Introduction: To promote judicious prescribing of methicillin-resistant Staphylococcus aureus (MRSA)-active therapy for skin and soft tissue infections (SSTI), we previously developed an MRSA risk assessment tool. The objective of this study was to validate this risk assessment tool internationally. Methods: A multicenter, prospective cohort study of adults with purulent SSTI was performed at seven international sites from July 2016 to March 2018. Patient MRSA risk scores were computed as follows: MRSA infection/colonization history (2 points); previous hospitalization, previous antibiotics, chronic kidney disease, intravenous drug use, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), diabetes with obesity (1 point each). Predictive performance of MRSA
BackgroundAnti-MRSA antibiotic under- and overprescribing for ABSSSI is common. To address this, we previously developed an MRSA risk assessment tool using prior literature and patient data from a single health system in Detroit, Michigan, USA. The objective of this study was to validate this risk assessment tool internationally.MethodsMulticenter, international, prospective cohort study. Inclusion: age ≥ 18 y; purulent ABSSSI from July 2016 to March 2018. Exclusion: no culture; osteoarticular infection; bite wounds; odontogenic infections. Patient MRSA risk scores were computed using the following criteria (point value): previous MRSA infection/colonization (2); previous hospitalization (1); previous antibiotics (1); chronic kidney disease (1); intravenous drug use (1); HIV/AIDS (1); diabetes with obesity (1). The likelihood ratio of each patient’s score was used to convert local surveillance MRSA percentage (prior probability) into an individual patient estimated MRSA probability (posterior probability). The predictive performance of local surveillance MRSA percentage, MRSA risk score, and estimated MRSA probability were quantified using the area under the Receiver Operating Characteristic curve (aROC) and compared using the Hanley and McNeil method.Results203 patients from 7 international sites included. The most common infection types were wound (28.6%), abscess (25.1%), and cellulitis with an abscess (20.7%). MRSA was observed in 33% of patients and ranged from 10% in Beijing, CN to 58.8% in Mexico City, MX. MRSA was significantly more prevalent among patients with higher MRSA risk scores (Figure 1). The MRSA risk score aROC (95% CI) [0.748 (0.678–0.819)] was significantly greater than local surveillance MRSA percentage [0.646 (0.569–0.722)] (P = 0.016). The estimated MRSA probability aROC [0.781 (0.716–0.845)] was significantly greater than local surveillance MRSA percentage (P < 0.001) but not the MRSA risk score (P = 0.192). ConclusionThe MRSA risk score and estimated MRSA probability were significantly more predictive of MRSA ABSSSI compared with local MRSA surveillance percentage. Further study, including potential impact of this MRSA risk assessment tool on prescribing patterns are required before widespread application.Disclosures K. Claeys, Nabriva: Scientific Advisor, Consulting feeMelinta: Scientific Advisor, Consulting fee. M. Dryden, Motif BioSciences: Board Member, Consulting fee. M. J. Rybak, Allergan: Consultant, Grant Investigator and Speaker’s Bureau, Research grant and Research support. Achaogen: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support. Bayer: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support. Melinta: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support. Merck: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support. Theravance: Consultant, Grant Investigator and ...
Demostrar el impacto de la pandemia por SARS-CoV-2 en la formación de residentes de Cirugía General del Hospital General de México, para implementar nuevas estrategias de enseñanza. Material y métodos: Se realizó una búsqueda intencionada en la base de datos institucional de procedimientos quirúrgicos, identificando los realizados por los médicos residentes del servicio de Cirugía General de noviembre del 2019 a febrero del 2020, previo a la pandemia por SARS-CoV-2 y se comparó con los procedimientos realizados en marzo y abril del 2020, posterior al inicio de la pandemia. Resultados: Grupo 1: se encontraron 1,494 procedimientos quirúrgicos con la siguiente distribución: R1 = 279 (18.67%), R2 = 444 (29.71%), R3 = 531 (35.54%) y R4 = 240 (16.06%). Con el siguiente promedio mensual (n = 373.5): R1 = 69.75, R2 = 111, R3 = 133 y R4 = 60. Grupo 2: 42 procedimientos quirúrgicos con la siguiente distribución: R1 = 3 (7.14%), R2 = 19 (45.23%), R3 = 14 (33.33%) y R4 = 6 (14.28). Conclusiones: La pandemia por SARS-CoV-2 disminuyó el número de procedimientos a los que se exponen los residentes de las especialidades quirúrgicas, pudiendo desencadenar en una desaceleración en las competencias prácticas o, incluso, un retroceso.
Hernia supraforaminal profunda: una variante de hernia interparietal de la región inguinalDeep supraforaminal hernia or falx inguinalis (joint area): an undescribed variant of hernia from the inguinal region
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.