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Study Design: Retrospective cohort study. Objective: Although surgical risk factors for developing spine surgical site infections (S-SSI) have been identified, the impact of such knowledge in its prevention has not been demonstrated. Methods: We evaluated in 500 patients undergoing spine surgery between 2011 and 2019 at Hospital 12 de Octubre the changes in S-SSI rates over time. Surgical variables independently related to S-SSI were analyzed by univariate and multivariate analysis using binary logistic regression models. A case-control sub-analysis (1:4), matched by the surgical variables identified in the overall cohort was also performed. Results: Twenty cases of S-SSI were identified (4%), with a significant decrease in the incidence rate across consecutive time periods (6.6% [2011-2014] vs.86% [2015-2019]; P -value <.0001)). Multivariate analysis identified arthrodesis involving sacral levels (odds ratio [OR]: 2.57; 95% confidence interval [95%CI]: 1.02-6.47; P- value =.044) and instrumentation over 4-8 vertebrae (OR: 2.82; 95%CI: 1.1-7.1; P- value =.027) as independent risk factors for S-SSI. The reduction in the incidence of S-SSI concurred temporally with a reduction in instrumentations involving 4-8 vertebrae (55% vs 21.8%; P- value <.0001) and sacral vertebrae (46.9% vs 24.6%; P -value <.0001) across both periods. The case-control analysis matched by these surgical variables failed to identify other factors independently related to the occurrence of S-SSI. Conclusions: Spinal fusion of more than 4 levels and the inclusion of sacral levels were independently related to the risk of S-SSI. Optimization of surgical techniques by reducing these two types of instrumentation could significantly reduce S-SSI rates. [ABSTRACT FROM AUTHOR]

There are three dimensions to consider in the profession of Social Education: knowledge, practice and ethics. While the former two have been widely developed, that of ethics has been largely ignored. Currently, there is an open theoretical debate on how to develop this ethical dimension, and this affects professionals in the field, who do not know how to incorporate it into their daily practice. This article aims to explore the ethical dimension and values involved in socio-educational relationships based on the discourses of scholars, professionals and participants or learners within the framework of Social Education. To this end, a qualitative research process was designed in two phases, namely, a systematic review of the academic literature and a multiple case study of four socio-educational relationships from two different fields of intervention: mental health and children at risk. The main findings of this study confirm that the dimension related to ethics and values plays a fundamental role in the socio-educational relationship, which will be useful when building an analytical framework to analyse said dimension. Finally, the study allows us to describe how social educators incorporate values into their daily practice, providing a snapshot of how this dimension of Social Education is currently evolving in the Spanish context. [ABSTRACT FROM AUTHOR]

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Background: Recent studies have reported an increased susceptibility to infection among vitamin D‐deficient kidney transplant (KT) recipients, although methodological concerns remain. Methods: Serum 25‐hydroxyvitamin D (25(OH)D) levels were measured in 246 KT recipients at post‐transplant months 1, 3, 6 and 12. Vitamin D status was analysed in terms of deficiency (Endocrine Society [<20 ng/mL] and Institute of Medicine [IoM, <12 ng/mL] criteria) and as a continuous variable. Cox models for overall, bacterial and opportunistic infection were adjusted for nutritional status and immunosuppression‐related covariates. Results: Median serum 25(OH)D increased from month 1 (10.5 ng/mL) to month 6 (16.3 ng/mL; P‐value = 0.001). Prevalence of vitamin D deficiency at month 1 ranged from 87.0% to 61.0% (depending on the diagnostic criteria) and significantly decreased over the next months. After adjustment for age and nutritional status, vitamin D deficiency (serum 25(OH)D < 12 ng/mL) at month 1 was an independent risk factor for overall (hazard ratio [HR]: 1.70; 95% confidence interval [CI]: 1.08‐2.69; P‐value = 0.023) and opportunistic infection (HR: 4.05; 95% CI: 1.57‐10.46; P‐value = 0.004), but not for bacterial infection. A protective effect for overall (adjusted HR: 0.76; 95% CI: 0.63‐0.93; P‐value = 0.007) and opportunistic infection (adjusted HR: 0.62; 95% CI: 0.45‐0.86; P‐value = 0.004) was observed when 25(OH)D levels were analyzed per one‐quartile increases. Conclusions: Vitamin D status influences the risk of infection among KT recipients, with the association being particularly evident for opportunistic events and mainly restricted to the early post‐transplant period. [ABSTRACT FROM AUTHOR]

There are scarce data on the efficacy of ertapenem in the treatment of bacteremia due to extended-spectrum-beta-lactamase (ESBL)-producing Enterobacterales (ESBL-E) in kidney transplant (KT) recipients. We evaluated the association between treatment with ertapenem or meropenem and clinical cure in KT recipients with nonsevere bacteremic urinary tract infections (B-UTI) caused by ESBL-E. We performed a registered, retrospective, international (29 centers in 14 countries) cohort study (INCREMENT-SOT, NCT02852902). The association between targeted therapy with ertapenem versus meropenem and clinical cure at day 14 (the principal outcome) was studied by logistic regression. Propensity score matching and desirability of outcome ranking (DOOR) analyses were also performed. A total of 201 patients were included; only 1 patient (treated with meropenem) in the cohort died. Clinical cure at day 14 was reached in 45/100 (45%) and 51/101 (50.5%) of patients treated with ertapenem and meropenem, respectively (adjusted OR 1.29; 95% CI 0.51 to 3.22; P  = 0.76); the propensity score-matched cohort included 55 pairs (adjusted OR for clinical cure at day 14, 1.18; 95% CI 0.43 to 3.29; P  = 0.74). In this cohort, the proportion of cases treated with ertapenem with better DOOR than with meropenem was 49.7% (95% CI, 40.4 to 59.1%) when hospital stay was considered. It ranged from 59 to 67% in different scenarios of a modified (weights-based) DOOR sensitivity analysis when potential ecological advantage or cost was considered in addition to outcome. In conclusion, targeted therapy with ertapenem appears as effective as meropenem to treat nonsevere B-UTI due to ESBL-E in KT recipients and may have some advantages.