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Antibiotics
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Antibiotics in the Critically Ill Patient
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Antibiotics in the Critically Ill Patient

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (28 February 2025) | Viewed by 8663

Special Issue Editors

Dr. Emanuele Russo

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Guest Editor
Anesthesia and Intensive Care, Ospedale Maurizio Bufalini di Cesena, 47521 Cesena, Italy
Interests: intensive care unit; critical care; neurocritical care; infection control; epidemiology; bioethics, resources management
Dr. Vanni Agnoletti

E-Mail Website
Guest Editor
Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL Romagna, 47521 Cesena, Italy
Interests: dynamics of infection; evolution; anesthesia; airway management; intensive care; healthcare management
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Fausto Catena

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Guest Editor
Department of Emergency Surgery and Trauma, Bufalini Hospital, AUSL Romagna, 47521 Cesena, Italy
Interests: acute care surgery; infections; trauma; emergency general surgery; intra-abdominal infections
Special Issues, Collections and Topics in MDPI journals
Dr. Bruno Viaggi

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Guest Editor
Neurointensive Care Unit, Department of Anesthesiology, Careggi University Hospital, Florence, Italy
Interests: intensive care; infections; microbiology

Special Issue Information

Dear Colleagues,

Infectious issues have always been a major concern in the management of critically ill patients. Clinical features and the derangement of several physiological and pharmacological traits require a distinctive and careful approach.

As a result, intensivist physicians developed a high level of interest in the area of infections and an aptitude for multidisciplinary dialogue with microbiologists, infectious disease specialists, pharmacologists, and all professionals involved in these topics.

The introduction in clinical practice of molecular biology techniques and the release of a dozen new antibiotic molecules are leading to rapid generational change in the diagnostic/therapeutic paradigm.

The implementation of new tests and drugs into clinical practice requires high levels of understanding.

Furthermore, intensive care units have been overloaded over the past 3 years by the SARS-CoV-2 pandemic. COVID-19 patients, in addition to logistical problems, suffer from a high prevalence of bacterial over-infections, which are extremely difficult to diagnose and treat. The SARS-CoV-2 pandemic, therefore, led to the suspension of antimicrobial stewardship programs and the spread of multidrug-resistant germs in intensive care units.

Hence, we believe that a Special Issue of Antibiotics focusing on critically ill patients is of great significance. The aim is to report research, experiences, works, ideas, and strategies on these topics. We are looking for papers about innovative diagnostic techniques, recently introduced molecules, pharmacodynamic/pharmacokinetic features, epidemiological data, risk stratification strategy, and multidrug-resistant bacteria management.

Dr. Emanuele Russo
Dr. Vanni Agnoletti
Dr. Fausto Catena
Dr. Bruno Viaggi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • antimicrobial stewardship
  • intensive care unit
  • ventilator-associated pneumonia
  • antibiotic therapy
  • antibiotic therapy
  • PK/PD
  • molecular microbiology testing
  • critically ill patient

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Published Papers (4 papers)

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Research

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14 pages, 1985 KiB  
Article
Role of Rifaximin in the Prognosis of Critically Ill Patients with Liver Cirrhosis
by Zhaohui Bai, Congcong Li, Yongjie Lai, Xiaojuan Hu, Luwen Shi, Xiaodong Guan and Yang Xu
Antibiotics 2025, 14(3), 287; https://doi.org/10.3390/antibiotics14030287 - 10 Mar 2025
Viewed by 832
Abstract
Background/Objectives: Critically ill patients with liver cirrhosis impose a substantial health burden on the world. Rifaximin is a potential treatment option for such patients. Methods: We extracted critically ill patients with liver cirrhosis from the Medical Information Mart for Intensive Care [...] Read more.
Background/Objectives: Critically ill patients with liver cirrhosis impose a substantial health burden on the world. Rifaximin is a potential treatment option for such patients. Methods: We extracted critically ill patients with liver cirrhosis from the Medical Information Mart for Intensive Care (MIMIC) IV database. Based on study outcomes, the current study included prevention and treatment cohorts. A 1:1 propensity score matching (PSM) analysis was performed to match the characteristics of patients. The risk of ICU admission and intensive care unit (ICU), in-hospital, 90-day, and 180-day death were explored. Cox regression analyses were conducted, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. Kaplan-Meier curves were further drawn to demonstrate the cumulative 90-day and 180-day survival rate. Results: Overall, 5381 critically ill patients with liver cirrhosis were included. In the prevention cohort, rifaximin could decrease the risk of ICU admission (HR = 0.427, 95%CI: 0.338–0.539, p < 0.001). In the treatment cohort, rifaximin could decrease the risk of ICU (HR = 0.530, 95%CI: 0.311–0.902, p = 0.019) and in-hospital death (HR = 0.119, 95%CI: 0.033–0.429, p = 0.001) in critically ill patients with liver cirrhosis. However, rifaximin could not decrease the risk of 90-day (HR = 0.905, 95%CI: 0.658–1.245, p = 0.541) and 180-day (HR = 1.043, 95%CI: 0.804–1.353, p = 0.751) death in critically ill patients with liver cirrhosis. Kaplan-Meier curve analyses also showed that rifaximin could not significantly decrease the 90-day (p = 0.570) and 180-day (p = 0.800) cumulative mortality. Conclusions: This study suggests that rifaximin can significantly decrease the risk of ICU admission and improve short-term survival but does not impact long-term survival in critically ill patients with liver cirrhosis. Full article
(This article belongs to the Special Issue Antibiotics in the Critically Ill Patient)
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18 pages, 2139 KiB  
Article
Interprofessional Therapeutic Drug Monitoring of Piperacillin/Tazobactam Enhances Care for Patients with Acute-on-Chronic Liver Failure in the ICU: A Retrospective Observational Pilot Study
by Stephan Schmid, Katharina Zimmermann, Chiara Koch, Patricia Mester, Georgios Athanasoulas, Jonas Buttenschoen, Daniel Fleischmann, Sophie Schlosser-Hupf, Vlad Pavel, Tobias Schilling, Martina Müller and Alexander Kratzer
Antibiotics 2025, 14(2), 202; https://doi.org/10.3390/antibiotics14020202 - 14 Feb 2025
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Abstract
Background: Acute-on-chronic liver failure (ACLF) is a severe, rapidly progressing syndrome in patients with liver cirrhosis, often triggered by bacterial infections. Piperacillin/Tazobactam is a key antibiotic in this setting, and therapeutic drug monitoring (TDM) helps optimize its dosing. This study evaluates the impact [...] Read more.
Background: Acute-on-chronic liver failure (ACLF) is a severe, rapidly progressing syndrome in patients with liver cirrhosis, often triggered by bacterial infections. Piperacillin/Tazobactam is a key antibiotic in this setting, and therapeutic drug monitoring (TDM) helps optimize its dosing. This study evaluates the impact of an interprofessional TDM strategy for Piperacillin/Tazobactam in ACLF patients in the ICU. Methods: This retrospective ICU study evaluated an interprofessional TDM approach for optimizing Piperacillin/Tazobactam dosing in critically ill ACLF patients. The team, consisting of physicians, clinical pharmacists, and staff nurses, engaged in shared decision making, collaboratively interpreting TDM results and adjusting the dosing accordingly. This study included 26 patients with ACLF who underwent initial TDM and 7 who received follow-up TDM. Piperacillin/Tazobactam dosing was modified based on TDM recommendations, with serum concentrations measured weekly. Adherence to and the implementation of interprofessional dosing recommendations were systematically analyzed to assess the impact of this approach. Results: The initial TDM showed that 30.8% of patients had Piperacillin/Tazobactam levels within the target range, while 53.8% were above and 15.4% below. The interprofessional team recommended dose reductions in seven patients, increases in three, and no change in eleven, with five requiring antibiotic modifications. At the first follow-up TDM, 20.0% reached target levels, while 80.0% remained above, with no subtherapeutic cases. The team recommended one further dose reduction and maintained dosing in four patients. All recommendations were fully implemented, demonstrating strong adherence to the collaborative protocol. Conclusions: The interprofessional TDM strategy optimized Piperacillin/Tazobactam dosing in ACLF patients with full adherence to the recommendations. This collaborative approach improves outcomes and supports global efforts to curb antibiotic resistance. Full article
(This article belongs to the Special Issue Antibiotics in the Critically Ill Patient)
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Review

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12 pages, 256 KiB  
Review
Source Control and Antibiotics in Intra-Abdominal Infections
by Raffaele Bova, Giulia Griggio, Carlo Vallicelli, Giorgia Santandrea, Federico Coccolini, Luca Ansaloni, Massimo Sartelli, Vanni Agnoletti, Francesca Bravi and Fausto Catena
Antibiotics 2024, 13(8), 776; https://doi.org/10.3390/antibiotics13080776 - 16 Aug 2024
Cited by 1 | Viewed by 2494
Abstract
Intra-abdominal infections (IAIs) account for a major cause of morbidity and mortality, representing the second most common sepsis-related death with a hospital mortality of 23–38%. Prompt identification of sepsis source, appropriate resuscitation, and early treatment with the shortest delay possible are the cornerstones [...] Read more.
Intra-abdominal infections (IAIs) account for a major cause of morbidity and mortality, representing the second most common sepsis-related death with a hospital mortality of 23–38%. Prompt identification of sepsis source, appropriate resuscitation, and early treatment with the shortest delay possible are the cornerstones of management of IAIs and are associated with a more favorable clinical outcome. The aim of source control is to reduce microbial load by removing the infection source and it is achievable by using a wide range of procedures, such as definitive surgical removal of anatomic infectious foci, percutaneous drainage and toilette of infected collections, decompression, and debridement of infected and necrotic tissue or device removal, providing for the restoration of anatomy and function. Damage control surgery may be an option in selected septic patients. Intra-abdominal infections can be classified as uncomplicated or complicated causing localized or diffuse peritonitis. Early clinical evaluation is mandatory in order to optimize diagnostic testing and establish a therapeutic plan. Prognostic scores could serve as helpful tools in medical settings for evaluating both the seriousness and future outlook of a condition. The patient’s conditions and the potential progression of the disease determine when to initiate source control. Patients can be classified into three groups based on disease severity, the origin of infection, and the patient’s overall physical health, as well as any existing comorbidities. In recent decades, antibiotic resistance has become a global health threat caused by inappropriate antibiotic regimens, inadequate control measures, and infection prevention. The sepsis prevention and infection control protocols combined with optimizing antibiotic administration are crucial to improve outcome and should be encouraged in surgical departments. Antibiotic and antifungal regimens in patients with IAIs should be based on the resistance epidemiology, clinical conditions, and risk for multidrug resistance (MDR) and Candida spp. infections. Several challenges still exist regarding the effectiveness, timing, and patient stratification, as well as the procedures for source control. Antibiotic choice, optimal dosing, and duration of therapy are essential to achieve the best treatment. Promoting standard of care in the management of IAIs improves clinical outcomes worldwide. Further trials and stronger evidence are required to achieve optimal management with the least morbidity in the clinical care of critically ill patients with intra-abdominal sepsis. Full article
(This article belongs to the Special Issue Antibiotics in the Critically Ill Patient)

Other

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17 pages, 594 KiB  
Systematic Review
Which Are the Best Regimens of Broad-Spectrum Beta-Lactam Antibiotics in Burn Patients? A Systematic Review of Evidence from Pharmacology Studies
by Gianpiero Tebano, Giulia la Martire, Luigi Raumer, Monica Cricca, Davide Melandri, Federico Pea and Francesco Cristini
Antibiotics 2023, 12(12), 1737; https://doi.org/10.3390/antibiotics12121737 - 14 Dec 2023
Cited by 1 | Viewed by 3418
Abstract
Background: Burn injury causes profound pathophysiological changes in the pharmacokinetic/pharmacodynamic (PK/PD) properties of antibiotics. Infections are among the principal complications after burn injuries, and broad-spectrum beta-lactams are the cornerstone of treatment. The aim of this study was to review the evidence for the [...] Read more.
Background: Burn injury causes profound pathophysiological changes in the pharmacokinetic/pharmacodynamic (PK/PD) properties of antibiotics. Infections are among the principal complications after burn injuries, and broad-spectrum beta-lactams are the cornerstone of treatment. The aim of this study was to review the evidence for the best regimens of these antibiotics in the burn patient population. Methods: We performed a systematic review of evidence available on MEDLINE (from its inception to 2023) of pharmacology studies that focused on the use of 13 broad-spectrum beta-lactams in burn patients. We extracted and synthetized data on drug regimens and their ability to attain adequate PK/PD targets. Results: We selected 35 studies for analysis. Overall, studies showed that both high doses and the continuous infusion (CI) of broad-spectrum beta-lactams were needed to achieve internationally-recognized PK/PD targets, ideally with therapeutic drug monitoring guidance. The most extensive evidence concerned meropenem, but similar conclusions could be drawn about piperacillin-tazobactam, ceftazidime, cefepime, imipenem-clinastatin and aztreonam. Insufficient data were available about new beta-lactam-beta-lactamase inhibitor combinations, ceftaroline, ceftobiprole and cefiderocol. Conclusions: Both high doses and CI of broad-spectrum beta-lactams are needed when treating burn patients due to the peculiar changes in the PK/PD of antibiotics in this population. Further studies are needed, particularly about newer antibiotics. Full article
(This article belongs to the Special Issue Antibiotics in the Critically Ill Patient)
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