scholarly journals 245. Risk Factors Associated with Open Fracture Complications Following Antibiotic Prophylaxis

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S231-S231
Author(s):  
Elizabeth Cusack ◽  
Kaylee Maynard ◽  
Ted Louie ◽  
John Gorczyca ◽  
Courtney M Jones ◽  
...  

Abstract Background Surgical site infection is concerning after an open fracture. The Eastern Association for the Surgery of Trauma guidelines provide antibiotic selection and duration recommendations based on open fracture type. Risk factors for open fracture complications (e.g. infection, acute kidney injury [AKI], multi-drug resistant organisms [MDRO], or Clostridioides infection [C. difficile]) and overall guideline adherence are unclear at our institution. Methods This was a single center, retrospective study of adult patients with an open fracture who received antibiotic prophylaxis and were admitted for at least 24 hours between March 2011 and October 2020. Patients were excluded if open fracture was due to gun-shot wound, had a history of renal replacement therapy, MDRO, or C. difficile infection, were an outside hospital transfer, received antibiotics for another indication, or had a delayed presentation. The primary outcome was to identify risk factors for infection and secondary outcomes to identify risk factors for AKI, MDRO, C. difficile infection, and to evaluate guideline adherence. Patient demographics including injury details and management, microbiologic cultures, and antibiotic information were collected. Data were analyzed by univariate analysis, as appropriate, and logistic regression. Results A total of 401 patients met study criteria; median age 46 years, 62% male, and 77% white. Fracture classifications were similar: 30% type I, 39% type II, and 30% type III. Infection occurred in 18% of patients, AKI in 18%, MDRO in 3%, and no patients developed C. difficile. Of those with culture-positive infection, 51% grew gram-positive organisms. In bivariate analysis, fracture classification (p=0.023), medical fracture management (p=0.034), and antibiotic choice (p=0.004) were associated with infection. The only independent risk factor associated with AKI was receiving a nephrotoxic medication (p=0.012). Eighty-one percent received guideline adherent antibiotics and of those that received too narrow antibiotics, 36% developed an infection (p=0.004). Conclusion Appropriate fracture classification and antibiotic choice is crucial to reduce infection following open fracture. Reducing concomitant exposure to nephrotoxic agents may reduce the risk of AKI. Disclosures All Authors: No reported disclosures

2021 ◽  
pp. 205141582098403
Author(s):  
Antônio Antunes Rodrigues ◽  
Valdair Muglia ◽  
Emanuel Veras de Albuquerque ◽  
Rafael Ribeiro Mori ◽  
Rafael Neuppmann Feres ◽  
...  

Objective: To identify risk factors for major post-biopsy complications under augmented prophylaxis protocol. The risk factors already described mainly comprise outdated antibiotic prophylaxis protocols. Material and methods: This retrospective cohort study included patients that underwent transrectal ultrasound-guided biopsies, from 2011 to 2016. All patients had received antibiotic prophylaxis with ciprofloxacin and gentamicin. Patients were grouped according to the presence or absence of post-biopsy complications. Demographic variables and possible risk factors based on routine clinical assessment were registered. Correlation tests, univariate and multivariate analyses were used to identify risk factors for post-biopsy complications. Results: Of the 404 patients that were included, 25 (6.2%) presented 27 post-biopsy complications, distributed as follows: acute urinary retention ( n = 14, 3.5%), infections ( n = 11, 2.7%) and hemorrhage ( n = 2, 0.5%). On univariate analysis, patients who presented complications showed higher body mass index and post-voiding residual volumes. Multivariate analysis identified ethnicity and prostate-specific antigen (PSA) density as possible risk factors for biopsy complications. The presence of bacterial resistance identified by rectal swabs did not correlate with the incidence of complications and infections. Conclusions: Non-infectious post-biopsy complications were more frequent than infectious ones in this cohort. Higher post-voiding residual volumes and PSA density, that indicates prostate enlargement, were identified as risk factors and interpreted as secondary to bladder outlet obstruction. The higher body mass index and ethnicity were also identified as risk factors and attributed to the heterogeneity of the patients included. Level of evidence: Not applicable for this multicentre audit.


2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S579-S580
Author(s):  
A Frontali ◽  
M Rottoli ◽  
A Chierici ◽  
G Poggioli ◽  
Y Panis

Abstract Background Graciloplasty (GP) is indicated in case of recurrent rectovaginal fistula (RVF), even in patients with Crohn’s disease, after failure of previous local treatments. The aim of this study was to evaluate risk factors for GP failure performed for recurrent RVF in these patients. Methods We realised a retrospective study based on a prospective database of GP, realised in two Tertiary expert Centers in Italy (Bologna) and France (Clichy). Results Thirty-two patients undergoing 34 GP (2 patients have undergone 2 GP for failure of first GP): we excluded second GP and 2 patients without available follow-up: 30 patients undergoing a first GP for RVF (n = 29) or ileal-vaginal fistula after ileal-pouch-anal-anastomosis (IPAA) (n = 1) with a mean age of 41 ± 10 years (range, 25–64) were analysed. After a mean follow-up of 65 ± 52 months (2–183), a success of GP (considered as absence of diverting stoma and RVF healing) was noted in 17/30 patients (57%). We evaluated risk factors for failure of the procedure and we found only 2 risk factors on univariate analysis: (1) absence of a postoperative prophylactic antibiotherapy: only 2/13 (15%) patients with a GP failure had a postoperative antibiotic-prophylaxis vs. 9/15 (60%) patients with success of GP (p = 0.0238); (2) a postoperative perineal infection: 7/13 (54%) with a GP failure developed a postoperative perineal infection vs. 2/17 (12%) patients (p = 0.0196). Conclusion Graciloplasty for recurrent rectovaginal fistula in patients with Crohn’s disease is effective in 57% of patients. Our study underlines the possible benefit of a postoperative antibiotic-prophylaxis because it seems to increase significantly the success rate of the procedure.


2009 ◽  
Vol 30 (2) ◽  
pp. 109-116 ◽  
Author(s):  
W. Matthew Linam ◽  
Peter A. Margolis ◽  
Mary Allen Staat ◽  
Maria T. Britto ◽  
Richard Hornung ◽  
...  

Objective.To identify risk factors associated with surgical site infection (SSI) after pediatric posterior spinal fusion procedure by examining characteristics related to the patient, the surgical procedure, and tissue hypoxia.Design.Retrospective case-control study nested in a hospital cohort study.Setting.A 475-bed, tertiary care children's hospital.Methods.All patients who underwent a spinal fusion procedure during the period from January 1995 through December 2006 were included. SSI cases were identified by means of prospective surveillance using National Nosocomial Infection Surveillance system definitions. Forty-four case patients who underwent a posterior spinal fusion procedure and developed an SSI were identified and evaluated. Each case patient was matched (on the basis of date of surgery, ± 3 months) to 3 control patients who underwent a posterior spinal fusion procedure but did not develop an SSI. Risk factors for SSI were evaluated by univariate analysis and multivariable conditional logistic regression. Odds ratios (ORs), with 95% confidence intervals (CIs) andPvalues, were calculated.Results.From 1995 to 2006, the mean annual rate of SSI after posterior spinal fusion procedure was 4.4% (range, 1.1%—6.7%). Significant risk factors associated with SSI in the univariate analysis included the following: a body mass index (BMI) greater than the 95th percentile (OR, 3.5 [95% CI, 1.5–8.3]); antibiotic prophylaxis with clindamycin, compared with other antibiotics (OR, 3.5 [95% CI, 1.2 10.0]); inappropriately low dose of antibiotic (OR, 2.6 [95% CI, 1.0–6.6]); and a longer duration of hypothermia (ie, a core body temperature of less than 35.5°C) during surgery (OR, 0.4 [95% CI, 0.2–0.9]). An American Society of Anesthesiologists (ASA) score of greater than 2, obesity (ie, a BMI greater than the 95th percentile), antibiotic prophylaxis with clindamycin, and hypothermia were statistically significant in the multivariable model.Conclusion.An ASA score greater than 2, obesity, and antibiotic prophylaxis with clindamycin were independent risk factors for SSI. Hypothermia during surgery appears to provide protection against SSI in this patient population.


2020 ◽  
Vol 3 (2) ◽  
pp. 337-343
Author(s):  
Helfrida Situmorang

The irreversible risk factors for osteoporosis are age, gender, race, family / hereditary history, body shape and history of fractures. The risk factors for osteoporosis that can be changed are smoking, vitamin and nutritional deficiencies, lifestyle, eating disorders (anorexia nervosa), early menopause, and the use of certain drugs such as corticosteroids, glucocorticosteroids, and diuretics. The purpose of this study was to determine the factors associated with the incidence of osteoporosis. The research design used was non-experimental, namely a correlational research design, namely research conducted to determine the relationship between two variables. The population in this study were all osteoporosis patients with age. over 45 years old who seek treatment at the Puskesmas Gunting Saga Kec. Kualuh Selatan District of North Labuhan Batu totaling 45 people. The sampling method used was the total sampling technique, which was the same as the population of 45 people. Data collection used is the method of filling out a questionnaire which includes written questions used to obtain data information from the questionnaire. The data analysis conducted was univariate analysis and bivariate analysis. In this study, researchers still adhere to ethical principles. The results illustrate that the respondents are mostly 51-65 years old as many as 27 people (60%). Most of the sex of respondents were women as many as 37 people (82.2 %%). Most of the respondents had no history of osteoporosis as many as 31 people (68.9%). Most of the body mass index of respondents whose body mass index was over 34 people (75.6%). Most of the respondents in the smoking category did not smoke as many as 32 people (71.7%). Most of the respondents' physical activity in the category of independent physical activity was 38 people (84.4%). The conclusion is that there is no relationship between age, sex, family history, body mass index, and smoking with the incidence of osteoporosis. Meanwhile, physical activity has a relationshipwithosteoporosis.   Abstrak Faktor-faktor resiko osteoporosis yang tidak dapat diubah yaitu usia, jenis kelamin, ras, riwayat keluarga/keturunan, bentuk tubuh dan sejarah patah tulang. Faktor–faktor resiko osteoporosis yang dapat diubah adalah merokok, defisiensi vitamin dan gizi, gaya hidup, gangguan makan (anoreksia nervosa), menopause dini, serta penggunaan obat-obatan tertentu seperti kortikosteroid, glukokortikosteroid, serta diuretik. Tujuan penelitian ini adalah untuk mengetahui mengetahui faktor-faktor yang berhubungan dengan kejadian osteoporosis Rancangan penelitian yang digunakan adalah non eksperimen yaitu rancangan atau desain penelitian yang bersifat korelasional yaitu penelitian yang dilakukan untuk mengetahui hubungan dua variabel.Populasi dalam penelitian ini adalah semua pasien osteoporosis dengan usia diatas 45 tahun yang berobat di Puskesmas Gunting Saga Kec. Kualuh Selatan Kab Labuhan Batu Utara berjumlah 45 orang.Metode pengambilan sampel yang digunakan dengan teknik total sampling yaitu sama dengan populasi adalah sebanyak 45 orang. Pengumpulan data yang digunakan yaitu metode pengisian kuesioner yang meliputi pertanyaan tertulis yang digunakan untuk memperoleh informasidata dari kuesioner.Analisa data yang dilakukan adalah analisis univariat dan analisis bivariat. Dalam penelitian ini peneliti tetap berpedoman pada prinsip-prinsip etik.Hasil penelitian menggambarkan bahwa responden sebagian besar berumur 51-65 tahun sebanyak 27 orang (60%). Jenis kelamin responden sebagian besar wanita sebanyak  37 orang (82.2%%).Riwayat keluarga responden sebagian besar berstatus tidak ada riwayat osteoporosis sebanyak 31 orang (68.9%).Indeks masa tubuh responden sebagian besar Indeks masa tubuh lebih sebanyak 34 orang (75.6%).Merokok responden sebagian besar kategori tidak merokok sebanyak 32 orang (71.7%).Aktivitas fisik responden sebagian besar kategori aktivitas fisik mandiri sebanyak 38 orang (84.4%).Kesimpulan bahwa tidak ada hubungan umur, jeniskelamin, riwayat keluarga,indeks massa tubuh,dan merokok dengan kejadian osteoporosis. Sedangkan aktivitas fisikada hubungan dengan kejadian osteoporosis.


2020 ◽  
Vol 9 (6) ◽  
pp. 1637
Author(s):  
Gheorghe G. Balan ◽  
Mukul Arya ◽  
Adrian Catinean ◽  
Vasile Sandru ◽  
Mihaela Moscalu ◽  
...  

Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been one of the most intensely studied endoscopic procedures due to its overall high complication rates when compared to other digestive endoscopy procedures. The safety and outcome of such procedures have been linked to multiple procedure- or patient-related risk factors. The aim of our study is to evaluate whether the morphology of the major duodenal papilla influences the ERCP outcomes and complication rates. Methods: A total of 322 patients with a native papilla have been included in the study over an eight month period. Morphology of the papilla has been classified into normal papilla and four anatomical variations (Type I-IV). All patients have been prospectively monitored over a 15 day period after ERCP. Procedural outcomes and complication rates have been registered. Results: Morphology of the papilla influences both overall complication rates (95%CI, p = 0.0066) and post-ERCP pancreatitis rates (95%CI, p = 0.01001) in univariate analysis. Type IV papillae have proven to be independent risk factors for post-ERCP pancreatitis in multivariate analysis (OR = 12.176, 95%CI, p = 0.005). Type I papillae have been significantly linked to difficult cannulation (AUC = 0.591, 95%CI, p = 0.008); Conclusions: In the monitored cohort morphology of the major duodenal papilla has significantly influenced both ERCP outcomes and post-procedural complication rates.


2020 ◽  
Vol 8 (2) ◽  
Author(s):  
Hemi Fitriani ◽  
Achmad Setya R ◽  
Popy Nurdiana

Maternal nutrition status during pregnancy highly contributed to risk factors of stunting among children. Bone ossification approximately begins in the sixth weeks of embryonic development and continues to the end of pregnancy. However, inadequate nutrient supply in pregnant women harmed fetal growth. The study aimed to identify the association between pregnant women’s nutrition status and stunting. The case-control study using the retrospective design involved mothers with children aged 12-59 months. A proportional random sampling technique was applied to select participants. The sample was 80 toddlers, divided into 40 stunted, and 40 non-stunted toddlers. Data were taken from 27 April to 3 May 2019 through observations following the Mother and Child Health handbook and children's height. Weight gain calculation during pregnancy determined the maternal nutrition status, referred to as maternal pre-pregnancy body mass index. The univariate analysis used frequency distribution, while bivariate analysis used the chi-square test. This study obtained approval from The Health Research Ethics Committee of the Institute of Health Science of General Achmad Yani, Cimahi. The mothers' poor nutritional status caused as many as 85% of stunted toddlers' prevalence during pregnancy. Results showed that maternal nutritional status during pregnancy was significantly associated with stunting among children (p-value: 0.000). The OR value was 13,222, which means children born to mothers with inadequate nutrient supply during pregnancy were more likely to be stunted as much as 13,222 times, than children born to mothers who had good nutrient supply. It is recommended that health workers prevent stunting from pregnancy by providing supplementary food to pregnant women, and promoting the health of the maternal nutritional status during pregnancy. Suggestions for pregnant women is to increase nutrient intake and nutritional status during pregnancy to prevent stunting in children.


2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Cintya Andriani ◽  
Nur Indrawati Lipoeto ◽  
Bobby Indra Utama

AbstrakPreeklampsia merupakan penyebab utama kematian maternal selain perdarahan dan infeksi. Penyebab pasti terjadinya preeklampsia belum diketahui, namun terdapat faktor risiko yang mempengaruhi kejadian preeklampsia. Di RSUP Dr. M Djamil Padang terjadi peningkatan kasus preeklampsia setiap tahunnya dari tahun 2008-2012. Tujuan penelitian ini adalah menentukan hubungan antara Indeks Massa Tubuh (IMT) dan kejadian preeklampsia di RSUP Dr. M. Djamil Padang. Penelitian dilakukan di bagian Rekam Medis dengan menggunakan desain cross sectional study komparatif terhadap 46 pasien preeklampsia dan 46 ibu hamil yang tidak preeklampsia yang bersalin di RSUP Dr. M. Djamil Padang dalam kisaran tahun 2011-2013. Hasil analisis univariat menunjukkan nilai rerata IMT sebelum hamil pada pasien preeklampsia dengan nilai 24,15 kg/m2 berada pada kategori overweight, sedangkan ibu hamil yang tidak preeklampsia berada pada kategori normal, dengan nilai rerata IMT 22,3 kg/m2. Berdasarkan analisis bivariat menggunakan Mann Whitney tes diperoleh nilai P: 0,014 (P<0,05). Kesimpulan penelitianini adalah terdapat hubungan yang bermakna antara IMT dengan kejadian preeklampsia di RSUP Dr. M. Djamil Padang.Kata kunci: preeklampsia, faktor risiko, indeks massa tubuh AbstractPreeclampsia is the leading cause of maternal death in addition to bleeding and infection. The exact cause of preeclampsia still unknown, but there are risk factors that affect the preeclampsia’s incident. There was an increase of preeclampsia’s case in RSUP Dr. M. Djamil Padang each year from 2008-2012. The objective of this study was to determine the correlation between Body Mass Indeks (BMI) and preeclampsia’s incident in RSUP Dr. M. Djamil Padang. The research was done at medical records department using cross sectional study comparative’s design toward 46 preeclamptic patients and 46 pregnant women who did not preeclampsia, which gave birth in RSUP Dr. M. Djamil Padang on the range 2011-2013. Results of univariate analysis showed that BMI average value of patients with preeclampsia before pregnant were in overweight category (24,15 kg/m2), whereas pregnant women who did not preeclampsia are in normal category (22,3 kg/m2). Based on bivariate analysis using the Mann Whitney test, p value was obtained 0,014 (P<0,05). The conclusion is there’s significant correlation between BMI with preeclampsia’s incident in RSUP Dr. M. Djamil Padang.Keywords: preeclampsia, risk factors, body mass indeks


2021 ◽  
Vol 4 (2) ◽  
pp. 4-14
Author(s):  
Feby Esmiralda ◽  
Aila Karyus ◽  
Kodrat Pramudho

DM is a chronic metabolic disease characterized by hyperglycemia and cause serious complications with an increasing prevalence rate. Control of risk factors that affect the incidence of DM is needed to prevent the emergence of DM and delay disease complications. The purpose of this study is to determine the risk factors that influence the incidence of type 2 diabetes outpatients at the DKT Bandar Lampung Hospital. This type of research is quantitative observational analytic with a case control approach. The population came from all patients undergoing outpatient treatment at the Internal Medicine Department of the DKT Hospital in Bandar Lampung with 44 case samples and 44 control samples. Data analysis used univariate analysis with percentages, bivariate analysis with Chi Square and multivariate analysis with multiple logistic regression. The results showed that there was a significant influence between the risk factors for age (p value 0.017), hereditary history of diabetes (p value 0.03), physical activity (p value 0.002) and obesity (p value 0.001) with the incidence of type 2 diabetes, while a history of hypertension has no effect on the incidence of type 2 diabetes mellitus (p value 0.135). Meanwhile, the most dominant variable influencing the incidence of outpatient type 2 diabetes mellitus at DKT Bandar Lampung Hospital is physical activity with OR 5.29. Maximum promotive, preventive, curative and rehabilitative efforts are needed to control risk factors for type 2 diabetes


2018 ◽  
Vol 71 (suppl 2) ◽  
pp. 733-739 ◽  
Author(s):  
Luz Marina Alfonso Dutra ◽  
Maria Rita Carvalho Garbi Novaes ◽  
Manuela Costa Melo ◽  
Danyelle Lorrane Carneiro Veloso ◽  
Dayane Leticia Faustino ◽  
...  

ABSTRACT Objective: To identify the risk factors for foot ulceration through the tracing of diabetic peripheral neuropathy and peripheral arterial disease in individuals with type I and II diabetes, who were assisted in reference centers of the Federal District, Brazil. Method: a cross-sectional and analytical study, with the assessment of 117 individuals in outpatient clinics of the Federal District. Continuous variables were compared through Mann-Whitney test, and categorized variables, through Chi-square test for univariate analysis and Logistics regression test for multivariate analysis. Results: painful diabetic peripheral neuropathy was present in 37 (75.5%) of the individuals with neuropathy. Deformities and loss of protective plant sensibility were related to neuropathy (p=0.014 and p=0.001, respectively). Of the 40 (34.2%) individuals in the sample who presented peripheral arterial disease, 26 (65%) presented calcification risk. Conclusion: signs of painful peripheral polyneuropathy, peripheral arterial disease, deformities, loss of protective plantar sensibility, and dry skin were identified as risk factors for ulceration.


2019 ◽  
Vol 18 (1) ◽  
pp. 1
Author(s):  
Nofi Yigibalom ◽  
Sulistiyani Sulistiyani ◽  
Nurjazuli Nurjazuli

Latar Belakang: Tuberkulosis (TB) paru masih merupakan masalah kesehatan yang  menyebabkan kematian pada jutaan orang setiap tahun. Kabupaten Jayawijaya pada 2016 yang diperiksa dahak sebanyak 301 kasus dengan BTA positifnya 64 kasus bila kondisi ini terus meningkat dan berlanjut setiap tahunnya, maka Kabupaten Jayawijaya akan kehilangan manusia yang produktif. Penelitian ini bertujuan menganalisis hubungan antara kebiasaan tinggal di rumah etnis dan membuang dahak  sembarang dengan kejadian TB paru di Kabupaten Jayawijaya.Metode: Jenis penelitian ini adalah penelitian stu dyobservasional analitik dengan pendekatan case control. Subjek penelitian adalah 100 responden, yang terdiri dari 50 kasus terdiagnosis TB paru BTA positif dan 50 kontrol yang terdiagnosis BTA negatif. Pengumpulan data: wawancara, observasi langsung dan pengukuran. Analisis statistik dilakukan  menggunakan uji Chi square dengan nilai p <0,05.Hasil: Hasil Analisis univariat pencahayaan alami dalam  menunjukkan rumah rata-rata kasus 23,95 lux  dan  kontrol 24,20 lux, kelembaban rumah rata-rata 52,38 %,  kontrol 51,59%,, suhu  rumah rata-rata  kasus 27,490C,kontrol 27,260C. Analisis bivariat menunjukkan ada hubungan kebiasaan tinggal dirumah etnis honai dengan OR = 2,667 dan kebiasaan membuang dahak sembarang dengan OR = 4,750.Simpulan: Kebiasaan membuang dahak sembarang, dan kebiasaan tinggal di rumah etnis merupakan faktor risiko kejadian TB paru. Maka perlu adanya sosialisasi terkait faktor risiko kejadian TB terhadap penderita dan  masyarakat umum, serta perlu adanya perbaikan lingkungan fisik rumah dan sanitasi rumah. ABSTRACTTitle: Risk Factors For Habitual Living in Ethnic House and  Sputum Spit the  Pulmonary  TB Jayawijaya District, PapuaBackground : Tuberculosis of the lung is still a health problem that causes death to millions of people every year. Jayawijaya in 2016 examined 301 sputum smear positive cases with 64 cases if this condition continues to increase and continues each year, then the Jayawijaya Regency will lose a productive human being. This study aims to analyze the relationship between ethnic home stay habits and throw sputum arbitrarily with the incidence of pulmonary TB in Jayawijaya District.Methods : This research is an observational analytic study with case control approach. The subjects were 100 respondents, consisting of 50 cases diagnosed with positive smear pulmonary tuberculosis and 50 controls diagnosed with smear negative. Data collection: interviews, direct observation and measurement. Statistical analysis was performed using Chi square test with p value < 0,05. Results: The results of the univariate analysis showed that natural lighting in the house the average cases of 23,95 lux and control 24,20 lux, the average humidity of the house was 52,38%, control 51,59% ,, the average house temperature was 27,490C, control 27,26 0C. Bivariate analysis showed that there was an association of habitual residence of ethnic homes honai with OR = 2,667 and spiraling habit of spitting with OR = 4,750Conclusion: The habit of sputtering any sputum, and the habit of living in ethnic homes is a risk factor for pulmonary TB incidence. So the need for socialization related risk factors for TB incidence of patients and the general public, and the need for improvement of the physical environment of home and sanitation.


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