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Raina R, Subhash S, Schmitt CP, Shroff R. Prevention and management of peritoneal dialysis associated infections in children: Continuing to grow and reaching new milestones. Perit Dial Int 2024; 44:299-302. [PMID: 39228321 DOI: 10.1177/08968608241279094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024] Open
Affiliation(s)
- Rupesh Raina
- Akron Children Hospital and Northeast Ohio Medical University, Akron, OH, USA
- Akron General Medical Center at Cleveland Clinic, Akron, OH, USA
| | - Sanat Subhash
- Akron General Medical Center at Cleveland Clinic, Akron, OH, USA
| | - Claus Peter Schmitt
- Department of Pediatrics 1, Heidelberg University, Medical Faculty, Center for Pediatric and Adolescent Medicine, Heidelberg, Germany
| | - Rukshana Shroff
- Renal Unit, UCL Great Ormond Street Hospital and Institute of Child Health, London, UK
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2
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Friedrich B, Lyer S, Janko C, Unterweger H, Brox R, Cunningham S, Dutz S, Taccardi N, Bikker FJ, Hurle K, Sebald H, Lenz M, Spiecker E, Fester L, Hackstein H, Strauß R, Boccaccini AR, Bogdan C, Alexiou C, Tietze R. Scavenging of bacteria or bacterial products by magnetic particles functionalized with a broad-spectrum pathogen recognition receptor motif offers diagnostic and therapeutic applications. Acta Biomater 2022; 141:418-428. [PMID: 34999260 DOI: 10.1016/j.actbio.2022.01.001] [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: 11/03/2021] [Revised: 12/21/2021] [Accepted: 01/03/2022] [Indexed: 11/19/2022]
Abstract
Sepsis is a dysregulated host response of severe bloodstream infections, and given its frequency of occurrence and high mortality rate, therapeutic improvements are imperative. A reliable biomimetic strategy for the targeting and separation of bacterial pathogens in bloodstream infections involves the use of the broad-spectrum binding motif of human GP-340, a pattern-recognition receptor of the scavenger receptor cysteine rich (SRCR) superfamily that is expressed on epithelial surfaces but not found in blood. Here we show that these peptides, when conjugated to superparamagnetic iron oxide nanoparticles (SPIONs), can separate various bacterial endotoxins and intact microbes (E. coli, S. aureus, P. aeruginosa and S. marcescens) with high efficiency, especially at low and thus clinically relevant concentrations. This is accompanied by a subsequent strong depletion in cytokine release (TNF, IL-6, IL-1β, Il-10 and IFN-γ), which could have a direct therapeutic impact since escalating immune responses complicates severe bloodstream infections and sepsis courses. SPIONs are coated with aminoalkylsilane and capture peptides are orthogonally ligated to this surface. The particles behave fully cyto- and hemocompatible and do not interfere with host structures. Thus, this approach additionally aims to dramatically reduce diagnostic times for patients with suspected bloodstream infections and accelerate targeted antibiotic therapy. STATEMENT OF SIGNIFICANCE: Sepsis is often associated with excessive release of cytokines. This aspect and slow diagnostic procedures are the major therapeutic obstacles. The use of magnetic particles conjugated with small peptides derived from the binding motif of a broad-spectrum mucosal pathogen recognition protein GP-340 provides a highly efficient scavenging platform. These peptides are not found in blood and therefore are not subject to inhibitory mechanisms like in other concepts (mannose binding lectine, aptamers, antibodies). In this work, data are shown on the broad bacterial binding spectrum, highly efficient toxin depletion, which directly reduces the release of cytokines. Host cells are not affected and antibiotics not adsorbed. The particle bound microbes can be recultured without restriction and thus be used directly for diagnostics.
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Affiliation(s)
- Bernhard Friedrich
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius-Stiftung-Professorship, Universitätsklinikum Erlangen, Germany
| | - Stefan Lyer
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius-Stiftung-Professorship, Universitätsklinikum Erlangen, Germany
| | - Christina Janko
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius-Stiftung-Professorship, Universitätsklinikum Erlangen, Germany
| | - Harald Unterweger
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius-Stiftung-Professorship, Universitätsklinikum Erlangen, Germany
| | - Regine Brox
- Department of Transfusion Medicine and Hemostaseology, Universitätsklinikum Erlangen, Germany
| | - Sarah Cunningham
- Department of Transfusion Medicine and Hemostaseology, Universitätsklinikum Erlangen, Germany
| | - Silvio Dutz
- Institute of Biomedical Engineering and Informatics (BMTI), Technische Universität Ilmenau, Germany
| | - Nicola Taccardi
- Institute of Chemical Reaction Engineering, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Floris J Bikker
- Department of Oral Biochemistry, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam (UvA) and Vrije Universiteit Amsterdam (VU), the Netherlands
| | - Katrin Hurle
- GeoZentrum Nordbayern, Mineralogy, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Heidi Sebald
- Immunologie und Hygiene, Mikrobiologisches Institut - Klinische Mikrobiologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Malte Lenz
- Institute of Micro- and Nanostructure Research and Center for Nanoanalysis and Electron Microscopy (CENEM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Germany; Interdisciplinary Center for Nanostructure Films (IZNF), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Germany
| | - Erdmann Spiecker
- Institute of Micro- and Nanostructure Research and Center for Nanoanalysis and Electron Microscopy (CENEM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Germany; Interdisciplinary Center for Nanostructure Films (IZNF), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Germany
| | - Lars Fester
- Institute of Anatomy and Cell Biology Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Holger Hackstein
- Department of Transfusion Medicine and Hemostaseology, Universitätsklinikum Erlangen, Germany
| | - Richard Strauß
- Department of Medicine 1, Universitätsklinikum Erlangen, Germany
| | - Aldo R Boccaccini
- Institute of Biomaterials, Department of Materials Science and Engineering, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Christian Bogdan
- Immunologie und Hygiene, Mikrobiologisches Institut - Klinische Mikrobiologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Christoph Alexiou
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius-Stiftung-Professorship, Universitätsklinikum Erlangen, Germany
| | - Rainer Tietze
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius-Stiftung-Professorship, Universitätsklinikum Erlangen, Germany.
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Mao W, Lu D, Zhou J, Zhen J, Yan J, Li L. Chinese ICU physicians' knowledge of antibiotic pharmacokinetics/pharmacodynamics (PK/PD): a cross-sectional survey. BMC MEDICAL EDUCATION 2022; 22:173. [PMID: 35287666 PMCID: PMC8920424 DOI: 10.1186/s12909-022-03234-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Patients with sepsis have a high mortality rate, accumulated evidences suggest that an optimal antibiotic administration strategy based on pharmacokinetics/pharmacodynamics (PK/PD) can improve the prognosis of septic patients. Therefore, we assessed Chinese intensive care unit (ICU) physicians' knowledge about PK/PD. METHODS In December 2019, we designed a questionnaire focused on Chinese ICU physicians' knowledge about PK/PD and collected the questionnaires after 3 months. The questionnaire was distributed via e-mail and WeChat, and was distributed to ICU doctors in 31 administrative regions of China except Hong Kong, Macao and Taiwan. The passing score was corrected by the Angoff method, and the ICU physicians' knowledge about PK/PD was analysed accordingly. RESULTS We received a total of 1,309 questionnaires and retained 1,240 valid questionnaires. The passing score was 90.8, and the overall pass rate was 56.94%. The pass rate for tertiary and secondary hospitals was 59.07% and 37.19%, respectively. ICU physicians with less than 5 years of work experience and resident physician accounted for the highest pass rate, while those with between 5 to 10 years of work experience and attending accounted for the lowest pass rate. The majority of participants in the Chinese Critical Care Certified Course (5C) were from Jiangsu and Henan provinces, and they had the highest average scores (125.8 and 126.5, respectively). For Beijing and Shanghai, the average score was only 79.4 and 90.9, respectively. CONCLUSIONS Chinese ICU physicians' knowledge about PK/PD is unsatisfactory. Therefore, it is essential to strengthen ICU physicians' knowledge about PK/PD.
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Affiliation(s)
- Wenchao Mao
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, 310013, China
| | - Difan Lu
- The First Affiliated Hospital of Zhejiang University, Hangzhou, 310003, Zhejiang, China
| | - Jia Zhou
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, 310013, China
| | - Junhai Zhen
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, 310013, China
| | - Jing Yan
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, 310013, China.
| | - Li Li
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, 310013, China.
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Silva CM, Baptista JP, Santos I, Martins P. Recommended Antibiotic Dosage Regimens in Critically Ill Patients with Augmented Renal Clearance: A Systematic Review. Int J Antimicrob Agents 2022; 59:106569. [DOI: 10.1016/j.ijantimicag.2022.106569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/15/2022] [Accepted: 03/06/2022] [Indexed: 12/17/2022]
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Polain A, Gorham J, Romeo I, Belliato M, Peluso L, Partipilo F, Njimi H, Brasseur A, Jacobs F, Creteur J, Hites M, Taccone FS. Prediction of Insufficient Beta-Lactam Concentrations in Extracorporeal Membranous Oxygenation Patients. Microorganisms 2021; 9:2219. [PMID: 34835344 PMCID: PMC8625763 DOI: 10.3390/microorganisms9112219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/12/2021] [Accepted: 10/19/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The aim of this study was to identify predictors of insufficient beta-lactam concentrations in patients undergoing extracorporeal membrane oxygenation (ECMO). METHODS Retrospective analysis of all patients receiving ECMO support and treated with ceftazidime or cefepime (CEF), piperacillin/tazobactam (TZP), or meropenem (MEM). Trough drug concentrations (Cmin) were measured before the subsequent dose, according to the decision of the attending physician. Insufficient drug concentrations were identified if Cmin was below the clinical breakpoint of Pseudomonas aeruginosa. RESULTS A total of 222 Cmin (CEF, n = 41; TZP, n = 85; MEM, n = 96) from 110 patients were included; insufficient concentrations were observed in 26 (12%) antibiotic assessments; 21 (81%) of those occurred during MEM therapy. Insufficient Cmin were associated with a shorter time from initiation of antibiotics to measurement, a lower single dose of antibiotic, a higher creatinine clearance (CrCL), lower sequential organ failure assessment (SOFA) scores, and less use of continuous renal replacement therapy (CRRT) when compared to others. CONCLUSIONS Insufficient broad-spectrum beta-lactam concentrations were observed in 12% of drug measurement during ECMO therapy. Higher than recommended drug regimens could be considered in the very early phase of therapy and in those patients with augmented renal clearance and with less severe organ dysfunction.
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Affiliation(s)
- Amandine Polain
- Deparment of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (A.P.); (J.G.); (I.R.); (L.P.); (H.N.); (A.B.); (J.C.)
| | - Julie Gorham
- Deparment of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (A.P.); (J.G.); (I.R.); (L.P.); (H.N.); (A.B.); (J.C.)
| | - Immacolata Romeo
- Deparment of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (A.P.); (J.G.); (I.R.); (L.P.); (H.N.); (A.B.); (J.C.)
- UOC Anestesia e Rianimazione 2 Cardiopolmonare, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Mirko Belliato
- UOC Anestesia e Rianimazione 2 Cardiopolmonare, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Lorenzo Peluso
- Deparment of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (A.P.); (J.G.); (I.R.); (L.P.); (H.N.); (A.B.); (J.C.)
| | | | - Hassane Njimi
- Deparment of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (A.P.); (J.G.); (I.R.); (L.P.); (H.N.); (A.B.); (J.C.)
| | - Alexandre Brasseur
- Deparment of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (A.P.); (J.G.); (I.R.); (L.P.); (H.N.); (A.B.); (J.C.)
| | - Frederique Jacobs
- Clinic of Infectious Diseases, Hopital Erasme, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (F.J.); (M.H.)
| | - Jacques Creteur
- Deparment of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (A.P.); (J.G.); (I.R.); (L.P.); (H.N.); (A.B.); (J.C.)
| | - Maya Hites
- Clinic of Infectious Diseases, Hopital Erasme, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (F.J.); (M.H.)
| | - Fabio Silvio Taccone
- Deparment of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (A.P.); (J.G.); (I.R.); (L.P.); (H.N.); (A.B.); (J.C.)
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Laudisio A, Nenna A, Musarò M, Angeletti S, Nappi F, Lusini M, Chello M, Incalzi RA. Perioperative management after elective cardiac surgery: the predictive value of procalcitonin for infective and noninfective complications. Future Cardiol 2021; 17:1349-1358. [PMID: 33876946 DOI: 10.2217/fca-2020-0245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: Procalcitonin (PCT) has been associated with adverse outcomes after cardiac surgery. Nevertheless, there is no consensus on thresholds and timing of PCT measurement to predict adverse outcomes. Materials & methods: A total of 960 patients undergoing elective cardiac surgery were retrospectively evaluated. PCT levels were measured from the first to the seventh postoperative day (POD). The onset of complications was recorded. Results: Complications occurred in 421 (44%) patients. PCT on the third POD was associated with the occurrence of any kind of complications (odds ratio: 1.06; p: 0.037), and noninfectious complications (odds ratio: 1.05; p: 0.035), after adjusting. PCT above the median value at the third POD (>0.33 μg/l) predicted postoperative complications (incidence rate ratio: 1.13; p = 0.035). Conclusion: PCT seems to predict postoperative complications in cardiac surgery. The determination at the third POD yields the greatest sensitivity and specificity.
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Affiliation(s)
- Alice Laudisio
- Geriatrics, Università Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Antonio Nenna
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Marta Musarò
- Geriatrics, Università Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Silvia Angeletti
- Clinical Laboratory Science, Università Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Francesco Nappi
- Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris 93200, France
| | - Mario Lusini
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Massimo Chello
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome 00128, Italy
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Sganga G, Baguneid M, Dohmen P, Giamarellos-Bourboulis EJ, Romanini E, Vozikis A, Eckmann C. Management of superficial and deep surgical site infection: an international multidisciplinary consensus. Updates Surg 2021; 73:1315-1325. [PMID: 33770411 PMCID: PMC8397635 DOI: 10.1007/s13304-021-01029-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/11/2021] [Indexed: 12/19/2022]
Abstract
Surgical site infections represent a considerable burden for healthcare systems. To obtain a consensus on the impact and future clinical and economic needs regarding SSI management in an era of multidrug resistance. A modified Delphi method was used to obtain consensus among experts from five European countries. The Delphi questionnaire was assembled by a steering committee, verified by a panel of experts and administered to 90 experts in 8 different surgical specialities (Abdominal, Cancer, Cardiac, General surgery, Orthopaedic, Thoracic, Transplant and Vascular and three other specialities (infectious disease, internal medicine microbiology). Respondents (n = 52) reached consensus on 62/73 items including that resistant pathogens are an increasing matter of concern and increase both treatment complexity and the length of hospital stay. There was strong positive consensus on the cost-effectiveness of early discharge (ED) programs, improvement of quality of life with ED and association between increased length of stay and economic burden to the hospital. However, established ED protocols were not widely available in their hospitals. Respondents expressed a positive consensus on the usefulness of antibiotics that allow ED. Surgeons are aware of their responsibility in an interdisciplinary team for the treatment of SSI, and of the impact of multidrug-resistant bacteria in the context of SSI. Reducing the length of hospital stays by applying ED protocols and implementing new treatment alternatives is crucial to reduce harm to patients and costs for the hospital.
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Affiliation(s)
- Gabriele Sganga
- Division of Emergency Surgery and Trauma, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Mohamed Baguneid
- School of Medical Sciences, University of Manchester, Manchester, UK
- Surgical Institute, Al Ain Hospital, Al Ain, United Arab Emirates
- College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | - Pascal Dohmen
- Department of Cardiac Surgery, Heart Center Rostock, University Medicine Rostock, Rostock, Germany
- Department of Cardiothoracic Surgery Faculty of Health Science, University of the Free State, Bloemfontein, South Africa
| | | | - Emilio Romanini
- RomaPro Center for Hip and Knee Arthroplasty, Polo Sanitario San Feliciano, Via Enrico De Ossò 6, Rome, Italy
| | - Athanassios Vozikis
- Laboratory of Health Economics and Management, University of Piraeus, Piraeus, Greece
| | - Christian Eckmann
- Department of General, Visceral and Thoracic Surgery, Klinikum Hannoversch-Muenden, Goettingen University, Göttingen, Germany
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