Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) have traditionally been considered prevalent pathogens in foot infections. Whether empiric therapy directed against these organisms is necessary, and in which specific patient population, remains unclear. The aim of this study was to identify risk factors to forecast the probability of isolating P. aeruginosa or MRSA in these infected wounds. We reviewed the records of 140 patients with infected chronic foot ulcers. Data on baseline demographic, clinical, surgical, microbiology, and treatment parameters were collected. Multivariable logistic regression models, validated via bootstrapping methods, were used to establish risk factors associated with isolation of these organisms. We then used these models to build predictive nomograms for clinical use, and to calculate sensitivity, specificity, positive and negative predictive values. A total of 307 bacterial isolates were identified, most frequently MRSA (24.3%). P. aeruginosa was found in 14.3% of these cultures. Amputation (OR 5.75, 95% CI 1.48–27.63) and renal disease (OR 5.46, 95% CI 1.43–25.16) were associated with higher P. aeruginosa isolation, whereas, diabetes (OR 0.07, 95% CI 0.01–0.34) and IDSA infection category >3 (OR 0.18, 95% CI 0.03–0.65) were associated with lower odds (Figure 1). Analysis for MRSA showed that amputation was associated with lower (OR 0.29, 95% CI 0.09–0.79) risk, while history of MRSA infection (OR 5.63, 95% CI 1.56–20.63) was associated with higher odds of isolating this organism (Figure 2). The models’ ability to discriminate was found to be reasonable to strong, as evidenced by the optimism-corrected C statistic of 0.81 and 0.69, respectively. We developed easy to use nomograms based on logistic regression models with strong predictive performances to forecast risk of drug-resistant pathogens. They may be used in clinical practice to judge the probability of isolating these two resistance prone organisms. Nomogram to predict probability of infections with P. aeruginosa Nomogram to predict probability of infections with MRSA All authors: No reported disclosures.
Hydrogels are three-dimensional materials that can withstand a great amount of water incorporation while maintaining integrity. This allows hydrogels to be very unique biomedical materials, especially for drug delivery. Much effort has been made to incorporate hydrophilic molecules in hydrogels in the field of drug delivery, while loading of hydrophobic drugs has not been vastly studied. However, in recent years, research has also been conducted on incorporating hydrophobic molecules within hydrogel matrices for achieving a steady release of drugs to treat various ailments. Here, we summarize the types of hydrogels used as drug delivery vehicles, various methods to incorporate hydrophobic molecules in hydrogel matrices, and the potential therapeutic applications of hydrogels in cancer.
