scholarly journals Correlation between hemolytic profile and phylotype of Cutibacterium acnes (formerly Propionibacterium acnes) and orthopedic implant infection

2019 ◽  
Vol 12 (6) ◽  
pp. 390-398
Author(s):  
Julia Lee ◽  
Kerryl E Greenwood Quaintance ◽  
Audrey N Schuetz ◽  
Dave R Shukla ◽  
Robert H Cofield ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Chart Review ◽  
Propionibacterium Acnes ◽  
De Novo ◽  
Retrospective Chart Review ◽  
Orthopedic Implant ◽  
Type Ii ◽  
Surgical Wounds ◽  
Cutibacterium Acnes ◽  
Orthopedic Infection

Introduction Cutibacterium acnes is a recognized culprit for implant-associated infections, but positive cultures do not always indicate clinically relevant infection. Studies have shown a correlation between the β-hemolytic phenotype of C. acnes and its infectious capacity, but correlation with genetic phylotype has not been performed in literature. The purpose of this study is to evaluate β-hemolysis phenotype, genetic phylotype, and mid-term clinical outcomes of C. acnes isolated from orthopedic surgical sites. Methods Fifty-four C. acnes isolates previously obtained from surgical wounds of patients undergoing hip, knee, shoulder, or spine implant removal were re-cultured. There were 21 females and 33 males with an average age of 59 years (range, 18–84). Twenty-four were from clinically infected sites whereas 30 were considered contaminants. De novo β-hemolysis was analyzed and a retrospective chart review was performed to evaluate clinical outcomes at 7.1 years (range, 0.1–12.8). Results On Brucella agar with 5% rabbit blood, 46% of contaminant and 43% of infectious isolates were hemolytic. Type II phylotype was significantly more nonhemolytic regardless of infectious or contaminant status (p < 0.05). Type 1B correlated with a hemolytic-infectious phenotype and Type 1A with a hemolytic-contaminant phenotype but was not statistically significant. Conclusion The β-hemolytic profile of C. acnes did not correlate with phylotype or clinically relevant orthopedic infection.

Double fascicular nerve transfer to the biceps and brachialis muscles after brachial plexus injury: clinical outcomes in a series of 29 cases

2011 ◽  
Vol 114 (6) ◽  
pp. 1520-1528 ◽  
Author(s):  
Wilson Z. Ray ◽  
Mitchell A. Pet ◽  
Andrew Yee ◽  
Susan E. Mackinnon
Keyword(s):  
Brachial Plexus ◽  
Clinical Outcomes ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Study Results ◽  
The Mean ◽  
Flexion Strength

Object The clinical outcomes of patients with brachial plexus injuries who underwent double fascicular transfer (DFT) using fascicles from the median and ulnar nerves to reinnervate the biceps and brachialis muscles were evaluated. Methods The authors conducted a retrospective chart review of 29 patients with brachial plexus injuries that were treated with DFT for restoration of elbow flexion. All patients underwent pre- and postoperative clinical evaluation using the Medical Research Council grading system. Results The mean patient age was 37 years (range 17–68 years), and there was a mean follow-up of 19 ± 12 months (range 8–68 months). At the most recent follow-up, all but 1 patient (97%) had regained elbow flexion. Eight patients recovered Grade M5, 15 patients recovered Grade M4, and 4 patients recovered Grade M3 elbow flexion strength. There was no evidence of functional deficit in the donor nerve distributions. Conclusions Study results demonstrated the reliable restoration of M4–M5 elbow flexion following double fascicular transfer in patients with brachial plexus injuries.

scholarly journals P019: What happens to John Doe? Unidentified patients in the emergency department: a retrospective chart review

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S71-S71
Author(s):  
K. Tastad ◽  
J. Koh ◽  
D. Goodridge ◽  
J. Stempien ◽  
T. Oyedokun
Keyword(s):  
Emergency Department ◽  
Clinical Outcomes ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Inclusion Criteria ◽  
Identification Methods ◽  
Police Services ◽  
Admission Rates ◽  
Time Period ◽  
Minimal Research

Introduction: Patients who are not identified upon presentation to the emergency department (ED), commonly referred to as John or Jane Does (JDs), are a vulnerable population due to the sequelae associated with this lack of patient information. To date, there has been minimal research describing JDs. We aimed to characterize the JD population and determine if it differs significantly from the general ED population. Methods: We conducted a retrospective chart review of 114 JDs admitted to Saskatoon EDs from May 2018 to April 2019. Patients met inclusion criteria if they were provided a unique JD identification number at ED admission because their identities were unknown or unverifiable. Data regarding demographics, clinical presentation, ED course, mode of identification, and major clinical outcomes (i.e. admission rates, mortality rates) were gathered from electronic records. A second reviewer abstracted a random 21.0% sample of charts to ensure validity of the data. The JD population was then compared to the general population of ED patients that presented during the same time period. Results: Male JDs most commonly presented as trauma activations (85.7%) in contrast to female JDs who most commonly presented with issues related to substance abuse (51.4%). Compared to the general ED population, a greater percentage of JDs were categorized as CTAS 1 or 2 (85.8% vs 18.9%, p < 0.0001), more likely to be 44 years of age or younger (82.4% vs 58.5%, p < 0.0001), and more likely to be male (64.9% vs 49.1%, p < 0.0001). Descriptive statistics on the JD population demonstrated that most JDs received consults to inpatient services (58.8%). Of JDs who presented to the ED, 34.2% were admitted to hospital. The mortality of the JD population was 13.2% at 3 months. The ED average (SD) length of stay for JDs was 8.7 (9.0) hours. How JDs were ultimately identified was recorded only 70.2% of the time. Most frequently, JDs identified themselves (26.3%), other identification methods included police services (14.9%), family members (7.9%), registered nurses (6.1%), government-issued identification (5.3%), social work (4.4%) or other measures (5.4%). Conclusion: JD's represent a unique population in the ED. Both their presentations and clinical outcomes differ significantly from the generalized ED population. More research is needed to better identify strategies to improve the management and identification methods of these unique patients.

scholarly journals Induction and Donor Specific Antibodies in Low Immunologic Risk Kidney Transplant Recipients

Kidney360 ◽  
2020 ◽  
Vol 1 (12) ◽  
pp. 1407-1418
Author(s):  
Natalie M. Bath ◽  
Arjang Djamali ◽  
Sandesh Parajuli ◽  
Didier Mandelbrot ◽  
Glen Leverson ◽  
...  
Keyword(s):  
Chart Review ◽  
De Novo ◽  
Retrospective Chart Review ◽  
High Volume ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Specific Antibodies ◽  
Kaplan Meier ◽  
Donor Specific Antibodies ◽  
One Year

BackgroundOptimal induction for patients without pretransplant donor-specific antibodies (DSAs) is poorly defined. The goal of this study was to compare the incidence of de novo DSA (dnDSA) and graft outcomes between induction therapies in patients with a negative virtual crossmatch (VXM).MethodsA retrospective chart review was performed, identifying 782 patients with a negative VXM who underwent kidney transplantation at a single, high-volume institution between January 2013 and May 2017. Kaplan–Meier analysis was used to assess the incidence of dnDSA and allograft survival between induction therapies in this group. dnDSA is defined as the development of new post-transplant DSA, at any MFI level.ResultsInduction therapy included alemtuzumab (N=87, 11%), basiliximab (N=522, 67%), and anti-thymocyte globulin (ATG; N=173, 22%). One-year graft survival was similar between groups (alemtuzumab, 100%; basiliximab, 98%; ATG, 99%). Incidence of acute rejection at 1 year was <2% and not different between the three groups. Alemtuzumab was associated with the highest incidence of dnDSA at 14%, compared with 5% and 8% in basiliximab and ATG groups, respectively, at 1 year (P=0.009). In multivariate regression analyses, alemtuzumab retained its significant association with a dnDSA HR of 2.5 (95% CI, 1.51 to 4.25; P=0.0004).ConclusionsIn summary, alemtuzumab was associated with a higher rate of dnDSA development in patients with a negative VXM; however, this finding was not associated with rejection or graft failure.

scholarly journals 888. Impact of Mandatory Infectious Diseases Consult on All-cause In-patient Mortality and 30-Day Readmission in Patients with Severe Sepsis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S21-S22
Author(s):  
Cindy Hou ◽  
Todd P Levin ◽  
Nikunj M Vyas ◽  
Stefanie Deangelo ◽  
Jean Klepka ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Infectious Diseases ◽  
Clinical Outcomes ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Sepsis Mortality ◽  
Readmission Rates ◽  
Group A ◽  
Severe Infections ◽  
The Impact

Abstract Background Severe sepsis is associated with high mortality and readmission rates. Infectious diseases (ID) consultations (IDC) improve clinical outcomes in patients with severe infections. In March 2016, a mandatory ID consultation (MIDC) policy for this patient population was implemented. This study’s goal was to determine the impact of MIDC on clinical outcomes. Methods In efforts to reduce mortality and complications from sepsis at our institution, multidisciplinary intervention led to a policy for MIDC for patients with sepsis. This intervention was monitored daily by the clinical initiatives team to ensure compliance. We conducted a retrospective chart review of patients with severe sepsis from all sources in Pre-MIDC group from January 2015 to February 2016 and Post-MIDC group from March 2016 to December 2017. The primary endpoint of the study was to evaluate the impact of MIDC on all-cause inpatient mortality (ACIM) and 30-day readmission in patients with severe sepsis. Secondary endpoint focused on the impact of MIDC on time to IDC and patient seen by ID physician. Subgroup analysis evaluated the impact of early vs. late IDC on ACIM. Results There was a total of 511 patients in Pre-MIDC and 635 patients in Post-MIDC groups. No differences were seen in the demographics between the groups. Overall a difference was not seen in ACIM between the two groups (9.2% vs. 8%, P = 0.52); however, Post-MIDC group had lower rates of 30-day readmission due to sepsis/infection (12.1% vs. 4.9%, P = 0.01) and shorter length of stay (8.5 vs. 6.7 days, P = 0.001). We did observe an association with early IDC from admission to a decrease in ACIM compared with late IDC (7.8% vs. 9.4%, P = 0.03). Times to IDC from admission (33.5 hours vs. 16.75 hours, P = 0.001) and patient seen by ID physician from time of IDC order (23 hours vs. 8.75 hours, P = 0.0001) was faster in Post-MIDC group. A decline was observed in sepsis mortality by 16% since MIDC implementation compared with Pre-MIDC. Conclusion Implementation of MIDC led to faster time to IDC and patients seen by ID physicians which was directly associated with a decrease in ACIM. MIDC did not show a difference in overall ACIM; however, it decreased 30-day readmission due to sepsis/infection and shorter LOS. We also observed a consistent decline in overall sepsis mortality through this intervention. Disclosures All Authors: No reported Disclosures.

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