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A Themed Issue in Honor of Professor Jordi Rello—Outstanding Contributions in the Fields of Management of Severe Infections and Sepsis

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A special issue of Antibiotics (ISSN 2079-6382).

Deadline for manuscript submissions: closed (30 September 2022) | Viewed by 47320

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Prof. Dr. Jeffrey Lipman

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1. Jamieson Trauma Institute, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia
2. The University of Queensland Centre for Clinical Research, Brisbane, QLD 4029, Australia
Interests: antibiotic administration (particularly pharmacokinetics); pharmacodynamics; clinical trials
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Dear Colleagues,

This Special Issue will honor Prof. Dr. Jordi Rello for his outstanding contributions in the fields of management of severe infections and sepsis. Prof Rello earned with honours his Medical Degree (1985) and PhD in Infectious Diseases (1990) at University of Barcelona, Spain, completing a residence/fellowship in Critical Care in Hospital Sant Pau in Barcelona. Dr Rello received additional training in infection control and ID epidemiology at Harvard Medical School, Boston. Currently, he is Director of the Clinical Research and Innovation in Pneumonia and Sepsis (CRIPS) Group at Vall d'Hebron Research Institute and CIBERES: http://www.vhir.org/gr/crips, located in Vall d’Hebron Barcelona Hospital Campus.

He has conducted clinical practice as a consultant, led research, and trained fellows in critical care and severe infections since 1990, with special focus on severe pneumonia and precision medicine in sepsis. He has served as medical advisor for Biopharma, led in the formation of several international clinical practices’ guidelines, and coordinated multidisciplinary groups on evidence-based medicine. After serving as critical care consultant in Hospital Clinic de Barcelona and Hospital Parc Tauli in Sabadell, Dr Rello became Head of the ICU Department in 1999 in the University Hospital de Tarragona and in 2000 at the University Hospital Vall d’Hebron, Barcelona. He is also a research advisor at the CHRU of Nîmes, France.

He has directed over 20 doctoral theses as part of his academic duties as Professor of Medicine at the Universitat Autònoma de Barcelona and Rovira and Virgili University in Tarragona. Currently, he is Chairman of Medicine at Universitat Internacional de Catalunya, Barcelona, Spain. He is an active member of the European Respiratory Society (FERS), and he also founded the Critically Ill Patients Working Groups at the European Society of Intensive Care Medicine where he served as Chair; he has been Deputy of the Infection Section at the European Society of Intensive Care medicine, and a council member as a representative of the Research and Scientific Committees. He has been President of the Catalonian Society of Critical Care and Secretary of the Catalonian Society of Infectious Diseases.

He has served as editor of multiple books, including the Textbook of Infections in Critically ill Patients and the Book Series Perspectives in Severe Infections in the ICU. He has served in many Editorial Boards, serving as associate editor at the European Journal of Infectious Diseases, BMC Infectious Diseases, and Anesthesia, Critical Care & Pain Medicine. He is a member of the Réanimation Committee at the Societé Française of Anesthesiologie et Réanimation (SFAR)

Prof. Rello has 630+ indexed manuscripts with 48,000+ citations (overall 2,850 per year since 2013), an H-index of 114 (64 since 2016) and i-10 index of 453 (340 since 2016)— accessed via Google Scholar. He has written 35+ papers with over 250 citations. He has been awarded as an international honorary professor of CSCCM—Chinese Medical Association (2018), and Fellow from the European Respiratory Society (2020), as well as the Young investigator Award from the American College of Chest Physicians, Award to the best year article of the year award from the Infectious Diseases Society of America, Annual Cardiovascular Specialty Award from the Society of critical Care Medicine, and Young Investigator University Award from Generalitat de Catalunya, among others.

Prof. Dr. Jeffrey Lipman
Guest Editor

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Published Papers (13 papers)

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18 pages, 3007 KiB

Open AccessArticle

Impact of Antibiotic Prophylaxis on Surgical Site Infections in Cardiac Surgery

by Christian de Tymowski, Tarek Sahnoun, Sophie Provenchere, Marylou Para, Nicolas Derre, Pierre Mutuon, Xavier Duval, Nathalie Grall, Bernard Iung, Solen Kernéis, Jean-Christophe Lucet and Philippe Montravers

Antibiotics 2023, 12(1), 85; https://doi.org/10.3390/antibiotics12010085 - 4 Jan 2023

Cited by 3 | Viewed by 3606

Abstract

(1) Background: Cephalosporins (CA) are the first-line antibiotic prophylaxis recommended to prevent surgical site infection (SSI) after cardiac surgery. The combination of vancomycin/gentamicin (VGA) might represent a good alternative, but few studies have evaluated its efficacy in SSI prevention. (2) Methods: A single-centre retrospective study was conducted over a 13-year period in all consecutive adult patients undergoing elective cardiac surgery. Patients were stratified according to the type of antibiotic prophylaxis. CA served as the first-line prophylaxis, and VGA was used as the second-line prophylaxis. The primary endpoint was SSI occurrence at 90 days, which was defined as the need for reoperation due to SSI. (3) Results: In total, 14,960 adult patients treated consecutively from 2006 to 2019 were included in this study, of whom 1774 (12%) received VGA and 540 (3.7%) developed SSI. VGA patients had higher severity with increased 90-day mortality. Nevertheless, the frequency of SSI was similar between CA and VGA patients. However, the microbiological aetiologies were different, with more Gram-negative bacteria noted in the VGA group. (4) Conclusions: VGA seems to be as effective as CA in preventing SSI. Full article

(This article belongs to the Special Issue A Themed Issue in Honor of Professor Jordi Rello—Outstanding Contributions in the Fields of Management of Severe Infections and Sepsis)

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12 pages, 933 KiB

Open AccessArticle

Pharmacokinetic Characteristics of Nebulized Colistimethate Sodium Using Two Different Types of Nebulizers in Critically Ill Patients with Ventilator-Associated Respiratory Infections

by Anna Kyriakoudi, Konstantinos Pontikis, Georgia Valsami, Stavrina Avgeropoulou, Efthymios Neroutsos, Eirini Christodoulou, Eleni Moraitou, Sophia L. Markantonis, Aristides Dokoumetzidis, Jordi Rello and Antonia Koutsoukou

Antibiotics 2022, 11(11), 1528; https://doi.org/10.3390/antibiotics11111528 - 1 Nov 2022

Cited by 6 | Viewed by 2828

Abstract

Background: Rising antimicrobial resistance has led to a revived interest in inhaled colistin treatment in the critically ill patient with ventilator-associated respiratory infection (VARI). Nebulization via vibrating mesh nebulizers (VMNs) is considered the current standard-of-care, yet the use of generic jet nebulizers (JNs) is more widespread. Few data exist on the intrapulmonary pharmacokinetics of colistin when administered through VMNs, while there is a complete paucity regarding the use of JNs. Methods: In this study, 18 VARI patients who received 2 million international units of inhaled colistimethate sodium (CMS) through a VMN were pharmacokinetically compared with six VARI patients who received the same drug dose through a JN, in the absence of systemic CMS administration. Results: Surprisingly, VMN and JN led to comparable formed colistin exposures in the epithelial lining fluid (ELF) (median (IQR) AUC_0–24: 86.2 (46.0–185.9) mg/L∙h with VMN and 91.5 (78.1–110.3) mg/L∙h with JN). The maximum ELF concentration was 10.4 (4.7–22.6) mg/L and 7.4 (6.2–10.3) mg/L, respectively. Conclusions: Based on our results, JN might be considered a viable alternative to the theoretically superior VMN. Therapeutic drug monitoring in the ELF can be advised due to the observed low exposure, high variability, and appreciable systemic absorption. Full article

(This article belongs to the Special Issue A Themed Issue in Honor of Professor Jordi Rello—Outstanding Contributions in the Fields of Management of Severe Infections and Sepsis)

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7 pages, 913 KiB

Open AccessArticle

National Early Warning Score (NEWS) Outperforms Quick Sepsis-Related Organ Failure (qSOFA) Score for Early Detection of Sepsis in the Emergency Department

by Dimitri Durr, Tapio Niemi, Jeremie Despraz, Selin Tusgul, Fabrice Dami, Rachid Akrour, Pierre-Nicolas Carron, Marie-Annick Le Pogam, Thierry Calandra and Sylvain Meylan

Antibiotics 2022, 11(11), 1518; https://doi.org/10.3390/antibiotics11111518 - 31 Oct 2022

Cited by 13 | Viewed by 3415

Abstract

Background: Prompt recognition of sepsis is critical to improving patients’ outcomes. We compared the performance of NEWS and qSOFA scores as sepsis detection tools in patients admitted to the emergency department (ED) with suspicion of sepsis. Methodology: A single-center 12-month retrospective study comparing NEWS using the recommended cut-off of ≥5 and qSOFA as sepsis screening tools in a cohort of patients transported by emergency medical services (EMS) to the Lausanne University Hospital (LUH). We used the Sepsis-3 consensus definition. The primary study endpoint was the detection of sepsis. Secondary endpoints were ICU admission and 28-day all-cause mortality. Results: Among 886 patients admitted to ED by EMS for suspected infection, 556 (63%) had a complete set of vital parameters panel enabling the calculation of NEWS and qSOFA scores, of whom 300 (54%) had sepsis. For the detection of sepsis, the sensitivity of NEWS > 5 was 86% and that of qSOFA ≥ 2 was 34%. Likewise, the sensitivities of NEWS ≥ 5 for predicting ICU admission and 28-day mortality were higher than those of qSOFA ≥ 2 (82% versus 33% and 88% versus 37%). Conversely, the specificity of qSOFA ≥ 2 for sepsis detection was higher than that of NEWS ≥ 5 (90% versus 55%). The negative predictive value of NEWS > 5 was higher than that of qSOFA ≥ 2 (77% versus 54%), while the positive predictive value of qSOFA ≥ 2 was higher than that of NEWS ≥ 5 (80% versus 69%). Finally, the accuracy of NEWS ≥ 5 was higher than that of qSOFA ≥ 2 (72% versus 60%). Conclusions: The sensitivity of NEWS ≥ 5 was superior to that of qSOFA ≥ 2 to identify patients with sepsis in the ED and predict ICU admission and 28-day mortality. In contrast, qSOFA ≥ 2 had higher specificity and positive predictive values than NEWS ≥ 5 for these three endpoints. Full article

(This article belongs to the Special Issue A Themed Issue in Honor of Professor Jordi Rello—Outstanding Contributions in the Fields of Management of Severe Infections and Sepsis)

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15 pages, 677 KiB

Open AccessArticle

Antimicrobial Stewardship during COVID-19 Outbreak: A Retrospective Analysis of Antibiotic Prescriptions in the ICU across COVID-19 Waves

by Ines Lakbar, Louis Delamarre, Fanny Curtel, Gary Duclos, Karine Bezulier, Ines Gragueb-Chatti, Ignacio Martin-Loeches, Jean-Marie Forel and Marc Leone

Antibiotics 2022, 11(11), 1517; https://doi.org/10.3390/antibiotics11111517 - 30 Oct 2022

Cited by 3 | Viewed by 2347

Abstract

The demographics and outcomes of ICU patients admitted for a COVID-19 infection have been characterized in extensive reports, but little is known about antimicrobial stewardship for these patients. We designed this retrospective, observational study to investigate our hypothesis that the COVID-19 pandemic has disrupted antimicrobial stewardship practices and likely affected the rate of antibiotic de-escalation (ADE), patient outcomes, infection recurrence, and multidrug-resistant bacteria acquisition. We reviewed the prescription of antibiotics in three ICUs during the pandemic from March 2020 to December 2021. All COVID-19 patients with suspected or proven bacterial superinfections who received antibiotic treatment were included. The primary outcome was the rate of ADE, and secondary outcomes included the rate of appropriate empirical treatment, mortality rates and a comparison with a control group of infected patients before the COVID-19 pandemic. We included 170 COVID-19 patients who received antibiotic treatment for a suspected or proven superinfection, of whom 141 received an empirical treatment. For the latter, antibiotic treatment was de-escalated in 47 (33.3%) patients, escalated in 5 (3.5%) patients, and continued in 89 (63.1%) patients. The empirical antibiotic treatment was appropriate for 87.2% of cases. ICU, hospital, and day 28 and day 90 mortality rates were not associated with the antibiotic treatment strategy. The ADE rate was 52.2% in the control group and 27.6% in the COVID-19 group (p < 0.001). Our data suggest that empirical antibiotic treatment was appropriate in most cases. The ADE rates were lower in the COVID-19 group than in the control group, suggesting that the stress associated with COVID-19 affected our practices. Full article

(This article belongs to the Special Issue A Themed Issue in Honor of Professor Jordi Rello—Outstanding Contributions in the Fields of Management of Severe Infections and Sepsis)

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11 pages, 667 KiB

Open AccessArticle

Bacteraemia Is Associated with Increased ICU Mortality in the Postoperative Course of Lung Transplantation

by Alexy Tran-Dinh, Marion Guiot, Sébastien Tanaka, Brice Lortat-Jacob, Enora Atchade, Nathalie Zappella, Pierre Mordant, Yves Castier, Hervé Mal, Gaelle Weisenburger, Jonathan Messika, Nathalie Grall and Philippe Montravers

Antibiotics 2022, 11(10), 1405; https://doi.org/10.3390/antibiotics11101405 - 13 Oct 2022

Cited by 1 | Viewed by 1559

Abstract

We aimed to describe the prevalence, risk factors, morbidity and mortality associated with the occurrence of bacteraemia during the postoperative ICU stay after lung transplantation (LT). We conducted a retrospective single-centre study that included all consecutive patients who underwent LT between January 2015 and October 2021. We analysed all the blood cultures drawn during the postoperative ICU stay, as well as samples from suspected infectious sources in case of bacteraemia. Forty-six bacteria were isolated from 45 bacteraemic patients in 33/303 (10.9%) patients during the postoperative ICU stay. Staphylococcus aureus (17.8%) was the most frequent bacteria, followed by Pseudomonas aeruginosa (15.6%) and Enterococcus faecium (15.6%). Multidrug-resistant bacteria accounted for 8/46 (17.8%) of the isolates. The most common source of bacteraemia was pneumonia (38.3%). No pre- or intraoperative risk factor for bacteraemia was identified. Recipients who experienced bacteraemia required more renal replacement therapy, invasive mechanical ventilation, norepinephrine support, tracheotomy and more days of hospitalization during the ICU stay. After adjustment for age, sex, type of LT procedure and the need for intraoperative ECMO, the occurrence of bacteraemia was associated with a higher mortality rate in the ICU (aOR = 3.55, 95% CI [1.56–8.08], p = 0.003). Bacteraemia is a major source of concern for lung transplant recipients. Full article

(This article belongs to the Special Issue A Themed Issue in Honor of Professor Jordi Rello—Outstanding Contributions in the Fields of Management of Severe Infections and Sepsis)

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13 pages, 316 KiB

Open AccessArticle

COVID-19 Secondary Infections in ICU Patients and Prevention Control Measures: A Preliminary Prospective Multicenter Study

by Sergio Ruiz-Santana, María-Luisa Mora-Quintero, Pedro Saavedra, Raquel Montiel-González, Catalina Sánchez-Ramírez, Guillermo Pérez-Acosta, Mar Martín-Velasco, Cristóbal Rodríguez-Mata, José-Manuel Lorenzo-García, Dácil Parrilla-Toribio, Tanya Carrillo-García and Juan-Carlos Martín-González

Antibiotics 2022, 11(8), 1016; https://doi.org/10.3390/antibiotics11081016 - 28 Jul 2022

Cited by 3 | Viewed by 3285

Abstract

The incidence of secondary infections in critically ill coronavirus disease 2019 (COVID-19) patients is worrisome. We investigated whether selective digestive decontamination (SDD) added to infection control measures during an intensive care unit (ICU) stay modified these infection rates. Methods: A retrospective observational cohort study was carried out in four ICUs in Spain. All consecutive ventilated patients with a SARS-CoV-2 infection engaged in national infection control programs between 1 March and 10 December 2020 were investigated. Patients were grouped into two cohorts according to the site of ICU admission. Secondary relevant infections were included. Infection densities corresponding to ventilator-associated pneumonia (VAP), catheter bacteremia, secondary bacteremia, and multi-resistant germs were obtained as the number of events per 1000 days of exposure and were compared between SDD and non-SDD groups using Poisson regression. Factors that had an independent association with mortality were identified using multidimensional logistic analysis. Results: There were 108 patients in the SDD cohort and 157 in the non-SDD cohort. Patients in the SDD cohort showed significantly lower rates (p < 0.001) of VAP (1.9 vs. 9.3 events per 1000 ventilation days) and MDR infections (0.57 vs. 2.28 events per 1000 ICU days) and a non-significant reduction in secondary bacteremia (0.6 vs. 1.41 events per 1000 ICU days) compared with those in the non-SDD cohort. Infections caused by MDR pathogens occurred in 5 patients in the SDD cohort and 21 patients in the non-SDD cohort (p = 0.006). Differences in mortality according to SDD were not found. Conclusion: The implementation of SDD in infection control programs significantly reduced the incidence of VAP and MDR infections in critically ill SARS-CoV-2 infected patients. Full article

(This article belongs to the Special Issue A Themed Issue in Honor of Professor Jordi Rello—Outstanding Contributions in the Fields of Management of Severe Infections and Sepsis)

Review

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15 pages, 314 KiB

Open AccessReview

Cefiderocol Treatment for Severe Infections due to Difficult-to-Treat-Resistant Non-Fermentative Gram-Negative Bacilli in ICU Patients: A Case Series and Narrative Literature Review

by Paul-Henri Wicky, Joséphine Poiraud, Manuel Alves, Juliette Patrier, Camille d’Humières, Minh Lê, Laura Kramer, Étienne de Montmollin, Laurent Massias, Laurence Armand-Lefèvre and Jean-François Timsit

Antibiotics 2023, 12(6), 991; https://doi.org/10.3390/antibiotics12060991 - 1 Jun 2023

Cited by 13 | Viewed by 2920

Abstract

Cefiderocol (FDC) is a siderophore cephalosporin now recognized as a new weapon in the treatment of difficult-to-treat-resistant (DTR) Gram-negative pathogens, including carbapenemase-producing enterobacterales and non-fermentative Gram-negative bacilli (GNB). This article reports our experience with an FDC-based regimen in the treatment of 16 extremely severe patients (invasive mechanical ventilation, 15/16; extracorporeal membrane oxygenation, 9/16; and renal replacement therapy, 8/16) infected with DTR GNB. Our case series provides detailed insight into the pharmacokinetic profile and the microbiological data in real-life conditions. In the narrative review, we discuss the interest of FDC in the treatment of non-fermentative GNB in critically ill patients. We reviewed the microbiological spectrum, resistance mechanisms, pharmacokinetics/pharmacodynamics, efficacy and safety profiles, and real-world evidence for FDC. On the basis of our experience and the available literature, we discuss the optimal FDC-based regimen, FDC dosage, and duration of therapy in critically ill patients with DTR non-fermentative GNB infections. Full article

(This article belongs to the Special Issue A Themed Issue in Honor of Professor Jordi Rello—Outstanding Contributions in the Fields of Management of Severe Infections and Sepsis)

31 pages, 468 KiB

Open AccessReview

Novel Antimicrobial Agents for Gram-Negative Pathogens

by Marios Karvouniaris, Maria Panagiota Almyroudi, Mohd Hafiz Abdul-Aziz, Stijn Blot, Elisabeth Paramythiotou, Evdoxia Tsigou and Despoina Koulenti

Antibiotics 2023, 12(4), 761; https://doi.org/10.3390/antibiotics12040761 - 16 Apr 2023

Cited by 14 | Viewed by 5065

Abstract

Gram-negative bacterial resistance to antimicrobials has had an exponential increase at a global level during the last decades and represent an everyday challenge, especially for the hospital practice of our era. Concerted efforts from the researchers and the industry have recently provided several novel promising antimicrobials, resilient to various bacterial resistance mechanisms. There are new antimicrobials that became commercially available during the last five years, namely, cefiderocol, imipenem-cilastatin-relebactam, eravacycline, omadacycline, and plazomicin. Furthermore, other agents are in advanced development, having reached phase 3 clinical trials, namely, aztreonam-avibactam, cefepime-enmetazobactam, cefepime-taniborbactam, cefepime-zidebactam, sulopenem, tebipenem, and benapenem. In this present review, we critically discuss the characteristics of the above-mentioned antimicrobials, their pharmacokinetic/pharmacodynamic properties and the current clinical data. Full article

(This article belongs to the Special Issue A Themed Issue in Honor of Professor Jordi Rello—Outstanding Contributions in the Fields of Management of Severe Infections and Sepsis)

15 pages, 544 KiB

Open AccessEditor’s ChoiceReview

How to Identify Invasive Candidemia in ICU—A Narrative Review

by Joana Alves, Carles Alonso-Tarrés and Jordi Rello

Antibiotics 2022, 11(12), 1804; https://doi.org/10.3390/antibiotics11121804 - 12 Dec 2022

Cited by 14 | Viewed by 4477

Abstract

The incidence of invasive fungal infection in ICUs has increased over time, and Candida spp. is the most common cause. Critical care patients are a particular set of patients with a higher risk of invasive fungal infections; this population is characterized by extensive use of medical devices such as central venous lines, arterial lines, bladder catheters, hemodialysis and mechanical intubation. Blood cultures are the gold standard diagnosis; still, they are not an early diagnostic technique. Mannan, anti-mannan antibody, 1,3-β-D-glucan, Candida albicans germ tube antibody, Vitek 2, PNA-FISH, MALDI-TOF, PCR and T2Candida panel are diagnostic promising microbiological assays. Scoring systems are tools to distinguish patients with low and high risk of infection. They can be combined with diagnostic tests to select patients for pre-emptive treatment or antifungal discontinuation. Candidemia is the focus of this narrative review, an approach to contributing factors and diagnosis, with an emphasis on critical care patients. Full article

(This article belongs to the Special Issue A Themed Issue in Honor of Professor Jordi Rello—Outstanding Contributions in the Fields of Management of Severe Infections and Sepsis)

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15 pages, 669 KiB

Open AccessReview

Antibiotic Therapy for Difficult-to-Treat Infections in Lung Transplant Recipients: A Practical Approach

by Lorena van den Bogaart and Oriol Manuel

Antibiotics 2022, 11(5), 612; https://doi.org/10.3390/antibiotics11050612 - 2 May 2022

Cited by 3 | Viewed by 3463

Abstract

Lung transplant recipients are at higher risk to develop infectious diseases due to multi-drug resistant pathogens, which often chronically colonize the respiratory tract before transplantation. The emergence of these difficult-to-treat infections is a therapeutic challenge, and it may represent a contraindication to lung transplantation. New antibiotic options are currently available, but data on their efficacy and safety in the transplant population are limited, and clinical evidence for choosing the most appropriate antibiotic therapy is often lacking. In this review, we provide a summary of the best evidence available in terms of choice of antibiotic and duration of therapy for MDR/XDR P. aeruginosa, Burkholderia cepacia complex, Mycobacterium abscessus complex and Nocardia spp. infections in lung transplant candidates and recipients. Full article

(This article belongs to the Special Issue A Themed Issue in Honor of Professor Jordi Rello—Outstanding Contributions in the Fields of Management of Severe Infections and Sepsis)

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33 pages, 571 KiB

Open AccessReview

The Role of Colistin in the Era of New β-Lactam/β-Lactamase Inhibitor Combinations

by Abdullah Tarık Aslan and Murat Akova

Antibiotics 2022, 11(2), 277; https://doi.org/10.3390/antibiotics11020277 - 20 Feb 2022

Cited by 22 | Viewed by 6057

Abstract

With the current crisis related to the emergence of carbapenem-resistant Gram-negative bacteria (CR-GNB), classical treatment approaches with so-called “old-fashion antibiotics” are generally unsatisfactory. Newly approved β-lactam/β-lactamase inhibitors (BLBLIs) should be considered as the first-line treatment options for carbapenem-resistant Enterobacterales (CRE) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) infections. However, colistin can be prescribed for uncomplicated lower urinary tract infections caused by CR-GNB by relying on its pharmacokinetic and pharmacodynamic properties. Similarly, colistin can still be regarded as an alternative therapy for infections caused by carbapenem-resistant Acinetobacter baumannii (CRAB) until new and effective agents are approved. Using colistin in combination regimens (i.e., including at least two in vitro active agents) can be considered in CRAB infections, and CRE infections with high risk of mortality. In conclusion, new BLBLIs have largely replaced colistin for the treatment of CR-GNB infections. Nevertheless, colistin may be needed for the treatment of CRAB infections and in the setting where the new BLBLIs are currently unavailable. In addition, with the advent of rapid diagnostic methods and novel antimicrobials, the application of personalized medicine has gained significant importance in the treatment of CRE infections. Full article

(This article belongs to the Special Issue A Themed Issue in Honor of Professor Jordi Rello—Outstanding Contributions in the Fields of Management of Severe Infections and Sepsis)

Other

Jump to: Research, Review

5 pages, 219 KiB

Open AccessPerspective

Evolution of the Concept of Sepsis

by Jean-Louis Vincent

Antibiotics 2022, 11(11), 1581; https://doi.org/10.3390/antibiotics11111581 - 9 Nov 2022

Cited by 2 | Viewed by 2797

Abstract

Sepsis has been recognized for more than 2500 years, but the criteria used to identify it have evolved. Sepsis is an infection associated with some degree of organ dysfunction—put very simplistically, sepsis is a ‘bad infection’. Specific criteria may be useful for research purposes but have less value in day-to-day clinical practice. What is relevant here is early recognition and some awareness of severity so that appropriate therapy can be started without delay. Full article

(This article belongs to the Special Issue A Themed Issue in Honor of Professor Jordi Rello—Outstanding Contributions in the Fields of Management of Severe Infections and Sepsis)

14 pages, 2021 KiB

Open AccessEditor’s ChoiceSystematic Review

Safety and Efficacy of Devices Delivering Inhaled Antibiotics among Adults with Non-Cystic Fibrosis Bronchiectasis: A Systematic Review and a Network Meta-Analysis

by Sofia Tejada, Sergio Ramírez-Estrada, Carlos G. Forero, Miguel Gallego, Joan B. Soriano, Pablo A. Cardinal-Fernández, Stephan Ehrmann and Jordi Rello

Antibiotics 2022, 11(2), 275; https://doi.org/10.3390/antibiotics11020275 - 19 Feb 2022

Cited by 6 | Viewed by 3745

Abstract

It remains unknown whether the type of aerosol generating device is affecting efficacy and safety among non-cystic fibrosis bronchiectasis (NCFB) adults. The proposal of this network meta-analysis (NMA) is to evaluate effectiveness and safety of inhaled antibiotics administered via dry powder inhaler (DPI) and via nebulizers (SVN) among adult patients with NCFB. Inclusion criteria were randomized-controlled trials, adults (≥18 years) with NCFB, and inhaled antibiotics administered via DPI as intervention. Search strategy was performed in PubMed, Web of Science, and Cochrane Library from 2000 to 2019. Sixteen trials (2870 patients) were included. Three trials (all ciprofloxacin) used DPIs and thirteen used SVN (three ciprofloxacin). Both DPI and SVN devices achieved similar safety outcomes (adverse events, antibiotic discontinuation, severe adverse events, and bronchospasm). Administration of ciprofloxacin via DPI significantly improved time to first exacerbation (87 days, 95% CI 34.3–139.7) and quality of life (MD −7.52; 95% CI −13.06 to −1.98) when compared with via SVN. No other significant differences were documented in clinical efficacy (at least one exacerbation, FEV₁% predicted) and microbiologic response (bacterial eradication, emergence of new potential pathogens, and emergence of antimicrobial resistance) when comparing devices. Our NMA documented that time to first exacerbation and quality of life, were more favorable for DPIs. Decisions on the choice of devices should incorporate these findings plus other criteria, such as simplicity, costs or maintenance requirements. Full article

(This article belongs to the Special Issue A Themed Issue in Honor of Professor Jordi Rello—Outstanding Contributions in the Fields of Management of Severe Infections and Sepsis)

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