Objective To investigate the prevalence of postoperative delirium (POD) in elderly patients undergoing major orthopedic surgery and analyze its influencing factors, so as to provide evidence for early screening and intervention of POD. Methods The medical records of elderly patients undergoing major orthopedic surgery in the Department of Orthopaedics of the First Medical Center, Chinese PLA General Hospital between January 2021 and December 2022 were retrospectively collected. The included patients were divided into POD group and non-POD group. The patients’ demographic characteristics, medical history, laboratory indicators, perioperative medication, intraoperative and postoperative indicators were collected to analyze the risk factors affecting POD. Results A total of 455 elderly patients were included. Among them, there were 75 cases in the POD group and 380 cases in the non-POD group. The incidence of POD was 16.5% (75/455). There were statistically significant differences in age, body mass index, number of combined underlying diseases≥3, albumin<35 g/L, American Society of Anesthesiologists (ASA) classification, intraoperative blood loss≥200 mL, intraoperative blood transfusion, postoperative Visual Analogue Scale (VAS) score, indwelling catheters, admission to intensive care unit (ICU), and length of ICU stay between the two groups (P<0.05). The results of logistic regression analysis showed that age≥79 years, number of combined underlying diseases≥3, albumin<35 g/L, intraoperative blood loss≥200 mL, ASA grade≥Ⅲ, postoperative VAS score, and postoperative admission to ICU (P<0.05) were independent influencing factors for POD occurrence in elderly patients undergoing major orthopedic surgery. Conclusions POD is one of the common postoperative complications in elderly patients undergoing major orthopedic surgery. Age≥79 years, number of combined underlying diseases≥3, albumin<35 g/L, intraoperative blood loss≥200 mL, ASA grade≥Ⅲ, postoperative VAS score, and postoperative admission to ICU are independent risk factors for POD in elderly patients undergoing major orthopedic surgery. Clinical staff should evaluate and screen these factors early and take preventive measures to reduce the incidence of POD.
Objective To perform rapid antimicrobial susceptibility testing (RAST) on positive blood cultures of Enterobacterales using a total laboratory automation (TLA) system following both Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) standards, and to evaluate the two RAST methods. Methods Positive blood culture bottles growing Enterobacterales [54 Escherichia coli (E. coli) and 60 Klebsiella pneumoniae (K. pneumoniae) isolates] were collected at West China Hospital of Sichuan University between April and August 2022. CLSI RAST (8 and 16 h) and EUCAST RAST (4, 6, and 8 h) were performed using the TLA system, and results were compared with Vitek 2 antimicrobial susceptibility testing. Results CLSI RAST demonstrated lower categorical agreement with Vitek 2 (E. coli: 66.7% at 8 h, 81.9% at 16 h; K. pneumoniae: 72.8% at 8 h, 84.0% at 16 h) and tended to overcall resistance. EUCAST RAST showed increasing zone readability over time and high categorical agreement with Vitek 2 (E. coli: 97.1%, 96.2%, and 96.1% at 4, 6, and 8 h, respectively; K. pneumoniae: 96.1%, 97.1%, and 97.9% at 4, 6, and 8 h, respectively), as well as low error rates (major errors <3%). With the exception of ciprofloxacin, both the readability and categorical agreement for each antimicrobial agent against E. coli at 8 h were favorable (>90%). Similarly, for K. pneumoniae, the readability and categorical agreement for each antimicrobial agent at 8 h also demonstrated good performance (>90%). Conclusions According to CLSI-M52 criteria, EUCAST RAST at 4, 6, and 8 h shows equivalent performance to Vitek 2. Except for ciprofloxacin against E. coli, all antimicrobials tested at 8 h exhibit good readability and categorical agreement (>90%). CLSI RAST has lower categorical agreement and a higher tendency to interpret isolates as resistant.