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Microorganisms
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Infections in Intensive Care Units
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Infections in Intensive Care Units

A special issue of Microorganisms (ISSN 2076-2607). This special issue belongs to the section "Medical Microbiology".

Deadline for manuscript submissions: closed (30 November 2021) | Viewed by 24549

Special Issue Editors

Prof. Dr. Dominic Wichmann

E-Mail Website
Guest Editor
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Interests: Critical Care; COVID-19; Infectious Diseases; Antibiotic and Antimykotic Therapies; Tropical Medicine; Therapeutic Drug Monitoring in ICU patients
Special Issues, Collections and Topics in MDPI journals
Dr. Jörn Grensemann

E-Mail Website
Guest Editor
Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
Interests: theurapeutic drug monitoring; infections of the central nervous system; airway management

Special Issue Information

Infections are relevant for all critically ill patients in the ICU. Some of the patients are treated in the ICU because of severe infection, and the others are exposed to a significantly increased risk of infection due to their treatment. The reasons for this are manifold, for example, immunosuppressive therapies (medicinal or, e.g., in the context of dialysis/plasmapheresis), postoperative complications, or device-related infections.

In this issue of Microorganisms we would like to focus on infections and their pathogens in critically ill patients in the ICU. These may be pathogen-specific factors that promote infection in the ICU setting (biofilm formation on catheter materials), aspects of the management of specific infections (e.g., ventriculitis in neurosurgical patients or difficult-to-treat pathogens in burn patients), or interventions to reduce/treat infections. Submissions on the abovementioned issues are especially encouraged.

Keywords

  • intensive care
  • therapeutic drug monitoring
  • difficult-to-treat infections
  • multi-resistant pathogens

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Published Papers (6 papers)

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Research

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13 pages, 1159 KiB  
Article
Voriconazole Pharmacokinetics Are Not Altered in Critically Ill Patients with Acute-on-Chronic Liver Failure and Continuous Renal Replacement Therapy: An Observational Study
by Jörn Grensemann, Christoph Pfaffendorf, Sebastian G. Wicha, Christina König, Kevin Roedl, Dominik Jarczak, Stefanie Iwersen-Bergmann, Carolin Manthey, Stefan Kluge and Valentin Fuhrmann
Microorganisms 2021, 9(10), 2087; https://doi.org/10.3390/microorganisms9102087 - 3 Oct 2021
Cited by 7 | Viewed by 2697
Abstract
Infection and sepsis are a main cause of acute-on-chronic liver failure (ACLF). Besides bacteria, molds play a role. Voriconazole (VRC) is recommended but its pharmacokinetics (PK) may be altered by ACLF. Because ACLF patients often suffer from concomitant acute renal failure, we studied [...] Read more.
Infection and sepsis are a main cause of acute-on-chronic liver failure (ACLF). Besides bacteria, molds play a role. Voriconazole (VRC) is recommended but its pharmacokinetics (PK) may be altered by ACLF. Because ACLF patients often suffer from concomitant acute renal failure, we studied the PK of VRC in patients receiving continuous renal replacement therapy (RRT) with ACLF and compared it to PK of VRC in critically ill patients with RRT without concomitant liver failure (NLF). In this prospective cohort study, patients received weight-based VRC. Pre- and post-dialysis membrane, and dialysate samples obtained at different time points were analyzed by high-performance liquid chromatography. An integrated dialysis pharmacometric model was used to model the available PK data. The recommended, 50% lower, and 50% higher doses were analyzed by Monte-Carlo simulation (MCS) for day 1 and at steady-state with a target trough concentration (TC) of 0.5–3mg/L. Fifteen patients were included in this study. Of these, 6 patients suffered from ACLF. A two-compartment model with linear clearance described VRC PK. No difference for central (V1) or peripheral (V2) volumes of distribution or clearance could be demonstrated between the groups. V1 was 80.6L (95% confidence interval: 62.6–104) and V2 106L (65–166) with a body clearance of 4.7L/h (2.87–7.81) and RRT clearance of 1.46L/h (1.29–1.64). MCS showed TC below/within/above target of 10/74/16% on day 1 and 9/39/52% at steady-state for the recommended dose. A 50% lower dose resulted in 26/72/1% (day 1) and 17/64/19% at steady-state and 7/57/37% and 7/27/67% for a 50% higher dose. VRC pharmacokinetics are not significantly influenced by ACLF in critically ill patients who receive RRT. Maintenance dose should be adjusted in both groups. Due to the high interindividual variability, therapeutic drug monitoring seems inevitable. Full article
(This article belongs to the Special Issue Infections in Intensive Care Units)
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12 pages, 1028 KiB  
Article
The Pathogenic Bacteria of Deep Neck Infection in Patients with Type 1 Diabetes, Type 2 Diabetes, and Without Diabetes from Chang Gung Research Database
by Chih-Wei Luan, Chia-Yen Liu, Yao-Hsu Yang, Ming-Shao Tsai, Yao-Te Tsai, Cheng-Ming Hsu, Ching-Yuan Wu, Pey-Jium Chang and Geng-He Chang
Microorganisms 2021, 9(10), 2059; https://doi.org/10.3390/microorganisms9102059 - 29 Sep 2021
Cited by 11 | Viewed by 3020
Abstract
Deep neck infection (DNI) is a lethal emergent condition. Patients with types 1 and 2 diabetes mellitus (T1DM and T2DM, respectively) are predisposed to DNI and have poorer prognoses. The mainstay of the treatment is surgical drainage and antibiotics; however, the pathogenic bacteria [...] Read more.
Deep neck infection (DNI) is a lethal emergent condition. Patients with types 1 and 2 diabetes mellitus (T1DM and T2DM, respectively) are predisposed to DNI and have poorer prognoses. The mainstay of the treatment is surgical drainage and antibiotics; however, the pathogenic bacteria of T1DM-DNI have not been studied before. We obtained the data of 8237 patients with DNI who were hospitalized from 2004 to 2015 from the Chang Gung Research Database, which contains multi-institutional medical records in Taiwan. Using diagnostic codes, we classified them into T1DM-DNI, T2DM-DNI, and non-DM-DNI and analyzed their pathogenic bacteria, disease severity, treatment, and prognosis. The top three facultative anaerobic or aerobic bacteria of T1DM-DNI were Klebsiella pneumoniae (KP, 40.0%), Viridans Streptococci (VS, 22.2%), and methicillin-sensitive Staphylococcus aureus (MSSA, 8.9%), similar for T2DM (KP, 32.2%; VS, 23.3%; MSSA, 9.5%). For non-DM-DNI, it was VS (34.6%), KP (9.8%), and coagulase-negative Staphylococci (8.7%). The order of anaerobes for the three groups was Peptostreptococcus micros, Prevotella intermedia, and Peptostreptococcus anaerobius. Patients with T1DM-DNI and T2DM-DNI had higher white blood cell (WBC) counts and C-reactive protein (CRP) levels, more cases of surgery, more cases of tracheostomy, longer hospital stays, more mediastinal complications, and higher mortality rates than those without DM-DNI. Patients in the death subgroup in T1DM-DNI had higher WBC counts, band forms, and CRP levels than those in the survival subgroup. Patients with DM-DNI had more severe disease and higher mortality rate than those without DM-DNI. KP and Peptostreptococcus micros are the leading pathogens for both patients with T1DM-DNI and those with T2DM-DNI. Clinicians should beware of high serum levels of infection markers, which indicate potential mortality. Full article
(This article belongs to the Special Issue Infections in Intensive Care Units)
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8 pages, 492 KiB  
Article
Clinical Course and Outcome of Patients with SARS-CoV-2 Alpha Variant Infection Compared to Patients with SARS-CoV-2 Wild-Type Infection Admitted to the ICU
by Jorge Garcia Borrega, Jan-Hendrik Naendrup, Katrin Heindel, Laura Hamacher, Eva Heger, Veronica Di Cristanziano, Antje-Christin Deppe, Fabian Dusse, Wolfgang Alois Wetsch, Dennis Alexander Eichenauer, Alexander Shimabukuro-Vornhagen, Boris Böll and Matthias Kochanek
Microorganisms 2021, 9(9), 1944; https://doi.org/10.3390/microorganisms9091944 - 13 Sep 2021
Cited by 9 | Viewed by 2442
Abstract
The alpha variant of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is associated with higher transmissibility and possibly higher mortality compared with wild-type SARS-CoV-2. However, few data are available on the clinical course of infections with the alpha variant compared with [...] Read more.
The alpha variant of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is associated with higher transmissibility and possibly higher mortality compared with wild-type SARS-CoV-2. However, few data are available on the clinical course of infections with the alpha variant compared with wild-type SARS-CoV-2 in critically ill patients in intensive care units (ICUs). Therefore, we retrospectively analyzed patients admitted to our ICU due to SARS-CoV-2 Alpha variant infection and compared characteristics and course to patients with SARS-CoV-2 wild-type infection. The median age of patients with Alpha variant infections was 57 years compared to 62 years in the wild-type group. ICU survival was 41/80 (51%) in the Alpha variant group and 35/80 (44%) in the wild-type group (p = 0.429). Results of a matched-pair analysis based on age and sex illustrated that 45/58 patients (77.6%) in the Alpha variant group and 38/58 (65.5%) patients in the wild-type group required mechanical ventilation (p = 0.217). ICU survival was documented for 28/58 patients (48.3%) in the Alpha variant group and 27/58 patients (46.6%) in the wild-type group (p = 1). Thus, ICU mortality among patients with SARS-CoV-2 infections remains high. Although the Alpha variant group included younger patients requiring mechanical ventilation, no significant differences between patients with the SARS-CoV-2 Alpha variant and the SARS-CoV-2 wild-type, respectively, were detected with respect to clinical course and ICU mortality. For future VOCs, we believe it would be important to obtain valid and rapid data on the clinical course of critically ill patients who test positive for COVID-19 in order to perform appropriate epidemiological planning of intensive care capacity. Full article
(This article belongs to the Special Issue Infections in Intensive Care Units)
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Review

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20 pages, 8803 KiB  
Review
Virulence Potential and Treatment Options of Multidrug-Resistant (MDR) Acinetobacter baumannii
by Sunil Kumar, Razique Anwer and Arezki Azzi
Microorganisms 2021, 9(10), 2104; https://doi.org/10.3390/microorganisms9102104 - 6 Oct 2021
Cited by 39 | Viewed by 7727
Abstract
Acinetobacter baumannii is an opportunistic pathogen which is undoubtedly known for a high rate of morbidity and mortality in hospital-acquired infections. A. baumannii causes life-threatening infections, including; ventilator-associated pneumonia (VAP), meningitis, bacteremia, and wound and urinary tract infections (UTI). In 2017, the [...] Read more.
Acinetobacter baumannii is an opportunistic pathogen which is undoubtedly known for a high rate of morbidity and mortality in hospital-acquired infections. A. baumannii causes life-threatening infections, including; ventilator-associated pneumonia (VAP), meningitis, bacteremia, and wound and urinary tract infections (UTI). In 2017, the World Health Organization listed A. baumannii as a priority-1 pathogen. The prevalence of A. baumannii infections and outbreaks emphasizes the direct need for the use of effective therapeutic agents for treating such infections. Available antimicrobials, such as; carbapenems, tigecycline, and colistins have insufficient effectiveness due to the appearance of multidrug-resistant strains, accentuating the need for alternative and novel therapeutic remedies. To understand and overcome this menace, the knowledge of recent discoveries on the virulence factors of A. baumannii is needed. Herein, we summarized the role of various virulence factors, including; outer membrane proteins, efflux pumps, biofilm, penicillin-binding proteins, and siderophores/iron acquisition systems. We reviewed the recent scientific literature on different A. baumannii virulence factors and the effective antimicrobial agents for the treatment and management of bacterial infections. Full article
(This article belongs to the Special Issue Infections in Intensive Care Units)
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11 pages, 5399 KiB  
Review
Human Infections by Wohlfahrtiimonas chitiniclastica: A Mini-Review and the First Report of a Burn Wound Infection after Accidental Myiasis in Central Europe
by Martin Hladík, Bretislav Lipovy, Yvona Kaloudova, Marketa Hanslianova, Ivana Vitkova, Tereza Deissova, Tomas Kempny, Martin Svoboda, Zdenek Kala, Pavel Brychta and Petra Borilova Linhartova
Microorganisms 2021, 9(9), 1934; https://doi.org/10.3390/microorganisms9091934 - 11 Sep 2021
Cited by 7 | Viewed by 4294
Abstract
Wohlfahrtiimonas chitiniclastica are bacteria that cause rare infections, typically associated with the infestation of an open wound with fly larvae. Here, we present a unique case report of the first W. chitiniclastica isolation from a burn wound with accidental myiasis in a 63-year-old [...] Read more.
Wohlfahrtiimonas chitiniclastica are bacteria that cause rare infections, typically associated with the infestation of an open wound with fly larvae. Here, we present a unique case report of the first W. chitiniclastica isolation from a burn wound with accidental myiasis in a 63-year-old homeless man and a literature review focused on human infections caused by these bacteria. So far, 23 cases of infection with W. chitiniclastica have been reported; in 52% of these, larvae were found in the wound area. Most of these cases suffered from chronic non-healing wound infections but none of these were burn injuries. The overall fatality rate associated directly with W. chitiniclastica in these cases was 17%. Infections with parasitic larvae occur in moderate climates (especially in people living in poor conditions); therefore, an infection with rare bacteria associated with accidental myiasis, such as W. chitiniclastica, can be expected to become more common there. Thus, in view of the absence of recommendations regarding the treatment of patients with accidental myiasis and, therefore, the risk of infection with W. chitiniclastica or other rare pathogens, we provide a list of recommendations for the treatment of such patients. The importance of meticulous microbial surveillance using molecular biological methods to facilitate the detection of rare pathogens is emphasized. Full article
(This article belongs to the Special Issue Infections in Intensive Care Units)
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Other

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9 pages, 1934 KiB  
Case Report
Multiple Secondary Healthcare-Associated Infections Due to Carbapenem-Resistant Organisms in a Critically Ill COVID-19 Patient on Extensively Prolonged Venovenous Extracorporeal Membrane Oxygenation Support—A Case Report
by Hiroaki Baba, Hajime Kanamori, Issei Seike, Ikumi Niitsuma-Sugaya, Kentaro Takei, Kengo Oshima, Yudai Iwasaki, Yuko Ogata, Hirona Nishimaki, Daisuke Konno, Takuya Shiga, Koji Saito, Koichi Tokuda and Tetsuji Aoyagi
Microorganisms 2022, 10(1), 19; https://doi.org/10.3390/microorganisms10010019 - 23 Dec 2021
Cited by 5 | Viewed by 3416
Abstract
Patients with severe Coronavirus disease 2019 (COVID-19) are at high risk for secondary infection with multidrug-resistant organisms (MDROs). Secondary infections contribute to a more severe clinical course and longer intensive care unit (ICU) stays in patients with COVID-19. A man in his 60s [...] Read more.
Patients with severe Coronavirus disease 2019 (COVID-19) are at high risk for secondary infection with multidrug-resistant organisms (MDROs). Secondary infections contribute to a more severe clinical course and longer intensive care unit (ICU) stays in patients with COVID-19. A man in his 60s was admitted to the ICU at a university hospital for severe COVID-19 pneumonia requiring mechanical ventilation. His respiratory condition worsened further due to persistent bacteremia caused by imipenem-non-susceptible Klebsiella aerogenes and he required VV-ECMO. Subsequently, he developed a catheter-related bloodstream infection (CRBSI) due to Candida albicans, ventilator-associated pneumonia (VAP) due to multidrug-resistant Pseudomonas aeruginosa (MDRP), and a perianal abscess due to carbapenem-resistant K. aerogenes despite infection control procedures that maximized contact precautions and the absence of MDRO contamination in the patient’s room environment. He was decannulated from VV-ECMO after a total of 72 days of ECMO support, and was eventually weaned off ventilator support and discharged from the ICU on day 138. This case highlights the challenges of preventing, diagnosing, and treating multidrug-resistant organisms and healthcare-associated infections (HAIs) in the critical care management of severe COVID-19. In addition to the stringent implementation of infection prevention measures, a high index of suspicion and a careful evaluation of HAIs are required in such patients. Full article
(This article belongs to the Special Issue Infections in Intensive Care Units)
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