyse the definition of the NMT concept and furthermore as a basis for future research development on diabetic foot. METHODS: The procedure for reference source search include the principal data bases using "neuromuscular taping" and "diabetic foot" keywords for the period of 2010-2019. The concept analysis uses an 8-step approach with the Walker and Avant's method. CONCLUSIONS: NMT is a decompression application of an elastic tape on the skin on the diabetic foot that has the effect of reducing the inflammatory response, improving vascularity and neuromusculoskel-etal function. It aims to improve neuromusculoskeletal and lymphatic system functioning due to the presence of wrinkles, indicating dila-tion, with local effects on the sensorimotor and proprioceptive senses in conditions of care, rehabilitation and injury. RESULTS: Analysis of the NMT concept on diabetic foot obtained attributes of elastic tape, skin, pain, edema, injury, sensorimotor, circulation, drainage, relaxation, local, proprioceptive, motion func-tion, strength, contraction, stabilisation, reflex, rehabilitation, care, musculoskeletal, nerve, muscles, tendons, fascia, joints, lymphatic, longitudinal, wrinkles. There were four groups of attributes, namely inflammatory response, vascularity, neuromusculoskeletal function and musculoskeletal system. NMT application benefits for diabetic foot can be attributed to improving walking function, leg position, decreasing pain response, improving body function index, improving leg muscle strength and motor function, increasing range of movement (ROM), maintaining stability of leg joint function, preventing injury, increas-ing strength and improving position of ankle joints, reducing stiffness, reducing edema and helping wound healing processes.
