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Antibiotics
Special Issues
Antimicrobial Resistance and Therapy in Intensive Care Unit
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Antimicrobial Resistance and Therapy in Intensive Care Unit

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: 31 July 2024 | Viewed by 4225

Special Issue Editors

Dr. Pablo Vidal-Cortés

E-Mail Website
Guest Editor
Intensive Care Unit, Hospital Universitario de Ourense, Orense, Spain
Interests: sepsis; antibiotics
Dr. Borja Suberviola

E-Mail Website
Guest Editor
Hospital Universitario Marqués de Valdecilla, Santander, Spain
Interests: infections in critically ill patient
Dr. David Andaluz-Ojeda

E-Mail Website
Guest Editor
1. Complejo Asistencial Universitario, Palencia, Spain
2. Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
3. Fundación de Investigación HM, Madrid, Spain
Interests: sepsis; biomarkers; inflammation; personalized medicine; severe infection; COVID-19; critical care

Special Issue Information

Dear Colleagues,

In recent decades, antimicrobial resistance has become a global health problem. Despite the efforts and the money invested in the development of new antibiotics, bacteria are capable of developing resistance shortly after their commercialization. Patients admitted to intensive care units are at high risk of infection by multidrug-resistant bacteria and, when infected, need an appropriate treatment as soon as possible. This frequent situation is a challenge for doctors, who need to know the local microbiology, become familiar with the new methods of microbiological diagnosis, and have in-depth knowledge of the characteristics of antibiotics, both classic and those that have appeared in recent years. Today, we have a very varied antimicrobial arsenal, with antibiotics not only with a different spectrum and activity against resistance mechanisms, but also with fewer side effects than other molecules used to date due to the lack of alternatives. In addition, some of these antibiotics have peculiarities from the pharmacokinetic/pharmacodynamic point of view that can make a difference between therapeutic success or failure.

The objective of this Special Issue is to review the epidemiology and treatment of the key problem bacteria in intensive care units, trying to establish the best therapeutic scheme for each one of the most frequent resistance mechanisms. In addition, we will review new microbiological diagnostic methods and ways to optimize the performance of prescribed antibiotics.

Dr. Pablo Vidal-Cortés
Dr. Borja Suberviola
Dr. David Andaluz-Ojeda
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • ICU
  • sepsis
  • antimicrobial
  • multidrug-resistant bacteria
  • sepsis
  • antimicrobial stewardship

Published Papers (3 papers)

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Research

13 pages, 293 KiB  
Article
Catastrophic Streptococcus pyogenes Disease: A Personalized Approach Based on Phenotypes and Treatable Traits
by Juan Carlos Ruiz-Rodríguez, Luis Chiscano-Camón, Carolina Maldonado, Adolf Ruiz-Sanmartin, Laura Martin, Ivan Bajaña, Juliana Bastidas, Rocio Lopez-Martinez, Clara Franco-Jarava, Juan José González-López, Vicent Ribas, Nieves Larrosa, Jordi Riera, Xavier Nuvials-Casals and Ricard Ferrer
Antibiotics 2024, 13(2), 187; https://doi.org/10.3390/antibiotics13020187 - 15 Feb 2024
Viewed by 1186
Abstract
Streptococcal toxic shock syndrome (STTS) is a critical medical emergency marked by high morbidity and mortality, necessitating swift awareness, targeted treatment, and early source control due to its rapid symptom manifestation. This report focuses on a cohort of 13 patients admitted to Vall [...] Read more.
Streptococcal toxic shock syndrome (STTS) is a critical medical emergency marked by high morbidity and mortality, necessitating swift awareness, targeted treatment, and early source control due to its rapid symptom manifestation. This report focuses on a cohort of 13 patients admitted to Vall d’Hebron University Hospital Intensive Care Unit, Barcelona, from November 2022 to March 2023, exhibiting invasive Streptococcus pyogenes infections and meeting institutional sepsis code activation criteria. The primary infections were community-acquired pneumonia (61.5%) and skin/soft tissue infection (30.8%). All patients received prompt antibiotic treatment, with clinical source control through thoracic drainage (30.8%) or surgical means (23.1%). Organ support involved invasive mechanical ventilation, vasopressors, and continuous renal replacement therapy as per guidelines. Of note, 76.9% of patients experienced septic cardiomyopathy, and 53.8% required extracorporeal membrane oxygenation (ECMO). The study identified three distinct phenotypic profiles—hyperinflammatory, low perfusion, and hypogammaglobulinemic—which could guide personalized therapeutic approaches. STTS, with a mean SOFA score of 17 (5.7) and a 53.8% requiring ECMO, underscores the need for precision medicine-based rescue therapies and sepsis phenotype identification. Integrating these strategies with prompt antibiotics and efficient source control offers a potential avenue to mitigate organ failure, enhancing patient survival and recovery in the face of this severe clinical condition. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Therapy in Intensive Care Unit)
11 pages, 1357 KiB  
Article
Extended Versus Intermittent Meropenem Infusion in the Treatment of Nosocomial Pneumonia: A Retrospective Single-Center Study
by Dong-gon Hyun, Jarim Seo, Su Yeon Lee, Jee Hwan Ahn, Sang-Bum Hong, Chae-Man Lim, Younsuck Koh and Jin Won Huh
Antibiotics 2023, 12(10), 1542; https://doi.org/10.3390/antibiotics12101542 - 15 Oct 2023
Cited by 1 | Viewed by 1567
Abstract
The efficacy of extended meropenem infusions in patients with nosocomial pneumonia is not well defined. Therefore, we compared the clinical outcomes of extended versus intermittent meropenem infusions in the treatment of nosocomial pneumonia. We performed a retrospective analysis of extended versus intermittent meropenem [...] Read more.
The efficacy of extended meropenem infusions in patients with nosocomial pneumonia is not well defined. Therefore, we compared the clinical outcomes of extended versus intermittent meropenem infusions in the treatment of nosocomial pneumonia. We performed a retrospective analysis of extended versus intermittent meropenem infusions in adult patients who had been treated for nosocomial pneumonia at a medical ICU between 1 May 2018 and 30 April 2020. The primary outcome was mortality at 14 days. Overall, 64 patients who underwent an extended infusion and 97 with an intermittent infusion were included in this study. At 14 days, 10 (15.6%) patients in the extended group and 22 (22.7%) in the intermittent group had died (adjusted hazard ratio (HR), 0.55; 95% confidence interval (CI): 0.23–1.31; p = 0.174). In the subgroup analysis, significant differences in mortality at day 14 were observed in patients following empirical treatment with meropenem (adjusted HR, 0.17; 95% CI: 0.03–0.96; p = 0.045) and in Gram-negative pathogens identified by blood or sputum cultures (adjusted HR, 0.01; 95% CI: 0.01–0.83; p = 0.033). Extended infusion of meropenem compared with intermittent infusion as a treatment option for nosocomial pneumonia may have a potential advantage in specific populations. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Therapy in Intensive Care Unit)
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12 pages, 276 KiB  
Article
Real-Time TDM-Based Expert Clinical Pharmacological Advice Program for Attaining Aggressive Pharmacokinetic/Pharmacodynamic Target of Continuous Infusion Meropenem in the Treatment of Critically Ill Patients with Documented Gram-Negative Infections Undergoing Continuous Veno-Venous Hemodiafiltration
by Milo Gatti, Matteo Rinaldi, Tommaso Tonetti, Antonio Siniscalchi, Pierluigi Viale and Federico Pea
Antibiotics 2023, 12(10), 1524; https://doi.org/10.3390/antibiotics12101524 - 10 Oct 2023
Cited by 1 | Viewed by 1033
Abstract
(1) Objectives: to describe the pharmacokinetic/pharmacodynamic (PK/PD) profile of continuous infusion (CI) meropenem in critical patients with documented Gram-negative infections undergoing continuous veno-venous hemodiafiltration (CVVHDF) and to assess the relationship with microbiological outcome. (2) Methods: Data were retrospectively retrieved for patients admitted to [...] Read more.
(1) Objectives: to describe the pharmacokinetic/pharmacodynamic (PK/PD) profile of continuous infusion (CI) meropenem in critical patients with documented Gram-negative infections undergoing continuous veno-venous hemodiafiltration (CVVHDF) and to assess the relationship with microbiological outcome. (2) Methods: Data were retrospectively retrieved for patients admitted to the general and the post-transplant intensive care units in the period October 2022–May 2023 who underwent CVVHDF during treatment with CI meropenem optimized by means of a real-time therapeutic drug monitoring (TDM)-based expert clinical pharmacological advice (ECPA) program for documented Gram-negative infections. Steady-state meropenem plasma concentrations were measured, and the free fractions (fCss) were calculated. Meropenem total clearance (CLtot) was calculated at each TDM assessment, and the impact of CVVHDF dose intensity and of residual diuresis on CLtot was investigated by means of linear regression. Optimal meropenem PK/PD target attainment was defined as an fCss/MIC ratio > 4. The relationship between meropenem PK/PD target attainment and microbiological outcome was assessed. (3) Results: A total of 24 critical patients (median age 68 years; male 62.5%) with documented Gram-negative infections were included. Median (IQR) meropenem fCss was 19.9 mg/L (17.4–28.0 mg/L). Median (IQR) CLtot was 3.89 L/h (3.28–5.29 L/h), and median (IQR) CVVHDF dose intensity was 37.4 mL/kg/h (33.8–44.6 mL/kg/h). Meropenem dosing adjustments were provided in 20 out of 24 first TDM assessments (83.3%, all decreases) and overall in 26 out of the 51 total ECPA cases (51.0%). Meropenem PK/PD target attainment was always optimal, and microbiological eradication was achieved in 90.5% of assessable cases. (4) Conclusion: the real-time TDM-guided ECPA program was useful in attaining aggressive PK/PD targeting with CI meropenem in critically ill patients undergoing high-intensity CVVHDF and allowed microbiological eradication in most cases with dosing regimens ranging between 125 and 500 mg q6h over 6 h. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Therapy in Intensive Care Unit)
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