Infection, Super Infection and Antimicrobial Management in ICU—Series 2

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Infectious Diseases".

Deadline for manuscript submissions: 5 July 2024 | Viewed by 2030

Special Issue Editors


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Guest Editor
Department of Surgical Science, University of Turin, 10124 Torino, Italy
Interests: intensive care medicine; critical care medicine; ARDS; airway management; resuscitation; mechanical ventilation; extracorporeal support
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E-Mail Website
Guest Editor
1. Department of Surgical Sciences, University of Turin, 10124 Turin, Italy
2. Department of Anaesthesia, Intensive Care and Emergency, ‘Città della Salute e della Scienza’ University Hospital, 10126 Turin, Italy
Interests: infections; antimicrobial treatment; clinical biomarkers; intensive care medicine; critical care medicine; extracorporeal support; ARDS
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The recent Special Issue of the Journal of Clinical Medicine titled ‘Infection, Super-infection and Antimicrobial Management in ICU’ has been viewed 12082 times and received 28 citations supporting the idea that the problem of infection remains central to intensive care.

Indeed, infections cause over 50% of admissions, and over 50% of patients admitted acquire a (further) infection during hospitalization.

But "new" aspects contribute to the enrichment of the current scenario.

The development of rapid microbiological diagnostics, increasingly present in our laboratories, is changing the global scenario in terms of diagnostic timing and accuracy, with related impacts on antimicrobial therapies.

Likewise, the introduction of techniques for monitoring the plasma doses of antimicrobials (therapeutic drug monitoring) is certainly modifying the knowledge of aspects of clinical pharmacology and, consequently, the therapeutic approach used.

Nonetheless, the growth of travel, migration, and resistance determinants are "reshuffling" geographical areas, introducing "new" pathologies into areas that were not previously affected by them, with a notable impact in terms of the need for diagnostic recognition and management strategies.

It is, thus, worth considering how viral and fungal infections increasingly affect not only patients undergoing solid organ or marrow transplants but also recipients of innovative treatments who are increasingly exposed to new immunological risk phenotypes.

For all these aspects, a scientific, in-depth analysis of infections in critical areas remains essential and multifaceted, further expanding the contexts worthy of possible in-depth analysis.

The previous Special Issue focused on the following subjects:

  • Importance of superinfections in COVID-19 patients who are typically characterized by immunosuppression related to viral infection, need prolonged hospitalization, and are treated with immunomodulatory therapies (steroids, monoclonal antibodies, etc.);
  • Superinfections’ impact on outcomes in a cohort of patients who are relatively young and have few comorbidities but require prolonged invasive support;
  • Incidence, characteristics, and impact of bacterial infections caused by multidrug-resistant, Gram-negative pathogens in the context of COVID-19-related disease;
  • Incidence, characteristics, and impact of fungal infections, such as the most known invasive aspergillosis, as well as candidemia and/or other fungal infections (e.g., mucormycosis);
  • Antimicrobial surveillance, control, and management measures as implemented on a local, national, and international basis;

This second edition of this Special Issue further expands its range of interest, including—but not limited to—the following new themes:

  • Infections by multi-resistant pathogens and therapeutic strategies;
  • Serious infections in immunosuppressed patients;
  • Invasive bacterial infections;
  • Viral infections in critically ill patients;
  • Impact of new immunomodulatory therapies;
  • Impact of extracorporeal support strategies in severe infections;
  • Emerging infections and management strategies.

Prof. Dr. Luca Brazzi
Dr. Giorgia Montrucchio
Guest Editors

Manuscript Submission Information

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Keywords

  • superinfections
  • multidrug-resistant pathogens
  • antimicrobial stewardship
  • intensive care medicine
  • bacterial infections and mycoses
  • viral infections
  • immunosuppression
  • disease and emerging infections
  • arthropod-borne viruses
  • anti-infective agents
  • therapeutic drug monitoring

Related Special Issue

Published Papers (2 papers)

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Research

15 pages, 1194 KiB  
Article
Effectiveness of Copeptin, MR-proADM and MR-proANP in Predicting Adverse Outcomes, Alone and in Combination with Traditional Severity Scores, a Secondary Analysis in COVID-19 Patients Requiring Intensive Care Admission
by Emanuele Varaldo, Francesca Rumbolo, Nunzia Prencipe, Fabio Bioletto, Fabio Settanni, Giulio Mengozzi, Silvia Grottoli, Ezio Ghigo, Luca Brazzi, Giorgia Montrucchio and Alessandro Maria Berton
J. Clin. Med. 2024, 13(7), 2019; https://doi.org/10.3390/jcm13072019 - 30 Mar 2024
Viewed by 671
Abstract
Objective: To investigate whether copeptin, MR-proADM and MR-proANP, alone or integrated with the SOFA, MuLBSTA and SAPS II scores, are capable of early recognition of COVID-19 ICU patients at increased risk of adverse outcomes. Methods: For this predefined secondary analysis of a larger [...] Read more.
Objective: To investigate whether copeptin, MR-proADM and MR-proANP, alone or integrated with the SOFA, MuLBSTA and SAPS II scores, are capable of early recognition of COVID-19 ICU patients at increased risk of adverse outcomes. Methods: For this predefined secondary analysis of a larger cohort previously described, all consecutive COVID-19 adult patients admitted between March and December 2020 to the ICU of a referral, university hospital in Northern Italy were screened, and clinical severity scores were calculated upon admission. A blood sample for copeptin, MR-proADM and MR-proANP was collected within 48 h (T1), on day 3 (T3) and 7 (T7). Outcomes considered were ICU and in-hospital mortality, bacterial superinfection, recourse to renal replacement therapy (RRT) or veno-venous extracorporeal membrane oxygenation, need for invasive mechanical ventilation (IMV) and pronation. Results: Sixty-eight patients were enrolled, and in-hospital mortality was 69.1%. ICU mortality was predicted by MR-proANP measured at T1 (HR 1.005, 95% CI 1.001–1.010, p = 0.049), although significance was lost if the analysis was adjusted for procalcitonin and steroid treatment (p = 0.056). Non-survivors showed higher MR-proADM levels than survivors at all time points, and an increase in the ratio between values at baseline and at T7 > 4.9% resulted in a more than four-fold greater risk of in-hospital mortality (HR 4.417, p < 0.001). Finally, when considering patients with any reduction in glomerular filtration, an early copeptin level > 23.4 pmol/L correlated with a more than five-fold higher risk of requiring RRT during hospitalization (HR 5.305, p = 0.044). Conclusion: Timely evaluation of MR-proADM, MR-proANP and copeptin, as well as changes in the former over time, might predict mortality and other adverse outcomes in ICU patients suffering from severe COVID-19. Full article
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10 pages, 2373 KiB  
Article
Prevalence and Antimicrobial Resistance Patterns of Hospital Acquired Infections through the COVID-19 Pandemic: Real-Word Data from a Tertiary Urological Centre
by Filippo Gavi, Barbara Fiori, Carlo Gandi, Marco Campetella, Riccardo Bientinesi, Filippo Marino, Daniele Fettucciari, Francesco Rossi, Stefano Moretto, Rita Murri, Francesco Pierconti, Marco Racioppi and Emilio Sacco
J. Clin. Med. 2023, 12(23), 7278; https://doi.org/10.3390/jcm12237278 - 24 Nov 2023
Cited by 2 | Viewed by 1147
Abstract
Background: Antimicrobial resistance (AMR) remains a significant public health concern, closely linked to antibiotic overuse. During the COVID-19 pandemic, broad-spectrum antibiotics were frequently administered, potentially exacerbating AMR. This study aimed to assess AMR patterns in our urology department before and after the pandemic. [...] Read more.
Background: Antimicrobial resistance (AMR) remains a significant public health concern, closely linked to antibiotic overuse. During the COVID-19 pandemic, broad-spectrum antibiotics were frequently administered, potentially exacerbating AMR. This study aimed to assess AMR patterns in our urology department before and after the pandemic. Methods: The study encompassed patients admitted to our urology department from January 2016 to December 2022, with confirmed urinary tract infection, bloodstream infection, or wound infection based on positive culture results. Descriptive statistics, including mean, frequency, and percentage, summarized the data. Trends were analyzed using the Joinpoint Regression program. Results: A total of 506 patients were included. Escherichia coli and Klebsiella pneumoniae displayed resistance rates of 65% and 62% to ciprofloxacin, respectively. K. pneumoniae showed resistance rates of 41% to piperacillin tazobactam and 3rd generation cephalosporins (3GC). Carbapenem resistance was observed in 38% of K. pneumoniae isolates. Additionally, 26% of E. coli, 26% of K. pneumoniae, and 59% of Proteus mirabilis isolates were ESBL-positive. Among gram+, 72% of Staphylococcus aureus isolates were MRSA, and 23% of Enterococcus faecium isolates were VRE. Trends in antimicrobial susceptibility patterns over the 7-year study period revealed a statistically significant decrease in E. coli resistance to amoxicillin-clavulanic acid (APC: −5.85; C.I. 95% p < 0.05) and a statistically significant increase in K. pneumoniae resistance to 3GC (APC: 9.93; CI (−19.9–14.4 95% p < 0.05). There were no statistically significant differences in AMR incidence pre- and post-COVID-19. Conclusion: The COVID-19 pandemic did not appear to influence the AMR incidence in our urology department. However, the overall prevalence of AMR and MDROs in our department remains high compared to European AMR. Full article
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