Citation: Journal of Wound Care. 2022, 31(8), 683-88
Author: Bradley Pittam, Ruby Chumber, Gaurav Vashisht, Sophie Miller, Christina O'Dowd, Thomas Ledson, Upendram Srinivas-Shankar
Abstract: Objective: People with diabetes who are on haemodialysis (HD) are at a high risk of diabetic foot infections (DFI) and related complications. We explored the value of treating DFI with intravenous (IV) antibiotics during HD.
Method: This was an observational study of consecutively treated patients with DFIs with IV antibiotics during HD. Data collected included baseline characteristics, IV antibiotics used, details of multidisciplinary interventions and DFI treatment outcome.
Results: A cohort of 11 patients, mean (±standard deviation) age 62.4±12.7 years, had 15 episodes of treatment with IV antibiotics during HD. Of the patients, six (54.5%) were male and nine (81.8%) had type 2 diabetes. The estimated mean glomerular filtration rate (eGFR) was 11.4±3.9ml/minute. All patients had infected foot ulceration, soft tissue infection, six (54.5%) patients had osteomyelitis, and two (18.2%) had wet gangrene. The commonest IV antibiotic used was vancomycin (10/15 episodes, 66.7%). Other IV antibiotics used were daptomycin and meropenem. In three episodes, oral ciprofloxacin was used with IV antibiotics. The mean duration of antibiotic treatment was 9.2±4.9 weeks. Of the episodes, 11 (73.3%) were treated successfully with IV antibiotics alone and two (13.3%) episodes required minor surgical debridement/amputation. Some 10 (90.9%) members of the cohort had peripheral arterial disease and of those, five (50%) underwent angioplasty during IV antibiotic treatment.
Conclusion: HD provides a good opportunity for treatment with IV antibiotics in DFI. This mode of administration of IV antibiotics, along with multidisciplinary intervention, is associated with ulcer healing and resolution of infection in over three-quarters of patients with DFI.
Declaration of interest: The authors have no conflicts of interest to declare.
Keywords: diabetes; diabetic foot infection; haemodialysis; intravenous antibiotics; vancomycin; vascular complications; wound; wound bed; wound care; wound dressing; wound healing.
Thursday 1 September 2022
WUTH publication: The value of administering intravenous antibiotics during haemodialysis in the treatment of diabetic foot infections
WUTH publication: The first international Delphi consensus statement on Laparoscopic Gastrointestinal surgery
Citation: International Journal of Surgery. 2022, 104, 106766. Epub 2022 Jul 13.
Author: Islam Omar, Karl Miller, Brijesh Madhok, Bassem Amr, Rishi Singhal, Yitka Graham, Sjaak Pouwels, Mohammad Abu Hilal, Sandeep Aggarwal, Irfan Ahmed, Ali Aminian, Basil Jaser Ammori, Tan Arulampalam, Altaf Awan, José María Balibrea, Aneel Bhangu, Richard Raymond Brady, Wendy Brown, Manish Chand, Ara Darzi, Talvinder Singh Gill, Ramen Goel, Bussa R Gopinath, Mark van Berge Henegouwen, Jacques M Himpens, David Daniel Kerrigan, Misha Luyer, Christian Macutkiewicz, Julio Mayol, Sanjay Purkayastha, Raul Jacobo Rosenthal, Scott Alan Shikora, Peter Kenneth Small, Neil James Smart, Mark A Taylor, Tehemton E Udwadia, Tim Underwood, Yirupaiahgari Ks Viswanath, Neil Thomas Welch, Steven D Wexner, Michael Samuel James Wilson, Des C Winter, Kamal K Mahawar
Abstract: Background: Laparoscopic surgery has almost replaced open surgery in many areas of Gastro-Intestinal (GI) surgery. There is currently no published expert consensus statement on the principles of laparoscopic GI surgery. This may have affected the training of new surgeons. This exercise aimed to achieve an expert consensus on important principles of laparoscopic GI surgery.
Methods: A committee of 38 international experts in laparoscopic GI surgery proposed and voted on 149 statements in two rounds following a strict modified Delphi protocol.
Results: A consensus was achieved on 133 statements after two rounds of voting. All experts agreed on tailoring the first port site to the patient, whereas 84.2% advised avoiding the umbilical area for pneumoperitoneum in patients who had a prior midline laparotomy. Moreover, 86.8% agreed on closing all 15 mm ports irrespective of the patient's body mass index. There was a 100% consensus on using cartridges of appropriate height for stapling, checking the doughnuts after using circular staplers, and keeping the vibrating blade of the ultrasonic energy device in view and away from vascular structures. An 84.2% advised avoiding drain insertion through a ≥10 mm port site as it increases the risk of port-site hernia. There was 94.7% consensus on adding laparoscopic retrieval bags to the operating count and ensuring any surgical specimen left inside for later removal is added to the operating count.
Conclusion: Thirty-eight experts achieved a consensus on 133 statements concerning various aspects of laparoscopic GI Surgery. Increased awareness of these could facilitate training and improve patient outcomes.
Keywords: Ergonomics; Gastrointestinal surgery; Guidelines; Hepatobiliary; Laparoscopic surgery; Minimally invasive; Patient safety; Surgical training.
WUTH publication: Complications in Device Therapy: Spectrum, Prevalence, and Management
Citation: Current Heart Failure Reports. 2022 Aug 6. Online ahead of print.
Author: J Llewellyn, D Garner, A Rao
Abstract: Purpose of review: Cardiac implantable electronic device implant numbers are continually increasing due to the expanding indications and ageing population. This review explores the complications associated with device therapy and discusses ways to minimise and manage such complications.
Recent findings: Complications related to device therapy contribute to mortality and morbidity. Recent publications have detailed clear guidelines for appropriate cardiac device selection, as well as consensus documents discussing care quality and optimal implantation techniques. There have also been advances in device technologies that may offer alternative options to patients at high risk of/or already having encountered a complication. Adherence to guidelines, appropriate training, and selection of device, in addition to good surgical technique are key in reducing the burden of complications and improving acceptability of device therapy.
Keywords: Complications; Device therapy; Management.