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Alnimr A. Antimicrobial Resistance in Ventilator-Associated Pneumonia: Predictive Microbiology and Evidence-Based Therapy. Infect Dis Ther 2023:10.1007/s40121-023-00820-2. [PMID: 37273072 DOI: 10.1007/s40121-023-00820-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Ventilator-associated pneumonia (VAP) is a serious intensive care unit (ICU)-related infection in mechanically ventilated patients that is frequent, as more than half of antibiotics prescriptions in ICU are due to VAP. Various risk factors and diagnostic criteria for VAP have been referred to in different settings. The estimated attributable mortality of VAP can go up to 50%, which is higher in cases of antimicrobial-resistant VAP. When the diagnosis of pneumonia in a mechanically ventilated patient is made, initiation of effective antimicrobial therapy must be prompt. Microbiological diagnosis of VAP is required to optimize timely therapy since effective early treatment is fundamental for better outcomes, with controversy continuing regarding optimal sampling and testing. Understanding the role of antimicrobial resistance in the context of VAP is crucial in the era of continuously evolving antimicrobial-resistant clones that represent an urgent threat to global health. This review is focused on the risk factors for antimicrobial resistance in adult VAP and its novel microbiological tools. It aims to summarize the current evidence-based knowledge about the mechanisms of resistance in VAP caused by multidrug-resistant bacteria in clinical settings with focus on Gram-negative pathogens. It highlights the evidence-based antimicrobial management and prevention of drug-resistant VAP. It also addresses emerging concepts related to predictive microbiology in VAP and sheds lights on VAP in the context of coronavirus disease 2019 (COVID-19).
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Affiliation(s)
- Amani Alnimr
- Department of Microbiology, College of Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia.
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2
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Varvarà P, Calà C, Maida CM, Giuffrè M, Mauro N, Cavallaro G. Arginine-Rich Peptidomimetic Ampicillin/Gentamicin Conjugate To Tackle Nosocomial Biofilms: A Promising Strategy To Repurpose First-Line Antibiotics. ACS Infect Dis 2023; 9:916-927. [PMID: 36926826 DOI: 10.1021/acsinfecdis.2c00579] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Combined therapy with penicillins and aminoglycosides has been proved beneficial to address many persistent bacterial infections with possible synergistic effects. However, the different pharmacokinetic profiles of these two antibiotic classes may not guarantee a concerted spatio-temporal delivery at the site of action, decreasing the efficacy of this combination and promoting resistance. Herein, we propose a multifunctional antibiotic-polymer conjugate, designed to colocalize ampicillin and gentamicin to tackle persistent biofilm infections. The two antibacterial molecules were grafted along with the amino acid l-arginine to a biocompatible polymer backbone with peptidomimetic hydrophilic structure, obtaining the antimicrobial poly(argilylaspartamide-co-aspartic) acid-ampicillin, gentamicin (PAA-AG) conjugate. The PAA-AG conjugate displayed excellent biocompatibility on human cell lines if compared with free drugs, potentially enlarging their therapeutic window and safety, and suitable mucoadhesive characteristics which may help local treatments of mucosal infections. Studies on planktonic cultures of clinical and reference strains of S. aureus, P. aeruginosa, and E. coli revealed that PAA-AG holds a broad-spectrum antibacterial efficacy, revealing high potency in inhibiting the growth of the tested strains. More interestingly, PAA-AG exhibited excellent antibiofilm activity on both Gram+ and Gram- communities, showing inhibition of their formation at subMIC concentrations as well as inducing the regression of mature biofilms. Given the high biocompatibility and broad antibiofilm efficacy, combined with the opportunity for synchronous co-delivery, the PAA-AG conjugate could be a valuable tool to increase the success of ampicillin/gentamicin-based antibiotic multitherapy.
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Affiliation(s)
- Paola Varvarà
- Laboratory of Biocompatible Polymers, Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, via Archirafi 32, 90123 Palermo, Italy
| | - Cinzia Calà
- Department of "Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza - G. D'Alessandro", University of Palermo, Via Del Vespro 133, 90127 Palermo, Italy
| | - Carmelo M Maida
- Department of "Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza - G. D'Alessandro", University of Palermo, Via Del Vespro 133, 90127 Palermo, Italy
| | - Mario Giuffrè
- Department of "Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza - G. D'Alessandro", University of Palermo, Via Del Vespro 133, 90127 Palermo, Italy
| | - Nicolò Mauro
- Laboratory of Biocompatible Polymers, Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, via Archirafi 32, 90123 Palermo, Italy
| | - Gennara Cavallaro
- Laboratory of Biocompatible Polymers, Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, via Archirafi 32, 90123 Palermo, Italy.,ATeN Center - Advanced Technologies Network Center, University of Palermo, Viale delle Scienze - Edificio 18/A, 90128 Palermo, Italy
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3
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Wang Y, Xiao Y, Yang Q, Wang F, Wang Y, Yuan C. Clinical prediction models for multidrug-resistant organism colonisation or infection in critically ill patients: a systematic review protocol. BMJ Open 2022; 12:e064566. [PMID: 36175101 PMCID: PMC9528596 DOI: 10.1136/bmjopen-2022-064566] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Multidrug-resistant organisms (MDROs) are pathogenic bacteria that are the leading cause of hospital-acquired infection which is associated with high morbidity and mortality rates in intensive care units, increasing hospitalisation duration and cost. Predicting the risk of MDRO colonisation or infection for critically ill patients supports clinical decision-making. Several models predicting MDRO colonisation or infection have been developed; however, owing to different disease scenarios, bacterial species and few externally validated cohorts in different prediction models; the stability and applicability of these models for MDRO colonisation or infection in critically ill patients are controversial. In addition, there are currently no standardised risk scoring systems to predict MDRO colonisation or infection in critically ill patients. The aim of this systematic review is to summarise and assess models predicting MDRO colonisation or infection in critically ill patients and to compare their predictive performance. METHODS AND ANALYSIS We will perform a systematic search of PubMed, Cochrane Library, CINAHL, Embase, Web of science, China National Knowledge Infrastructure and Wanfang databases to identify all studies describing the development and/or external validation of models predicting MDRO colonisation or infection in critically ill patients. Two reviewers will independently extract and review the data using the Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist; they will also assess the risk of bias using the Prediction Model Risk of Bias Assessment Tool. Quantitative data on model predictive performance will be synthesised in meta-analyses, as applicable. ETHICS AND DISSEMINATION Ethical permissions will not be required because all data will be extracted from published studies. We intend to publish our results in peer-reviewed scientific journals and to present them at international conferences on critical care. PROSPERO REGISTRATION NUMBER CRD42022274175.
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Affiliation(s)
- Yi Wang
- Intensive Care Unit, Peking University First Hospital, Beijing, China
| | - Yanyan Xiao
- Intensive Care Unit, Peking University First Hospital, Beijing, China
| | - Qidi Yang
- Intensive Care Unit, Peking University First Hospital, Beijing, China
| | - Fang Wang
- Intensive Care Unit, Peking University First Hospital, Beijing, China
| | - Ying Wang
- Intensive Care Unit, Peking University First Hospital, Beijing, China
| | - Cui Yuan
- Intensive Care Unit, Peking University First Hospital, Beijing, China
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4
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López-Hernández I, López-Cerero L, Fernández-Cuenca F, Pascual Á. The role of the microbiology laboratory in the diagnosis of multidrug-resistant Gram-negative bacilli infections. The importance of the determination of resistance mechanisms. Med Intensiva 2022; 46:455-464. [PMID: 35643635 DOI: 10.1016/j.medine.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 06/15/2023]
Abstract
Early diagnosis and treatment has an important impact on the morbidity and mortality of infections caused by multidrug-resistant bacteria. Multidrug-resistant gram-negative bacilli (MR-GNB) constitute the main current threat in hospitals and especially in intensive care units (ICU). The role of the microbiology laboratory is essential in providing a rapid and effective response. This review updates the microbiology laboratory procedures for the rapid detection of BGN-MR and its resistance determinants. The role of the laboratory in the surveillance and control of outbreaks caused by these bacteria, including typing techniques, is also studied. The importance of providing standardized resistance maps that allow knowing the epidemiological situation of the different units is emphasized. Finally, the importance of effective communication systems for the transmission of results and decision making in the management of patients infected by BGN-MR is reviewed.
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Affiliation(s)
- I López-Hernández
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - L López-Cerero
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - F Fernández-Cuenca
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain.
| | - Á Pascual
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
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5
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Mandelli G, Dore F, Langer M, Garbero E, Alagna L, Bianchin A, Ciceri R, Di Paolo A, Giani T, Giugni A, Gori A, Lefons U, Muscatello A, Olivieri C, Pan A, Pedeferri M, Rossi M, Rossolini GM, Russo E, Silengo D, Viaggi B, Bertolini G, Finazzi S. Effectiveness of a Multifaced Antibiotic Stewardship Program: A Pre-Post Study in Seven Italian ICUs. J Clin Med 2022; 11:4409. [PMID: 35956026 PMCID: PMC9369193 DOI: 10.3390/jcm11154409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/14/2022] [Accepted: 07/25/2022] [Indexed: 02/01/2023] Open
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 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.
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Affiliation(s)
- Giulia Mandelli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy; (G.M.); (E.G.); (G.B.); (S.F.)
| | - Francesca Dore
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy; (G.M.); (E.G.); (G.B.); (S.F.)
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
| | - Martin Langer
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
- Emergency-Ong, 20128 Milano, Italy
| | - Elena Garbero
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy; (G.M.); (E.G.); (G.B.); (S.F.)
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
| | - Laura Alagna
- Infectious Diseases Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.A.); (A.G.); (A.M.)
| | - Andrea Bianchin
- Anesthesia and Intensive Care, Ospedale Civile San Valentino di Montebelluna, 31044 Montebelluna, Italy;
| | - Rita Ciceri
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
- Anesthesia and Intensive Care, Ospedale Alessandro Manzoni di Lecco, 23900 Lecco, Italy
| | - Antonello Di Paolo
- Department of Clinical and Experimental Medicine, Università di Pisa, 56126 Pisa, Italy;
| | - Tommaso Giani
- Department of Experimental and Clinical Medicine, Università di Firenze, 50134 Firenze, Italy; (T.G.); (G.M.R.)
- Clinical Microbiology and Virology Unit, Azienda Ospedaliero Universitaria Careggi, 50134 Firenze, Italy
| | - Aimone Giugni
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
- Department of Intensive Care and Emergency Medical Services, Ospedale Maggiore, 40133 Bologna, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.A.); (A.G.); (A.M.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, 20122 Milan, Italy
| | - Ugo Lefons
- Anesthesia and Intensive Care, Ospedale Alta Val d’Elsa di Poggibonsi, 53036 Poggibonsi, Italy;
| | - Antonio Muscatello
- Infectious Diseases Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.A.); (A.G.); (A.M.)
| | - Carlo Olivieri
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
- Anesthesia and Intensive Care, Ospedale Sant’Andrea, ASL VC Vercelli, 13100 Vercelli, Italy
| | - Angelo Pan
- Infectious Diseases Unit, Istituti Ospitalieri di Cremona, 26100 Cremona, Italy;
| | - Matteo Pedeferri
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
- Anesthesia and Intensive Care, Presidio Ospedaliero San Leopoldo Mandić, 23807 Merate, Italy
| | - Marianna Rossi
- Division of Infectious Diseases, “San Gerardo” Hospital, University of Milano-Bicocca, 20900 Monza, Italy;
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, Università di Firenze, 50134 Firenze, Italy; (T.G.); (G.M.R.)
- Clinical Microbiology and Virology Unit, Azienda Ospedaliero Universitaria Careggi, 50134 Firenze, Italy
| | - Emanuele Russo
- Anesthesia and Intensive Care, Ospedale Maurizio Bufalini di Cesena, 47521 Cesena, Italy;
| | - Daniela Silengo
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
- Anesthesia and Intensive Care, Ospedale San Giovanni Bosco, 10154 Turin, Italy
| | - Bruno Viaggi
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
- Neuro Intensive Care Unit, Department of Anesthesiology, Azienda Ospedaliero Universitaria Careggi, 50134 Firenze, Italy
| | - Guido Bertolini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy; (G.M.); (E.G.); (G.B.); (S.F.)
| | - Stefano Finazzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy; (G.M.); (E.G.); (G.B.); (S.F.)
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
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Albin OR, Saravolatz L, Petrie J, Henig O, Kaye KS. Rethinking the ‘Pan-culture’: Clinical Impact of Respiratory Culturing in Patients with Low Pretest Probability of Ventilator-associated Pneumonia. Open Forum Infect Dis 2022; 9:ofac183. [PMID: 35774933 PMCID: PMC9239552 DOI: 10.1093/ofid/ofac183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background Respiratory cultures are often obtained as part of a “pan-culture” in mechanically ventilated patients in response to new fevers or leukocytosis, despite an absence of clinical or radiographic evidence suggestive of pneumonia. Methods This was a propensity score–stratified cohort study of hospitalized mechanically ventilated adult patients between 2014 and 2019, with a new abnormal temperature or serum white blood cell count (NATW), but without radiographic evidence of pneumonia, change in ventilator requirements, or documentation of purulent secretions. Two patient groups were compared: those with respiratory cultures performed within 36 hours after NATW and those without respiratory cultures performed. The co-primary outcomes were the proportion of patients receiving >2 days of total antibiotic therapy and >2 days of broad-spectrum antibiotic therapy within 1 week after NATW. Results Of 534 included patients, 113 (21.2%) had respiratory cultures obtained and 421 (78.8%) did not. Patients with respiratory cultures performed were significantly more likely to receive antibiotics for >2 days within 1 week after NATW than those without respiratory cultures performed (total antibiotic: adjusted odds ratio [OR], 2.57; 95% CI, 1.39–4.75; broad-spectrum antibiotic: adjusted OR, 2.47, 95% CI, 1.46–4.20). Conclusions Performance of respiratory cultures for fever/leukocytosis in mechanically ventilated patients without increasing ventilator requirements, secretion burden, or radiographic evidence of pneumonia was associated with increased antibiotic use within 1 week after incident abnormal temperature and/or white blood cell count. Diagnostic stewardship interventions targeting performance of unnecessary respiratory cultures in mechanically ventilated patients may reduce antibiotic overuse within intensive care units.
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Affiliation(s)
- Owen R. Albin
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Louis Saravolatz
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Joshua Petrie
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Oryan Henig
- Department of Infectious Diseases, Unit of Infection Control, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Keith S. Kaye
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Plasmon-modulated fluorescence nanoprobes for enzyme-free DNA detection via target signal enhancement and off-target quenching. Biosens Bioelectron 2022; 210:114288. [DOI: 10.1016/j.bios.2022.114288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/09/2022] [Accepted: 04/13/2022] [Indexed: 11/22/2022]
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El papel del laboratorio de microbiología en el diagnóstico de infecciones por bacilos gramnegativos multirresistentes. Importancia de la determinación de mecanismos de resistencias. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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9
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Hong CA, Park JC, Na H, Jeon H, Nam YS. Short DNA-catalyzed formation of quantum dot-DNA hydrogel for enzyme-free femtomolar specific DNA assay. Biosens Bioelectron 2021; 182:113110. [PMID: 33812283 DOI: 10.1016/j.bios.2021.113110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/09/2021] [Accepted: 02/19/2021] [Indexed: 02/07/2023]
Abstract
Fast, sensitive, specific, and user-friendly DNA assay is a key technique for the next generation point-of-care molecular diagnosis. However, high-cost, time-consuming, and complicated enzyme-based DNA amplification step is essential to achieve high sensitivity. Herein, a short target DNA-catalyzed formation of quantum dot (QD)-DNA hydrogel is proposed as a new DNA assay platform satisfying the above requirements. A single-stranded target DNA catalyzes the opening cycle of DNA hairpin loops, which are quickly self-assembled with DNA-functionalized QDs to generate QD-DNA hydrogel. The three-dimensional hydrogel network allows efficient resonance energy transfer, dramatically lowering the limit of detection down to ~6 fM without enzymatic DNA amplification. The QD-DNA hydrogel also enables a rapid detection (1 h) with high specificity even for a single-base mismatch. The clinical applicability of the QD-DNA hydrogel is demonstrated for the Klebsiella pneumoniae carbapenemase gene, one of the key targets of drug-resistant pathogenic bacteria.
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Affiliation(s)
- Cheol Am Hong
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Jae Chul Park
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Hyebin Na
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Huiju Jeon
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Yoon Sung Nam
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea.
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10
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Trivedi KK, Bartash R, Letourneau AR, Abbo L, Fleisher J, Gagliardo C, Kelley S, Nori P, Rieg GK, Silver P, Srinivasan A, Vargas J, Ostrowsky B. Opportunities to Improve Antibiotic Appropriateness in U.S. ICUs: A Multicenter Evaluation. Crit Care Med 2021; 48:968-976. [PMID: 32317600 DOI: 10.1097/ccm.0000000000004344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To use a standardized tool for a multicenter assessment of antibiotic appropriateness in ICUs and identify local antibiotic stewardship improvement opportunities. DESIGN Pilot point prevalence conducted on October 5, 2016; point prevalence survey conducted on March 1, 2017. SETTING ICUs in 12 U.S. acute care hospitals with median bed size 563. PATIENTS Receiving antibiotics on participating units on March 1, 2017. INTERVENTIONS The Centers for Disease Control and Prevention tool for the Assessment of Appropriateness of Inpatient Antibiotics was made actionable by an expert antibiotic stewardship panel and implemented across hospitals. Data were collected by antibiotic stewardship program personnel at each hospital, deidentified and submitted in aggregate for benchmarking. hospital personnel identified most salient reasons for inappropriate use by category and agent. MEASUREMENTS AND MAIN RESULTS Forty-seven ICUs participated. Most hospitals (83%) identified as teaching with median licensed ICU beds of 70. On March 1, 2017, 362 (54%) of 667 ICU patients were on antibiotics (range, 8-81 patients); of these, 112 (31%) were identified as inappropriate and administered greater than 72 hours among all 12 hospitals (range, 9-82%). Prophylactic antibiotic regimens and PICU patients demonstrated a statistically significant risk ratio of 1.76 and 1.90 for inappropriate treatment, respectively. Reasons for inappropriate use included unnecessarily broad spectrum (29%), no infection or nonbacterial syndrome (22%), and duration longer than necessary (21%). Of patients on inappropriate antibiotic therapy in surgical ICUs, a statistically significant risk ratio of 2.59 was calculated for noninfectious or nonbacterial reasons for inappropriate therapy. CONCLUSIONS In this multicenter point prevalence study, 31% of ICU antibiotic regimens were inappropriate; prophylactic regimens were often inappropriate across different ICU types, particularly in surgical ICUs. Engaging intensivists in antibiotic stewardship program efforts is crucial to sustain the efficacy of antibiotics and quality of infectious diseases care in critical care settings. This study underscores the value of standardized assessment tools and benchmarking to be shared with local leaders for targeted antibiotic stewardship program interventions.
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Affiliation(s)
| | - Rachel Bartash
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | | | - Lilian Abbo
- Division of Infectious Diseases, Department of Medicine, University of Miami, Jackson Health System, Miami, FL
| | - Jorge Fleisher
- Division of Infectious Diseases, Steward Health Care, Brighton, MA
| | - Christina Gagliardo
- Division of Pediatric Infectious Diseases, Albert Einstein College of Medicine, Maimonides Medical Center, Brooklyn, NY
| | | | - Priya Nori
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Gunter K Rieg
- Infectious Diseases, Kaiser Permanente South Bay Medical Center, Harbor City, CA
| | | | - Arjun Srinivasan
- Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jaclyn Vargas
- Medicine + Pediatrics, LA County USC Medical Center, Los Angeles, CA
| | - Belinda Ostrowsky
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
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11
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Martin-Loeches I, Metersky M, Kalil A, Pezzani MD, Torres A. Strategies for implementation of a multidisciplinary approach to the treatment of nosocomial infections in critically ill patients. Expert Rev Anti Infect Ther 2020; 19:759-767. [PMID: 33249874 DOI: 10.1080/14787210.2021.1857730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Intensive Care Units (ICU) are among the hospital wards exhibiting the highest prevalence of antimicrobial resistance (AMR), and resulting impact on patient outcomes. Antimicrobial resistance surveillance and antimicrobial stewardship (AMS) programs play a pivotal role in promoting interventions tailored to optimize infection diagnosis and treatment in the final attempt to limit unnecessary antimicrobial use and development of resistance. AREAS COVERED A narrative review of the literature was carried out to summarize the available evidence and develop a set of actions that should be considered for integration into the ICU stewardship framework. Four questions were addressed: how AMR surveillance can inform antibiotic policy in ICU; whether pharmacokinetic and pharmacodynamic (PK/PD) principles and the use of procalcitonin should be incorporated as a standard practice in ICU AMS programs to optimize antibiotic treatment and to drive antibiotic discontinuation; which criteria should drive treatment duration of ICU-associated infections. EXPERT OPINION In this review we aim to highlight that the ICU must be considered in its own right. Each ICU has its own characteristics depending on the country, on the local antibiotic resistance profile, on the patients feature and the severity of infection.
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Affiliation(s)
- Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization, St James's Hospital, Dublin, Ireland.,Hospital Clinic, IDIBAPS, Universidad De Barcelona, CIBERES, Barcelona, Spain
| | - Mark Metersky
- Dept of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Andre Kalil
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Maria Diletta Pezzani
- Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona Italy
| | - Antoni Torres
- Hospital Clinic, IDIBAPS, Universidad De Barcelona, CIBERES, Barcelona, Spain
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12
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Professionals Versus Popup Windows: The Value of Antimicrobial Stewardship in the ICU. Crit Care Med 2019; 47:290-291. [PMID: 30653058 DOI: 10.1097/ccm.0000000000003562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Gasparetto J, Tuon FF, Dos Santos Oliveira D, Zequinao T, Pipolo GR, Ribeiro GV, Benincá PD, Cruz JAW, Moraes TP. Intravenous-to-oral antibiotic switch therapy: a cross-sectional study in critical care units. BMC Infect Dis 2019; 19:650. [PMID: 31331272 PMCID: PMC6647098 DOI: 10.1186/s12879-019-4280-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 07/11/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the oral switch (OS) stewardship intervention in the intensive care unit (ICU). METHODS This was a retrospective study with a convenience sample in two Brazilian ICUs from different hospitals in patients with sepsis receiving antibiotic therapy. The stewardship intervention included OS in patients diagnosed with sepsis when clinical stability was achieved. The primary outcome was overall mortality. Other variables evaluated were as follows: cost of antimicrobial treatment, daily costs of intensive care, acute kidney injury, and length of stay. RESULTS There was no difference in mortality between the OS and non-OS groups (p = 0.06). Length of stay in the ICU (p = 0.029) was shorter and acute kidney injury incidence (p = 0.032) and costs of antimicrobial therapy (p < 0.001) were lower in the OS group. CONCLUSION OS stewardship programs in the ICU may be considered a safe strategy. Switch therapy reduced the cost and shortened the length of stay in ICUs.
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Affiliation(s)
- Juliano Gasparetto
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Felipe Francisco Tuon
- Laboratory of Emerging Infectious Diseases, Escola de Medicina, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil.
| | - Dayana Dos Santos Oliveira
- Laboratory of Emerging Infectious Diseases, Escola de Medicina, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Tiago Zequinao
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | | | | | - Paola Delai Benincá
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | | | - Thyago Proenca Moraes
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
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Pflanzner S, Phillips C, Mailman J, Vanstone JR. AMS in the ICU: empiric therapy and adherence to guidelines for pneumonia. BMJ Open Qual 2019; 8:e000554. [PMID: 31206061 PMCID: PMC6542434 DOI: 10.1136/bmjoq-2018-000554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/21/2019] [Accepted: 04/10/2019] [Indexed: 11/03/2022] Open
Affiliation(s)
- Shelby Pflanzner
- Department of Pharmacy Services, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Casey Phillips
- Antimicrobial Stewardship Program, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Jonathan Mailman
- Department of Pharmacy Services, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada.,College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jason Robert Vanstone
- Stewardship and Clinical Appropriateness, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
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15
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Posillico SE, Young BT, Ladhani HA, Zosa BM, Claridge JA. Current Evaluation of Antibiotic Usage in Complicated Intra-Abdominal Infection after the STOP IT Trial: Did We STOP IT? Surg Infect (Larchmt) 2019; 20:184-191. [PMID: 30676237 DOI: 10.1089/sur.2018.121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Sarah E. Posillico
- Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Brian T. Young
- Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Husayn A. Ladhani
- Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Brenda M. Zosa
- Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jeffrey A. Claridge
- Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
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16
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Timsit JF, Bassetti M, Cremer O, Daikos G, de Waele J, Kallil A, Kipnis E, Kollef M, Laupland K, Paiva JA, Rodríguez-Baño J, Ruppé É, Salluh J, Taccone FS, Weiss E, Barbier F. Rationalizing antimicrobial therapy in the ICU: a narrative review. Intensive Care Med 2019; 45:172-189. [PMID: 30659311 DOI: 10.1007/s00134-019-05520-5] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/04/2019] [Indexed: 12/13/2022]
Abstract
The massive consumption of antibiotics in the ICU is responsible for substantial ecological side effects that promote the dissemination of multidrug-resistant bacteria (MDRB) in this environment. Strikingly, up to half of ICU patients receiving empirical antibiotic therapy have no definitively confirmed infection, while de-escalation and shortened treatment duration are insufficiently considered in those with documented sepsis, highlighting the potential benefit of implementing antibiotic stewardship programs (ASP) and other quality improvement initiatives. The objective of this narrative review is to summarize the available evidence, emerging options, and unsolved controversies for the optimization of antibiotic therapy in the ICU. Published data notably support the need for better identification of patients at risk of MDRB infection, more accurate diagnostic tools enabling a rule-in/rule-out approach for bacterial sepsis, an individualized reasoning for the selection of single-drug or combination empirical regimen, the use of adequate dosing and administration schemes to ensure the attainment of pharmacokinetics/pharmacodynamics targets, concomitant source control when appropriate, and a systematic reappraisal of initial therapy in an attempt to minimize collateral damage on commensal ecosystems through de-escalation and treatment-shortening whenever conceivable. This narrative review also aims at compiling arguments for the elaboration of actionable ASP in the ICU, including improved patient outcomes and a reduction in antibiotic-related selection pressure that may help to control the dissemination of MDRB in this healthcare setting.
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Affiliation(s)
- Jean-François Timsit
- Medical and Infectious Diseases ICU, APHP, Bichat-Claude Bernard Hospital, 46 Rue Henri-Huchard, 75877, Paris Cedex 18, France.
- INSERM, IAME, UMR 1137, Paris-Diderot Sorbonne-Paris Cité University, Paris, France.
| | - Matteo Bassetti
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Olaf Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - George Daikos
- Scool of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Jan de Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Andre Kallil
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Eric Kipnis
- Surgical Critical Care Unit, Department of Anesthesiology, Critical Care and Perioperative Medicine, CHU Lille, Lille, France
| | - Marin Kollef
- Critical Care Research, Washington University School of Medicine and Respiratory Care Services, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Kevin Laupland
- Department of Medicine, Royal Inland Hospital, Kamloops, Canada
| | - Jose-Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar São João and Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jesús Rodríguez-Baño
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena, Departament of Medicine, University of Sevilla, Biomedicine Institute of Seville (IBiS), Seville, Spain
| | - Étienne Ruppé
- INSERM, IAME, UMR 1137, Paris-Diderot Sorbonne-Paris Cité University, Paris, France
- Bacteriology Laboratory, Bichat-Claude Bernard Hospital, APHP, Paris, France
| | - Jorge Salluh
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, IDOR, Rio De Janeiro, Brazil
| | | | - Emmanuel Weiss
- Department of Anesthesiology and Critical Care, Beaujon Hospital, AP-HP, Clichy, France
- INSERM, CRI, UMR 1149, Paris-Diderot Sorbonne-Paris Cité University, Paris, France
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Sader HS, Flamm RK, Dale GE, Rhomberg PR, Castanheira M. Murepavadin activity tested against contemporary (2016–17) clinical isolates of XDR Pseudomonas aeruginosa. J Antimicrob Chemother 2018; 73:2400-2404. [DOI: 10.1093/jac/dky227] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/18/2018] [Indexed: 12/29/2022] Open
Affiliation(s)
| | | | - Glenn E Dale
- Polyphor Ltd, Hegenheimermattweg 125, Allschwil, Switzerland
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18
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Shorr AF, Fisher K, Micek ST, Kollef MH. The Burden of Viruses in Pneumonia Associated With Acute Respiratory Failure: An Underappreciated Issue. Chest 2017; 154:84-90. [PMID: 29274318 DOI: 10.1016/j.chest.2017.12.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/08/2017] [Accepted: 12/01/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pneumonia associated with mechanical ventilation (MV) results in substantial mortality and represents a leading reason for the use of antibiotics. The role of viruses in this setting is unclear. Identifying a viral cause in such instances could facilitate antibiotic stewardship. METHODS We performed a secondary analysis of a prospective cohort with pneumonia requiring MV. We included both cases occurring in the community and hospital-onset cases and classified patients according to the cause of the pneumonia. The prevalence of viral pathogens represented the primary end point. We identified variables independently associated with isolation of a viral organism as the sole pathogen. RESULTS The cohort included 364 patients, and a virus was the sole pathogen in 79 cases (21.7%). The most common viruses included rhinovirus/enterovirus (n = 20), influenza A (n = 12), and respiratory syncytial virus (n = 11). The rate of in-hospital death was high (37.2%) and did not differ from that seen in other patients (36.5%). The duration of MV, hospital length of stay, and 30-day readmission rates also did not differ based on the cause of pneumonia. Two variables were independently associated with recovery of a virus: an Acute Physiology and Health Evaluation II score of < 26 (adjusted odds ratio [AOR], 0.51; 95% CI, 0.28-0.93; P = .027) and stem cell transplantation (SCT) (AOR, 4.39; 95% CI, 2.03-9.50; P = .001). A sensitivity analysis excluding patients who underwent SCT did not substantially alter our observations. CONCLUSIONS Viruses represent a major cause of pneumonia in critically ill patients requiring MV. Identifying such subjects presents an opportunity for discontinuing antibiotics. Clinicians should consider systematically evaluating patients with pneumonia requiring MV for viral pathogens.
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Affiliation(s)
- Andrew F Shorr
- Department of Medicine, Medstar Washington Hospital Center, Washington, DC; Pulmonary and Critical Care Medicine Section, Medstar Washington Hospital Center, Washington, DC.
| | - Kristen Fisher
- CardioPulmonary Associates of St. Lukes Hospital, Chesterfield, MO
| | - Scott T Micek
- St. Louis College of Pharmacy, Barnes Jewish Christian Hospital, St. Louis, MO
| | - Marin H Kollef
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Barnes Jewish Christian Hospital, St. Louis, MO
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