Staphylococcus aureus is the main pathogen responsible for bone and joint infections worldwide and is also capable of causing pneumonia and other invasive severe diseases. Panton-Valentine leukocidin (PVL) and methicillin-resistant S. aureus (MRSA) have been studied as factors related with severity in these infections. The aims of this study were to describe invasive community-acquired S. aureus (CA-SA) infections and to analyse factors related to severity of disease. Paediatric patients (aged 0-16 years) who had a CA-SA invasive infection were prospectively recruited from 13 centres in 7 European countries. Demographic, clinical and microbiological data were collected. Severe infection was defined as invasive infection leading to death or admission to intensive care due to haemodynamic instability or respiratory failure. A total of 152 children (88 boys) were included. The median age was 7.2 years (interquartile range, 1.3-11.9). Twenty-six (17%) of the 152 patients had a severe infection, including 3 deaths (2%). Prevalence of PVL-positive CA-SA infections was 18.6%, and 7.8% of the isolates were MRSA. The multivariate analysis identified pneumonia (adjusted odds ratio (aOR) 13.39 (95% confidence interval (CI) 4.11-43.56); p 0.008), leukopenia at admission (<3000/mm(3)) (aOR 18.3 (95% CI 1.3-259.9); p 0.03) and PVL-positive infections (aOR 4.69 (95% CI 1.39-15.81); p 0.01) as the only factors independently associated with severe outcome. There were no differences in MRSA prevalence between severe and nonsevere cases (aOR 4.30 (95% CI 0.68- 28.95); p 0.13). Our results show that in European children, PVL is associated with more severe infections, regardless of methicillin resistance.

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Background: Chronic Hyperglycaemia with HBA1C is an indicator affecting postoperative care after CABG. AKI is one of the frequent postoperative complications after CABG, impacting short- and long-term outcomes. This research project will investigate the association between chronic hyperglycemia and post operative incidence of AKI requiring CRRT in CABG patients. Methods: A retrospective study was conducted from 1st January 2016 to 31st December 2019 who underwent isolated CABG in Institut Jantung Negara, Malaysia. Patients were divided into two groups; patients who have HbA1c ≤6 and patients who have HbA1c >6. Primary outcome measured were the incidence of AKI that leads to CRRT. Secondary outcome measured were, mortality, chest reopen, length of ICU stay and total hospital stay. Results: Total of 2019 patients were included. Baseline characteristic were measured. BMI, hypertension and high cholesterol were significantly higher in the HbA1c > 6. The rest of the baseline characteristic including age, smoking status and COPD status showed no significant differences in both groups. 17 patients (1.5% p<0.05) develop AKI which requires CRRT in the HbA1c>6 group, compare to 3 patient (0.3% p<0.05) in the HbA1c ≤6 group. There were no significant differences in mortality and chest reopen rates. However, ICU length of stay is longer in the HbA1c>6 group at 2.3 ±3.1 days p<0.05, compare to HbA1c ≤6 at 2.1±3 days p<0.05. Total length of post-op hospital stay was also higher in the HbA1c>6 group at 8.3 ± 6.6 days p<0.05, compare to HbA1c ≤6 at 7.6 ± 4.5 days p<0.05. Conclusion: This study suggests chronic hyperglycaemia defined on a single measurement of HbA1c >6 was associated with higher incidence of AKI requiring CRRT. Length of ICU and post-op hospital stay were higher in the HbA1c >6 group. This finding might implicate the importance of sugar control preoperatively, especially in diabetes patients.

Original Research Article Objective: Assessing the performance of European System for Cardiac Operative Evaluation (EuroSCORE) and EuroSCORE II. Method: 4145 patients who underwent cardiac surgery between 1 st January 2015 to 31 st December 2016 in Institut Jantung Negara (IJN) were included. The entire cohort and isolated coronary bypass graft (CABG) patients were analyzed by measuring the area under the receiver operating characteristic (ROC) curve for model discrimination and Hosmer-Lemeshow Chi-squared test for model calibration. Performance of both models was compared. Result: For the entire cohort, ROC curve for EuroSCORE was 0.679; EuroSCORE II was 0.615. For isolated CABG patients, ROC curve for EuroSCORE was 0.670; EuroSCORE II was 0.609. For the entire cohort, Hosmer-Lemeshow test showed no significant difference between expected and observed mortality according to EuroSCORE model (Chi-square = 5.284, P = 0.508) and EuroSCORE II model (Chi-square = 15.828, P = 0.050). For the isolated CABG patients, Hosmer-Lemeshow test showed no significant difference between expected and observed mortality according to EuroSCORE model (Chi-square = 5.365, P = 0.498) and EuroSCORE II model (Chi-square = 9.839, P = 0.276). For the entire cohort (Table 7), the observed and predicted mortality were 4.56% and 3.7% respectively for EuroSCORE; observed and predicted mortality were similar at 4.56% for EuroSCORE II. For isolated CABG patients (Table 8), the observed and predicted mortality were 3.62% and 3.36% respectively for EuroSCORE; the observed and predicted mortality were 3.62% and 3.97% respectively for EuroSCORE II. Conclusion: Despite poor discrimination under the ROC, the calibration of both models was good and acceptable to be used for risk prediction tools in our centre.