Implant Removal in the Management of Prosthetic Joint Infection by Staphylococcus aureus: Outcome and Predictors of Failure in a Large Retrospective Multicenter Study

Objectives: To compare the characteristics and outcomes of cases with acute prosthetic joint infection (PJI; early post-surgical or hematogenous) by Staphylococcus aureus managed with implant removal (IRm) or debridement and retention (DAIR). To analyze the outcomes of all cases managed with IRm (initially or after DAIR failure). Methods: Retrospective, multicenter, cohort study of PJI by S. aureus (2003–2010). Overall failure included mortality within 60 days since surgery and local failure due to staphylococcal persistence/relapse. Results: 499 cases, 338 initially managed with DAIR, 161 with IRm. Mortality was higher in acute PJI managed initially with IRm compared to DAIR, but not associated with the surgical procedure, after propensity score matching. Underlying conditions, hemiarthroplasty, and methicillin-resistant S. aureus were risk factors for mortality. Finally, 249 cases underwent IRm (88 after DAIR failure); overall failure was 15.6%. Local failure (9.3%) was slightly higher in cases with several comorbidities, but independent of previous DAIR, type of IRm, and rifampin treatment. Conclusions: In a large multicenter study of S. aureus PJI managed with IRm, failure was low, but mortality significant, especially in cases with acute PJI and underlying conditions, but not associated with the IRm itself. Rifampin efficacy was limited in this setting.Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y CompetitividadMinisterio Educación Españ

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Recubrimiento de sustratos con óxidos metálicos dopados. Preparación, caracterización y aplicaciones

Dada la gran importancia que actualmente tiene la fotocatálisis heterogénea y los procesos de oxidación avanzada en cuanto a la descontaminación de aguas se refiere. La utilización de TiO2 y luz UV permite la degradación de una gran variedad de contaminantes orgánicos en aguas, si bien el valor real de la cantidad de contaminante degradado depende directamente de los diversos factores que intervienen en las reacciones del proceso. Estudiar la influencia entre las variables durante el proceso de preparación de los recubrimientos de TiO2; electrodos recubiertos mediante disoluciones sol-gel, dónde el porcentaje de Rutenio, Tántalo y la temperatura de sinterización condicionan las propiedades de los recubrimientos obtenidos. Se centra el estudio en el caso del patent blue VF, como molécula representativa de los diversos contaminantes que puede tener el agua. Se estudia la influencia en la eliminación del contaminante en los distintos electrodos y la variación en la respuesta de eliminación dependiendo de las condiciones de las disoluciones contaminantes.Given the immense importance that heterogeneous photocatalysis currently has and advanced oxidation processes with regard to the decontamination of water is referred. The utilization of TiO2 and UV rays permits the degradation of a great variety of organic contaminants found in water, although the actual value of the amount of degraded contaminants depends directly on the diverse factors that intervene in the reaction process. Studying the interaction between variables during the process of preparing the coating of TiO2; coated electrodes by means of sol-gel dissolutions, where the percentage of Ruthenium, Tantalum and the temperature of synchronization are dependent on the properties of the obtained coverings. We focus on studying the case of the (patent blue VF), which a molecule that represents the diverse contaminants that may be found in water. We study the influence of the elimination of contaminants on the district electrodes and the variation of the response of elimination depending on the conditions, of the dissolutions of contaminants

Recubrimiento de sustratos con óxidos metálicos dopados. Preparación, caracterización y aplicaciones

Dada la gran importancia que actualmente tiene la fotocatálisis heterogénea y los procesos de oxidación avanzada en cuanto a la descontaminación de aguas se refiere. La utilización de TiO2 y luz UV permite la degradación de una gran variedad de contaminantes orgánicos en aguas, si bien el valor real de la cantidad de contaminante degradado depende directamente de los diversos factores que intervienen en las reacciones del proceso. Estudiar la influencia entre las variables durante el proceso de preparación de los recubrimientos de TiO2; electrodos recubiertos mediante disoluciones sol-gel, dónde el porcentaje de Rutenio, Tántalo y la temperatura de sinterización condicionan las propiedades de los recubrimientos obtenidos. Se centra el estudio en el caso del patent blue VF, como molécula representativa de los diversos contaminantes que puede tener el agua. Se estudia la influencia en la eliminación del contaminante en los distintos electrodos y la variación en la respuesta de eliminación dependiendo de las condiciones de las disoluciones contaminantes.Given the immense importance that heterogeneous photocatalysis currently has and advanced oxidation processes with regard to the decontamination of water is referred. The utilization of TiO2 and UV rays permits the degradation of a great variety of organic contaminants found in water, although the actual value of the amount of degraded contaminants depends directly on the diverse factors that intervene in the reaction process. Studying the interaction between variables during the process of preparing the coating of TiO2; coated electrodes by means of sol-gel dissolutions, where the percentage of Ruthenium, Tantalum and the temperature of synchronization are dependent on the properties of the obtained coverings. We focus on studying the case of the (patent blue VF), which a molecule that represents the diverse contaminants that may be found in water. We study the influence of the elimination of contaminants on the district electrodes and the variation of the response of elimination depending on the conditions, of the dissolutions of contaminants

Científicos en el aula

El trabajo obtuvo el Primer Premio de la Modalidad B de los 'Premios Tomás García Verdejo' a las buenas prácticas educativas en la Comunidad Autónoma de Extremadura para el curso académico 2013/2014Se describe el proyecto llevado a cabo en el IES Campos de San Roque (Valverde de Leganés, Badajoz), orientado a promover en el alumnado el pensamiento científico-técnico y el interés por la investigación y la innovación. Entre las actividades llevadas a cabo destacan: la celebración de la Semana de la Ciencia, realización de proyectos de investigación, participación en la Reunión Científica organizada por la Asociación 'Investigación en Secundaria Meridies' celebrada en el IES Vegas Bajas (Montijo, Badajoz) en 2014 y el desarrollo del concurso 'El problema de la semana'ExtremaduraES

El Rebellao, fuente de conocimiento

El trabajo obtuvo un Premio Tomás García Verdejo a las buenas prácticas educativas en la Comunidad Autónoma de Extremadura para el curso académico 2016/2017. Modalidad BSe describe un proyecto llevado a cabo en el IES Campos de San Roque de Valverde de Leganés (Badajoz) que partió de una excavación en un yacimiento arqueológico en el entorno del centro, en la finca 'El Rebellao', actividad que pretendía construir activamente el conocimiento histórico del entorno del centro. Entre los objetivos de la iniciativa están: concienciar a los alumnos en el estudio y defensa del desconocido patrimonio histórico y natural del entorno; concebir el conocimiento científico como un saber integrado; participar activamente en la construcción del conocimiento histórico especialmente mediante la arqueología; comprender y expresarse con corrección oralmente y por escrito; desarrollar la creatividad y el gusto estético mediante la lectura, para realizar creaciones literarias y audiovisuales de calidad; fomentar el interés por las culturas del pasado a partir del estudio de artefactos y las manifestaciones artísticas legadas y buscar la implicación de las familias en el proceso de aprendizaje de sus hijosExtremaduraES

The Not-So-Good Prognosis of Streptococcal Periprosthetic Joint Infection Managed by Implant Retention:The Results of a Large Multicenter Study

Background.: Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success. Methods.: A retrospective, observational, multicenter, international study was performed during 2003-2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The primary endpoint was failure, defined as death related to infection, relapse/persistence of infection, or the need for salvage therapy. Results.: Overall, 462 cases were included (median age 72 years, 50% men). The most frequent species was Streptococcus agalactiae (34%), and 52% of all cases were hematogenous. Antibiotic treatment was primarily using β-lactams, and 37% of patients received rifampin. Outcomes were evaluable in 444 patients: failure occurred in 187 (42.1%; 95% confidence interval, 37.5%-46.7%) after a median of 62 days from debridement; patients without failure were followed up for a median of 802 days. Independent predictors (hazard ratios) of failure were rheumatoid arthritis (2.36), late post-surgical infection (2.20), and bacteremia (1.69). Independent predictors of success were exchange of removable components (0.60), early use of rifampin (0.98 per day of treatment within the first 30 days), and long treatments (≥21 days) with β-lactams, either as monotherapy (0.48) or in combination with rifampin (0.34). Conclusions.: This is the largest series to our knowledge of streptococcal PJI managed by DAIR, showing a worse prognosis than previously reported. The beneficial effects of exchanging the removable components and of β-lactams are confirmed and maybe also a potential benefit from adding rifampin