Prince Medical (France)

Pressure injuries represent a significant healthcare challenge in ICUs, particularly among older adults with diabetes. This study examined the relationship between hemoglobin levels and hospital-acquired pressure injury (HAPrI) development. This retrospective cohort study analyzed MIMIC-IV database data from 10,468 ICU patients aged ≥65 years with stays of 2-14 days. Primary outcome was HAPrI development during ICU stay. Clinical and laboratory factors were compared between diabetic and non-diabetic patients. Among 10,468 patients (mean age 77.56±8.05 years), 366 (3.5%) developed HAPrIs. Diabetes patients (n=1,513, 14.5%) had significantly higher HAPrI rates than non-diabetic patients (6.3% vs 3.0%; P<0.001). Diabetic patients who developed HAPrIs had markedly lower minimum hemoglobin levels than those without HAPrIs (7.94±2.07 vs 10.00±1.73 g/dL; P<0.001). Among diabetic patients with HAPrIs, those developing multiple injuries had lower hemoglobin levels than those with single injuries (7.22±2.06 vs 8.30±2.00 g/dL; P=0.02). Low hemoglobin levels are strongly associated with HAPrI development in older ICU patients with diabetes, with anemia severity correlating with multiple injury occurrence. Hemoglobin optimization may represent an important targeted prevention strategy for high-risk ICU patients.

CITATION: Adami, P. E. et al. 2021. Infectious Diseases Outbreak Management Tool for endurance mass participation sporting events : an international effort to counteract the COVID-19 spread in the endurance sport setting. British Journal of Sports Medicine, 55:181–182, doi:10.1136/bjsports-2020-103091.

BackgroundThe indication for antibiotic prophylaxis in burn patients remains highly controversial, with no consensus having been reached. The objective of antibiotic prophylaxis is to reduce the risk of postoperative local and systemic infections. Burn surgery is associated with a high incidence of bacteremia, postoperative infections, and sepsis. However, antibiotic prophylaxis exposes patients to the risk of selecting drug-resistant pathogens as well as to the adverse effects of antibiotics (i.e., Clostridium difficile colitis). The lack of data precludes any strong international recommendations regarding perioperative prophylaxis using systemic antibiotics in this setting.The goal of this project is therefore to determine whether perioperative systemic antibiotic prophylaxis can reduce the incidence of postoperative infections in burn patients.MethodsThe A2B trial is a multicenter (10 centers), prospective, randomized, double-blinded, placebo-controlled study. The trial will involve the recruitment of 506 adult burn patients with a total body surface area (TBSA) burn of between 5 and 40% and requiring at least one excision-graft surgery for deep burn injury. Participants will be randomized to receive antibiotic prophylaxis (antibiotic prophylaxis group) or a placebo (control group) 30 min before the incision of the first two surgeries. The primary outcome will be the occurrence of postoperative infections defined as postoperative sepsis and/or surgical site infection and/or graft lysis requiring a new graft within 7 days after surgery. Secondary outcomes will include mortality at day 90 postrandomization, skin graft lysis requiring a new graft procedure, postoperative bacteremia (within 48 h of surgery), postoperative sepsis, postoperative surgical site infection, number of hospitalizations until complete healing (> 95% TBSA), number of hospitalization days living without antibiotic therapy at day 28 and day 90, and multiresistant bacterial colonization or infection at day 28 and day 90.DiscussionThe trial aims to provide evidence on the efficacy and safety of antibiotic prophylaxis for excision-graft surgery in burn patients.Trial registrationClinicalTrials.gov NCT04292054. Registered on 2 March 2020

Background:This article describes a new bone transport technique for femoral and tibial bone defects using lengthening nails combined with locking plates. We term it plate-assisted bone segment transport (PABST).Methods:Nine patients with five femoral and four tibial bone defects from open fractures or malignancies were treated between 2016 and 2018. Mean femoral defect length was 9.3 cm (range 7 to 11.5). Mean tibial defect was 8.9 cm (range 4.8 to 15). The patients were evaluated for time to weight bearing, consolidation index, mechanical axis deviation, and limb length discrepancy.Results:Seven of nine patients have fully consolidated. The mean consolidation time was 6.6 months. The consolidation index was 0.9 (femur) and 1.26 (tibia) mo/cm. Two patients required supplementary lengthening. One patient had mild varus, one mild valgus; the remainder had a normal mechanical axis. Limb length discrepancy remained acceptable in all patients. The main complications were heterotopic ossification, delayed healing, and reduced knee motion.Conclusion:Bone transport with lengthening nails and locking plates is an effective and patient-friendly way of treating bone defects, eliminating the adverse effects of external fixation and reducing treatment time. The plate provides stability during transport and docking; it can address concomitant fractures and facilitates acute shortenings.