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Reprints and Permissions. Buetti, N. Chlorhexidine-impregnated sponge versus chlorhexidine gel dressing for short-term intravascular catheters: which one is better?. Crit Care 24, Download citation. Received : 23 May Accepted : 12 July Published : 23 July Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative.
Skip to main content. Search all BMC articles Search. Download PDF. Research Open Access Published: 23 July Chlorhexidine-impregnated sponge versus chlorhexidine gel dressing for short-term intravascular catheters: which one is better? Methods Adult critically ill patients who required short-term central venous or arterial catheter insertion Impregnated With Pus recruited. Results A total of patients and catheters were observed in 16 intensive care units. Conclusions We described a similar infection risk for gel-dress and sponge-dress.
Trials registration These studies were registered within ClinicalTrials. Background Short-term central venous catheters CVCs are instrumental in the care of critically ill patients for the intravenous administration of fluid resuscitation, safe intravenous administration of medications, and support in the monitoring of hemodynamic parameters. Study catheters and dressings This post hoc analysis evaluated data from patients with short-term CVCs and ACs included in both studies.
Dressing disruption was defined by a leakage or soiling and led to an immediate dressing change. Statistical analysis Characteristics of patients and catheters were described as count percent or median interquartile range for qualitative and quantitative variables, respectively. Results Patients, catheters, and dressings Between anda total of patients, catheters, and 25, dressing changes were observed Fig. Full size image. Discussion Using high-quality data from two RCTs, this post hoc analysis Impregnated With Pus that the daily hazard rate of intravascular catheter infections was similar between gel-dress and sponge-dress.
Conclusions Using the largest dataset ever collected from large multicentered RCTs conducted with consistent catheter care, we illustrated that the infection risk was similar for gel-dress and sponge-dress. References 1. Google Scholar 2. Article Google Scholar 3. Article Google Scholar 4. Article Google Scholar 5. Article Google Scholar 6. Article Google Scholar 7. Article Google Scholar 8. Article Google Scholar Chapter Google Scholar View author publications.
Ethics declarations Ethics approval and consent to participate Both studies were approved by the national ethics committee. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Supplementary information. Additional file 1: Table S1.
About this article. Cite this article Buetti, N. Copy to clipboard. Contact us Submission enquiries: Access here and click Contact Us General enquiries: info biomedcentral. However, when carrying out infected bone resection, the completely negative resection margin is relatively difficult to be identified, which may lead to the residue of pathogens. Furthermore, the removal of infected bone sometimes causes the formation of dead space, which will be filled with hematoma soon and provide an environment for the growth of bacteria.
Muscle flap used to be Impregnated With Pus method to obliterate the defects caused by debridement, but it is limited when managing with deeper defects and may disturb the bone healing [ 13 ]. Local antibiotic delivery system has been widely used as an adjuvant after the surgical treatment of osteomyelitis and achieved good results [ 1415 ].
Compared with intravenous route, the local antibiotic delivery has the advantages of more accurate positioning, higher local concentration, less side effects and longer duration. At the same time, it works as a bone substitute which fills the dead space caused by bone resection and reduces the incidence of reinfection.
Polymethyl-methacrylate cement PMMA has acted as an antibiotic carrier to fill the defects caused by debridement since Buchholz successfully applied it in joint prosthesis. However, its non-biodegradable characteristics, the high temperature it produces and a second surgery for removal all limit its application on osteomyelitis especially in DFO [ 16 ]. Nowadays, biodegradable antibiotic-impregnated materials such as calcium sulfate, calcium phosphate, bioactive glasses and collagen are gradually applied as a substitute for PMMA in the management of osteomyelitis.
All materials mentioned above have advantages of biocompatibility and drug compatibility. Among those substitutes, calcium sulfate is most frequently used materials since it enjoyed some eminent advantages. This ideal elution duration makes it more available than collagen too short and calcium phosphate too long to be a bone graft.
Furthermore, it hardly produces the foreign body reaction and helps the formation of new bone. The complications of calcium sulfate are also acceptable, including postoperative drainage and transient hypercalcemia [ 17 ]. Previous studies had reported that satisfying outcomes could be received when using antibiotic-impregnated calcium sulfate as an adjuvant after surgical treatment of DFO. However, few comparative studies had been carried out to confirm those results.
This retrospective study was designed to observe the outcomes of surgical treatment combined with adjuvant antibiotic-impregnated calcium sulfate versus surgical treatment alone in the treatment of DFO and to compare the differences of healing rate, time to healing, osteomyelitis recurrence rate and amputation rate between two groups. This retrospective study focused on patients with DFO treated in our orthopedic department Impregnated With Pus January to June The main inclusion criteria were as follows: 1 patients with DFO underwent surgical bone resection alone or surgical bone resection combined with adjuvant antibiotic-impregnated calcium sulfate.
The main exclusion criteria included: 1 Patients received major amputation or non-surgical treatments. Finally, 46 patients with 48 infected limbs met the criteria were included in the study.
Before admitting to our department for surgical treatment, 46 patients 48 limbs with suspicious DFO suspected by clinical presentation and the active X-ray, MRI or probe-to-bone test results [ 7 ] were sampled using percutaneous bone biopsy [ 18 ] in our diabetic foot unit for culturing and histology test.
Preoperative antibiotic therapy was applied empirically after sampling in the first several days and tailored to culture and susceptibility findings. For patient with negative culture result but accompanied with the presentation of inflammation and positive of histology test, empirical antibiotics were adjusted according to the inflammatory markers. DFO are usually polymicrobial and Staphylococcus aureus has been proven as the most common pathogens in DFO [ 1920 ].
Thus, it is a necessity that empirical treatment of DFO should consist of antibiotics with activity against S. Depending on the calcium sulfate applied or not, 46 patients 48 limbs were divided into two groups: the CS group and the control group.
The characteristics of patients in two groups were presented in Table 1. All surgical procedures were carried out by two experienced surgeons. The surgical treatment performed as the resection of infected bones and removal of the necrotic soft tissues. Healthy bones and soft tissues were preserved as far as possible for minimizing the biomechanical changes and covering the wounds. For postoperative wounds care, patients were suggested to offload in involved limbs.
Routine dressings and skin moisturizers were applied every two days until wound healing or infection recurring. Once wounds achieving healing, patents were educated never walk in shoes that contributed to a foot ulcer. Customized insoles and shoes were recommended to reduce pressure transfer during follow-up. In this single-stage study, we defined the wound healing as complete epithelialization covered the wound and the absent of infection.
Non-healing was defined if the wound was infected before healing and was treated with a second operation or antibiotics. Osteomyelitis recurrence was defined if the appearance of bone infection was presented at the same or adjacent site after wound healing. Patients suffered from non-healing were excluded from the further calculation for recurrence rate even if the wounds eventually healed with subsequent therapy. Surgical procedures were carried out after spinal, nerve block or regional anesthesia.
In the CS group, necrotic granulation tissues, pus and infected soft tissues in the ulcers were removed until the bleeding tissue has been exposed.
Following the removal of ulcers or sinus, the bone procedures were carried out. If osteomyelitis was located in diaphyses, devitalized bones in the base of ulcers were exposed and excised to the level of healthy cancellous and cortical bone. If possible, the bases of metatarsal and phalangeal bones were necessary to be preserved for healthy tendons attaching.
When infections were located in interphalangeal or metatarsophalangeal joints, however, the joints as well as partial distal and proximal bones were needed to be excised. Fibrous tissues, fascia and tendons nearby were also completely removed in case the residue of pathogens. Following bones resection, the defects were irrigated with 0.
If necessary, Kirschner wires were adopted to maintain the bones stable. After removal of infected bones and necrotic soft tissues, antibiotic-impregnated calcium sulfate was prepared. Then they were dissolved with sterile saline solution and injected into the dead space range from 0. After operations, the Impregnated With Pus were sutured primarily without tension.
In the control group, patients received the same operation expect for the application of antibiotic-loaded calcium sulfate. Continuous variables which were verified of normal distribution and the homogeneity of variance were compared using Independent-Samples T Test; Continuous variables which failed to pass normality test were compared using a Mann—Whitney U test.
From to46 patients 48 limbs met the criteria were included in the study. The preoperative culture results were presented in Table 2. In control group, Staphylococcus aureus was the most common pathogen isolated by culture followed by Escherichia coli and Enterococcus faecalis. Twenty limbs The follow-up outcomes of two groups were presented in Table 3. Click here to see a video clip of a jigger-infested woman having difficulty in walking.
Click here to see a video clip of a jigger-infested trying to remove a jigger using a pin. Animals that may be carrying the fleas should also be treated. Victims and their families should also be educated on the need to observe hygiene. Wearing shoes should be encouraged to ensure Impregnated With Pus the flea does not find entry into ones feet.
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