Infection, Super Infection and Antimicrobial Management in ICU

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

Deadline for manuscript submissions: closed (20 March 2023) | Viewed by 20412

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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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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,

Although there is growing evidence covering their relevance, the prevalence and microbiology characteristics of bacterial superinfections in critically ill COVID-19 patients are not yet completely understood.

It is instead fully recognized that in patients affected by severe viral respiratory tract infections, the presence of a concomitant infection is associated with poor clinical outcomes. For example, in patients with influenza, superimposed bacterial infections are present in 20–30% of patients, and this condition is associated with increased rates of shock, mechanical ventilation, and mortality. Similarly, in 2003, for the SARS-CoV epidemic, an increased rate of Methicillin-resistant Staphylococcus aureus (MRSA) was reported from 3.53% (3.53 cases per 100 admissions) of cases during the pre-SARS period to 25.3% during the SARS period, with an increased rate of ventilator-acquired pneumonia in ICUs, which was mostly (47.1%) caused by MRSA.

Currently, the pathogens causing secondary infections in SARS-CoV-2 patients seem to be diverse: negative bacilli were the most common, followed by MRSA and Candida.

Assessing the risk of difficult-to-treat bacterial superinfections, such as multidrug-resistant (MDR) Gram-negative bacilli, according to comorbidities, lung abnormalities or systemic diseases, the severity of pneumonia and the risks of drug-related effects are crucial points for the clinical management.

Despite the wide—and not always appropriate—use of broad-spectrum antimicrobials, specific data about bacterial and fungal co-infection in COVID-19 patients are lacking, and confirmed evidence is urgently required to build prospective evidence and to support the development of antimicrobial policy and appropriate stewardship interventions.

The present Special Issue aims to focus on the following key points:

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

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

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Keywords

  • superinfections
  • COVID-19
  • SARS-CoV-2
  • multidrug-resistant pathogens
  • antimicrobial stewardship
  • antimicrobial resistance
  • fungal infections
  • bacterial infections
  • intensive care medicine
  • critical care medicine

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Published Papers (10 papers)

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Research

14 pages, 1614 KiB  
Article
Incidence of Healthcare-Associated Infections in a Neonatal Intensive Care Unit before and during the COVID-19 Pandemic: A Four-Year Retrospective Cohort Study
by Mariateresa Ceparano, Antonio Sciurti, Claudia Isonne, Valentina Baccolini, Giuseppe Migliara, Carolina Marzuillo, Fabio Natale, Gianluca Terrin, Paolo Villari and The Collaborating Group
J. Clin. Med. 2023, 12(7), 2621; https://doi.org/10.3390/jcm12072621 - 30 Mar 2023
Cited by 4 | Viewed by 2235
Abstract
The COVID-19 pandemic may have had an impact on healthcare-associated infection (HAI) rates. In this study, we analyzed the occurrence of HAIs in a neonatal intensive care unit (NICU) of the Umberto I teaching hospital in Rome before and during the pandemic. All [...] Read more.
The COVID-19 pandemic may have had an impact on healthcare-associated infection (HAI) rates. In this study, we analyzed the occurrence of HAIs in a neonatal intensive care unit (NICU) of the Umberto I teaching hospital in Rome before and during the pandemic. All infants admitted from 1 March 2018 to 28 February 2022 were included and were divided into four groups according to their admission date: two groups before the pandemic (periods I and II) and two during the pandemic (periods III and IV). The association between risk factors and time-to-first event was analyzed using a multivariable Cox regression model. Over the four-year period, a total of 503 infants were included, and 36 infections were recorded. After adjusting for mechanical ventilation, birth weight, sex, type of delivery, respiratory distress syndrome, and previous use of netilmicin and fluconazole, the multivariable analysis confirmed that being hospitalized during the pandemic periods (III and IV) was the main risk factor for HAI acquisition. Furthermore, a change in the etiology of these infections was observed across the study periods. Together, these findings suggest that patient management during the pandemic was suboptimal and that HAI surveillance protocols should be implemented in the NICU setting promptly. Full article
(This article belongs to the Special Issue Infection, Super Infection and Antimicrobial Management in ICU)
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13 pages, 811 KiB  
Article
Next-Generation Sequencing in Critically Ill COVID-19 Patients with Suspected Bloodstream Infections: A Retrospective Cohort Study
by Christoph J. Leitl, Sandra E. Stoll, Wolfgang A. Wetsch, Tobias Kammerer, Alexander Mathes, Bernd W. Böttiger, Harald Seifert and Fabian Dusse
J. Clin. Med. 2023, 12(4), 1466; https://doi.org/10.3390/jcm12041466 - 12 Feb 2023
Cited by 4 | Viewed by 1762
Abstract
Background: Rapid pathogen identification and appropriate antimicrobial therapy are crucial in critically ill COVID-19 patients with bloodstream infections (BSIs). This study aimed to evaluate the diagnostic performance and potential therapeutic benefit of additional next-generation sequencing (NGS) of microbial DNA from plasma in these [...] Read more.
Background: Rapid pathogen identification and appropriate antimicrobial therapy are crucial in critically ill COVID-19 patients with bloodstream infections (BSIs). This study aimed to evaluate the diagnostic performance and potential therapeutic benefit of additional next-generation sequencing (NGS) of microbial DNA from plasma in these patients. Methods: This monocentric descriptive retrospective study reviewed clinical data and pathogen diagnostics in COVID-19 ICU patients. NGS (DISQVER®) and blood culture (BC) samples were obtained on suspicion of BSIs. Data were reviewed regarding the adjustment of antimicrobial therapy and diagnostic procedures seven days after sampling and analyzed using the Chi²-test. Results: Twenty-five cases with simultaneous NGS and BC sampling were assessed. The NGS positivity rate was 52% (13/25) with the detection of 23 pathogens (14 bacteria, 1 fungus, 8 viruses), and the BC positivity rate was 28% (7/25, 8 bacteria; p = 0.083). The NGS-positive patients were older (75 vs. 59.5 years; p = 0.03) with a higher prevalence of cardiovascular disease (77% vs. 33%; p = 0.03). These NGS results led to diagnostic procedures in four cases and to the commencement of four antimicrobial therapies in three cases. Empirical treatment was considered appropriate and continued in three cases. Conclusions: In COVID-19 patients with suspected BSIs, NGS may provide a higher positivity rate than BC and enable new therapeutic approaches. Full article
(This article belongs to the Special Issue Infection, Super Infection and Antimicrobial Management in ICU)
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13 pages, 1539 KiB  
Article
Incidence, Outcomes and Risk Factors of Recurrent Ventilator Associated Pneumonia in COVID-19 Patients: A Retrospective Multicenter Study
by Ines Gragueb-Chatti, Hervé Hyvernat, Marc Leone, Geoffray Agard, Noémie Peres, Christophe Guervilly, Mohamed Boucekine, Dany Hamidi, Laurent Papazian, Jean Dellamonica, Alexandre Lopez and Sami Hraiech
J. Clin. Med. 2022, 11(23), 7097; https://doi.org/10.3390/jcm11237097 - 30 Nov 2022
Cited by 6 | Viewed by 1713
Abstract
Background: High incidence of ventilator associated pneumonia (VAP) has been reported in critically ill patients with COVID-19. Among these patients, we aimed to assess the incidence, outcomes and risk factors of VAP recurrences. Methods: We conducted an observational retrospective study in three French [...] Read more.
Background: High incidence of ventilator associated pneumonia (VAP) has been reported in critically ill patients with COVID-19. Among these patients, we aimed to assess the incidence, outcomes and risk factors of VAP recurrences. Methods: We conducted an observational retrospective study in three French intensive care units (ICUs). Patients admitted for a documented COVID-19 from March 2020 to May 2021 and requiring mechanical ventilation (MV) for ≥48 h were included. The study main outcome was the incidence of VAP recurrences. Secondary outcomes were the duration of MV, ICU and hospital length of stay and mortality according to VAP and recurrences. We also assessed the factors associated with VAP recurrences. Results: During the study period, 398 patients met the inclusion criteria. A total of 236 (59%) of them had at least one VAP episode during their ICU stay and 109 (46%) of these patients developed at least one recurrence. The incidence of VAP recurrence considering death and extubation as competing events was 29.6% (IC = [0.250–0.343]). Seventy-eight percent of recurrences were due to the same bacteria (relapses). Patients with a VAP recurrence had a longer duration of MV as compared with one VAP and no VAP patients (41 (25–56) vs. 16 (8–30) and 10 (5–18) days; p < 0.001) and a longer ICU length of stay (46 (29–66) vs. 22 (12–36) and 14 (9–25) days; p < 0.001). The 90-day mortality was higher in the recurrence group as compared with the no VAP group only (31.2 vs. 21.0% (p = 0.021)). In a multivariate analysis including bacterial co-infection at admission, the use of immunosuppressive therapies and the bacteria responsible for the first VAP episode, the duration of MV was the only factor independently associated with VAP recurrence. Conclusion: In COVID-19 associated respiratory failure, recurrences affected 46% of patients with a first episode of VAP. VAP recurrences were mainly relapses and were associated with a prolonged duration of MV and ICU length of stay but not with a higher mortality. MV duration was the only factor associated with recurrences. Full article
(This article belongs to the Special Issue Infection, Super Infection and Antimicrobial Management in ICU)
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11 pages, 1442 KiB  
Article
Effect of the Pandemic Outbreak on ICU-Associated Infections and Antibiotic Prescription Trends in Non-COVID19 Acute Respiratory Failure Patients
by Enrico Bussolati, Rosario Cultrera, Alessandra Quaranta, Valentina Cricca, Elisabetta Marangoni, Riccardo La Rosa, Sara Bertacchini, Alessandra Bellonzi, Riccardo Ragazzi, Carlo Alberto Volta, Savino Spadaro and Gaetano Scaramuzzo
J. Clin. Med. 2022, 11(23), 7080; https://doi.org/10.3390/jcm11237080 - 29 Nov 2022
Cited by 3 | Viewed by 1612
Abstract
Background: The COVID-19 pandemic had a relevant impact on the organization of intensive care units (ICU) and may have reduced the overall compliance with healthcare-associated infections (HAIs) prevention programs. Invasively ventilated patients are at high risk of ICU-associated infection, but there is little [...] Read more.
Background: The COVID-19 pandemic had a relevant impact on the organization of intensive care units (ICU) and may have reduced the overall compliance with healthcare-associated infections (HAIs) prevention programs. Invasively ventilated patients are at high risk of ICU-associated infection, but there is little evidence regarding the impact of the pandemic on their occurrence in non-COVID-19 patients. Moreover, little is known of antibiotic prescription trends in the ICU during the first wave of the pandemic. The purpose of this investigation is to assess the incidence, characteristics, and risk factors for ICU-associated HAIs in a population of invasively ventilated patients affected by non-COVID-19 acute respiratory failure (ARF) admitted to the ICU in the first wave of the COVID-19 pandemic, and to evaluate the ICU antimicrobial prescription strategies. Moreover, we compared HAIs and antibiotic use to a cohort of ARF patients admitted to the ICU the year before the pandemic during the same period. Methods: this is a retrospective, single-centered cohort study conducted at S. Anna University Hospital (Ferrara, Italy). We enrolled patients admitted to the ICU for acute respiratory failure requiring invasive mechanical ventilation (MV) between February and April 2020 (intra-pandemic group, IP) and February and April 2019 (before the pandemic group, PP). We excluded patients admitted to the ICU for COVID-19 pneumonia. We recorded patients’ baseline characteristics, ICU-associated procedures and devices. Moreover, we evaluated antimicrobial therapy and classified it as prophylactic, empirical or target therapy, according to the evidence of infection at the time of prescription and to the presence of a positive culture sample. We compared the results of the two groups (PP and IP) to assess differences between the two years. Results: One hundred and twenty-eight patients were screened for inclusion and 83 patients were analyzed, 45 and 38 in the PP and I group, respectively. We found a comparable incidence of HAIs (62.2% vs. 65.8%, p = 0.74) and multidrug-resistant (MDR) isolations (44.4% vs. 36.8% p= 0.48) in the two groups. The year of ICU admission was not independently associated with an increased risk of developing HAIs (OR = 0.35, 95% CI 0.16–1.92, p = 0.55). The approach to antimicrobial therapy was characterized by a significant reduction in total antimicrobial use (21.4 ± 18.7 vs. 11.6 ± 9.4 days, p = 0.003), especially of target therapy, in the IP group. Conclusions: ICU admission for non-COVID-19 ARF during the first wave of the SARS-CoV-2 pandemic was not associated with an increased risk of ICU-associated HAIs. Nevertheless, ICU prescription of antimicrobial therapy changed and significantly decreased during the pandemic. Full article
(This article belongs to the Special Issue Infection, Super Infection and Antimicrobial Management in ICU)
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13 pages, 650 KiB  
Article
Bacterial Aspiration Pneumonia in Generalized Convulsive Status Epilepticus: Incidence, Associated Factors and Outcome
by Romain Tortuyaux, Frédéric Wallet, Philippe Derambure and Saad Nseir
J. Clin. Med. 2022, 11(22), 6673; https://doi.org/10.3390/jcm11226673 - 10 Nov 2022
Cited by 2 | Viewed by 2208
Abstract
Suspicion of bacterial aspiration pneumonia (BAP) is frequent during generalized convulsive status epilepticus (GCSE). Early identification of BAP is required in order to avoid useless antibiotic therapy. In this retrospective monocentric study, we aimed to determine the incidence of aspiration syndrome and BAP [...] Read more.
Suspicion of bacterial aspiration pneumonia (BAP) is frequent during generalized convulsive status epilepticus (GCSE). Early identification of BAP is required in order to avoid useless antibiotic therapy. In this retrospective monocentric study, we aimed to determine the incidence of aspiration syndrome and BAP in GCSE requiring mechanical ventilation (MV) and factors associated with the occurrence of BAP. Patients were older than 18 years and had GCSE requiring MV. To distinguish BAP from pneumonitis, tracheal aspirate and quantitative microbiological criterion were used. Out of 226 consecutive patients, 103 patients (46%) had an aspiration syndrome, including 54 (52%) with a BAP. Staphylococcus aureus represented 33% of bacterial strains. No relevant baseline characteristics differed, including serum levels of CRP, PCT, and albumin. The median duration of treatment for BAP was 7 days (5–7). Patients with BAP did not have a longer duration of MV (p = 0.18) and ICU stay (p = 0.18) than those with pneumonitis. At 3 months, 24 patients (44%) with BAP and 10 (27%) with pneumonitis had a poor functional outcome (p = 0.06). In conclusion, among patients with GCSE, half of the patients had an aspiration syndrome and one-quarter suffered from BAP. Clinical characteristics and biomarkers were not useful for differentiating BAP from pneumonitis. These results highlight the need for a method to rapidly differentiate BAP from pneumonitis, such as polymerase-chain-reaction-based techniques. Full article
(This article belongs to the Special Issue Infection, Super Infection and Antimicrobial Management in ICU)
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11 pages, 418 KiB  
Article
Dose Optimization of Meropenem in Patients on Veno-Arterial Extracorporeal Membrane Oxygenation in Critically Ill Cardiac Patients: Pharmacokinetic/Pharmacodynamic Modeling
by Soyoung Kang, Seungwon Yang, Jongsung Hahn, June Young Jang, Kyoung Lok Min, Jin Wi and Min Jung Chang
J. Clin. Med. 2022, 11(22), 6621; https://doi.org/10.3390/jcm11226621 - 8 Nov 2022
Cited by 2 | Viewed by 1929
Abstract
Background: Our objective was to determine an optimal dosage regimen of meropenem in patients receiving veno-arterial extracorporeal membrane oxygenation (V-A ECMO) by developing a pharmacokinetic/pharmacodynamic (PK/PD) model. Methods: This was a prospective cohort study. Blood samples were collected during ECMO (ECMO-ON) and after [...] Read more.
Background: Our objective was to determine an optimal dosage regimen of meropenem in patients receiving veno-arterial extracorporeal membrane oxygenation (V-A ECMO) by developing a pharmacokinetic/pharmacodynamic (PK/PD) model. Methods: This was a prospective cohort study. Blood samples were collected during ECMO (ECMO-ON) and after ECMO (ECMO-OFF). The population pharmacokinetic model was developed using nonlinear mixed-effects modeling. A Monte Carlo simulation was used (n = 10,000) to assess the probability of target attainment. Results: Thirteen adult patients on ECMO receiving meropenem were included. Meropenem pharmacokinetics was best fitted by a two-compartment model. The final pharmacokinetic model was: CL (L/h) = 3.79 × 0.44CRRT, central volume of distribution (L) = 2.4, peripheral volume of distribution (L) = 8.56, and intercompartmental clearance (L/h) = 21.3. According to the simulation results, if more aggressive treatment is needed (100% fT > MIC target), dose increment or extended infusion is recommended. Conclusions: We established a population pharmacokinetic model for meropenem in patients receiving V-A ECMO and revealed that it is not necessary to adjust the dosage depending on V-A ECMO. Instead, more aggressive treatment is needed than that of standard treatment, and higher dosage is required without continuous renal replacement therapy (CRRT). Also, extended infusion could lead to better target attainment, and we could provide updated nomograms of the meropenem dosage regimen. Full article
(This article belongs to the Special Issue Infection, Super Infection and Antimicrobial Management in ICU)
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13 pages, 1659 KiB  
Article
Invasiveness of Ventilation Therapy Is Associated to Prevalence of Secondary Bacterial and Fungal Infections in Critically Ill COVID-19 Patients
by Marie Louise de Hesselle, Stefan Borgmann, Siegbert Rieg, Jörg Janne Vehreshild, Christoph D. Spinner, Carolin E. M. Koll, Martin Hower, Melanie Stecher, Daniel Ebert, Frank Hanses, Julia Schumann and on behalf of the SAREL Investigators
J. Clin. Med. 2022, 11(17), 5239; https://doi.org/10.3390/jcm11175239 - 5 Sep 2022
Cited by 8 | Viewed by 1615
Abstract
Superinfections are a fundamental critical care problem, and their significance in severe COVID-19 cases needs to be determined. This study analyzed data from the Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) cohort focusing on intensive care patients. A retrospective analysis of patient [...] Read more.
Superinfections are a fundamental critical care problem, and their significance in severe COVID-19 cases needs to be determined. This study analyzed data from the Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) cohort focusing on intensive care patients. A retrospective analysis of patient data from 840 cases of COVID-19 with critical courses demonstrated that co-infections were frequently present and were primarily of nosocomial origin. Furthermore, our analysis showed that invasive therapy procedures accompanied an increased risk for healthcare-associated infections. Non-ventilated ICU patients were rarely affected by secondary infections. The risk of infection, however, increased even when non-invasive ventilation was used. A further, significant increase in infection rates was seen with the use of invasive ventilation and even more so with extracorporeal membrane oxygenation (ECMO) therapy. The marked differences among ICU techniques used for the treatment of COVID-19-induced respiratory failure in terms of secondary infection risk profile should be taken into account for the optimal management of critically ill COVID-19 patients, as well as for adequate antimicrobial therapy. Full article
(This article belongs to the Special Issue Infection, Super Infection and Antimicrobial Management in ICU)
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11 pages, 280 KiB  
Article
The Burden of Carbapenem-Resistant Acinetobacter baumannii in ICU COVID-19 Patients: A Regional Experience
by Giorgia Montrucchio, Silvia Corcione, Tommaso Lupia, Nour Shbaklo, Carlo Olivieri, Miriam Poggioli, Aline Pagni, Davide Colombo, Agostino Roasio, Stefano Bosso, Fabrizio Racca, Valeria Bonato, Francesco Della Corte, Stefania Guido, Andrea Della Selva, Enrico Ravera, Nicoletta Barzaghi, Martina Cerrano, Pietro Caironi, Giacomo Berta, Cecilia Casalini, Bruno Scapino, Michele Grio, Massimiliano Parlanti Garbero, Gabriella Buono, Federico Finessi, Simona Erbetta, Paola Federica Sciacca, Gilberto Fiore, Alessandro Cerutti, Sergio Livigni, Daniela Silengo, Fulvio Agostini, Maurizio Berardino, Mauro Navarra, Silvia Vendramin, Enzo Castenetto, Marco Maria Liccardi, Emilpaolo Manno, Luca Brazzi and Francesco Giuseppe De Rosaadd Show full author list remove Hide full author list
J. Clin. Med. 2022, 11(17), 5208; https://doi.org/10.3390/jcm11175208 - 2 Sep 2022
Cited by 22 | Viewed by 2111
Abstract
Since the beginning of the COVID-19 pandemic, the impact of superinfections in intensive care units (ICUs) has progressively increased, especially carbapenem-resistant Acinetobacter baumannii (CR-Ab). This observational, multicenter, retrospective study was designed to investigate the characteristics of COVID-19 ICU patients developing CR-Ab colonization/infection during [...] Read more.
Since the beginning of the COVID-19 pandemic, the impact of superinfections in intensive care units (ICUs) has progressively increased, especially carbapenem-resistant Acinetobacter baumannii (CR-Ab). This observational, multicenter, retrospective study was designed to investigate the characteristics of COVID-19 ICU patients developing CR-Ab colonization/infection during an ICU stay and evaluate mortality risk factors in a regional ICU network. A total of 913 COVID-19 patients were admitted to the participating ICUs; 19% became positive for CR-Ab, either colonization or infection (n = 176). The ICU mortality rate in CR-Ab patients was 64.7%. On average, patients developed colonization or infection within 10 ± 8.4 days from ICU admission. Scores of SAPS II and SOFA were significantly higher in the deceased patients (43.8 ± 13.5, p = 0.006 and 9.5 ± 3.6, p < 0.001, respectively). The mortality rate was significantly higher in patients with extracorporeal membrane oxygenation (12; 7%, p = 0.03), septic shock (61; 35%, p < 0.001), and in elders (66 ± 10, p < 0.001). Among the 176 patients, 129 (73%) had invasive infection with CR-Ab: 105 (60.7%) Ventilator-Associated Pneumonia (VAP), and 46 (26.6%) Bloodstream Infections (BSIs). In 22 cases (6.5%), VAP was associated with concomitant BSI. Colonization was reported in 165 patients (93.7%). Mortality was significantly higher in patients with VAP (p = 0.009). Colonized patients who did not develop invasive infections had a higher survival rate (p < 0.001). Being colonized by CR-Ab was associated with a higher risk of developing invasive infections (p < 0.001). In a multivariate analysis, risk factors significantly associated with mortality were age (OR = 1.070; 95% CI (1.028–1.115) p = 0.001) and CR-Ab colonization (OR = 5.463 IC95% 1.572–18.988, p = 0.008). Constant infection-control measures are necessary to stop the spread of A. baumannii in the hospital environment, especially at this time of the SARS-CoV-2 pandemic, with active surveillance cultures and the efficient performance of a multidisciplinary team. Full article
(This article belongs to the Special Issue Infection, Super Infection and Antimicrobial Management in ICU)
14 pages, 810 KiB  
Article
Effectiveness of a Multifaced Antibiotic Stewardship Program: A Pre-Post Study in Seven Italian ICUs
by Giulia Mandelli, Francesca Dore, Martin Langer, Elena Garbero, Laura Alagna, Andrea Bianchin, Rita Ciceri, Antonello Di Paolo, Tommaso Giani, Aimone Giugni, Andrea Gori, Ugo Lefons, Antonio Muscatello, Carlo Olivieri, Angelo Pan, Matteo Pedeferri, Marianna Rossi, Gian Maria Rossolini, Emanuele Russo, Daniela Silengo, Bruno Viaggi, Guido Bertolini and Stefano Finazziadd Show full author list remove Hide full author list
J. Clin. Med. 2022, 11(15), 4409; https://doi.org/10.3390/jcm11154409 - 28 Jul 2022
Cited by 7 | Viewed by 1962
Abstract
Multidrug resistance has become a serious threat for health, particularly in hospital-acquired infections. To improve patients’ safety and outcomes while maintaining the efficacy of antimicrobials, complex interventions are needed involving infection control and appropriate pharmacological treatments in antibiotic stewardship programs. We conducted a [...] Read more.
Multidrug resistance has become a serious threat for health, particularly in hospital-acquired infections. To improve patients’ safety and outcomes while maintaining the efficacy of antimicrobials, complex interventions are needed involving infection control and appropriate pharmacological treatments in antibiotic stewardship programs. We conducted a multicenter pre-post study to assess the impact of a stewardship program in seven Italian intensive care units (ICUs). Each ICU was visited by a multidisciplinary team involving clinicians, microbiologists, pharmacologists, infectious disease specialists, and data scientists. Interventions were targeted according to the characteristics of each unit. The effect of the program was measured with a panel of indicators computed with data from the MargheritaTre electronic health record. The median duration of empirical therapy decreased from 5.6 to 4.6 days and the use of quinolones dropped from 15.3% to 6%, both p < 0.001. The proportion of multi-drug-resistant bacteria (MDR) in ICU-acquired infections fell from 57.7% to 48.8%. ICU mortality and length of stay remained unchanged, indicating that reducing antibiotic administration did not harm patients’ safety. This study shows that our stewardship program successfully improved the management of infections. This suggests that policy makers should tackle multidrug resistance with a multidisciplinary approach based on continuous monitoring and personalised interventions. Full article
(This article belongs to the Special Issue Infection, Super Infection and Antimicrobial Management in ICU)
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14 pages, 656 KiB  
Article
Effectiveness of an Active and Continuous Surveillance Program for Intensive Care Units Infections Based on the EPIC III (Extended Prevalence of Infection in Intensive Care) Approach
by Giorgia Montrucchio, Gabriele Sales, Giulia Catozzi, Stefano Bosso, Martina Scanu, Titty Vita Vignola, Andrea Costamagna, Silvia Corcione, Rosario Urbino, Claudia Filippini, Francesco Giuseppe De Rosa and Luca Brazzi
J. Clin. Med. 2022, 11(9), 2482; https://doi.org/10.3390/jcm11092482 - 28 Apr 2022
Cited by 2 | Viewed by 1763
Abstract
We evaluated the effectiveness of the Extended Prevalence of Infection in Intensive Care (EPIC) III data collection protocol as an active surveillance tool in the eight Intensive Care Units (ICUs) of the Intensive and Critical Care Department of the University Hospital of Turin. [...] Read more.
We evaluated the effectiveness of the Extended Prevalence of Infection in Intensive Care (EPIC) III data collection protocol as an active surveillance tool in the eight Intensive Care Units (ICUs) of the Intensive and Critical Care Department of the University Hospital of Turin. A total of 435 patients were included in a six-day study over 72 ICU beds. 42% had at least one infection: 69% at one site, 26% at two sites and 5% at three or more sites. ICU-acquired infections were the most common (64%), followed by hospital-associated infections (22%) and community-acquired (20%), considering that each patient may have developed more than one infection type. 72% of patients were receiving at least one antibiotic: 48% for prophylaxis and 52% for treatment. Mortality, the length of ICU and hospital stays were 13%, 14 and 29 days, respectively, being all estimated to be significantly different in patients without and with infection (8% vs. 20%; 4 vs. 20 and 11 vs. 50 (p < 0.001). Our data confirm a high prevalence of infections, sepsis and the use of antimicrobials. The repeated punctual prevalence survey seems an effective method to carry out the surveillance of infections and the use of antimicrobials in the ICU. The use of the European Centre for Disease Prevention and Control (ECDC) definitions and the EPIC III protocol seems strategic to allow comparisons with national and international contexts. Full article
(This article belongs to the Special Issue Infection, Super Infection and Antimicrobial Management in ICU)
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