BACKGROUND:Blood administration sets are changed after a prescribed time interval with variations in guidelines. In Canada, sets are changed every 4 h based on the theory of potential bacterial attachment. This study aimed to investigate whether bacteria adhere to the inner surfaces of blood administration sets during mimicked transfusions of red blood cell concentrates (RBCCs). STUDY DESIGN AND METHODS:Serratia marcescens was used to test bacterial adhesion on a Primary PLUM Y-type Blood Set. Study phases (N ≥ 3): (i) RBCCs spiked with 10 CFU/mL and bacterial recovery after 4 h; (ii) and (iii) RBCCs spiked with 1 CFU/mL and bacterial recovery after 2 h (ii) and after 2 h and 24 h (iii); (iv) RBCCs inoculated with 0.1 CFU/mL and bacterial detection at 2-24 h. Bacterial adhesion was verified with dislodging, cultures, and scanning electron microscopy after completion of mimicked RBCC transfusions. RESULTS:At 10 CFU/mL, S. marcescens was recovered in one of three assays; however, at 1 CFU/mL, bacterial recovery after 2 h was minimal (one of six assays), although proliferation at 24 h was significant. With initial loads of 0.1 CFU/mL, bacteria were only detected at 8 and 24 h, and in the filter, in one of five trials. CONCLUSION:This pilot report provides evidence of bacterial growth in transfusion sets. Data obtained with S. marcescens indicate that the use of blood administration sets could be extended from 4 to ≥6 h after the infusion of the first RBCC with no impact on patient safety. These findings align with existing guidelines endorsing a longer interval between changes of blood product administration sets.
There are a number of guidelines on how to manage ischemic heart disease (IHD), but inconsistencies in healthcare access, varying infrastructure, resource constraints and diverse local practices restrict their global applicability. This underscores the need for universal recommendations that address the unique challenges faced by patients and healthcare providers worldwide. Our Global Guidelines emphasize the incorporation of novel therapies, while integrating standards of care with the most up-to-date evidence to enable clinicians to optimize IHD management. These Global Guidelines provide evidence-based recommendations that represent a group consensus considering the previously published guidelines that have reviewed many of the issues related to the management of IHD but have also provided recommendations on several issues where resource limitations may put constraints on the evaluation and treatments provided to patients with IHD. Such recommendations aim to guide situations when resources are somewhat limited or when resources are severely limited. Hence, this document presents a comprehensive update to IHD management guidelines, thereby aiming to provide a unified strategy for the management of IHD that is applicable to all cardiovascular care worldwide.
Objective:Neonatal late-onset sepsis is associated with increased mortality and morbidity, adversely impacting long-term outcome. The objective of this study was to examine neurodevelopmental (ND) outcomes at 18 to 24 months' corrected age (CA) in infants with late-onset bacterial sepsis (LOS) and to categorize outcomes based on type of bacterial pathogen in a cohort of preterm infants born less than 29 weeks gestation in Canada. Study Design:We conducted a retrospective cohort study of all non-anomalous infants born at <29 weeks gestational age (GA) who were admitted to Canadian NICUs, from January 1, 2010, to December 31, 2017, who had an ND assessment at 18 to 24 months' CA at Canadian Neonatal Follow-Up Network clinics. The primary outcome was the composite outcome of death or ND impairment (NDI). Secondary outcomes included significant NDI, and each component of primary outcome. We compared ND outcomes among infants with Gram-positive (GP) sepsis, Gram-negative (GN) sepsis, mixed sepsis, and no sepsis using bivariate and multivariate analyses after adjusting for potential confounders. Results:Of the 3,640 infants included, 823 (22.6%) developed LOS. Of the 823 infants, 569 (69.1%) had GP sepsis, 172 (20.9%) had GN sepsis, and 82 (10%) had mixed sepsis. Infants with LOS had significantly lower birth weight, GA, younger mothers, and significantly higher rates of major neonatal morbidities compared with the no-sepsis group. In multivariable logistic regression, infants with GN sepsis and mixed sepsis had significantly higher odds of death/NDI (GN sepsis, adjusted odds ratio [aOR] = 1.80; 95% CI: 1.27, 2.54; mixed LOS, aOR = 2.38, 95% CI: 1.41, 4.01) as compared with no sepsis. Conclusion:Late-onset bacterial sepsis, particularly Gram-negative and mixed sepsis, was associated with an increased risk of adverse outcomes including death or NDI at 18 to 24 months CA in infants born <29 weeks' GA in Canada. Key Points:· Late-onset sepsis is an important risk factor for morbidity and mortality in preterm infants.. · The clinical presentations vary depending on the causative bacteria.. · There is limited data on neurodevelopmental outcomes based on type of bacterial pathogen..
BACKGROUND:Little is known regarding pulmonary hypertension (PH) in adults with a systemic right ventricle. OBJECTIVES:This study evaluates the hemodynamic profile of PH in patients with transposition of great arteries palliated with an atrial switch repair (TGA-AS) and congenitally corrected TGA (CCTGA). METHODS:This was a retrospective cohort study of adults with TGA-AS or CCTGA who had undergone invasive hemodynamic assessment. Exclusion criteria were single ventricle anatomy, previous Rastelli, arterial switch, or double switch operation. PH was defined by a mean pulmonary artery pressure (mPAP) >20 mm Hg and subtypes according to 2022 European Society of Cardiology guidelines. The primary combined clinical endpoint was death, heart transplantation, or need for mechanical circulatory support. RESULTS:A total of 261 patients were studied (TGA-AS, n = 161 and CCTGA, n = 100). PH prevalence was similar in both groups (65% vs 69%, P = 0.74). PH subtype was precapillary in 24%, isolated postcapillary (IpcPH) 25%, combined postcapillary and precapillary 51% (similar in both groups). The relationship between pulmonary capillary wedge pressure and mPAP was overall similar between 2 groups but there was greater variability in pulmonary capillary wedge pressure once mPAP >40 mm Hg in the TGA-AS group. The incidence of the primary endpoint was similar in both groups (24 v 29%; P = 0.39). Factors associated with the primary clinical endpoint were elevated PVR (in particular, in the TGA-AS subgroup) and lower aortic pulsatility index (both groups). CONCLUSIONS:In this large study evaluating the hemodynamic phenotype in patients with a systemic RV referred for catheterization, PH was common and most commonly the combined postcapillary and precapillary subtype.
Purpose of review:The purpose of this commentary is to address the challenges of implementing the evolving Kidney Disease Improving Global Outcomes (KDIGO) glomerulonephritis (GN) guidelines within the Canadian health care context, highlighting barriers to adoption of the guidelines and discussing contextual issues unique to Canada. Sources of information:The KDIGO 2021 guidelines with 2024 updates in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis and lupus nephritis, as well as the 2025 updated guideline for immunoglobulin A (IgA) nephropathy. Methods:A Canadian Society of Nephrology (CSN) working group with expertise in GN was formed, representing nephrologists, pathologists, pharmacists, and patient partners with geographic representation from across Canada. Recommendations and practice points were reviewed by member surveys, with discussions to reach consensus and frame the commentary. Key findings:The commentary highlights diagnostic investigations, the role of immune treatments for primary glomerular diseases, and the growing role of conservative kidney therapies. Limitations:A review of the quality of evidence was not undertaken. Implementation and uptake of the guidelines will vary across each province given drug availability and cost. Implications:The commentary aims to provide tailored guidance to enhance the care of Canadians living with glomerular disease.
