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Antibiotics
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Nosocomial Infections and Complications in ICU Settings
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Nosocomial Infections and Complications in ICU Settings

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

Deadline for manuscript submissions: 30 September 2025 | Viewed by 5050

Special Issue Editor

Prof. Dr. Ignacio Martín-Loeches

E-Mail Website
Guest Editor
Department of Clinical Medicine, Trinity College Dublin, D08 NHY1 Dublin, Ireland
Interests: critical care; pneumonia; ICU; sepsis; shock

Special Issue Information

Dear Colleagues,

Nosocomial infections and critical complications are a major concern in intensive care units (ICUs) worldwide. Despite advancements in medical care, the incidence of infections such as ventilator-associated pneumonia (VAP), catheter-related bloodstream infections, and complications from therapies such as extracorporeal membrane oxygenation (ECMO) remain high, leading to increased morbidity and mortality. This Special Issue aims to provide a comprehensive overview of nosocomial infections, focusing on the interplay between microbial pathogens, host immunity, and therapeutic interventions.

This Special Issue will address key topics, including pneumonia in mechanically ventilated patients, ECMO-related infections, and sepsis, which remains one of the leading causes of death in ICUs. We also seek studies exploring the role of dysregulated coagulation in critical illnesses, highlighting how it exacerbates infection-related complications. Original research, systematic reviews, and clinical trials that address novel diagnostics, prevention strategies, and therapeutic approaches are highly encouraged.

This Special Issue will provide a platform for critical care specialists, infectious disease experts, and researchers to advance our understanding of ICU-acquired infections, driving innovations in both prevention and management to enhance patient outcomes. We welcome submissions that explore both basic and translational science, as well as clinical applications.

Prof. Dr. Ignacio Martín-Loeches
Guest Editor

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

  • nosocomial infections
  • critical care
  • pneumonia
  • ICU
  • sepsis

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

Published Papers (3 papers)

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17 pages, 556 KiB  
Article
Factors Associated with Mortality in Nosocomial Lower Respiratory Tract Infections: An ENIRRI Analysis
by Luis Felipe Reyes, Antoni Torres, Juan Olivella-Gomez, Elsa D. Ibáñez-Prada, Saad Nseir, Otavio T. Ranzani, Pedro Povoa, Emilio Diaz, Marcus J. Schultz, Alejandro H. Rodríguez, Cristian C. Serrano-Mayorga, Gennaro De Pascale, Paolo Navalesi, Szymon Skoczynski, Mariano Esperatti, Luis Miguel Coelho, Andrea Cortegiani, Stefano Aliberti, Anselmo Caricato, Helmut J. F. Salzer, Adrian Ceccato, Rok Civljak, Paolo Maurizio Soave, Charles-Edouard Luyt, Pervin Korkmaz Ekren, Fernando Rios, Joan Ramon Masclans, Judith Marin, Silvia Iglesias-Moles, Stefano Nava, Davide Chiumello, Lieuwe D. Bos, Antonio Artigas, Filipe Froes, David Grimaldi, Mauro Panigada, Fabio Silvio Taccone, Massimo Antonelli and Ignacio Martin-Loechesadd Show full author list remove Hide full author list
Antibiotics 2025, 14(2), 127; https://doi.org/10.3390/antibiotics14020127 - 26 Jan 2025
Viewed by 1377
Abstract
Background: Nosocomial lower respiratory tract infections (nLRTIs) are associated with unfavorable clinical outcomes and significant healthcare costs. nLRTIs include hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and other ICU-acquired pneumonia phenotypes. While risk factors for mortality in these infections are critical to guide [...] Read more.
Background: Nosocomial lower respiratory tract infections (nLRTIs) are associated with unfavorable clinical outcomes and significant healthcare costs. nLRTIs include hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and other ICU-acquired pneumonia phenotypes. While risk factors for mortality in these infections are critical to guide preventive strategies, it remains unclear whether they vary based on their requirement of invasive mechanical ventilation (IMV) at any point during the hospitalization. Objectives: This study aims to identify risk factors associated with short- and long-term mortality in patients with nLRTIs, considering differences between those requiring IMV and those who do not. Methods: This multinational prospective cohort study included ICU-admitted patients diagnosed with nLRTI from 28 hospitals across 13 countries in Europe and South America between May 2016 and August 2019. Patients were selected based on predefined inclusion and exclusion criteria, and clinical data were collected from medical records. A random forest classifier determined the most optimal clustering strategy when comparing pneumonia site acquisition [ward or intensive care unit (ICU)] versus intensive mechanical ventilation (IMV) necessity at any point during hospitalization to enhance the accuracy and generalizability of the regression models. Results: A total of 1060 patients were included. The random forest classifier identified that the most efficient clustering strategy was based on ventilation necessity. In total, 76.4% of patients [810/1060] received IMV at some point during the hospitalization. Diabetes mellitus was identified to be associated with 28-day mortality in the non-IMV group (OR [IQR]: 2.96 [1.28–6.80], p = 0.01). The 90-day mortality-associated factor was MDRP infection (1.98 [1.13–3.44], p = 0.01). For ventilated patients, chronic liver disease was associated with 28-day mortality (2.38 [1.06–5.31] p = 0.03), with no variable showing statistical and clinical significance at 90 days. Conclusions: The risk factors associated with 28-day mortality differ from those linked to 90-day mortality. Additionally, these factors vary between patients receiving invasive mechanical ventilation and those in the non-invasive ventilation group. This underscores the necessity of tailoring therapeutic objectives and preventive strategies with a personalized approach. Full article
(This article belongs to the Special Issue Nosocomial Infections and Complications in ICU Settings)
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15 pages, 1209 KiB  
Article
Development and Validation of a Machine Learning Model for the Prediction of Bloodstream Infections in Patients with Hematological Malignancies and Febrile Neutropenia
by Antonio Gallardo-Pizarro, Christian Teijón-Lumbreras, Patricia Monzo-Gallo, Tommaso Francesco Aiello, Mariana Chumbita, Olivier Peyrony, Emmanuelle Gras, Cristina Pitart, Josep Mensa, Jordi Esteve, Alex Soriano and Carolina Garcia-Vidal
Antibiotics 2025, 14(1), 13; https://doi.org/10.3390/antibiotics14010013 - 28 Dec 2024
Viewed by 1915
Abstract
Background/Objectives: The rise of multidrug-resistant (MDR) infections demands personalized antibiotic strategies for febrile neutropenia (FN) in hematological malignancies. This study investigates machine learning (ML) for identifying patient profiles with increased susceptibility to bloodstream infections (BSI) during FN onset, aiming to tailor treatment approaches. [...] Read more.
Background/Objectives: The rise of multidrug-resistant (MDR) infections demands personalized antibiotic strategies for febrile neutropenia (FN) in hematological malignancies. This study investigates machine learning (ML) for identifying patient profiles with increased susceptibility to bloodstream infections (BSI) during FN onset, aiming to tailor treatment approaches. Methods: From January 2020 to June 2022, we used the unsupervised ML algorithm KAMILA to analyze data from hospitalized hematological malignancy patients. Eleven features categorized clinical phenotypes and determined BSI and multidrug-resistant Gram-negative bacilli (MDR-GNB) prevalences at FN onset. Model performance was evaluated with a validation cohort from July 2022 to March 2023. Results: Among 462 FN episodes analyzed in the development cohort, 116 (25.1%) had BSIs. KAMILA’s stratification identified three risk clusters: Cluster 1 (low risk), Cluster 2 (intermediate risk), and Cluster 3 (high risk). Cluster 2 (28.4% of episodes) and Cluster 3 (43.7%) exhibited higher BSI rates of 26.7% and 37.6% and GNB BSI rates of 13.4% and 19.3%, respectively. Cluster 3 had a higher incidence of MDR-GNB BSIs, accounting for 75% of all MDR-GNB BSIs. Cluster 1 (27.9% of episodes) showed a lower BSI risk (<1%) with no GNB infections. Validation cohort results were similar: Cluster 3 had a BSI rate of 38.1%, including 78% of all MDR-GNB BSIs, while Cluster 1 had no GNB-related BSIs. Conclusions: Unsupervised ML-based risk stratification enhances evidence-driven decision-making for empiric antibiotic therapies at FN onset, crucial in an era of rising multi-drug resistance. Full article
(This article belongs to the Special Issue Nosocomial Infections and Complications in ICU Settings)
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13 pages, 795 KiB  
Article
The Effect of a Care Bundle on the Rate of Blood Culture Contamination in a General Intensive Care Unit
by Fani Veini, Michael Samarkos, Pantazis-Michael Voutsinas and Anastasia Kotanidou
Antibiotics 2024, 13(11), 1082; https://doi.org/10.3390/antibiotics13111082 - 13 Nov 2024
Viewed by 1294
Abstract
Background/objectives: Blood culture (BC) contamination is a frequent problem which leads to increased laboratory workload, inappropriate use of antibiotics and the associated adverse events, and increased healthcare costs. This study prospectively examined the effect of a care bundle on BC contamination rates [...] Read more.
Background/objectives: Blood culture (BC) contamination is a frequent problem which leads to increased laboratory workload, inappropriate use of antibiotics and the associated adverse events, and increased healthcare costs. This study prospectively examined the effect of a care bundle on BC contamination rates in a high workload ICU. Results: During the study, in total, 4236 BC vials were collected. After the intervention, the BC contamination rate decreased significantly from 6.2% to 1.3%. The incidence rate of contaminated BC sets was significantly lower following the intervention: 0.461 vs. 0.154 BC sets per 100 ICU bed-days. Overall compliance with the BC care bundle increased dramatically from 3.4% to 96.9%. Methods: We performed a before–after study in a general ICU from January 2018 to May 2019, with the intervention starting on November 2018. Blood culture sets were classified as positive, contaminated, indeterminate, and negative. We used bivariate and interrupted time series analysis to assess the effect of the intervention on BC contamination rates and other BC quality indicators. Conclusions: The BC care bundle was effective in reducing BC contamination rates and improving several quality indicators in our setting. The indeterminate BC rate is an important but understudied problem, and we suggest that it should be included in BC quality indicators as well. A significant limitation of the study was that the long-term effect of the intervention was not assessed. Full article
(This article belongs to the Special Issue Nosocomial Infections and Complications in ICU Settings)
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