Methicillin-Susceptible Staphylococcus aureus Biofilm Formation on Vascular Grafts: an In Vitro Study

Staphylococcus aureus; Biofilm; InfectionStaphylococcus aureus; Biopelícula; InfecciónStaphylococcus aureus; Biopel·lícula; InfeccióThe aim of this study was to quantify in vitro biofilm formation by methicillin-susceptible Staphylococcus aureus (MSSA) on the surfaces of different types of commonly used vascular grafts. We performed an in vitro study with two clinical strains of MSSA (MSSA2 and MSSA6) and nine vascular grafts: Dacron (Hemagard), Dacron-heparin (Intergard heparin), Dacron-silver (Intergard Silver), Dacron-silver-triclosan (Intergard Synergy), Dacron-gelatin (Gelsoft Plus), Dacron plus polytetrafluoroethylene (Fusion), polytetrafluoroethylene (Propaten; Gore), Omniflow II, and bovine pericardium (XenoSure). Biofilm formation was induced in two phases: an initial 90-minute adherence phase and a 24-hour growth phase. Quantitative cultures were performed, and the results were expressed as log10 CFU per milliliter. The Dacron-silver-triclosan graft and Omniflow II were associated with the least biofilm formation by both MSSA2 and MSSA6. MSSA2 did not form a biofilm on the Dacron-silver-triclosan graft (0 CFU/mL), and the mean count on the Omniflow II graft was 3.89 CFU/mL (standard deviation [SD] 2.10). The mean count for the other grafts was 7.01 CFU/mL (SD 0.82). MSSA6 formed a biofilm on both grafts, with 2.42 CFU/mL (SD 2.44) on the Dacron-silver-triclosan graft and 3.62 CFU/mL (SD 2.21) on the Omniflow II. The mean biofilm growth on the remaining grafts was 7.33 CFU/mL (SD 0.28). The differences in biofilm formation on the Dacron-silver-triclosan and Omniflow II grafts compared to the other tested grafts were statistically significant. Our findings suggest that of the vascular grafts we studied, the Dacron-silver-triclosan and Omniflow II grafts might prevent biofilm formation by MSSA. Although further studies are needed, these grafts seem to be good candidates for clinical use in vascular surgeries at high risk of infections due to this microorganism. IMPORTANCE The Dacron silver-triclosan and Omniflow II vascular grafts showed the greatest resistance to in vitro methicillin-susceptible Staphylococcus aureus biofilm formation compared to other vascular grafts. These findings could allow us to choose the most resistant to infection prosthetic graft

PICO Questions and DELPHI Methodology for the Management of Venous Thromboembolism Associated with COVID-19

COVID-19; Anticoagulació; Malaltia tromboembòlica venosaCOVID-19; Anticoagulación; Enfermedad tromboembólica venosaCOVID-19; Anticoagulation; Venous thromboembolic diseasePatients with coronavirus disease 2019 (COVID-19) have a higher risk of venous thromboembolic disease (VTE) than patients with other infectious or inflammatory diseases, both as macrothrombosis (pulmonar embolism and deep vein thrombosis) or microthrombosis. However, the use of anticoagulation in this scenario remains controversial. This is a project that used DELPHI methodology to answer PICO questions related to anticoagulation in patients with COVID-19. The objective was to reach a consensus among multidisciplinary VTE experts providing answers to those PICO questions. Seven PICO questions regarding patients with COVID-19 responded with a broad consensus: 1. It is recommended to avoid pharmacological thromboprophylaxis in most COVID-19 patients not requiring hospital admission; 2. In most hospitalized patients for COVID-19 who are receiving oral anticoagulants before admission, it is recommended to replace them by low molecular weight heparin (LMWH) at therapeutic doses; 3. Thromboprophylaxis with LMWH at standard doses is suggested for COVID-19 patients admitted to a conventional hospital ward; 4. Standard-doses thromboprophylaxis with LMWH is recommended for COVID-19 patients requiring admission to Intensive Care Unit; 5. It is recommended not to determine D-Dimer levels routinely in COVID-19 hospitalized patients to select those in whom VTE should be suspected, or as a part of the diagnostic algorithm to rule out or confirm a VTE event; 6. It is recommended to discontinue pharmacological thromboprophylaxis at discharge in most patients hospitalized for COVID-19; 7. It is recommended to withdraw anticoagulant treatment after 3 months in most patients with a VTE event associated with COVID-19. The combination of PICO questions and DELPHI methodology provides a consensus on different recommendations for anticoagulation management in patients with COVID-19.This work was carried out with the institutional support and unconditional financial assistance of Sanofi, which had no role in the design, interpretation, or writing of the manuscript

Variation in the choice of elective surgical procedure for abdominal aortic aneurysm in Spain

Abdominal aortic aneurysm; Endovascular aneurysm repair; Open surgical repairAneurisma aòrtic abdominal; Reparació endovascular d'aneurismes; Reparació quirúrgica obertaAneurisma aórtico abdominal; Reparación endovascular de aneurismas; Reparación quirúrgica abiertaOBJECTIVE: The two main surgical treatments for abdominal aortic aneurysm (AAA) are open surgical repair (OSR) and endovascular aneurysm repair (EVAR). The aim of this study was to analyze variation among Spanish hospitals in the use of OSR or EVAR for AAA. A secondary aim was to assess changes in preferences for these two procedures over time. METHODS: This was a retrospective longitudinal study based on discharge data from public hospitals in Spain during 2002-2012. Patient inclusion criteria were: age >18 years, elective admission, primary diagnosis of unruptured AAA, and surgical treatment with OSR or EVAR. The characteristics of the treating center, patients, and in-hospital mortality were recorded. RESULTS: We included 16,737 patients from 114 hospitals; 6,809 (40.7%) underwent EVAR and 9,928 (59.3%) underwent OSR. The total volume of surgeries increased throughout the period, and the probability that any given procedure was EVAR increased by 20% per year (OR 1.20, P<0.001). The volume and distribution of the two procedures varied highly across the participating hospitals. Overall, in-hospital mortality rate was 3.6% and it decreased during the study period (5.3% in 2002 and 3.2% in 2012), mainly due to a decrease in OSR-related mortality, despite a slight increase in EVAR-related mortality. Hospitals with higher surgical volumes were more likely to use EVAR and have lower in-hospital mortality rates. CONCLUSION: This study reveals high variability in the surgical treatment of unruptured AAA across Spanish hospitals. The number of interventions has increased in recent years, with EVAR accounting for a growing percentage of these surgical procedures. Overall in-hospital mortality rates decreased significantly during this period, mainly due to lower mortality among patients undergoing OSR. In-hospital mortality rates were lower in higher-volume centers, regardless of the surgical approach used. Further research on variability and appropriateness of surgical management of AAA is required to assess the suitability of concentrating elective AAA repair in more experienced centers to potentially achieve better outcomes

Systematic review of the results of kidney transplantation in patients with aortoiliac revascularization surgery

Enfermedad renal crónica; Trasplante renal; Cirugía de revascularizaciónChronic kidney disease; Kidney transplantation; Revascularization surgeryMalaltia renal crònica; Trasplantament renal; Cirurgia de revascularitzacióIntroducción: la enfermedad renal crónica (ERC) acelera el proceso de arterioesclerosis, lo que incrementa la prevalencia de enfermedad arterial periférica (EAP). El objetivo de esta revisión sistemática es evaluar los resultados del trasplante renal en pacientes sometidos a cirugía abierta de revascularización del sector aortoilíaco por arteriopatía crónica de las extremidades inferiores. Material y métodos: revisión sistemática según las recomendaciones QUOROM de artículos en PubMed y Cochrane, en español e inglés, que incluían pacientes con ERC y cirugía abierta de revascularización del sector aortoilíaco en el pasado o como indicación previa a un trasplante renal. Los artículos incluidos describían complicaciones inmediatas, supervivencia del injerto y supervivencia del paciente después del trasplante renal. Resultados: la búsqueda generó 253 artículos. Tras la revisión se seleccionaron 8 artículos que incluían 101 pacientes, de los que el 84,2 % fueron trasplantados. La incidencia de complicaciones tras la revascularización fue del 25,9 % y la incidencia de complicaciones tras el trasplante renal fue del 28,2 %. La mediana de seguimiento fue de 22 meses (rango: 6,7 a 71). La supervivencia del injerto renal fue del 80 % y la del paciente fue del 90,5 % al final del seguimiento. Conclusión: la coexistencia de enfermedad arterial y renal no debe considerarse un obstáculo para la realización de un trasplante renal. Los datos publicados hasta el momento muestran resultados satisfactorios en la supervivencia del injerto y del paciente.Introduction: chronic kidney disease (CKD) increases and accelerates the arterial calcification process, increasing the prevalence of peripheral arterial disease in these patients. The aim of this systematic review is to evaluate the results of kidney transplantation in patients who have undergone open revascularization surgery in the aorto-iliac sector for chronic lower limb arteriopathy. Material and methods: systematic review, following QUORUM recommendations, of articles in PubMed and Cochrane, in English or Spanish, which include patients with CKD, who have undergone open revascularization surgery of the aorto-iliac sector in the past or as a prior indication to kidney transplantation. Articles included described immediate complications, graft survival and patient survival after kidney transplantation. Results: the search generated 253 articles and after the systematic review, 8 articles that included, 101 patients were selected, 84.2 % of whom were transplanted. Complications of revascularization surgery were 25.9 % and complications of kidney transplantation were 28.2 %. Median follow-up was 22 months (range: 6.7 to 71). Graft survival was 80 % and patient survival was 100 % at the end of follow-up. Conclusion: the coexistence of vascular and kidney disease should not be an obstacle to performing a kidney transplantation. Since the data published so far shows satisfactory results in graft and patient survival

Estudio coste efectividad del proceso diagnóstico de la trombosis venosa profunda desde la atención primaria

Analizar el coste-efectividad de la aplicación de algoritmos diagnósticos en pacientes con sospecha de un primer episodio de trombosis venosa profunda (TVP) en la atención primaria, en comparación con la derivación sistemática a centros especializados. Estudio observacional, transversal y analítico. Pacientes seleccionados en urgencias hospitalarias derivados desde la atención primaria para completar estudio y diagnóstico. Se reclutó a 138 candidatos con clínica compatible con un primer episodio de TVP; 22 fueron excluidos (sin informe de derivación, clínica de más de 30 días, anticoagulados y TVP previa), incluyéndose finalmente a 116 pacientes, un 61% mujeres, de 71 años edad media. Variables de las escalas de probabilidad clínica de Wells y Oudega, dímero-D (portátil y hospitalario), ecografía-Doppler y costes directos generados por los 3 circuitos analizados: derivación sistemática de todos los pacientes, derivación según escala de Oudega o de Wells. En el 18,9% se confirmó el diagnóstico de TVP. Las 2 escalas de probabilidad clínica presentaron una sensibilidad del 100% (IC del 95%: 85,1-100) y una especificidad alrededor del 40%. Con la aplicación de las escalas, se hubiesen podido evitar con total seguridad un tercio de las derivaciones a urgencias hospitalarias (p < 0,001) y se hubieran podido disminuir los costes del proceso diagnóstico en 8.620 € según Oudega y 9.741 € según Wells, por cada 100 pacientes atendidos. La aplicación de algoritmos diagnósticos en las sospechas de TVP permitiría al médico de atención primaria una orientación más resolutiva y coste-efectiva del proceso diagnóstico

Prevalence of Peripheral Arterial Disease and Associated Vascular Risk Factors in 65-Years-Old People of Northern Barcelona

Asintomático; Factores de riesgo cardiovascular; PrevalenciaAsimptomàtic; Factors de risc cardiovascular; PrevalençaAsymptomatic; Cardiovascular risk factors; PrevalenceObjective: To determine the prevalence and risk factors associated with peripheral arterial disease (PAD) in Northern Barcelona at 65 years of age. Methods: A single-center, cross-sectional study, including males and females 65 years of age, health care cardholders of Barcelona Nord. PAD was defined as an ankle–brachial index (ABI) < 0.9. Attending subjects were evaluated for a history of common cardiovascular risk factors. A REGICOR score was obtained, as well as a physical examination and anthropometric measurements. Results: From November 2017 to December 2018, 1174 subjects were included: 479 (40.8%) female and 695 (59.2%) male. Overall prevalence of PAD was 6.2% (95% CI: 4.8–7.6%), being 7.9% (95% CI: 5.9–9.9%) in males and 3.8% (95% CI: 2.1–5.5%) in females. An independent strong association was seen in male smokers and diabetes, with ORs pf 7.2 (95% CI: 2.8–18.6) and 1.8 (95% CI: 1.0–3.3), respectively, and in female smokers and hypertension, with ORs of 5.2 (95% CI: 1.6–17.3) and 3.3 (95% CI: 1.2–9.0). Male subjects presented with higher REGICOR scores (p < 0.001). Conclusion: Higher-risk groups are seen in male subjects with a history of smoking and diabetes and female smokers and arterial hypertension, becoming important subgroups for our primary healthcare centers and should be considered for ABI screening programs.This work was logistically supported by the PERIS 2016–2020 medical research grant from Generalitat de Catalunya (Spain). Expedient Number SLT002/16/00441

Prevalence of peripheral arterial disease and associated vascular risk factors in 65-years-old people of northern barcelona

Objective: To determine the prevalence and risk factors associated with peripheral arterial disease (PAD) in Northern Barcelona at 65 years of age. Methods: A single-center, cross-sectional study, including males and females 65 years of age, health care cardholders of Barcelona Nord. PAD was defined as an ankle-brachial index (ABI) < 0.9. Attending subjects were evaluated for a history of common cardiovascular risk factors. A REGICOR score was obtained, as well as a physical examination and anthropometric measurements. Results: From November 2017 to December 2018, 1174 subjects were included: 479 (40.8%) female and 695 (59.2%) male. Overall prevalence of PAD was 6.2% (95%CI: 4.8-7.6%), being 7.9% (95%CI: 5.9-9.9%) in males and 3.8% (95%CI: 2.1-5.5%) in females. An independent strong association was seen in male smokers and diabetes, with ORs pf 7.2 (95% CI: 2.8-18.6) and 1.8 (95% CI: 1.0-3.3), respectively, and in female smokers and hypertension, with ORs of 5.2 (95% CI: 1.6-17.3) and 3.3 (95% CI: 1.2-9.0). Male subjects presented with higher REGICOR scores (p < 0.001). Conclusion: Higher-risk groups are seen in male subjects with a history of smoking and diabetes and female smokers and arterial hypertension, becoming important subgroups for our primary healthcare centers and should be considered for ABI screening programs

Active Smoking Increases Microsomal PGE 2

Background. The cyclooxygenase- (COX-) 2/microsomal PGE-synthase- (mPGES-) 1/PGE-receptor- (EP-) 4 axis could play a key role in the physiopathology of abdominal aortic aneurysm (AAA) in humans. In this study, we investigated the influence of cardiovascular risk factors on the expression of the PGE2 pathway in human AAA. Methods. Aortic (n=89) and plasma (n=79) samples from patients who underwent AAA repair were collected. Patients were grouped according to risk factors. COX-isoenzymes, mPGES-1, EPs, α-actin, and CD45 and CD68 transcripts levels were quantified by QRT-PCR and plasma PGE2 metabolites by EIA. Results. Current smoking (CS) patients compared to no-CS had significantly higher local levels of mPGES-1 (P=0.009), EP-4 (P=0.007), and PGE2 metabolites plasma levels (P=0.008). In the multiple linear regression analysis, these parameters remained significantly enhanced in CS after adding confounding factors. Results from association studies with cell type markers suggested that the increased mPGES-1/EP-4 levels were mainly associated with microvascular endothelial cells. Conclusions. This study shows that elements of the PGE2 pathway, which play an important role in AAA development, are increased in CS. These results provide insight into the relevance of tobacco smoking in AAA development and reinforce the potential of mPGES-1 and EP-4 as targets for therapy in AAA patients

Reducing residual thrombotic risk in patients with peripheral artery disease : impact of the COMPASS trial

Altres ajuts: Writing and editorial assistance was funded by Bayer Hispania.Patients with peripheral artery disease (PAD) are at a high risk not only for the classical cardiovascular (CV) outcomes (major adverse cardiovascular events; MACE) but also for vascular limb events (major adverse limb events; MALE). Therefore, a comprehensive approach for these patients should include both goals. However, the traditional antithrombotic approach with only antiplatelet agents (single or dual antiplatelet therapy) does not sufficiently reduce the risk of recurrent thrombotic events. Importantly, the underlying cause of atherosclerosis in patients with PAD implies both platelet activation and the initiation and promotion of coagulation cascade, in which Factor Xa plays a key role. Therefore, to reduce residual vascular risk, it is necessary to address both targets. In the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial that included patients with stable atherosclerotic vascular disease, the rivaroxaban plus aspirin strategy (versus aspirin) markedly reduced the risk of both CV and limb outcomes, and related complications, with a good safety profile. In fact, the net clinical benefit outcome composed of MACE; MALE, including major amputation, and fatal or critical organ bleeding was significantly reduced by 28% with the COMPASS strategy, (hazard ratio: 0.72; 95% confidence interval: 0.59-0.87). Therefore, the rivaroxaban plus aspirin approach provides comprehensive protection and should be considered for most patients with PAD at high risk of such events