Clinical Advances in Bacteremia: From Pathophysiology to New Therapeutic Possibilities

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Infectious Diseases".

Deadline for manuscript submissions: closed (25 September 2022) | Viewed by 10576

Special Issue Editors


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Guest Editor
1. Laboratory of Microbiology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
2. Blood transfusion Department, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
Interests: immunohematology; clinical immunology; neutrophil biology; medical microbiology

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Guest Editor
Pediatric Department, Democritus University of Thrace, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
Interests: allergy; asthma; paediatric infectious diseases

Special Issue Information

Dear Colleagues,

Bacteremia refers to the presence of viable bacteria in the bloodstream. Bacteremia can occur in daily activities such as oral hygiene (toothbrushing) as a transient that may be spontaneously cleared, without clinical sequelae. When the host immune mechanisms cannot eliminate the bacteria from the blood, bacteremia can lead to incidence of focal infection, or the infection may progress to general bloodstream infections (BSI) and life-threatening infection or sepsis.

The pathophysiology of bacteremia is not fully understood. Cellular innate and adaptive immune responses are responsible for initial microbe clearance. The first barrier to bacterial invasion is the skin and mucosal surfaces. The solution of the continuity of the skin or mucosa plays a pivotal role pathophysiology of bacteremia. Subsequently, innate immune cells such as macrophages and neutrophils recognize microorganisms through the sensing of common microbial structures known as pathogen-associated molecular patterns (PAMPs). The most studied PAMPs are lipotechoic acid, lipopeptides, lipopolysaccharide (LPS), peptidoglycan, flagellin, and microbial nucleic acids. At the site of infection, immune cells such as neutrophils employ three major strategies to fight against microbes: phagocytosis, degranulation, and the release of neutrophil extracellular traps (NETs). In order for bacteria to cause bacteremia, they must evade the host immune mechanisms.

The first-line therapeutic intervention for bacteremia is antibiotics. Bacteremia requires urgent and appropriate antibiotics. Delay in the administration of appropriate antibiotics is associated with increased mortality. On the other hand, the long-term use and abuse of traditional antibiotics leads to the development of multiple drug resistance (MDR) bacterial strains. Today, the bacterial drug resistance is healthy problem.

With bacterial resistance becoming a serious threat worldwide, antimicrobial peptides have become a promising research area.

Dr. Theocharis G. Konstantinidis
Dr. Dimitrios Cassimos
Guest Editors

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Keywords

  • bloodstream infections (BSI)
  • sepsis
  • pathogen-associated molecular patterns (PAMPs)
  • neutrophils (PMNs)
  • antimicrobial peptides (AMPs)
  • multiple drug resistance (MDR)

Published Papers (3 papers)

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Research

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17 pages, 708 KiB  
Article
Catheter-Associated Urinary Tract Infections, Bacteremia, and Infection Control Interventions in a Hospital: A Six-Year Time-Series Study
by Amalia Papanikolopoulou, Helena C. Maltezou, Athina Stoupis, Dimitra Kalimeri, Androula Pavli, Fotini Boufidou, Maria Karalexi, Nikos Pantazis, Constantinos Pantos, Yannis Tountas, Vasiliki Koumaki, Maria Kantzanou and Athanasios Tsakris
J. Clin. Med. 2022, 11(18), 5418; https://doi.org/10.3390/jcm11185418 - 15 Sep 2022
Cited by 6 | Viewed by 2440
Abstract
Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Urine catheters are often reservoirs of multidrug-resistant (MDR) bacteria and sources of pathogens transmission to other patients. The current study was conducted to investigate the correlation between CAUTIs, MDR bacteremia, and [...] Read more.
Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Urine catheters are often reservoirs of multidrug-resistant (MDR) bacteria and sources of pathogens transmission to other patients. The current study was conducted to investigate the correlation between CAUTIs, MDR bacteremia, and infection control interventions, in a tertiary-care hospital in Athens, from 2013 to 2018. The following data were analyzed per month: 1. CAUTI incidence; 2. consumption of hand hygiene disinfectants; 3. incidence of isolation of MDR carrier patients, and 4.incidence of bacteremia/1000 patient-days [total resistant a.Gram-negative: carbapenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae; b.Gram-positive: vancomycin-resistant Enterococci and methicillin-resistant Staphylococcus aureus]. The use of scrub disinfectant solutions was associated with decreased CAUTI rate in Total Hospital Clinics (OR: 0.97, 95% CI: 0.96–0.98, p-value: <0.001) and in Adults ICU (OR: 0.79, 95% CI: 0.65–0.96, p-value:0.018) while no correlation was found with isolation rate of MDR-carrier pathogens. Interestingly, an increase in total bacteremia (OR: 0.81, 95% CI: 0.75–0.87, p-value:<0.001) or carbapenem-resistant bacteremia correlated with decreased incidence of CAUTIs (OR: 0.96, 95% CI: 0.94–0.99, p-value: 0.008). Hand hygiene measures had a robust and constant effect on infection control, reducing the incidence of CAUTIs. Full article
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9 pages, 1100 KiB  
Article
The Presence of Bacteremia Indicates Higher Inflammatory Response and Augments Disease Severity in Adult Patients with Urinary Tract Infections
by Chien-Chin Hsu, Pei-Chen Lin and Kuo-Tai Chen
J. Clin. Med. 2022, 11(14), 4223; https://doi.org/10.3390/jcm11144223 - 21 Jul 2022
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Abstract
Background: This study investigated the association between the presence of bacteremia and increase in the requirement for intensive care in adult patients with urinary tract infection (UTI). The study also analyzed the differences in clinical features between patients with versus without bacteremia. Methods: [...] Read more.
Background: This study investigated the association between the presence of bacteremia and increase in the requirement for intensive care in adult patients with urinary tract infection (UTI). The study also analyzed the differences in clinical features between patients with versus without bacteremia. Methods: We conducted a retrospective screening of the medical records of adult patients admitted during a 4-month period at a single medical center. We excluded patients with concomitant infections and patients whose urine and blood samples were not collected in the emergency department (ED). The included patients were allocated to two groups—bacteremia and nonbacteremia groups—according to the blood culture results for samples collected in the ED. Results: The study cohort comprised 637 patients, including 158 (24.8%) patients in the bacteremia group and 479 (75.2%) patients in the nonbacteremia group. Compared with the patients in the nonbacteremia group, those in the bacteremia group satisfied more systemic inflammatory response syndrome (SIRS) criteria; they had a higher white cell count, C-reactive protein level, and sequential organ failure assessment (SOFA) scores; and had a greater requirement for intensive care (bacteremia vs. nonbacteremia; SIRS: 79.1% vs. 49.9%, p = 0.000; leukocytosis: 68.2% vs. 57.6%, p = 0.000; elevation of CRP: 96.2% vs. 78.6%, p = 0.000; SOFA: 39.2% vs. 23.2%, p = 0.000; requirement for intensive care: 13.9% vs. 4.4%, p = 0.000, respectively). According to the results of multivariate logistic regression, bacteremia and sepsis were independent factors associated with the requirement for intensive care. Conclusions: Bacteremia increased the requirement for intensive care in patients with UTI. Physicians can identify bacteremia using inflammatory markers, the SIRS criteria, and SOFA scores. Full article
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18 pages, 2097 KiB  
Review
Legionella pneumophila: The Journey from the Environment to the Blood
by Valeria Iliadi, Jeni Staykova, Sergios Iliadis, Ina Konstantinidou, Polina Sivykh, Gioulia Romanidou, Daniil F. Vardikov, Dimitrios Cassimos and Theocharis G. Konstantinidis
J. Clin. Med. 2022, 11(20), 6126; https://doi.org/10.3390/jcm11206126 - 18 Oct 2022
Cited by 11 | Viewed by 5548
Abstract
An outbreak of a potentially fatal form of pneumonia in 1976 and in the annual convention of the American Legion was the first time that Legionella spp. was identified. Thereafter, the term Legionnaires’ disease (LD) was established. The infection in humans is transmitted [...] Read more.
An outbreak of a potentially fatal form of pneumonia in 1976 and in the annual convention of the American Legion was the first time that Legionella spp. was identified. Thereafter, the term Legionnaires’ disease (LD) was established. The infection in humans is transmitted by the inhalation of aerosols that contain the microorganisms that belong to the Legionellaceae family and the genus Legionella. The genus Legionella contains genetically heterogeneous species and serogroups. The Legionella pneumophila serogroup 1 (Lp1) is the most often detected strain in outbreaks of LD. The pathogenesis of LD infection initiates with the attachment of the bacterial cells to the host cells, and subsequent intracellular replication. Following invasion, Legionella spp. activates its virulence mechanisms: generation of specific compartments of Legionella-containing vacuole (LCV), and expression of genes that encode a type IV secretion system (T4SS) for the translocation of proteins. The ability of L. pneumophila to transmigrate across the lung’s epithelium barrier leads to bacteremia, spread, and invasion of many organs with subsequent manifestations, complications, and septic shock. The clinical manifestations of LD depend on the bacterial load in the aerosol, the virulence factors, and the immune status of the patient. The infection has two distinct forms: the non- pneumatic form or Pontiac fever, which is a milder febrile flu-like illness, and LD, a more severe form, which includes pneumonia. In addition, the extrapulmonary involvement of LD can include heart, brain, abdomen, and joints. Full article
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