[Show abstract][Hide abstract] ABSTRACT: Background
Existing evidence concerning the management of traumatic brain injury (TBI) patients underlines the importance of appropriate treatment strategies in both prehospital and early in-hospital care. The objectives of this study were to analyze the current state of early TBI care in Austria with its physician-based emergency medical service. Subsequently, identified areas for improvement were transformed into treatment recommendations. The proposed changes were implemented in participating emergency medical services and hospitals and evaluated for their effect.
14 Austrian centers treating TBI patients participated in the study. Between 2009 and 2012 all patients with Glasgow Coma Scale score < 13 and/or AIS head > 2 within 48 h after the accident, were enrolled. Data were collected in 2 phases: in the first phase data of 408 patients were analyzed. Based on this, a set of recommendations expected to improve outcomes was developed by the study group and implemented in participating centers. Recommendations included time factors (transport to appropriate trauma center, avoiding secondary transfer), adequate treatment strategies (prehospital fluid and airway management, anesthesia, ventilation), monitoring (pulse oximetry and blood pressure monitoring in all patients, capnography in ventilated patients) for prehospital treatment. In the emergency department focus was on first CT scan as soon as possible, short interval between CT scan and surgery and early use of thrombelastometry to optimize coagulation. Following implementation of these recommendations, data on 325 patients were collected and analyzed in phase 2. Final analysis investigated the impact of the recommendations on patient outcomes.
Patients in both data collection phases showed comparable demographic and injury severity characteristics. Treatment changes, especially in terms of fluid management, monitoring and normoventilation as well as thrombelastometry measurements were implemented successfully in phase 2, and led to significant improvement of patient outcomes. Hospital mortality was reduced from 31 % to 23 %. We found a lower rate of unfavorable outcomes, a significant increase in unexpected survivors and more patients with unexpected favorable outcomes as well.
The results of this study clearly demonstrate that the outcomes of TBI patients can be improved with appropriate early care.
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 07/2015; 23(1). DOI:10.1186/s13049-015-0133-z · 2.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A surgical glove will protect surgeons and patients only if the glove's integrity remains intact. However, several studies have demonstrated that undetected micro-perforations of surgical gloves are common. Because of the possibility of surgical glove puncture, an antimicrobial surgical glove was developed. The aim of this laboratory based experimental study was to assess the antibacterial efficacy of the interior chlorhexidine-gluconate (CHG)-coat of an antimicrobial synthetic polyisoprene surgical glove by using a standardized microbiological challenge.
Sixteen healthy adult participants donned one antimicrobial surgical glove and one non-antimicrobial surgical glove randomly allocated to their dominant and non-dominant hand following a crossover design. During a 2-h wear time, participants performed standardized finger and hand movements. Thereafter, the interior surface of excised fingers of the removed gloves was challenged with 8.00 log10 cfu/mL S. aureus (ATCC 6538) or K. pneumoniae (ATCC 4352), respectively. The main outcome measure was the viable mean log10 cfu counts of the two glove groups after 5 min contact with the interior glove's surface.
When comparing an antimicrobial glove against an untreated reference glove after 2-h simulated use wear-time, a mean reduction factor of 6.24 log10 (S. aureus) and 6.22 log10 (K. pneumoniae) was achieved after 5 min contact.
These results demonstrate that wearing antibacterial gloves on hands does not negatively impact their antibacterial activity after 2-h of wear. This may have a potential benefit for patient safety in case of glove puncture during surgical procedures.
BMC Surgery 07/2015; 15(1):81. DOI:10.1186/s12893-015-0058-5 · 1.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives:
Transport-related accidents remain the largest single cause of death among people aged 15 to 29 in the European Union, and despite the decrease in number of fatalities from 1990 onwards they remain a significant public health problem. The aim of this article was to analyze the long-term trends and patterns of transport-related fatalities, identify the anatomic distribution of most significant injuries in different road users, and identify the primary populations at risk of transport-related death in Austria between 1980 and 2013.
Data on transport-related fatalities based on death certificates were obtained from Statistics Austria for the analyzed period. Crude and age-standardized mortality rates per 100,000 were calculated and broken down by age, gender, and month of death, and the anatomic distribution of most significant injuries were identified. Potential years of life lost before age 75 (PYLL-75) were used as a measure of public health impact.
A total of 39,709 transport-related fatalities were identified for the studied years; 74% were males and the mean age was 42.1 years (range 0-103). A decrease in the number of fatalities (from 2018 in 1980 to 554 in 2012), mortality rates (from 26 in 1980 to 7 in 2012), and PYLL-75 (from 68,960 in 1980 to 14,931 in 2012) was observed. Introduction of major prevention milestones (compulsory use of seat belts or child restraints) may have contributed to this decrease. Men 16-24 years old were at the highest risk of transport-related death. Pedestrian victims were more likely to be women and car drivers and motorcyclists were more often men. Most fatal transport accidents occurred between the months of May and October and prevailingly in towns of fewer than 20,000 inhabitants. Injuries to the head were the most significant injuries in all user groups (>50% of cases in all road user types). Reduced mortality rates could translate into higher prevalence of long-term disabilities in survivors of transport accidents.
Despite the decreasing trend observed, transport-related fatalities remain a serious public health issue in Austria. An increase in the mortality of motor vehicle drivers warrants more preventive action in this group. Further research is needed on other outcomes of transport accidents such as long-term disabilities to elucidate the true public health burden of transport accidents.
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to determine whether the type of intracranial traumatic lesions, the number of simultaneous traumatic lesions, and the occurrence of skull and facial bone fractures have an influence on S100B serum levels. Patients with blunt traumatic brain injury were prospectively enrolled into this cohort study over a period of 13 month. Venous blood samples were obtained prior to emergency cranial CT-scan in all patients within 3 hours after injury. The patients were then assigned into six groups: 1. patients with concussion, 2. with epidural hematoma, 3. with subdural hematoma, 4. with subarachnoid hemorrhage, 5. with brain contusions, 6. with brain edema. The study included 1696 head trauma patients with a mean age of 57.7 ± 25.3 years. 126 patients (8%) had 182 traumatic lesions on CT. Significant differences in S100B serum levels were found between cerebral edema and the other four bleeding groups: epidural p=0.0002, subdural p<0.0001, subarachnoid p=0.0001, brain contusions p=0.0003 and concussion p<0.0001. Significant differences of S100B values between patients with 1 and 2 intracranial lesions (p=0.014) or 3 (p<0.0001) simultaneous intracranial lesions were found. In patients with intracranial traumatic lesions, skull fractures, as well as skull and facial bone fractures occurring together were identified as significant additional factors for the increase in serum S100B levels (p<0.0001). Higher age was also associated with elevated S100B serum levels (p<0.0001). Our data show that peak S100B serum levels were found in patients with cerebral edema and brain contusions.
Journal of Neurotrauma 07/2014; 32(1). DOI:10.1089/neu.2013.3202 · 3.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
The goal was to compare epidemiology of hospital admissions for traumatic brain injury (TBI) in Austrian residents vs. visitors to Austria.
Data on all hospital admissions due to TBI (ICD-10 codes S06.0-S06.9; years 2009-2011) was provided by the Austrian Statistical Office. Data on Austrian population and on tourism (visitor numbers, nights spent) was retrieved from www.statistik.at . Age, sex, mechanism of injury, season and mortality was analysed for Austrian residents vs. visitors.
Visitors contributed 3.9% to the total population and 9.2% of all TBI cases. Incidence of hospital admissions was 292/100,000/year in Austrian residents and was 727/100,000/year in visitors. Male:female ratio was 1.39:1 in Austrian residents and 1.55:1 in visitors. Austrian cases were older than visitors' cases (mean age 41 vs. 28 years). Austrian cases were distributed evenly over the seasons, while 75% of the visitors' cases happened during winter and spring. The most frequently observed causes of TBI in Austrian residents were private accidents, while sports caused almost half of the visitors' cases. Hospital mortality was lower in visitors than in Austrian residents (0.8 vs. 2.1%).
Sports-related TBI of visitors causes a significant workload for Austrian hospitals. Better prevention is warranted.
[Show abstract][Hide abstract] ABSTRACT: ACL reconstruction with quadruple hamstring graft (HT) as well as bone-patellar tendon-bone autograft (PT) is a frequent procedure in athletes after ACL rupture. Both techniques are reported to provide for satisfying results but only few articles compare both techniques.
Prospective evaluation was performed on 96 patients with isolated ACL rupture undergoing reconstruction with a HT or PT autograft by a single surgeon at our institution. Long time follow-up after five years included the IKDC and KOOS evaluation form as well as clinical assessment (ROM, Lachmann testing, KT-2000).
Comparing both methods revealed no significant differences regarding IKDC and KOOS. The KT-2000 arthrometer testing showed a slightly increased mean laxity in the HT group. There were no differences regarding harvest side symptoms comparing HT and PT as well as one and two incision technique. Kneeling pain was significantly less common after HT autograft. HT as well as PT autograft achieve equally good clinical results in athletes at five year follow-up with no significant difference regarding knee stability. Although no difference concerning the harvest site was identified, HT seems to be favorable for patients who work in a kneeling position.
Wiener klinische Wochenschrift 05/2014; 126(13-14). DOI:10.1007/s00508-014-0550-4 · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although several publications concerning the use of the biomarkers S100B and neuron-specific enolase (NSE) in vertebral spine fractures in animal experimental studies have proven their usefulness as early indicators of injury severity, there are no clinical reports on their effectiveness as indicators in patients with spinal injuries. As these biomarkers have been examined, with promising results, in patients with traumatic brain injury, there is a potential for their implementation in patients with vertebral spine fractures.
The spine journal: official journal of the North American Spine Society 04/2014; 14(12). DOI:10.1016/j.spinee.2014.04.027 · 2.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
To investigate changes in TBI mortality in Austria during 1980-2012 and to identify causes for these changes.
Statistik Austria provided data (from death certificates) on all TBI deaths from January 1980-December 2012. Data included year/month of death, age, sex, residency of the cases and mechanism of accident. Data regarding the size of the age groups was obtained from Statistik Austria. Mortality rates (MR; deaths/10(5) population/year) were calculated for male vs. female patients and for different age groups. Changes in mechanisms of TBI were evaluated.
The MR decreased from 28.1 to 11.8 deaths/10(5) population/year. Traffic-related TBI deaths decreased from 62% to 9%. This caused a significant decrease in TBI deaths in younger age groups. Fall-related TBI deaths (mostly geriatric cases) remained unchanged. Falls became the leading cause; its rate increased from 22% to 64% of all TBI deaths. Thus, the mean age of fatal TBI cases increased by 20 years and the rate of cases aged <60 years decreased from 71% to 28%. Another important cause was suicide by firearms; its rate increased from 10% to 23% of all TBI deaths.
These findings warrant better prevention of falls in the elderly and of suicides.
[Show abstract][Hide abstract] ABSTRACT: The goal of this study was to compare outcomes of patients with severe traumatic brain injury (TBI) who had been admitted either during workdays from 7 a.m. to 7 p.m. ("regular service") or during any other time ("on-call service").
Between March 2002 and April 2012, 17 Austrian centers enrolled TBI patients into two observational studies that focused on effects of guideline compliance (n = 400) and on prehospital and early hospital management (n = 777), respectively. Data on trauma severity, clinical status, treatment, and outcomes were collected prospectively. All patients with severe TBI (Glasgow Coma Scale score < 9) were selected for this analysis. Secondary transfers and patients with unsurvivable injuries were excluded. The International Mission for Prognosis and Analysis of Clinical Trials in TBI core model was used to estimate probabilities of hospital death and unfavorable long-term outcome (Glasgow Outcome Scale score < 4). Based on time of arrival, patients were assigned to groups "regular service" or "on-call service."
Data from 852 patients were analyzed (413 "regular," 439 "on-call service"). "On-call" patients were younger (45 vs. 51 years, P < 0.001) and had a higher rate of alcohol intoxication (41 vs. 11 %, P < 0.001). Trauma severity was comparable; the probabilities of death and unfavorable outcome were identical. There were no differences regarding computed tomography findings or treatment. Hospital mortality (24 vs. 28 %, P = 0.191) and rate of patients with unfavorable outcome at 6 months (43 vs. 48 %, P = 0.143) were comparable.
In Austria, the time of hospital admission has no influence on outcomes after severe TBI.
Wiener klinische Wochenschrift 03/2014; 126(9-10). DOI:10.1007/s00508-014-0521-9 · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
The goal of this paper was to investigate the association between patterns of intracranial hypertension (IH) and outcomes, to describe the treatment of patients with different patterns of IH, and to examine whether IH is an independent predictor of mortality and unfavourable outcome, respectively.
A retrospective analysis of data collected prospectively in 9 central European centers is presented. 204 patients with severe TBI who had intracranial pressure (ICP) monitoring were coded as having either early (within first 2 days), late (after first 2 days), or no IH. IH was defined as >60 min of ICP >20 mmHg/day. The total number of hours/day of IH was recorded. Treatment was followed closely for the first 10 days using the therapy intensity level (TIL) score. Associations between types of IH and demographic factors, trauma severity, or treatment factors as well as outcomes were analysed.
Patients in the early IH group were the most severely injured. They had the highest TIL levels, had the highest mortality (48%) and the highest rate of unfavourable outcome (65%) followed by the late IH group (20% and 57%) and the no IH group (23% and 36%). Duration of IH correlated significantly with hospital mortality. IH was an independent predictor of mortality and unfavourable outcome after adjusting for age, Glasgow Coma Scale score, and Abbreviated Injury Score "head".
Intracranial hypertension with early onset is independently associated with significantly worse outcome in patients with severe TBI. The total duration of IH shows a significant correlation to mortality.
[Show abstract][Hide abstract] ABSTRACT: Traumatic brain injuries (TBI) are of special concern in the pediatric and adolescent population due to high incidence, mortality and potential years of life lost (PYLL). Knowledge on causes and mortality trends is essential for effective prevention. The aim of this study was to analyze the long term trends and causes of TBI-related mortality between 1980 and 2012 in the pediatric and adolescent populations of Austria. Death certificate data on TBI-related deaths of children and adolescents aged 0-19 years and exact population numbers were obtained from the Austrian Statistical Office. Five age-groups were created. Mortality trends, and causes of TBI were analyzed. PYLL were used to indicate the public health impact. Out of 5319 identified TBI-related deaths, 75% were male victims. The annual mortality rates per 100,000 between 1980 and 2012 decreased from 25 to 2.6 in males, from 8.5 to 1.0 in females and from 16.9 to 1.8 in the total population. 15-19 years old had the highest mortalities followed by 0-2 years old. Over 80% of deaths were caused by accidents, inflicted TBIs were most common in 0-2 years old and traffic accidents in 15-19 years old. 295,793 PYLL can be attributed to TBIs in the studied period. Measures to prevent traffic accidents contributed significantly to the decrease of mortality and PYLL, especially in 15-19 years old men. Causes and trends of TBI related mortality exhibit age group-specific patterns and this knowledge could contribute to plan further preventive action to reduce TBI fatalities in the studied population.
Journal of neurotrauma 01/2014; 31(11). DOI:10.1089/neu.2013.3200 · 3.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background Context
Although several publications concerning the use of the biomarkers S100B and NSE in vertebral spine fractures in animal experimental studies have proven their usefulness as early indicators of injury severity, there are no clinical reports on their effectiveness as indicators in patients with spinal injuries. As these biomarkers have been examined–with promising results–in patients with traumatic brain injury (TBI), there is a potential for their implementation in patients with vertebral spine fractures.
To investigate the early serum measurement of S100B and NSE in patients with vertebral spine fractures as compared to those in patients with acute fractures of the proximal femur.
Prospective longitudinal cohort study.
A cohort of 34 patients admitted over an 18-month period to a single medical center for suspected vertebral spine trauma. 29 patients were included in the control group.
S100B and NSE serum levels were assessed in different types of vertebral spine fractures.
We included patients over 16 years of age with vertebral spine fractures whose injuries were sustained within 24 hours prior to admission to the emergency room, and who had undergone a brief neurological examination. Spinal cord injuries were classified as being either paraesthesias, incomplete paraplegias or complete paraplegias. Blood serum was obtained from all patients within 24 hours after time of injury. Serum levels of S100B and NSE were statistically analyzed using Wilcoxon tests.
S100B serum levels were significantly higher in patients with vertebral spine fractures (p=0.01). In these patients, the mean S100B serum level was 0.75 μg/L (SD 1.44) [95% CI 0.24; 1.25]. The mean S100B serum level in control group patients was 0.14 μg/L (SD 0.11) [0.10; 0.19]. The 10 patients with neurological deficits had significantly higher S100B serum levels when compared to the patients with vertebral fractures but without neurological deficits (p=0.02). The mean S100B serum level in these patients was 1.18 μg/L (SD 1.96). In the 26 patients with vertebral spine fractures but without neurological injury, the mean S100B serum level was 0.42 μg/L (SD 0.91) [95% CI 0.08; 0.76]. The analysis revealed no significant difference in NSE levels.
Not only did we observed a significant correlation between S100B serum levels and vertebral spine fractures, a significant correlation was also seen between S100B serum levels and spinal cord injuries with neurological deficit. These results may be meaningful in clinical practice, and to future studies as well.
[Show abstract][Hide abstract] ABSTRACT: Object:
This study presents newly defined risk factors for detecting clinically important brain injury requiring neurosurgical intervention and intensive care, and compares it with the Canadian CT Head Rule (CCHR).
This prospective cohort study was conducted in a single Austrian Level-I trauma center and enrolled a consecutive sample of mildly head-injured adults who presented to the emergency department with witnessed loss of consciousness, disorientation, or amnesia, and a Glasgow Coma Scale (GCS) score of 13-15. The studied population consisted of a large number of elderly patients living in Vienna. The aim of the study was to investigate risk factors that help to predict the need for immediate cranial CT in patients with mild head trauma.
Among the 12,786 enrolled patients, 1307 received a cranial CT scan. Four hundred eighty-nine patients (37.4%) with a mean age of 63.9 ± 22.8 years had evidence of an acute traumatic intracranial lesion on CT. Three patients (< 0.1%) were admitted to the intensive care unit for neurological observation and received oropharyngeal intubation. Seventeen patients (0.1%) underwent neurosurgical intervention. In 818 patients (62.6%), no evidence of an acute trauma-related lesion was found on CT. Data analysis showed that the presence of at least 1 of the following factors can predict the necessity of cranial CT: amnesia, GCS score, age > 65 years, loss of consciousness, nausea or vomiting, hypocoagulation, dementia or a history of ischemic stroke, anisocoria, skull fracture, and development of a focal neurological deficit. Patients requiring neurosurgical intervention were detected with a sensitivity of 90% and a specificity of 67% by using the authors' analysis. In contrast, the use of the CCHR in these patients detected the need for neurosurgical intervention with a sensitivity of only 80% and a specificity of 72%.
The use of the suggested parameters proved to be superior in the detection of high-risk patients who sustained a mild head trauma compared with the CCHR rules. Further validation of these results in a multicenter setting is needed. Clinical trial registration no.: NCT00451789 ( ClinicalTrials.gov .).
Journal of Neurosurgery 12/2013; 120(2). DOI:10.3171/2013.10.JNS13726 · 3.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Traumatic brain injury (TBI) is an important cause of preventable deaths. The goal of this study was to provide data on epidemiology of TBI in Austria.
Data on all hospital discharges, outpatients, and extra- as well as in-hospital deaths due to TBI were collected from various sources for the years 2009-2011. Population data (number of male/female people per age-group, population of Austrian cities, towns, and villages) for 2009-2011 were collected from the national statistical office. Incidence, case fatality rate(s) (CFR), and mortality rate(s) (MR) were calculated for the whole population and for age groups.
Incidence (303/100,000/year), CFR (3.6 %), and MR (11/100,000/year) of TBI in Austria are comparable with those from other European countries. We found a high rate of geriatric TBI. The ratio between male and female cases was 1.4:1 for all cases, and was 2.2:1 for fatal cases. The most common mechanism was falls; traffic accidents accounted for only 7 % of the cases. Males died more frequently from traffic accidents and suicides, and females died more frequently from falls. CFRs and MRs increased with increasing age. CFRs were higher in patients from less populated areas, and MRs were lower in cases who lived closer to hospitals that admitted TBI.
The high rate of geriatric TBI warrants better prevention of falls in this age group.
Wiener klinische Wochenschrift 11/2013; 126(1-2). DOI:10.1007/s00508-013-0456-6 · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The number of bacteria recovered from a stainless steel coupon after touching a pigskin substrate with an examination glove coated on its outside with polyhexanide (PHMB), as compared to the number of bacteria recovered in the same manner with non-coated control gloves was evaluated.
Suspensions containing 1 x 109 colony-forming units of 4 clinically relevant bacterial species (Enterococcus faecium ATCC #51559; Escherichia coli ATCC #25922; Klebsiella pneumoniae ATCC #4352; and Staphylococcus aureus ATCC #33591) were used to contaminate Gamma-irradiated pigskin substrates. Bacterial recoveries from the pigskin substrate, stainless steel coupons, and each glove swatch were performed. A difference in the bacterial recovery from the stainless steel coupons after touching with coated and uncoated control gloves was measured.
For E. faecium, the coated glove showed a reduction of 4.63 log10 cfu recovery, when compared to control gloves. For E. coli, the coated glove showed 5.48 log10 cfu, for K. pneumoniae 5.03 log10 cfu, and for S. aureus 5.72 log10 cfu recovery, when compared to the non-coated control glove.
An in-vitro experiment designed to mimic cross-contamination of clinically relevant bacteria in a simulated healthcare setting following glove contact with a contaminated biological surface and cross-transfer to a stainless steel surface has demonstrated that an examination glove coated on its outside surface with PHMB was able to reduce bacterial recovery from a contaminated surface by > 4 log10 cfu, compared to a control non-coated examination glove. These elaborated results may encourage further clinical investigation on the clinical impact of an antibacterial examination glove.
[Show abstract][Hide abstract] ABSTRACT: To analyse the association between the Glasgow Coma Scale (GCS) score at intensive care unit (ICU) discharge and the 1-year outcome of patients with severe traumatic brain injury (TBI).
Retrospective analysis of prospectively collected observational data.
Between 01/2001 and 12/2005, 13 European centres enrolled 1,172 patients with severe TBI. Data on accident, treatment and outcomes were collected. According to the GCS score at ICU discharge, survivors were classified into four groups: GCS scores 3-6, 7-9, 10-12 and 13-15. Using the Glasgow Outcome Scale (GOS), 1-year outcomes were classified as "favourable" (scores 5, 4) or "unfavourable" (scores <4). Factors that may have contributed to outcomes were compared between groups and for favourable versus unfavourable outcomes within each group.
Of the 538 patients analysed, 308 (57 %) had GCS scores 13-15, 101 (19 %) had scores 10-12, 46 (9 %) had scores 7-9 and 83 (15 %) had scores 3-6 at ICU discharge. Factors significantly associated with these GCS scores included age, severity of trauma, neurological status (GCS, pupils) at admission and patency of the basal cisterns on the first computed tomography (CT) scan. Favourable outcome was achieved in 74 % of all patients; the rates were significantly different between GCS groups (93, 83, 37 and 10 %, respectively). Within each of the GCS groups, significant differences regarding age and trauma severity were found between patients with favourable versus unfavourable outcomes; neurological status at admission and CT findings were not relevant.
The GCS score at ICU discharge is a good predictor of 1-year outcome. Patients with a GCS score <10 at ICU discharge have a poor chance of favourable outcome.
European Journal of Trauma and Emergency Surgery 06/2013; 39(3):285-292. DOI:10.1007/s00068-013-0269-3 · 0.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A flexible methacrylate powder dressing (Altrazeal®) transforms into a wound contour conforming matrix once in contact with wound exudate. We hypothesised that it may also serve as a drug delivery vehicle for antiseptics. The antimicrobial efficacy and influence on bacterial growth kinetics in combination with three antiseptics was investigated in an in vitro porcine wound model. Standardized in vitro wounds were contaminated with Staphylococcus aureus (MRSA; ATCC 33591) and divided into six groups: no dressing (negative control), methacrylate dressing alone, and combinations with application of 0.02% Polyhexamethylene Biguanide (PHMB), 0.4% PHMB, 0.1% PHMB + 0.1% betaine, 7.7 mg/mL Povidone-iodine (PVP-iodine), and 0.1% Octenidine-dihydrochloride (OCT) + 2% phenoxyethanol. Bacterial load per gram tissue was measured over five days. The highest reduction was observed with PVP-iodine at 24 h to log10 1.43 cfu/g, followed by OCT at 48 h to log10 2.41 cfu/g. Whilst 0.02% PHMB resulted in a stable bacterial load over 120 h to log10 4.00 cfu/g over 120 h, 0.1% PHMB + 0.1% betaine inhibited growth during the first 48 h, with slightly increasing bacterial numbers up to log10 5.38 cfu/g at 120 h. These results indicate that this flexible methacrylate dressing can be loaded with various antiseptics serving as drug delivery system. Depending on the selected combination, an individually shaped and controlled antibacterial effect may be achieved using the same type of wound dressing.
International Journal of Molecular Sciences 05/2013; 14(5):10582-10590. DOI:10.3390/ijms140510582 · 2.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Paromomycin is used for selective bowel decontamination (SBD) in patients undergoing bone marrow transplantation in many hospitals, but there are no published resistance data for this compound in the recent medical literature. The aim of this study was to investigate the in vitro activity of paromomycin against the common intestinal bacteria E. coli and P. aeruginosa.
Methods: 94 E. coli isolates and 77 P. aeruginosa isolates derived from clinical specimens were tested by broth microdilution against paromomycin and amikacin, respectively, following the CLSI recommendations for testing amikacin.
Results: 86 of 94 E. coli isolates (91%) and 71 of 77 P. aeruginosa isolates (92%) showed in vitro susceptibility to amikacin (MIC90 for both compounds: 16 µg/ml, range: 1–32 µg/ml for E. coli and 1–>128 µg/ml for P. aeruginosa). Paromomycin was active against 83/94 E. coli isolates (88%; MIC90: 32 µg/ml, range: 2–>128 µg/ml), but showed poor in vitro activity against P. aeruginosa (3/77 isolates susceptible [4%]; MIC90: >128 µg/ml, range: 2–>128 µg/ml).
Conclusion: If SBD with inclusion of an aminoglycoside antibiotic is applied, paromomycin should not be used unless local resistance data provide evidence of a sufficient in vitro activity of this compound against P. aeruginosa.
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Literature does not provide any reliable comparison between angular stable plate fixation and rigid nail fixation for stabilization of supracondylar periprosthetic femoral fractures. Thus, the purpose of this study was to compare these two implants in clinical practice relating to fracture healing, functional results and treatment-related complications.
Patients and methods:
In this retrospective study (level IV), clinical and radiographic records of 86 patients (62 female and 24 male, average age: 75.6) with supracondylar periprosthetic femoral fractures between 1996 and 2010 were analyzed. 48 patients underwent lateral plate fixation by an angular stable plate system (LISS), whereas 38 patients were stabilized by a rigid interlocking nail device.
Sixty-four (76 %) patients returned to their pre-injury activity level and were satisfied with their clinical outcome. We had an overall Oxford outcome score of 2.21, with patients following angular stable plate fixation of 2.22, and patients after rigid nail fixation of 2.20. Successful fracture healing within 6 months was achieved in 74 (88 %) patients. Comparing between plate fixation and nail fixation, statistical analysis did not reveal any significant differences. Overall, we had a relatively high rate of fracture healing and a satisfactory functional outcome with both implants. Both methods of fixation showed similar results relating to the functional outcome and individual satisfaction of the patients. However, with regards to fracture healing and treatment-related complications, intramedullary nail fixation showed slight advantages.
Archives of Orthopaedic and Trauma Surgery 04/2013; 133(7). DOI:10.1007/s00402-013-1730-9 · 1.60 Impact Factor