Rates and Determinants of Return to Play after Anterior Cruciate Ligament Reconstruction in Division 1 College Football Athletes: A Study of the ACC, SEC, and PAC-12

OBJECTIVES: In competitive athletes, return to play (RTP) and return to pre-injury levels of performance are the main goals of anterior cruciate ligament (ACL) surgery. RTP has been studied in several athletic populations, such as the National Football League. However, to our knowledge, RTP has not been comprehensively evaluated in Division 1 college football. This study aimed to determine the rate of RTP amongst players in three major Division 1 college football conferences, and to investigate several athlete and surgery related variables that may affect RTP. We hypothesized that rates of RTP would be higher than those previously reported in the National Football League and that graft choice and history of concomitant menisectomy would affect RTP. We also hypothesized that players with more experience, at higher depth chart positions, and/or on scholarship would RTP at higher rates than other players. METHODS: Head team orthopaedists and athletic trainers at institutions in the Atlantic Coast Conference, Southeastern Conference, and Pacific 12 Conference were contacted to request their participation in the study. Following IRB approval participating institutions were sent a standardized data collection spreadsheet that asked for RTP and other athlete- and surgery-specific information on all football players undergoing ACL reconstruction from 2004-2010. RTP was defined as an athlete participating in a full practice or official game after the date of his surgery. Athletes whose eligibility expired while injured were excluded from our analysis. Data from each institution was pooled and Chi-square and Fisher Exact tests were used to test the association between any categorical variables and RTP rates. RESULTS: Data from a total of 184 athletes was obtained. The overall rate of RTP was 82% amongst all athletes. 76% of athletes were able to return to a level of play equal or higher than before their injury. Player’s depth chart position before injury did have a significant (p = .0049) association with RTP, with 73% of players who rarely played, 88% of utilized players, and 95% of starters returning to play after surgery. Athletes on scholarship returned to play at a higher rate (88%), than those not on scholarships (69%) (p = .014). Years of experience also had a significant (p = .047) effect on RTP, with freshman RTP at 83%, sophomores at 94%, juniors at 89%, seniors at 73%, and fifth year seniors at 75%. The use of autograft vs. allograft and the specific choice of autograft did not have a significant impact on RTP rates. Players who underwent a menisectomy returned to play at a rate (79%) similar to those who did not have a concomitant menisectomy (84%) (p = .56). CONCLUSION: The overall rate of RTP in our Division 1 college football athlete cohort was higher than that previously reported in professional football players. Athletes at higher positions on the depth chart and those on scholarship returned to play at higher rates. Year in school also had a significant effect on RTP rates, while the type of ACL graft and the performance of menisectomy did not

Clinical Outcomes and Bacterial Characteristics of Carbapenem-Resistant Acinetobacter baumannii Among Patients from Different Global Regions

Abstract Background Carbapenem-resistant Acinetobacter baumannii (CRAb) is one of the most problematic antimicrobial-resistant bacteria. We sought to elucidate the international epidemiology and clinical impact of CRAb. Methods In a prospective observational cohort study, 842 hospitalized patients with a clinical CRAb culture were enrolled at 46 hospitals in five global regions between 2017 and 2019. The primary outcome was all-cause mortality at 30 days from the index culture. The strains underwent whole-genome analysis. Results Of 842 cases, 536 (64%) represented infection. By 30 days, 128 (24%) of the infected patients died, ranging from 1 (6%) of 18 in Australia-Singapore to 54 (25%) of 216 in the United States and 24 (49%) of 49 in South-Central America, whereas 42 (14%) of non-infected patients died. Bacteremia was associated with a higher risk of death compared with other types of infection (40 [42%] of 96 vs. 88 [20%] of 440). In a multivariable logistic regression analysis, bloodstream infection and higher age-adjusted Charlson comorbidity index were independently associated with 30-day mortality. Clonal group 2 (CG2) strains predominated except in South-Central America, ranging from 216 (59%) of 369 in the United States to 282 (97%) of 291 in China. Acquired carbapenemase genes were carried by 769 (91%) of the 842 isolates. CG2 strains were significantly associated with higher levels of meropenem resistance, yet non-CG2 cases were over-represented among the deaths compared with CG2 cases. Conclusions CRAb infection types and clinical outcomes differed significantly across regions. While CG2 strains remained predominant, non-CG2 strains were associated with higher mortality. ClinicalTrials.gov #NCT0364622

Increased mortality in hospital- compared to community-onset carbapenem-resistant enterobacterales infections

Abstract Background The CDC reported a 35% increase in hospital-onset (HO) carbapenem-resistant Enterobacterales (CRE) infections during the COVID-19 pandemic. We evaluated patient outcomes following HO and community-onset (CO) CRE bloodstream infections (BSI). Methods Patients prospectively enrolled in CRACKLE-2 from 56 hospitals in 10 countries between 30 April 2016 and 30 November 2019 with a CRE BSI were eligible. Infections were defined as CO or HO by CDC guidelines, and clinical characteristics and outcomes were compared. The primary outcome was desirability of outcome ranking (DOOR) 30 days after index culture. Difference in 30-day mortality was calculated with 95% CI. Results Among 891 patients with CRE BSI, 65% were HO (582/891). Compared to those with CO CRE, patients with HO CRE were younger [median 60 (Q1 42, Q3 70) years versus 65 (52, 74); P < 0.001], had fewer comorbidities [median Charlson comorbidity index 2 (1, 4) versus 3 (1, 5); P = 0.002] and were more acutely ill (Pitt bacteraemia score ≥4: 47% versus 32%; P < 0.001). The probability of a better DOOR outcome in a randomly selected patient with CO BSI compared to a patient with HO BSI was 60.6% (95% CI: 56.8%–64.3%). Mortality at 30-days was 12% higher in HO BSI (192/582; 33%) than CO BSI [66/309 (21%); P < 0.001]. Conclusion We found a disproportionately greater impact on patient outcomes with HO compared to CO CRE BSIs; thus, the recently reported increases in HO CRE infections by CDC requires rigorous surveillance and infection prevention methods to prevent added mortality