Hartford Hospital, Inc.

Sulbactam-durlobactam is a combination β-lactam/β-lactamase inhibitor antibiotic approved in the United States for the treatment of adult patients with hospital-acquired and ventilator-associated bacterial pneumonia due to susceptible isolates of Acinetobacter baumannii-calcoaceticus complex. A liquid chromatography tandem mass spectrometry method for the quantification of sulbactam and durlobactam in human plasma and aqueous matrices has been developed and validated. The standard curves for each drug were linear over the range 0.5 to 50 μg/mL and use the isotopic analogs sulbactam-d₅ and [¹³C₂, ¹⁵N₂]-durlobactam as internal standards for their respective analytes. This simple, reproducible method for the determination of sulbactam and durlobactam concentrations was developed with the intent to conduct future pharmacokinetic analyses and to guide clinical laboratories in the development of a therapeutic drug monitoring assay.

Historically, studies have identified a great saphenous vein (GSV) diameter of at least 3.0 mm for optimal durability following lower-extremity bypass. With the recent publication of BEST-CLI and BASIL-2 studies, we sought to compare patency and postoperative complications utilizing GSV conduit of <3.0 mm to veins ≥3.0 mm or alternative conduits from a single institution.

Patients with preoperative GSV vein mapping in an Intersocietal Accreditation Commission accredited vascular lab who underwent infrainguinal bypass surgery at a tertiary center were included. Vascular lab software was utilized to compare patient median GSV across at least 6 anatomic locations. Patients were separated and stratified based on median GSV size (both overall and limited to above- or below-knee GSV). Primary outcomes included postoperative complications, 30-day major adverse limb events, major adverse cardiac events, and patency at regular follow-up intervals.

From January 2016 to February 2022, 178 patients underwent bypass with preoperative vein mapping: 82 who received GSV<3.0 mm and 96 who received GSV≥3.0 mm. Patients were evenly distributed in demographics including proximal and distal targets. Median follow-up was 1.90 years. Overall, use of <3.0 mm GSV was not associated with inferior 1-year primary patency compared to ≥3.0 GSV (82.1 vs. 89.4%); however, there was a significant increase in postoperative creatinine unique to patients with GSV<3.0 mm alone (8.5% vs. 1.1%, P = 0.026). There were no differences in 30-day major adverse cardiac event or major adverse limb event between groups. In surveillance up to 3 years, patients who received GSV≥3.0 mm versus GSV<3.0 mm conduits had similar reintervention and amputation-free survival rates (P = 0.999).

Patients who received GSV bypasses <3.0 mm have the same mid-term patency, reintervention rates, and amputation-free survival as patients who received GSV≥3.0 mm. Use of smaller GSVs may require closer follow-up for acute kidney injury. Nonetheless, under appropriate circumstances, suboptimal GSV can be utilized for lower-extremity arterial bypass.

Depression and suicidal ideation rates among geriatric trauma patients admitted to the hospital are currently unknown. This study aimed to determine the prevalence of depressive symptoms, suicidal ideation and prior attempts, and lethal means access among older patients admitted to trauma centers in the United States. We hypothesized that a significant number of these patients may have unrecognized symptoms of depression and/or suicidal ideation not identified prior to hospital discharge.

These data are from a multicenter survey study of injured older (≥55 years) patients admitted to non-ICU inpatient trauma services at five US trauma centers. Patients were approached to complete a tablet-based survey with two components: (1) validated depression and suicidal ideation screening tool (PHQ-9) and (2) household firearm ownership.

From November 2022 through May 2024, five level 1 trauma centers in five states administered surveys to 408 patients, who were mostly male, White, and older than 70 years. Overall, more than one-third (34.8%) screened positive for depressive symptoms and nearly 40% kept a firearm at home. Twenty percent of those patients experiencing suicidal ideation kept a firearm in the home.

We identified high rates of depressive symptoms among older patients admitted to trauma centers, with one-third of patients having access to firearms in their home. Identifying depressive symptoms and suicidal ideation among patients admitted to trauma centers may allow for mental health intervention and lethal means safety counseling prior to hospital discharge.

Prognostic and Epidemiological; Level III.