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Gatica S, Fuentes B, Rivera-Asín E, Ramírez-Céspedes P, Sepúlveda-Alfaro J, Catalán EA, Bueno SM, Kalergis AM, Simon F, Riedel CA, Melo-Gonzalez F. Novel evidence on sepsis-inducing pathogens: from laboratory to bedside. Front Microbiol 2023; 14:1198200. [PMID: 37426029 PMCID: PMC10327444 DOI: 10.3389/fmicb.2023.1198200] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Sepsis is a life-threatening condition and a significant cause of preventable morbidity and mortality globally. Among the leading causative agents of sepsis are bacterial pathogens Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, and Streptococcus pyogenes, along with fungal pathogens of the Candida species. Here, we focus on evidence from human studies but also include in vitro and in vivo cellular and molecular evidence, exploring how bacterial and fungal pathogens are associated with bloodstream infection and sepsis. This review presents a narrative update on pathogen epidemiology, virulence factors, host factors of susceptibility, mechanisms of immunomodulation, current therapies, antibiotic resistance, and opportunities for diagnosis, prognosis, and therapeutics, through the perspective of bloodstream infection and sepsis. A list of curated novel host and pathogen factors, diagnostic and prognostic markers, and potential therapeutical targets to tackle sepsis from the research laboratory is presented. Further, we discuss the complex nature of sepsis depending on the sepsis-inducing pathogen and host susceptibility, the more common strains associated with severe pathology and how these aspects may impact in the management of the clinical presentation of sepsis.
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Affiliation(s)
- Sebastian Gatica
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Brandon Fuentes
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Elizabeth Rivera-Asín
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Paula Ramírez-Céspedes
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Javiera Sepúlveda-Alfaro
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo A. Catalán
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Susan M. Bueno
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexis M. Kalergis
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Simon
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Claudia A. Riedel
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Felipe Melo-Gonzalez
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
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Martínez Pérez-Crespo PM, Rojas Á, Lanz-García JF, Retamar-Gentil P, Reguera-Iglesias JM, Lima-Rodríguez O, del Arco Jiménez A, Fernández Suárez J, Jover-Saenz A, Goikoetxea Aguirre J, León Jiménez E, Cantón-Bulnes ML, Ortega Lafont P, Armiñanzas Castillo C, Sevilla Blanco J, Cuquet Pedragosa J, Boix-Palop L, Becerril Carral B, Bahamonde-Carrasco A, Marrodan Ciordia T, Natera Kindelán C, Reche Molina IM, Herrero Rodríguez C, Pérez Camacho I, Vinuesa García D, Galán-Sánchez F, Smithson Amat A, Merino de Lucas E, Sánchez-Porto A, Guzmán García M, López-Hernández I, Rodríguez-Baño J, López-Cortés LE. Pseudomonas aeruginosa Community-Onset Bloodstream Infections: Characterization, Diagnostic Predictors, and Predictive Score Development-Results from the PRO-BAC Cohort. Antibiotics (Basel) 2022; 11:antibiotics11060707. [PMID: 35740114 PMCID: PMC9220177 DOI: 10.3390/antibiotics11060707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/15/2022] [Accepted: 05/19/2022] [Indexed: 02/05/2023] Open
Abstract
Community-onset bloodstream infections (CO-BSI) caused by gram-negative bacilli are common and associated with significant mortality; those caused by Pseudomonas aeruginosa are associated with worse prognosis and higher rates of inadequateempirical antibiotic treatment. The aims of this study were to describe the characteristics of patients with CO-BSI caused by P. aeruginosa, to identify predictors, and to develop a predictive score for P. aeruginosa CO-BSI. Materials/methods: PROBAC is a prospective cohort including patients >14 years with BSI from 26 Spanish hospitals between October 2016 and May 2017. Patients with monomicrobial P. aeruginosa CO-BSI and monomicrobial Enterobacterales CO-BSI were included. Variables of interest were collected. Independent predictors of Pseudomonas aeruginosa CO-BSI were identified by logistic regression and a prediction score was developed. Results: A total of 78patients with P. aeruginosa CO-BSI and 2572 with Enterobacterales CO-BSI were included. Patients with P. aeruginosa had a median age of 70 years (IQR 60−79), 68.8% were male, median Charlson score was 5 (IQR 3−7), and 30-daymortality was 18.5%. Multivariate analysis identified the following predictors of CO-BSI-PA [adjusted OR (95% CI)]: male gender [1.89 (1.14−3.12)], haematological malignancy [2.45 (1.20−4.99)], obstructive uropathy [2.86 (1.13−3.02)], source of infection other than urinary tract, biliary tract or intra-abdominal [6.69 (4.10−10.92)] and healthcare-associated BSI [1.85 (1.13−3.02)]. Anindex predictive of CO-BSI-PA was developed; scores ≥ 3.5 showed a negative predictive value of 89% and an area under the receiver operator curve (ROC) of 0.66. Conclusions: We did not find a good predictive score of P. aeruginosa CO-BSI due to its relatively low incidence in the overall population. Our model includes variables that are easy to collect in real clinical practice and could be useful to detect patients with very low risk of P. aeruginosa CO-BSI.
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Affiliation(s)
- Pedro María Martínez Pérez-Crespo
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen Macarena and Department of Medicine, University of Sevilla/Biomedicines Institute of Sevilla, 41009 Sevilla, Spain; (P.M.M.P.-C.); (J.F.L.-G.); (P.R.-G.); (I.L.-H.); (L.E.L.-C.)
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Nuestra Señora de Valme, 41014 Sevilla, Spain;
| | - Álvaro Rojas
- Departamento de Enfermedades Infecciosas del Adulto, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile;
| | - Joaquín Felipe Lanz-García
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen Macarena and Department of Medicine, University of Sevilla/Biomedicines Institute of Sevilla, 41009 Sevilla, Spain; (P.M.M.P.-C.); (J.F.L.-G.); (P.R.-G.); (I.L.-H.); (L.E.L.-C.)
| | - Pilar Retamar-Gentil
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen Macarena and Department of Medicine, University of Sevilla/Biomedicines Institute of Sevilla, 41009 Sevilla, Spain; (P.M.M.P.-C.); (J.F.L.-G.); (P.R.-G.); (I.L.-H.); (L.E.L.-C.)
| | - José María Reguera-Iglesias
- Servicio de Enfermedades Infecciosas, Hospital Regional Universitario de Málaga, IBIMA Málaga, 29010 Málaga, Spain;
| | - Olalla Lima-Rodríguez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain;
| | - Alfonso del Arco Jiménez
- Grupo Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Costa del Sol, 29603 Marbella, Spain;
| | - Jonathan Fernández Suárez
- Unidad de Microbiología, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
| | - Alfredo Jover-Saenz
- Unidad Funcional de Infecciones Nosocomiales, Hospital Arnau de Vilanova, 25198 Lérida, Spain;
| | | | - Eva León Jiménez
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Nuestra Señora de Valme, 41014 Sevilla, Spain;
| | | | - Pilar Ortega Lafont
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario de Burgos, 09006 Burgos, Spain;
| | - Carlos Armiñanzas Castillo
- Unidad de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, 39008 Santander, Spain;
| | - Juan Sevilla Blanco
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Jerez de la Frontera, 11407 Jerez de la Frontera, Spain;
| | - Jordi Cuquet Pedragosa
- Departamento de Medicina Interna, Hospital Universitario de Granollers, 08402 Granollers, Spain;
| | - Lucía Boix-Palop
- Unidad de Enfermedades Infecciosas, Hospital Universitari Mútua de Terrassa, 08221 Barcelona, Spain;
| | - Berta Becerril Carral
- Unidad Clínica de Gestión de Enfermedades Infecciosas y Microbiología, Área Sanitaria del Campo de Gibraltar, 11207 Cádiz, Spain;
| | | | - Teresa Marrodan Ciordia
- Departamento de Microbiología Clínica, Complejo Asistencial Universitario de León (CAULE), 24071 León, Spain;
| | - Clara Natera Kindelán
- Unidad Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain;
| | | | - Carmen Herrero Rodríguez
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología Clínica, Complejo Hospitalario de Jaén, 23007 Jaén, Spain;
| | - Inés Pérez Camacho
- Unidad de Medicina Tropical, Hospital General de Poniente, 04700 El Ejido, Spain;
| | - David Vinuesa García
- Unidad Gestión Clínica Enfermedades Infecciosas, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain;
| | - Fátima Galán-Sánchez
- Unidad de Gestión Clínica de Microbiología, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain;
| | - Alejandro Smithson Amat
- Unidad de Medicina Interna, Fundació Hospital de l’Esperit Sant, 08923 Santa Coloma de Gramenet, Spain;
| | - Esperanza Merino de Lucas
- Unidad de Enfermedades Infecciosas, Hospital Universitario General de Alicante, 03010 Alicante, Spain;
| | - Antonio Sánchez-Porto
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital de la Línea de la Concepción, 11300 La Línea de la Concepción, Spain;
| | | | - Inmaculada López-Hernández
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen Macarena and Department of Medicine, University of Sevilla/Biomedicines Institute of Sevilla, 41009 Sevilla, Spain; (P.M.M.P.-C.); (J.F.L.-G.); (P.R.-G.); (I.L.-H.); (L.E.L.-C.)
| | - Jesús Rodríguez-Baño
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen Macarena and Department of Medicine, University of Sevilla/Biomedicines Institute of Sevilla, 41009 Sevilla, Spain; (P.M.M.P.-C.); (J.F.L.-G.); (P.R.-G.); (I.L.-H.); (L.E.L.-C.)
- Correspondence: ; Tel.: +34-660-839-073; Fax: +34-955-926-552
| | - Luis Eduardo López-Cortés
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen Macarena and Department of Medicine, University of Sevilla/Biomedicines Institute of Sevilla, 41009 Sevilla, Spain; (P.M.M.P.-C.); (J.F.L.-G.); (P.R.-G.); (I.L.-H.); (L.E.L.-C.)
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