Clinical Efficacy and Nephrotoxicity of the Loading Dose Colistin for the Treatment of Carbapenem-Resistant Acinetobacter baumannii in Critically Ill Patients
Content: One of the most prevalent causes of nosocomial infections in critically sick patients is carbapenem-resistant Acinetobacter baumannii (CRAB). In severely sick patients, colistin methanesulfonate (CMS), an inactive prodrug, has been regarded a last-resort therapy for CRAB infection. The goal of this research was to compare 30-day survival and nephrotoxicity in critically ill patients who received a non-loading dose (LD) versus a loading dose (LD) of CMS for CRAB infection therapy.
Bacterial infections and death among patients with Covid-19 versus non Covid-19 patients with pneumonia
Many Coronavirus disease-2019 (Covid-19) patients have radiological signs of pneumonia. Because determining the presence of bacterial pneumonia is challenging, many of these patients are initially treated with antibiotics. The authors of this study compared the incidence of bacterial infections and death among Covid-19 patients with pulmonary infiltrates to those diagnosed with 'pneumonia' the prior year.
SARS‐CoV‐2 Omicron variant: Characteristics and prevention
The World Health Organization identified Omicron as a variant under monitoring (VUM) by WHO. This variation contains 15 mutations in the receptor-binding domain (RBD) of the spike which instantly generated global concerns about viral transmissibility, pathogenicity, and immune evasion. The paper explains the discovery and features of the Omicron variant and proposes potential techniques to avoid and overcome the variant's predominance.
Optimal empiric treatment for KPC-2-producing Klebsiella pneumoniae infections in critically ill patients with normal or decreased renal function using Monte Carlo simulation
Only a few clinical trials have been conducted to investigate the pharmacodynamics of fosfomycin (FOS), tigecycline (TGC), and colistin methanesulfonate (CMS) in combination against KPC-producing Klebsiella pneumoniae (KPC-Kp). In patients with normal or impaired renal function, Monte Carlo simulation was used to evaluate the probability of target attainment (PTA) and cumulative fraction of response (CFR) of each drug alone and in combination versus KPC-Kp.
A prospective study on the pathogenesis of catheter-associated bacteriuria in critically ill patients
To adjust preventative efforts, the pathophysiology of catheter-associated bacteriuria (CA-bacteriuria) in the intensive care unit (ICU) must be updated. The researchers wanted to know if the predominant channel of CA-bacteriuria in ICU patients was endoluminal or exoluminal.
Risk Factors for Fungal Co-Infections in Critically Ill COVID-19 Patients, with a Focus on Immunosuppressants
In the critical care unit, severe cases of coronavirus disease 2019 (COVID-19) are at risk of complications, including secondary infections with opportunistic fungal pathogens. Systemic fungal co-infections in COVID-19 patients in the hospital may worsen the condition, impair therapy efficacy, and increase death. In this paper, we underline the importance of fungal co-infections in aggravating COVID-19 illness severity and highlight new trends in fungal disease burden in COVID-19 patients.
Prognostic Scores and Azole-Resistant Aspergillus fumigatus in Invasive Aspergillosis from an Indian Respiratory Medicine ICU (ICU Patients with IA Suspicion)
The purpose of this study is to compare the efficacy of three general prognostic models (APACHE II, SAPS II, and SOFA) with serum galactomannan antigen in a clinically suspected invasive aspergillosis (IA) subpopulation admitted to a respiratory medicine intensive care unit (ICU) and to identify azole-resistant Aspergillus fumigatus (ARAF) cases.
An Evidence-Based Multidisciplinary Approach Focused at Creating Algorithms for Targeted Therapy of BSIs, cUTIs, and cIAIs Caused by Enterobacterales
Prompt implementation of appropriate targeted antibiotic therapy represents a valuable approach in improving clinical and ecological outcomes in critically septic patients. This multidisciplinary opinion article focused at developing evidence-based algorithms for targeted antibiotic therapy of bloodstream (BSIs), complicated urinary tract (cUTIs), and complicated intrabdominal infections (cIAIs) caused by Enterobacterales. The aim was to provide guidance for intensive care physicians either in appropriately placing novel antibiotics or in considering strategies for sparing the broadest-spectrum antibiotics.
A New PCR-Based Assay for Testing Bronchoalveolar Lavage Fluid Samples from Patients with Suspected Pneumocystis jirovecii Pneumonia
Fungal infections, mainly Pneumocystis jirovecii (PJ; pneumocystosis), Aspergillus (aspergillosis), or Mucorales (mucormycosis), account for about 5% of all severe respiratory infections (including bacterial, mycobacterial, or viral infections) that occur in immunocompromised patients . The non-specificity of either respiratory symptoms or imaging features necessitates differentiation among possible infectious etiologies as well as between infectious and non-infectious respiratory abnormalities. This article reports the detection of PJ DHFR DNA in BAL fluid samples, prospectively collected from patients hospitalized at our institution using a new in-house qPCR assay (hereafter referred to as PJ-PCR assay).
Potential of Therapeutic Bacteriophages in Nosocomial Infection Management
Nosocomial infections (NIs) are hospital-acquired infections that pose a high healthcare burden worldwide. The impact of NIs is further aggravated by the global spread of antimicrobial resistance (AMR). Conventional treatment and disinfection agents are often insufficient to catch up with the increasing AMR and tolerance of pathogenic bacteria. This has resulted in a need for alternative approaches and raised new interest in therapeutic bacteriophages (phages). Given the specificity of phage-host interactions, phage susceptibility testing can serve as a rapid and cost-effective method for bacterial subtyping. The library can also provide a database for routine monitoring of nosocomial infections as a prelude to preparing ready-to-use phages for patient treatment and environmental sterilization.
COVID-19 increased the risk of ICU-acquired bloodstream infections: a case–cohort study from the multicentric OUTCOMEREA network
CU patients are susceptible to hospital-acquired infections and, more specifically, ICU-acquired bloodstream infections (ICU-BSI) are associated with an increased morbidity and mortality. Although bacterial co-infections at hospital admission are infrequently observed, ICU patients with COVID-19 seem more prone to develop bacterial co-infections. The primary objective of this study was to investigate the risk of ICU bloodstream infection (BSI) in critically ill COVID-19 patients compared to non-COVID-19 patients. Subsequently, we performed secondary analyses in order to explain the observed results.
Evaluation of bacterial co-infections of the respiratory tract in COVID-19 patients admitted to ICU
COVID-19 is known as a new viral infection. Viral-bacterial co-infections are one of the biggest medical concerns, resulting in increased mortality rates. To date, few studies have investigated bacterial superinfections in COVID-19 patients. This article shows the current study on COVID-19 patients admitted to ICUs. The findings emphasize the concern of superinfection in COVID-19 patients due to Acinetobacter baumannii and Staphylococcus aureus. Consequently, it is important to pay attention to bacterial co-infections in critical patients positive for COVID-19.
High neutralizing antibody titer in intensive care unit patients with COVID-19
Coronavirus disease 2019 (COVID-19) has a wide spectrum of disease severity from mild upper respiratory symptoms to respiratory failure. This study determined the seroprevalence of 733 non-COVID-19 individuals in the Hong Kong Special Administrative Region and compared the neutralizing antibody (NAb) responses of eight COVID-19 patients admitted to the intensive care unit (ICU) with those of 42 patients not admitted to the ICU. NAb titer increased significantly at earlier infection stages among ICU patients than among non-ICU patients. The median number of days to reach the peak Nab titers after symptoms onset was shorter among the ICU patients (17.6) than that of the non-ICU patients (20.1).
PREVALENCE OF OPPORTUNISTIC INVASIVE ASPERGILLOSIS IN COVID‐19 PATIENTS WITH SEVERE PNEUMONIA
A few cases of IPA have been published in critical infection cases caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). However, the global incidence is underestimated, and more evidence is needed. A series of factors, such as lung damage caused by the SARS‐CoV‐2 infection, medical interventions and immunosuppressive treatments used could explain the increased risk of IFI in Coronavirus Disease. In this article, an open prospective observational study was carried out at the Rey Juan Carlos University Hospital (Mostoles, Spain), during the period from February 1 to April 30, 2020. The main aim of this study was to determine the prevalence of invasive fungal infections (IFIs) and describe possible associated risk factors in patients admitted due to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection.
SARS-COV-2, UNCONTROLLED DIABETES AND CORTICOSTEROIDS—AN UNHOLY TRINITY IN INVASIVE FUNGAL INFECTIONS OF THE MAXILLOFACIAL REGION?
In the backdrop of this COVID-19 expression, there has been a notable rise in the incidence of invasive fungal infections (IFI) of the maxillofacial region, namely mucormycosis and aspergillosis. The data of maxillofacial/rhino-cerebro-orbital fungal infections reported in patients infected with SARS-CoV-2 has led to the investigation of common contributing factors leading to such infections. This retrospective observational multi-centric study analysed patient data collected from clinicians belonging to different specialties in Bangalore, India. The data included the presentation and management of patients presenting with aggressive maxillofacial and rhino-cerebro-orbital fungal infections and explored the relationship between SARS-CoV-2, corticosteroid administration and uncontrolled diabetes mellitus.
SIXTY YEARS OF AMPHOTERICIN B: AN OVERVIEW OF THE MAIN ANTIFUNGAL AGENT USED TO TREAT INVASIVE FUNGAL INFECTIONS
The discovery of amphotericin B and its therapeutic uses is considered one of the most important scientific milestones of the twentieth century. Despite its toxic potential, it remains useful in the treatment of invasive fungal diseases owing to its broad spectrum of activity, low resistance rate, and excellent clinical and pharmacological action. The lipid-based formulations of amphotericin B have emerged and, even keeping the active principle in common, present distinct characteristics that may influence therapeutic results. This study presents an overview of the pharmacological properties of the different formulations for systemic use of amphotericin B available for the treatment of invasive fungal infections and points out the most relevant aspects for clinical practice.
GREATER FIBRINOLYSIS RESISTANCE BUT NO GREATER PLATELET AGGREGATION IN CRITICALLY ILL COVID-19 PATIENTSCoronavirus disease 2019 (COVID-19) still poses a critical threat to global health. The number of patients infected with SARS-CoV-2 and the global death rate is constantly increasing. The clinical manifestations range from asymptomatic or very mild to severe disease and death. The hemostatic balance in patients with coronavirus disease 2019 (COVID-19) seems to be shifted toward a hypercoagulable state. The aim of the current study was to assess the associated coagulation alterations by point-of-care-diagnostics, focusing on details of clot formation and lysis in these severely affected patients.
AN OVERVIEW OF THE MANAGEMENT OF THE MOST IMPORTANT INVASIVE FUNGAL INFECTIONS IN PATIENTS WITH BLOOD MALIGNANCIES
In patients with hematologic malignancies due to immune system disorders, especially persistent febrile neutropenia, invasive fungal infections (IFI) occur with high mortality. Aspergillosis, candidiasis, fusariosis, mucormycosis, cryptococcosis and trichosporonosis are the most important infections reported in patients with hematologic malignancies that undergo hematopoietic stem cell transplantation. These infections are caused by opportunistic fungal pathogens that do not cause severe issues in healthy individuals, but in patients with hematologic malignancies lead to disseminated infection with different clinical manifestations.
CEFTOLOZANE AND TAZOBACTAM FOR THE TREATMENT OF HOSPITAL ACQUIRED PNEUMONIA
Patients admitted to hospitals are at risk of developing nosocomial infections. These types of infections typically occur in immune-compromised patients. Furthermore, nosocomial infections are frequently caused by resistant organisms, including nonfermenting gram-negative bacilli such as Pseudomonas aeruginosa.
ASSOCIATION OF Α1-BLOCKER RECEIPT WITH 30-DAY MORTALITY AND RISK OF INTENSIVE CARE UNIT ADMISSION AMONG ADULTS HOSPITALIZED WITH INFLUENZA OR PNEUMONIA IN DENMARK
Alpha 1–adrenergic receptor blocking agents (α1-blockers) have been reported to have protective benefits against hyperinflammation and cytokine storm syndrome, conditions that are associated with mortality in patients with coronavirus disease 2019 and other severe respiratory tract infections. However, studies of the association of α1-blockers with outcomes among human participants with respiratory tract infections are scarce
ASSOCIATION BETWEEN EARLY TREATMENT WITH TOCILIZUMAB AND MORTALITY AMONG CRITICALLY ILL PATIENTS WITH COVID-19
Therapies that improve survival in critically ill patients with coronavirus disease 2019 (COVID-19) are needed. Tocilizumab, a monoclonal antibody against the interleukin 6 receptor, may counteract the inflammatory cytokine release syndrome in patients with severe COVID-19 illness.