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Sepsis: New Insights into Diagnosis and Treatment
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Sepsis: New Insights into Diagnosis and Treatment

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

Deadline for manuscript submissions: 30 July 2025 | Viewed by 3936

Special Issue Editors

Prof. Dr. Francesco Forfori

E-Mail Website
Guest Editor
Anesthesia and Intensive Care, Anesthesia and Resuscitation Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
Interests: sepsis; continuous renal replacement therapy; blood purification; ultrasound; adjuvant therapy; ARDS; nutrition; infection disease
Special Issues, Collections and Topics in MDPI journals
Dr. Etrusca Brogi

E-Mail Website
Guest Editor
Department Anaesthesia and Intensive Care, University of Pisa, 56126 Pisa, Italy
Interests: sepsis; ECMO; ultrasound; haemodynamic management; adjuvant therapy; ARDS

Special Issue Information

Dear Colleagues,

Sepsis represents a life-threatening condition with a huge impact on health care costs. Further, Sepsis is a “time-dependent” disease; the outcome is highly influenced by the prompt detection and efficiency of the management, even from the very “first hour”. Due to the centrality of the complex interactions between the infectious insult and the host's immune response, a deeper understanding of the mechanisms involved in the dysregulation host response is mandatory.

Interestingly, It is now clear that the individual genomic profile is partly responsible for the interindividual variability of the clinical evolution of sepsis. In light of this evidence, immunomorinitoring and immunotherapy have gained increasing recognition in recent decades. Unfortunately, until now, evidence has not supported the extensive introduction of adjuvant therapy in current clinical practice.

In this Special Issue, we invite researchers and clinicians to submit their work, including original clinical research studies, meta-analyses, and systematic reviews, that will provide additional insight on the diagnosis and treatment of septic shock.

Prof. Dr. Francesco Forfori
Dr. Etrusca Brogi
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 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. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly 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 2600 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

  • sepsis and sepsis subphenotypes
  • adjuvant therapy
  • blood purification strategies
  • immunomonitoring and immunotherapy
  • the microbiome in sepsis
  • crosstalk in multi-organ failure (MOF)
  • ultrasound in sepsis (POCUS)
  • sepsis-induced coagulophaty and DIC
  • antibiotic therapy
  • multimodal approaches to surgical source control

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

Published Papers (3 papers)

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Review

25 pages, 3799 KiB  
Review
Immunomodulation in Pediatric Sepsis: A Narrative Review
by Gabriella Bottari, Fabio Silvio Taccone, Angelica Corrias, Mariangela Irrera, Paolo Currao, Michele Salvagno, Corrado Cecchetti and Didier Payen
J. Clin. Med. 2025, 14(9), 2983; https://doi.org/10.3390/jcm14092983 - 25 Apr 2025
Viewed by 195
Abstract
Pediatric sepsis presents a unique clinical challenge due to the distinct characteristics of the developing immune system. The immune response in children differs significantly from that in adults, exhibiting a unique combination of resistance, disease tolerance, and resilience. These factors influence the clinical [...] Read more.
Pediatric sepsis presents a unique clinical challenge due to the distinct characteristics of the developing immune system. The immune response in children differs significantly from that in adults, exhibiting a unique combination of resistance, disease tolerance, and resilience. These factors influence the clinical presentation and prognosis of pediatric patients with sepsis. Over the past few years, various studies have explored the role of immunomodulatory therapies in managing sepsis, including the use of immunoglobulins, corticosteroids, monoclonal antibodies, and immunostimulatory treatments. However, the heterogeneity of the clinical presentations and individual responses makes it difficult to identify universally effective treatments. Recent research has highlighted the importance of a personalized approach based on specific biomarkers and patient phenotyping. Extracorporeal blood purification techniques have emerged as promising strategies for the modulation of hyperinflammation. However, strong evidence supporting their routine use in pediatric sepsis is lacking. This review provides a comprehensive overview of the current knowledge of the immune response in pediatric sepsis and discusses the main immunomodulatory strategies and future perspectives for personalized therapy. A deeper understanding of the immunological differences between children and adults could improve the prognosis and treatment efficacy, paving the way for new approaches to pediatric sepsis management. Full article
(This article belongs to the Special Issue Sepsis: New Insights into Diagnosis and Treatment)
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15 pages, 248 KiB  
Review
Antibiotic Stability and Feasibility in Elastomeric Infusion Devices for OPAT: A Review of Current Evidence
by Chiara Moreal, Luca Martini, Francesca Prataviera, Carlo Tascini and Simone Giuliano
J. Clin. Med. 2025, 14(8), 2722; https://doi.org/10.3390/jcm14082722 - 15 Apr 2025
Viewed by 329
Abstract
Background/Objectives: Elastomeric infusion pumps have emerged as a transformative tool in outpatient parenteral antimicrobial therapy (OPAT), enabling continuous intravenous administration outside hospital settings, enhancing patient autonomy, reducing healthcare costs, and playing a role in antimicrobial stewardship. This aim of this review is [...] Read more.
Background/Objectives: Elastomeric infusion pumps have emerged as a transformative tool in outpatient parenteral antimicrobial therapy (OPAT), enabling continuous intravenous administration outside hospital settings, enhancing patient autonomy, reducing healthcare costs, and playing a role in antimicrobial stewardship. This aim of this review is to update current evidence on antibiotic stability in elastomeric infusion pumps, analyzing environmental factors, clinical efficacy, and practical challenges associated with OPAT implementation. Methods: A narrative review was conducted using PubMed and the Cochrane Library, focusing on studies published between 2022 and 2025. Included studies assessed antibiotic stability in elastomeric pumps under real-world and laboratory conditions, examining factors such as temperature sensitivity, light exposure, and material interactions. Results: Findings indicate considerable variability in antibiotic stability, with some agents maintaining prolonged efficacy while others degrade rapidly under certain conditions. Antibiotics with greater stability are better suited for OPAT, whereas those prone to degradation present challenges for continuous infusion. Clinical studies report favorable treatment outcomes, including high cure rates and manageable adverse event profiles. However, discrepancies between laboratory-controlled conditions and real-world settings highlight the necessity for more comprehensive stability evaluations to ensure optimal antibiotic selection and administration in OPAT programs. Conclusions: Optimizing antibiotic formulations, standardizing stability protocols, and advancing elastomeric pump technologies are essential for enhancing OPAT effectiveness. Future research should focus on real-world simulation studies and refining device materials to expand the range of stable antibiotics, ensuring safer and more efficient outpatient antimicrobial therapy. Full article
(This article belongs to the Special Issue Sepsis: New Insights into Diagnosis and Treatment)
20 pages, 578 KiB  
Review
Artificial Intelligence in Sepsis Management: An Overview for Clinicians
by Elena Giovanna Bignami, Michele Berdini, Matteo Panizzi, Tania Domenichetti, Francesca Bezzi, Simone Allai, Tania Damiano and Valentina Bellini
J. Clin. Med. 2025, 14(1), 286; https://doi.org/10.3390/jcm14010286 - 6 Jan 2025
Viewed by 2798
Abstract
Sepsis is one of the leading causes of mortality in hospital settings, and early diagnosis is a crucial challenge to improve clinical outcomes. Artificial intelligence (AI) is emerging as a valuable resource to address this challenge, with numerous investigations exploring its application to [...] Read more.
Sepsis is one of the leading causes of mortality in hospital settings, and early diagnosis is a crucial challenge to improve clinical outcomes. Artificial intelligence (AI) is emerging as a valuable resource to address this challenge, with numerous investigations exploring its application to predict and diagnose sepsis early, as well as personalizing its treatment. Machine learning (ML) models are able to use clinical data collected from hospital Electronic Health Records or continuous monitoring to predict patients at risk of sepsis hours before the onset of symptoms. Background/Objectives: Over the past few decades, ML and other AI tools have been explored extensively in sepsis, with models developed for the early detection, diagnosis, prognosis, and even real-time management of treatment strategies. Methods: This review was conducted according to the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research Type) framework to define the study methodology. A critical overview of each paper was conducted by three different reviewers, selecting those that provided original and comprehensive data relevant to the specific topic of the review and contributed significantly to the conceptual or practical framework discussed, without dwelling on technical aspects of the models used. Results: A total of 194 articles were found; 28 were selected. Articles were categorized and analyzed based on their focus—early prediction, diagnosis, mortality or improvement in the treatment of sepsis. The scientific literature presents mixed outcomes; while some studies demonstrate improvements in mortality rates and clinical management, others highlight challenges, such as a high incidence of false positives and the lack of external validation. This review is designed for clinicians and healthcare professionals, and aims to provide an overview of the application of AI in sepsis management, reviewing the main studies and methodologies used to assess its effectiveness, limitations, and future potential. Full article
(This article belongs to the Special Issue Sepsis: New Insights into Diagnosis and Treatment)
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