Infection Diagnostics and Antimicrobial Therapy for Critical Patient

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 April 2025 | Viewed by 22661

Special Issue Editor


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Guest Editor
Asst Grande Ospedale Metropolitano Niguarda, Milan, Italy
Interests: infections in immunocomprmised hosts

Special Issue Information

Dear Colleagues,

A prompt and correct antibacterial therapy affects the mortality of critical patients. New diagnostic methods are available for a faster diagnosis than conventional techniques to start targeted antimicrobial therapy. Targeted therapy also reduces the risk of developing multidrug-resistant (MDR) bacteria. MDR bacteria are a major issue in many hospitals, especially in ICUs with in-hospital outbreaks and increased mortality. The development of MDR bacteria in ICUs is also due to the specific characteristics of critical patients (i.e., large volumes of distribution, multi organ failure, drug–drug interactions). The correct infusion of antibacterial (i.e., extended or continuous infusion) and therapeutic drug monitoring is fundamental. This Special Issue seeks manuscript submissions that further our understanding of diagnostic and antimicrobial therapy in critical patients. Submissions on new microbiological techniques (PCR: film array) in critical patients, adequate dosage of antibacterials in this setting with the support of therapeutic drug monitoring, and antibacterial therapy in difficult-to-treat bacteria in this setting (i.e., Stenotrophomonas, MDR Enterobacteria, Acinetobacter) are especially encouraged.

Kind regards

Dr. Giovanna Travi
Guest Editor

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Keywords

  • TDM (therapeutical drug monitoring)
  • bacterials array
  • septic shock
  • MDR (multi drug resistance)

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Published Papers (6 papers)

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Research

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17 pages, 835 KiB  
Article
A Machine Learning Approach to Determine Risk Factors for Respiratory Bacterial/Fungal Coinfection in Critically Ill Patients with Influenza and SARS-CoV-2 Infection: A Spanish Perspective
by Alejandro Rodríguez, Josep Gómez, Ignacio Martín-Loeches, Laura Claverias, Emili Díaz, Rafael Zaragoza, Marcio Borges-Sa, Frederic Gómez-Bertomeu, Álvaro Franquet, Sandra Trefler, Carlos González Garzón, Lissett Cortés, Florencia Alés, Susana Sancho, Jordi Solé-Violán, Ángel Estella, Julen Berrueta, Alejandro García-Martínez, Borja Suberviola, Juan J. Guardiola and María Bodíadd Show full author list remove Hide full author list
Antibiotics 2024, 13(10), 968; https://doi.org/10.3390/antibiotics13100968 - 14 Oct 2024
Viewed by 1258
Abstract
Background: Bacterial/fungal coinfections (COIs) are associated with antibiotic overuse, poor outcomes such as prolonged ICU stay, and increased mortality. Our aim was to develop machine learning-based predictive models to identify respiratory bacterial or fungal coinfections upon ICU admission. Methods: We conducted [...] Read more.
Background: Bacterial/fungal coinfections (COIs) are associated with antibiotic overuse, poor outcomes such as prolonged ICU stay, and increased mortality. Our aim was to develop machine learning-based predictive models to identify respiratory bacterial or fungal coinfections upon ICU admission. Methods: We conducted a secondary analysis of two prospective multicenter cohort studies with confirmed influenza A (H1N1)pdm09 and COVID-19. Multiple logistic regression (MLR) and random forest (RF) were used to identify factors associated with BFC in the overall population and in each subgroup (influenza and COVID-19). The performance of these models was assessed by the area under the ROC curve (AUC) and out-of-bag (OOB) methods for MLR and RF, respectively. Results: Of the 8902 patients, 41.6% had influenza and 58.4% had SARS-CoV-2 infection. The median age was 60 years, 66% were male, and the crude ICU mortality was 25%. BFC was observed in 14.2% of patients. Overall, the predictive models showed modest performances, with an AUC of 0.68 (MLR) and OOB 36.9% (RF). Specific models did not show improved performance. However, age, procalcitonin, CRP, APACHE II, SOFA, and shock were factors associated with BFC in most models. Conclusions: Machine learning models do not adequately predict the presence of co-infection in critically ill patients with pandemic virus infection. However, the presence of factors such as advanced age, elevated procalcitonin or CPR, and high severity of illness should alert clinicians to the need to rule out this complication on admission to the ICU. Full article
(This article belongs to the Special Issue Infection Diagnostics and Antimicrobial Therapy for Critical Patient)
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11 pages, 253 KiB  
Article
Cefiderocol-Based Regimen for Acinetobacter NDM-1 Outbreak
by Giovanna Travi, Francesco Peracchi, Marco Merli, Noemi Lo Re, Elisa Matarazzo, Livia Tartaglione, Alessandra Bielli, Giorgia Casalicchio, Fulvio Crippa, Chiara S. Vismara and Massimo Puoti
Antibiotics 2024, 13(8), 770; https://doi.org/10.3390/antibiotics13080770 - 15 Aug 2024
Viewed by 1311
Abstract
Variable outcomes have been reported with cefiderocol in infections due to carbapenem-resistant Acinetobacter baumannii (CRAB). Nonetheless, it may be the only option for metallo-beta-lactamase-producing strains. We describe an outbreak of NDM-CRAB infections treated with cefiderocol. Thirty-eight patients were colonized and/or infected. Thirteen patients [...] Read more.
Variable outcomes have been reported with cefiderocol in infections due to carbapenem-resistant Acinetobacter baumannii (CRAB). Nonetheless, it may be the only option for metallo-beta-lactamase-producing strains. We describe an outbreak of NDM-CRAB infections treated with cefiderocol. Thirty-eight patients were colonized and/or infected. Thirteen patients developed a systemic infection. A clinical cure was achieved in 10 (83%) patients, one VAP and 9 BSIs, at day 7. In vitro, the activity of cefiderocol does not appear to match in vivo effectiveness using currently available commercial tests. Despite high clinical cures, overall mortality remains high in severely ill patients. Cefiderocol may be considered in this specific setting, though the implementation of susceptibility tests and infection control measures is mandatory. Full article
(This article belongs to the Special Issue Infection Diagnostics and Antimicrobial Therapy for Critical Patient)
14 pages, 3474 KiB  
Article
A Real-World Data Observational Analysis of the Impact of Liposomal Amphotericin B on Renal Function Using Machine Learning in Critically Ill Patients
by Ignasi Sacanella, Erika Esteve-Pitarch, Jessica Guevara-Chaux, Julen Berrueta, Alejandro García-Martínez, Josep Gómez, Cecilia Casarino, Florencia Alés, Laura Canadell, Ignacio Martín-Loeches, Santiago Grau, Francisco Javier Candel, María Bodí and Alejandro Rodríguez
Antibiotics 2024, 13(8), 760; https://doi.org/10.3390/antibiotics13080760 - 12 Aug 2024
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Abstract
Background: Liposomal amphotericin B (L-AmB) has become the mainstay of treatment for severe invasive fungal infections. However, the potential for renal toxicity must be considered. Aims: To evaluate the incidence of acute kidney injury (AKI) in critically ill patients receiving L-AmB for more [...] Read more.
Background: Liposomal amphotericin B (L-AmB) has become the mainstay of treatment for severe invasive fungal infections. However, the potential for renal toxicity must be considered. Aims: To evaluate the incidence of acute kidney injury (AKI) in critically ill patients receiving L-AmB for more than 48 h. Methods: Retrospective, observational, single-center study. Clinical, demographic and laboratory variables were obtained automatically from the electronic medical record. AKI incidence was analyzed in the entire population and in patients with a “low” or “high” risk of AKI based on their creatinine levels at the outset of the study. Factors associated with the development of AKI were studied using random forest models. Results: Finally, 67 patients with a median age of 61 (53–71) years, 67% male, a median SOFA of 4 (3–6.5) and a crude mortality of 34.3% were included. No variations in serum creatinine were observed during the observation period, except for a decrease in the high-risk subgroup. A total of 26.8% (total population), 25% (low risk) and 13% (high risk) of patients developed AKI. Norepinephrine, the SOFA score, furosemide (general model), potassium, C-reactive protein and procalcitonin (low-risk subgroup) were the variables identified by the random forest models as important contributing factors to the development of AKI other than L-AmB administration. Conclusions: The development of AKI is multifactorial and the administration of L-AmB appears to be safe in this group of patients. Full article
(This article belongs to the Special Issue Infection Diagnostics and Antimicrobial Therapy for Critical Patient)
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28 pages, 1047 KiB  
Article
Rebound Inverts the Staphylococcus aureus Bacteremia Prevention Effect of Antibiotic Based Decontamination Interventions in ICU Cohorts with Prolonged Length of Stay
by James Hurley
Antibiotics 2024, 13(4), 316; https://doi.org/10.3390/antibiotics13040316 - 29 Mar 2024
Cited by 2 | Viewed by 1510
Abstract
Could rebound explain the paradoxical lack of prevention effect against Staphylococcus aureus blood stream infections (BSIs) with antibiotic-based decontamination intervention (BDI) methods among studies of ICU patients within the literature? Two meta-regression models were applied, each versus the group mean length of stay [...] Read more.
Could rebound explain the paradoxical lack of prevention effect against Staphylococcus aureus blood stream infections (BSIs) with antibiotic-based decontamination intervention (BDI) methods among studies of ICU patients within the literature? Two meta-regression models were applied, each versus the group mean length of stay (LOS). Firstly, the prevention effects against S. aureus BSI [and S. aureus VAP] among 136 studies of antibiotic-BDI versus other interventions were analyzed. Secondly, the S. aureus BSI [and S. aureus VAP] incidence in 268 control and intervention cohorts from studies of antibiotic-BDI versus that among 165 observational cohorts as a benchmark was modelled. In model one, the meta-regression line versus group mean LOS crossed the null, with the antibiotic-BDI prevention effect against S. aureus BSI at mean LOS day 7 (OR 0.45; 0.30 to 0.68) inverted at mean LOS day 20 (OR 1.7; 1.1 to 2.6). In model two, the meta-regression line versus group mean LOS crossed the benchmark line, and the predicted S. aureus BSI incidence for antibiotic-BDI groups was 0.47; 0.09–0.84 percentage points below versus 3.0; 0.12–5.9 above the benchmark in studies with 7 versus 20 days mean LOS, respectively. Rebound within the intervention groups attenuated and inverted the prevention effect of antibiotic-BDI against S. aureus VAP and BSI, respectively. This explains the paradoxical findings. Full article
(This article belongs to the Special Issue Infection Diagnostics and Antimicrobial Therapy for Critical Patient)
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11 pages, 228 KiB  
Communication
Experience with PCR Testing for Enteric Bacteria and Viruses of Emergency Department Patients with Acute Gastroenteritis: Are There Implications for the Early Treatment of Clostridioides difficile Infection?
by Andreas Iffland, Maria Zechel, Jan-Christoph Lewejohann, Birgit Edel, Stefan Hagel, Michael Hartmann, Bettina Löffler and Jürgen Rödel
Antibiotics 2024, 13(3), 243; https://doi.org/10.3390/antibiotics13030243 - 6 Mar 2024
Viewed by 1898
Abstract
Early identification of acute gastroenteritis (AGE) pathogens via PCR may improve the management of patients presenting to the emergency department (ED). In this study, we evaluated the implementation of a testing algorithm for ED patients with AGE using the BD MAX automated PCR [...] Read more.
Early identification of acute gastroenteritis (AGE) pathogens via PCR may improve the management of patients presenting to the emergency department (ED). In this study, we evaluated the implementation of a testing algorithm for ED patients with AGE using the BD MAX automated PCR system. Data from 133 patients were analyzed. A total of 56 patients (42%) tested positive via PCR for at least one bacterial or viral pathogen. The median time to report PCR results was 6.17 h compared to 57.28 h for culture results for bacterial pathogens. The most common pathogen was Clostridioides difficile (n = 20, 15%). In total, 14 of the 20 C. difficile-positive patients were aged >65 years and 17 of the 20 patients (85%) were diagnosed with a clinically relevant infection based on typical symptoms and laboratory values. They received antibiotics, mostly oral vancomycin, starting a median of 11.37 h after ED admission. The introduction of PCR for the diagnosis of AGE infection in patients presenting to the ED may have the greatest impact on the rapid identification of C. difficile and the timely administration of antibiotics if necessary. Full article
(This article belongs to the Special Issue Infection Diagnostics and Antimicrobial Therapy for Critical Patient)

Review

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13 pages, 640 KiB  
Review
Toxic Shock Syndrome: A Literature Review
by Enora Atchade, Christian De Tymowski, Nathalie Grall, Sébastien Tanaka and Philippe Montravers
Antibiotics 2024, 13(1), 96; https://doi.org/10.3390/antibiotics13010096 - 18 Jan 2024
Cited by 9 | Viewed by 14807
Abstract
Toxic shock syndrome (TSS) is a rare, life-threatening, toxin-mediated infectious process linked, in the vast majority of cases, to toxin-producing strains of Staphylococcus aureus or Streptococcus pyogenes. The pathophysiology, epidemiology, clinical presentation, microbiological features, management and outcome of TSS are described in [...] Read more.
Toxic shock syndrome (TSS) is a rare, life-threatening, toxin-mediated infectious process linked, in the vast majority of cases, to toxin-producing strains of Staphylococcus aureus or Streptococcus pyogenes. The pathophysiology, epidemiology, clinical presentation, microbiological features, management and outcome of TSS are described in this review. Bacterial superantigenic exotoxins induces unconventional polyclonal lymphocyte activation, which leads to rapid shock, multiple organ failure syndrome, and death. The main described superantigenic exotoxins are toxic shock syndrome toxin—1 (TSST-1) and enterotoxins for Staphylococcus aureus and Streptococcal pyrogenic exotoxins (SpE) A, B, and C and streptococcal superantigen A (SsA) for Streptococcus pyogenes. Staphylococcal TSS can be menstrual or nonmenstrual. Streptococcal TSS is linked to a severe group A streptococcal infection and, most frequently, to a necrotizing soft tissue infection. Management of TSS is a medical emergency and relies on early detection, immediate resuscitation, source control and eradication of toxin production, bactericidal antibiotic treatment, and protein synthesis inhibiting antibiotic administration. The interest of polyclonal intravenous immunoglobulin G administration as an adjunctive treatment for TSS requires further evaluation. Scientific literature on TSS mainly consists of observational studies, clinical cases, and in vitro data; although more data on TSS are required, additional studies will be difficult to conduct due to the low incidence of the disease. Full article
(This article belongs to the Special Issue Infection Diagnostics and Antimicrobial Therapy for Critical Patient)
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