INFECTION OF intravascular catheters remains an important source of morbidity and mortality for critically ill patients.^1-5 New technology for the diagnosis and prevention of catheter-related bloodstream infection (CRBSI) is rapidly evolving.⁶ Antimicrobial-coated catheters, ionic silver cuffs, antibiotic-impregnated hubs, and intraluminal antibiotic locks have all been shown^6-10 to reduce the incidence of CRBSI in critically ill patients. However, these prevention strategies are expensive and might increase hospital costs. In the current health care economic climate, the clinical and economic benefit of this new technology must outweigh the increased costs. Population-specific attributable cost estimates for CRBSI will aid in the formal cost-effective analysis of new technology as it becomes available.

Degloving soft-tissue injuries are serious and debilitating conditions. Deciding on the most appropriate treatment is often difficult. However, their impact on patients' outcomes is frequently underestimated. We aimed to study the incidence, clinical presentation, management and outcome of degloving soft-tissue injuries. We conducted a narrative traditional review using the key words; degloving injury and soft-tissue injuries through search engines PubMed, Science Direct, and Scopus. There are several therapeutic options for treating degloving soft-tissue injuries; however, no evidence-based guidelines have been published on how to manage degloving soft-tissue injuries, although numerous articles outline the management of such injuries. Degloving soft-tissue injuries are underreported and potentially devastating. They require early recognition, and early management. A multidisciplinary approach is usually needed to ensure the effective rehabilitation of these patients.

Purpose: To review the epidemiology of microbial isolates from bile cultures taken from patients with and without cholangitis admitted to an Asian academic medical center in order to compare antimicrobial sensitivities and to make recommendations for empiric antimicrobial therapy of patients with cholangitis in the Philippines. Methods: Routine aerobic bile culture results and corresponding clinical abstracts of surgical patients admitted to an academic medical center over a three-year period were analyzed. Results: The series consisted of 125 patients, 77 with cholangitis (62%) and 48 (38%) without, which was determined according to the Tokyo Guidelines. Patients with cholangitis were significantly more likely to have positive bile cultures (p = 0.012). Gram-negative bacilli were the most common isolates in both patients with (94%) and patients without (95%) cholangitis. For both groups, Escherichia coli (36%) had greatest sensitivity to amikacin, cefepime, ceftriaxone, gentamicin, imipenem-cilastatin meropenem, and piperacillin-tazobactam; Klebsiella pneumoniae (16%) had greatest sensitivity to amikacin, cefepime, ceftriaxone, gentamicin, imipenem-cilastatin meropenem, and piperacillin-tazobactam; and Pseudomonas aeruginosa (12.5%) was most sensitive to cefepime, gentamicin, imipenem-cilastatin meropenem, and piperacillin-tazobactam. Conclusions: Gram-negative bacilli (or Enterobacteriaceae) ( E. coli, K. pneumoniae, P. aeruginosa, and Enterobacter cloacae ) were the most common aerobic microbial isolates in bile cultures from patients with cholangitis in the Philippines. Their antimicrobial susceptibility patterns suggest that imipenem-cilastatin (sensitivity 100%), meropenem (100%), amikacin (90–100%), cefepime (75%–100%), ceftriaxone (75%–100%), gentamicin (67%–100%), and piperacillin-tazobactam (50%–100%) would be the most effective antimicrobials for both groups. However, the authors echo the caution from the Surgical Infection Society/Infectious Diseases Society of America against using aminoglycosides as empiric drugs when safer and equally effective regimens are available.

Traumatic cardiac arrest studies have reported improved survival rates recently, ranging from 1.7-7.5%. This population-based nationwide study aims to describe the epidemiology, interventions and outcomes, and determine predictors of survival from out-of-hospital traumatic cardiac arrest (OHTCA) in Qatar. An observational retrospective population-based study was conducted on OHTCA patients in Qatar, from January 2010 to December 2015. Traumatic cardiac arrest was redefined to include out-of-hospital traumatic cardiac arrest (OHTCA) and in-hospital traumatic cardiac arrest (IHTCA). A total of 410 OHTCA patients were included in the 6-year study period. The mean annual crude incidence rate of OHTCA was 4.0 per 100,000 population, in Qatar. OHTCA mostly occurred in males with a median age of 33. There was a preponderance of blunt injuries (94.3%) and head injuries (66.3%). Overall, the survival rate was 2.4%. Shockable rhythm, prehospital external hemorrhage control, in-hospital blood transfusion, and surgery were associated with higher odds of survival. Adrenaline (Epinephrine) lowered the odds of survival. The incidence of OHTCA was less than expected, with a low rate of survival. Thoracotomy was not associated with improved survival while Adrenaline administration lowered survival in OHTCA patients with majority blunt injuries. Interventions to enable early prehospital control of hemorrhage, blood transfusion, thoracostomy and surgery improved survival.