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Antibiotics
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Optimizing Empirical Antibiotic Therapy in Critical Care: Innovations in Diagnostics,...
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Optimizing Empirical Antibiotic Therapy in Critical Care: Innovations in Diagnostics, Digitalization, and Stewardship

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: 30 November 2026 | Viewed by 1950

Special Issue Editors

Dr. Mircea Stoian

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Guest Editor
Department of Anesthesiology and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, 540139 Targu Mures, Romania
Interests: critical care medicine; sepsis and septic shock; acute respiratory distress syndrome (ARDS); healthcare-associated infections (HAIs); artificial nutrition in critically ill patients
Special Issues, Collections and Topics in MDPI journals
Dr. Daniela C. Pasero

E-Mail Website
Guest Editor
Anaesthesiology and Intensive Care Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
Interests: infection control; sepsis/septic shock and biomarkers; mechanical ventilation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In the context of increasing antimicrobial resistance and the complex pathophysiology of critical illness, early and accurate initiation of empirical antibiotic therapy is essential for improving patient outcomes. This Special Issue welcomes contributions exploring the following:

  • Novel diagnostic approaches, including rapid molecular techniques, microbiome profiling, and biomarker-based tools for pathogen identification and antimicrobial susceptibility testing.
  • Digitalization and decision-support systems for real-time optimization of antibiotic regimens, integration of electronic health records, and AI-assisted treatment selection.
  • Innovative therapeutic strategies, encompassing new antibiotics, combination therapies, and targeted interventions to minimize the development of resistance.
  • Antimicrobial stewardship programs specifically designed for intensive care settings, with a focus on reducing polypharmacy, avoiding unnecessary broad-spectrum coverage, and personalizing treatment duration.
  • Translational and clinical studies that assess the impact of these innovations on patient survival, infection control, and healthcare resource utilization.

Original research articles, systematic reviews, meta-analyses, and expert perspectives are encouraged. Multidisciplinary contributions from intensivists, infectious disease specialists, microbiologists, pharmacologists, and health informatics experts are especially welcome.

Dr. Mircea Stoian
Dr. Daniela C. Pasero
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 250 words) can be sent to the Editorial Office for assessment.

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

  • critical care
  • intensive care units
  • empirical antibiotic therapy
  • antimicrobial stewardship
  • rapid molecular diagnostics
  • digital health
  • artificial intelligence
  • antimicrobial resistance
  • targeted therapy
  • polypharmacy reduction
  • novel antibiotics
  • sepsis management

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (2 papers)

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Research

18 pages, 962 KB  
Article
Six Years of Acinetobacter Species in Critical Care: Carbapenem Resistance and Non-Susceptibility, Clinical Outcomes, and Lessons for Stewardship
by Mircea Stoian, Leonard Azamfirei, Andrei Claudiu Stângaciu, Stefan Manea, Danusia Onisor, Andrei Manea, Andrei Cora, Alina Danilesco, Adrian Man and Adina Stoian
Antibiotics 2026, 15(3), 267; https://doi.org/10.3390/antibiotics15030267 - 4 Mar 2026
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Abstract
Background: Acinetobacter spp., particularly A. baumannii, is a major intensive care unit (ICU) pathogen frequently associated with carbapenem non-susceptibility and delayed initiation of receipt of therapy. Methods: We conducted a single-center retrospective ICU cohort study in Romania (January 2019–December 2024) [...] Read more.
Background: Acinetobacter spp., particularly A. baumannii, is a major intensive care unit (ICU) pathogen frequently associated with carbapenem non-susceptibility and delayed initiation of receipt of therapy. Methods: We conducted a single-center retrospective ICU cohort study in Romania (January 2019–December 2024) of adults with clinical cultures positive for Acinetobacter spp. (first isolate per patient). Susceptibility was interpreted per EUCAST. We assessed species distribution, carbapenem non-susceptibility, receipt of at least one in vitro active empiric agent, time to active therapy (TTAT, from index culture collection), early inflammatory biomarkers [neutrophile-to-lymphocyte ratio (NLR) and C-reactive protein (CRP)], and 30-day mortality. Predictors of mortality were evaluated using multivariable logistic regression and receiver operating characteristic (ROC) analysis. Results: A total of 234 episodes were included; A. baumannii accounted for 87.6% (205/234). Carbapenem non-susceptibility among Acinetobacter spp. isolates was 89.3% (209/234). Empiric antibiotics were initiated within 24 h in 95.7% of patients (224/234), yet only 49.6% (116/234) received at least one empiric agent later confirmed to be active. TTAT was 6 days (IQR 4–7), and active therapy within 72 h occurred in 8.5% (20/234). Thirty-day mortality was 73.1% (171/234) and did not differ between carbapenem non-susceptible (EUCAST I + R) and carbapenem-susceptible (EUCAST S) A. baumannii episodes (73.2% vs. 72.0%, p = 1.00). In multivariable analysis, age was independently associated with mortality (OR 1.36 per 10-year increase, 95% CI 1.04–1.90), with acceptable model discrimination (area under the curve = 0.74). Early NLR and CRP did not differ between carbapenem non-susceptible and carbapenem-susceptible A. baumannii episodes. Conclusions: In this ICU cohort, A. baumannii was the predominant species, and carbapenem non-susceptibility was highly prevalent. Despite early empiric therapy, receipt of at least one in vitro active agent was often delayed, and early inflammatory biomarkers had limited discriminatory value. These findings support locally tailored empiric strategies informed by local epidemiology and reinforce the need for improved diagnostics and stewardship interventions in high-burden ICU settings. Full article
(This article belongs to the Special Issue Optimizing Empirical Antibiotic Therapy in Critical Care: Innovations in Diagnostics, Digitalization, and Stewardship)
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18 pages, 1059 KB  
Article
The Resistance Paradox in COVID-19 Ventilator-Associated Pneumonia: A Retrospective Study on Rapid Molecular Stewardship
by Andrei Mihai Bălan, Tudor-Mihai Magdaș, Andrada Elena Urda-Cîmpean, Constantin Bodolea, Andrada Nemeș, Lucreția Avram, Dana Crișan and Sebastian Trancă
Antibiotics 2026, 15(3), 236; https://doi.org/10.3390/antibiotics15030236 - 24 Feb 2026
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Abstract
Background/Objectives: The COVID-19 pandemic complicated the diagnosis of Ventilator-Associated Pneumonia (VAP), leading to empiric antibiotic overuse due to the difficulty in distinguishing viral progression from bacterial superinfection. However, it remains unclear whether COVID-19-associated VAP displays a distinct antimicrobial resistance profile compared to classical [...] Read more.
Background/Objectives: The COVID-19 pandemic complicated the diagnosis of Ventilator-Associated Pneumonia (VAP), leading to empiric antibiotic overuse due to the difficulty in distinguishing viral progression from bacterial superinfection. However, it remains unclear whether COVID-19-associated VAP displays a distinct antimicrobial resistance profile compared to classical VAP. Methods: This monocentric, retrospective cohort study primarily investigated differences in clinical phenotypes and antibiotic resistance profiles between patients with VAP-COVID (n = 26) and non-COVID-VAP (n = 26). Logistic regression was used to identify factors associated with the COVID-19 phenotype and predictors of antimicrobial resistance. As a secondary objective, we evaluated the diagnostic efficacy of a multiplex Point-of-Care PCR (POC-PCR) system (n = 22) compared to standard culture (n = 26) regarding turnaround time and resistance detection. Results: Patients with VAP-COVID exhibited significantly higher resistance rates to carbapenems (76.9% vs. 50%, p = 0.04) and fluoroquinolones (88.5% vs. 61.5%, p = 0.02) despite fewer traditional risk factors at admission. The clinical profile of the VAP-COVID group was distinguished by a significantly lower incidence of parapneumonic pleural effusion (19.2% vs. 84.6%, p < 0.001) and a higher median Neutrophil-to-Lymphocyte Ratio (41.36 vs. 9.63, p < 0.001). Regarding diagnostic speed, POC-PCR significantly reduced the time to result validation compared to standard culture (~1 h vs. ~62.5 h, p < 0.001). Conclusions: VAP in COVID-19 patients presents a distinct microbiological profile characterized by higher antimicrobial resistance. In this context, the integration of rapid molecular diagnostics may support earlier microbiological guidance compared to standard methods. Full article
(This article belongs to the Special Issue Optimizing Empirical Antibiotic Therapy in Critical Care: Innovations in Diagnostics, Digitalization, and Stewardship)
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