Early clinical outcomes of two regimens of prophylactic antibiotics in cardiac surgical patients with delayed sternal closure

BACKGROUND Delayed sternal closure(DSC)can be a lifesaving approach for certain patients who have undergone cardiac surgery.The value of the type of prophylactic antibiotics in DSC is still debatable.AIM To investigate clinical outcomes of different prophylactic antibiotic regimens in patients who had DSC after cardiac surgery.METHODS This was a retrospective observational single-center study.Fifty-three consecutive patients who underwent cardiac surgery and had an indication for DSC were included.Patients were subjected to two regimens of antibiotics:Narrow-spectrum and broad-spectrum regimens.RESULTS The main outcome measures were length of hospital and intensive care unit(ICU)stay,duration of mechanical ventilation,and mortality.Of the 53 patients,12(22.6%)received narrow-spectrum antibiotics,and 41(77.4%)received broad-spectrum antibiotics.The mean age was 59.0±12.1 years,without significant differences between the groups.The mean duration of antibiotic use was significantly longer in the broad-spectrum than the narrowspectrum group(11.9±8.7 vs 3.4±2.0 d,P<0.001).The median duration of open chest was 3.0(2.0-5.0)d for all patients,with no difference between groups(P=0.146).The median duration of mechanical ventilation was significantly longer in the broad-spectrum group[60.0(Δinterquartile range(IQR)170.0)h vs 50.0(ΔIQR 113.0)h,P=0.047].Similarly,the median length of stay for both ICU and hospital were significantly longer in the broadspectrum group[7.5(ΔIQR 10.0)d vs 5.0(ΔIQR 5.0)d,P=0.008]and[27.0(ΔIQR 30.0)d vs 19.0(ΔIQR 21.0)d,P=0.031].Five(9.8%)patients were readmitted to the ICU and 18(34.6%)patients died without a difference between groups.CONCLUSION Prophylactic broad-spectrum antibiotics did not improve clinical outcomes in patients with DSC post-cardiac surgery but was associated with longer ventilation duration,length of ICU and hospital stays vs narrow-spectrum antibiotics.

Impact of COVID-19 pandemic on liver,liver diseases,and liver transplantation programs in intensive care units

Emerging worldwide data have been suggesting that coronavirus disease 2019(COVID-19)pandemic consequences are not limited to the respiratory and cardiovascular systems but encompass adverse gastrointestinal manifestations including acute liver injury as well.Severe cases of liver injury associated with higher fatality rates were observed in critically ill patients with COVID-19.Intensive care units(ICU)have been the center of disposition of severe cases of COVID-19.This review discusses the pathogenesis of acute liver injury in ICU patients with COVID-19,and analyzes its prevalence,consequences,possible drug-induced liver injury,and the impact of the pandemic on liver diseases and transplantation programs.

Insight into appropriate medication prescribing for elderly in the COVID-19 era

Coronavirus disease 2019(COVID-19)complicates clinical management in elderly population.There is an additional need to properly treat and monitor elderly COVID-19 patients.This paper discusses the inappropriate medication prescribing in the elderly and suggests an updated valid assessment tool considering COVID-19 and its treatment.