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Nosocomial Infections Caused by Acinetobacter spp. — Therapeutic Problems
Published in E. Bergogne-Bénézin, M.L. Joly-Guillou, K.J. Towner, Acinetobacter, 2020
Early appropriate antibiotic treatment is able to reduce the fatality rate of Gram-negative bacteraemia by approximately 50%. In addition, the frequency with which shock develops is reduced, and even after the development of shock, patients with adequate antibiotic therapy have a better prognosis (Kreger et al., 1980). Since Acinetobacter is considered to be an organism of relatively low virulence, the role of early appropriate therapy has been a matter for debate. Tilley and Roberts (1994) studied the outcome of bacteraemia caused by Acinetobacter in 52 pa-tients. The prognosis appeared to correlate more closely with the type of underlying disease and its severity than with other factors, including the appropriateness of the initial therapy. In another study of 27 patients with nosocomial Acinetobacter bacteraemia, 6 had polymicrobial sepsis that carried a higher mortality than ‘pure’Acinetobacter bacteraemia (50% vs. 0%) (Smego, 1985). In contrast, in a case-control study, Fagon et al. (1993) found that ventilator-associated pneumonia caused by Pseudomonas aeruginosa or Acinetobacter spp. was responsible for an attributable mortality of 42.8%, compared to 27% in the overall population of patients with ventilator-associated pneumonia. In another control study performed during an outbreak of A. baumannii infections, the mortality attributable to respiratory tract infections was 50% (Kaul et al., 1994).
Pneumonia (CAP, HAP and VAP)
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Ventilator-associated pneumonia is a serious complication of intensive care and carries a significant mortality and morbidity. Gram-negative bacilli are commonly isolated, and antibiotic resistance can be a major problem with limited therapeutic options. Local antibiotic-resistance patterns should be noted when considering empirical therapy for both HAP and VAP. Recent antibiotic therapy is recognized as a risk for resistant pathogens in both HAP and VAP. Depending on the local prevalence of MRSA, potential regimes would include piperacillin-tazobactam, meropenem with vancomycin or linezolid if MRSA cover is required. Extended sensitivity testing of isolates may be needed to guide susceptibility to agents not commonly used such as colistin, fosfomycin and newer agents such as ceftazidime/avibactam, particularly when MDR pathogens such as Acinetobacter are found.
Intensive Care Medicine
Published in Elizabeth Combeer, The Final FRCA Short Answer Questions, 2019
The lack of a universally accepted diagnostic tool for VAP causes problems when comparing rates between units or evaluating interventions to reduce its incidence. The CDC (see reference at the end of this question) has produced an algorithm for diagnosing ventilator associated events for the purposes of surveillance. After a period of 48 hours of stability or improvement on ventilation, deterioration in oxygenation qualifies as a ventilator associated event. Further clinical and microbiological findings are then used to determine whether this is a ventilator-associated condition, infection-related ventilator-associated complication, or possible ventilator-associated pneumonia.
Bacterial and fungal infections: a frequent and deadly complication among critically ill acute liver failure patients
Published in Infectious Diseases, 2023
Félicie Belicard, Kieran Pinceaux, Estelle Le Pabic, Valentin Coirier, Flora Delamaire, Benoît Painvin, Mathieu Lesouhaitier, Adel Maamar, Pauline Guillot, Quentin Quelven, Pauline Houssel, Karim Boudjema, Florian Reizine, Christophe Camus
The overall incidence rate of ICU-acquired infections was 14.2‰ (57 of 4020 ICU-days, 95% CI 10.7–18.4‰). The incidence rate according to three consecutive periods was 17.4‰ (11.2–25.6‰, 2000–2007), 9.8‰ (5.2–16.8‰, 2008–2015) and 15.1‰ (9.1–23.6‰, 2016–2021) (p = .24). The acquisition delay was 5 [3–10] days for infections acquired before/without LTx and 9 [9–14] days for those acquired after LTx. The incidence rate of ventilator-associated pneumonia was 11.8 per 1000 ventilator-days and the incidence rate of bloodstream infection was 5.5‰. Compared with the pre-decontamination period, the incidence rate of all-site acquired infections did not change significantly with the use of the decontamination regimen (12.2‰ versus 18.4‰, incidence rate ratio 0.65 [0.38–1.13], p = .10).
Colistin conditioning surfaces combined with antimicrobial treatment to prevent ventilator-associated infections
Published in Biofouling, 2022
Diana Alves, Hélder Lopes, Idalina Machado, Maria Olívia Pereira
Patients in intensive care units are often subjected to mechanical ventilation, which is associated with a substantial risk of ventilator-associated pneumonia (VAP). VAP is the most common nosocomial infection in intensive care units, resulting in prolonged hospitalization, and high morbidity and mortality rates (Wu et al. 2019). The endotracheal tube (ETT) has been reported to constitute a major risk factor for the development of VAP by acting both as a reservoir for potential pathogens and as a bridge between the oropharyngeal environment and the sterile bronchoalveolar space by bypassing host defenses (Pinciroli et al. 2013; Grgurich et al. 2013). Microorganisms can reach the surface of ETT as a result of contaminated oropharyngeal contents or gastric secretion reflux. Microbial adhesion and subsequent biofilm formation are then favored for the inadequate inhibitory concentration of antimicrobials sometimes found in the airways (Adair et al. 1999; Prat and Lacoma 2016). Biofilm formation is a crucial step in the pathogenesis of these infections (Diaconu et al. 2018), as bacterial cells within a biofilm encase themselves in a self-produced matrix of extracellular polymeric substances (Flemming and Wingender 2010), which confers them protection against antimicrobial treatments and the host immune system (Prakash et al. 2003).
Strategies for implementation of a multidisciplinary approach to the treatment of nosocomial infections in critically ill patients
Published in Expert Review of Anti-infective Therapy, 2021
Ignacio Martin-Loeches, Mark Metersky, Andre Kalil, Maria Diletta Pezzani, Antoni Torres
Historically, hospital-acquired and ventilator-associated pneumonia were treated with 14 or more days of antibiotics. Then, the 2005 American Thoracic Society Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia recommended 7 days of therapy for most patients with HAP and VAP [54]. The recommendation was based on several studies that demonstrated clinical improvement prior to 7 days in most VAP patients and on a large randomized trial showing similar overall outcomes between patients who received 8 days of therapy compared to patients who received 15 days of therapy [55]. While outcomes were equivalent in the two groups, a higher rate of recurrent VAP was diagnosed at 28 days in the subgroup of patients who had VAP caused by non-fermenting Gram negative bacilli (NF-GNB), including Pseudomonas spp. (the majority), Acinetobacter spp. and Stenotrophomonas maltophila.