Successful Bacteriophage-Antibiotic Combination Therapy against Multidrug-Resistant Pseudomonas aeruginosa Left Ventricular Assist Device Driveline Infection

Publisher Copyright: © 2023 by the authors.There is considerable interest in the use of bacteriophages (phages) to treat Pseudomonas aeruginosa infections associated with left ventricular assist devices (LVADs). These infections are often challenging to manage due to high rates of multidrug resistance and biofilm formation, which could potentially be overcome with the use of phages. We report a case of a 54-year-old man with relapsing multidrug-resistant P. aeruginosa LVAD driveline infection, who was treated with a combination of two lytic antipseudomonal phages administered intravenously and locally. Treatment was combined with LVAD driveline repositioning and systemic antibiotic administration, resulting in a successful outcome with clinical cure and eradication of the targeted bacteria. However, laboratory in vitro models showed that phages alone could not eradicate biofilms but could prevent biofilm formation. Phage-resistant bacterial strains evolved in biofilm models and showed decreased susceptibility to the phages used. Further studies are needed to understand the complexity of phage resistance and the interaction of phages and antibiotics. Our results indicate that the combination of phages, antibiotics, and surgical intervention can have great potential in treating LVAD-associated infections. More than 21 months post-treatment, our patient remains cured of the infection.publishersversionPeer reviewe

Systematic review of patient-reported outcome measures in patients with varicose veins.

BACKGROUND: Varicose veins can affect quality of life. Patient-reported outcome measures (PROMs) provide a direct report from the patient about the impact of the disease without interpretation from clinicians or anyone else. The aim of this study was to examine the quality of the psychometric evidence for PROMs used in patients with varicose veins. METHODS: A systematic review was undertaken to identify studies that reported the psychometric properties of generic and disease-specific PROMs in patients with varicose veins. Literature searches were conducted in databases including MEDLINE, up to July 2016. The psychometric criteria used to assess these studies were adapted from published recommendations in accordance with US Food and Drug Administration guidance. RESULTS: Nine studies were included which reported on aspects of the development and/or validation of one generic (36-Item Short Form Health Survey, SF-36®) and three disease-specific (Aberdeen Varicose Vein Questionnaire, AVVQ; Varicose Veins Symptoms Questionnaire, VVSymQ®; Specific Quality-of-life and Outcome Response - Venous, SQOR-V) PROMs. The evidence from included studies provided data to support the construct validity, test-retest reliability and responsiveness of the AVVQ. However, its content validity, including weighting of the AVVQ questions, was biased and based on the opinion of clinicians, and the instrument had poor acceptability. VVSymQ® displayed good responsiveness and acceptability rates. SF-36® was considered to have satisfactory responsiveness and internal consistency. CONCLUSION: There is a scarcity of psychometric evidence for PROMs used in patients with varicose veins. These data suggest that AVVQ and SF-36® are the most rigorously evaluated PROMs in patients with varicose veins

Electronic personal assessment questionnaire for vascular conditions (ePAQ-VAS): development and validity

Background This paper describes the development and validation of an electronic personal assessment questionnaire for vascular conditions (ePAQ‐VAS) that captures the symptomatology, quality of life and clinically relevant data of patients presenting to vascular services. Methods A two‐stage survey was conducted in patients attending a tertiary vascular department. Patients completed the ePAQ‐VAS remotely online, or on site using an electronic tablet. In the first stage of the survey, the responses were used to perform confirmatory factor analysis to assess the construct validity and remove redundant items. The internal reliability of disease‐specific scales was investigated. In the second stage of the survey, the acceptability, known‐group validity, test–retest reliability, and responsiveness of ePAQ‐VAS was assessed. Results In total, 721 patients completed ePAQ‐VAS. Their mean(s.d.) age was 63·5(15·7) years and 468 (64·9 per cent) were men. Some 553 patients (76·7 per cent) completed the questionnaire in clinic and the remainder completed the questionnaire online. The results of the confirmatory factor analysis confirmed the conceptual model for ePAQ‐VAS structure and eliminated six items. Internal reliability was acceptable for all the scales (Cronbach's α greater than 0·7). The test–retest reliability measured by the intraclass correlation coefficient ranged from 0·65 to 0·99. The results showed that the instrument was responsive over time with the standardized response mean ranging from 0·69 to 1·60. Conclusion ePAQ‐VAS is a holistic data‐collection process that is relevant to vascular service users and has potential to contribute to patient‐focused care and the collection of aggregate data for service evaluation. A demonstration version of the final version of ePAQ can be viewed at http://demo‐questionnaire.epaq.co.uk/home/project?id=VASC_1.7&page=1

Lower prevalence of stump reflux after endovenous laser flush ablation of the great saphenous vein: A single center prospective randomized study

Background: This single center prospective randomized study was performed to compare the effect of endovenous laser flush ablation (EVLAf) of the great saphenous vein (GSV) close to the sapheno-femoral junction (SFJ) with a standard ablation (EVLAs) up to two cm distally of the SFJ on reflux in the GSV stump. Patients and methods: Between April 2013 and January 2016, 146 legs in 146 consecutive patients, meeting the inclusion/exclusion criteria, were treated by EVLA. All patients were randomized into 2 groups. In group 1 EVLAf started from the SFJ level, and in group 2 EVLAs started two cm below the SFJ. The primary endpoint was reflux in the GSV stump after 900 days. Secondary endpoints were reflux in the anterior accessory saphenous vein (AASV), proximal clinically recurrent varicose veins related to reflux in the stump and/or the AASV. Results: At day 900, 27 patients were lost to follow-up. Reflux in the stump was detected in 3.6% in group 1 and in 22.2% in group 2 (p<0.05). Reflux in the AASV was present in 7.1% in group 1 and in 17.46% in group 2 (p=0.09). Proximal clinically recurrent varicose veins were observed in 8.9% in group 1 and in 19.1% in group 2 (p=0.12). The greatest diameter of the stump was significantly larger in group 2 (group 1: 0.41 cm, group 2: 0.6 cm, p<0.001). Conclusions: EVLAf is associated with a significantly lower incidence of reflux in the GSV stump, with a trend to a lower incidence of reflux in the AASV and with a lower incidence of proximal recurrent varicose veins after 900 days follow-up compared to EVLAs. EVLAf may improve the clinical recurrence rate after EVLA of the GSV