Evdoxia Tsigou

Background: Pandrug-resistant (PDR) Acinetobacter baumannii represents a major therapeutic challenge in regions where carbapenem-resistant A. baumannii (CRAB) is endemic. Whether the PDR phenotype independently worsens clinical outcomes beyond the effects of disease severity and therapeutic limitations remains uncertain. This study compared the characteristics, management, and outcomes of severe infections caused by PDR and carbapenem-resistant, colistin-susceptible A. baumannii. Methods: We conducted a retrospective analysis of prospectively collected data across 11 tertiary-care hospitals in Greece (February 2022–June 2024). Consecutive adults with bloodstream infection or hospital-acquired/ventilator-associated pneumonia caused by CRAB or PDR A. baumannii were enrolled. The primary outcome was 14-day clinical failure; secondary outcomes included 28-day mortality, microbiological eradication, organ dysfunction, and organ-support-free days. Multivariable logistic and Cox regression analyses, before and after propensity score matching, were performed to adjust for confounding. Results: Among 142 patients, 91 (64%) had PDR and 51 (36%) had carbapenem-resistant, colistin-susceptible infections. Clinical failure occurred in 41% of patients and did not differ significantly between PDR and CRAB infections (39% vs. 45%; p = 0.440). Twenty-eight-day mortality was 33% and 22%, respectively (p = 0.139). After adjustment, the PDR phenotype was not independently associated with clinical failure or mortality. Higher APACHE II score and pneumonia independently predicted clinical failure, whereas sulbactam-containing therapy was associated with lower odds of failure (OR 0.24, 95% CI 0.07–0.79). Older age, higher SOFA score, impaired lactate clearance, and tigecycline-containing therapy independently predicted 28-day mortality. In matched analysis, PDR showed a non-significant upward trend in 28-day mortality (HR 2.36, 95% CI 0.97–5.76; p = 0.059). Conclusions: In severe A. baumannii infections, the PDR phenotype was not an independent determinant of clinical failure or short-term mortality. Patient severity and antimicrobial strategy were major outcome correlates; treatment associations should be interpreted cautiously given the observational design.

Gram-negative bacterial resistance to antimicrobials has had an exponential increase at a global level during the last decades and represent an everyday challenge, especially for the hospital practice of our era. Concerted efforts from the researchers and the industry have recently provided several novel promising antimicrobials, resilient to various bacterial resistance mechanisms. There are new antimicrobials that became commercially available during the last five years, namely, cefiderocol, imipenem-cilastatin-relebactam, eravacycline, omadacycline, and plazomicin. Furthermore, other agents are in advanced development, having reached phase 3 clinical trials, namely, aztreonam-avibactam, cefepime-enmetazobactam, cefepime-taniborbactam, cefepime-zidebactam, sulopenem, tebipenem, and benapenem. In this present review, we critically discuss the characteristics of the above-mentioned antimicrobials, their pharmacokinetic/pharmacodynamic properties and the current clinical data.

Traditional diagnosis of acute kidney injury (AKI) depends on detection of oliguria and rise of serum creatinine level, which is an unreliable and delayed marker of kidney damage. Delayed diagnosis of AKI in the critically ill patient is related to increased morbidity and mortality, prolonged length of stay, and cost escalation. The discovery of a reliable biomarker for early diagnosis of AKI would be very helpful in facilitating early intervention, evaluating the effectiveness of therapy, and eventually reducing cost and improving outcome. Innovative technologies such as genomics and proteomics have contributed to the discovery of new biomarkers, such as neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (Cys C), kidney injury molecule-1 (KIM-1), interleukin-18 (IL-18), and liver-type fatty acid binding protein (L-FABP). The current status of the most promising of these novel AKI biomarkers, including NGAL, Cys C, KIM-1, L-FABP, and IL-18, is reviewed.

Background: Heroin use carries a large burden of morbidity and mortality. Heroin overdose and in particular events that need intensive care unit (ICU) admission have not been widely examined. The aim of this study was to describe the causes of ICU admission and the outcome of patients with a heroin overdose.Methods: A retrospective chart review of all patients with a heroin overdose admitted to the ICU between 1987 and 2006 was conducted.Results: Forty-two records were available for review. The average age of the patients was 28 years. In the field, 19 persons were found in coma Glasgow Coma Scale (GCS < 8) and respiratory depression and were treated with naloxone. The reasons for ICU admission included hypoxemia in 37 (88 percent), 28 of whom had acute lung injury (ALI) and nine aspiration pneumonia, shock in three (7.2 percent) and persistent mental compromise in two patients (4.8 percent). Intubation and mechanical ventilation (MV) were instituted in 37 patients. In 19 of the 37 patients, weaning and extubation became possible within the first 24 hours. Sixteen patients suffered complications and received MV for 5 ± 2 days, with a mean length of ICU stay of 8 ± 1 days, while two patients succumbed because of anoxemic encephalopathy and brain death. The complications observed were acute respiratory distress syndrome in eight patients, severe sepsis in four, catheter-related bacteremia in one, iatrogenic pneumothorax in one, and rhabdomyolysis in two, while four among them died due to severe sepsis.Conclusions: In our study, ALI and aspiration pneumonia were the most frequently observed respiratory complications after acute heroin overdose requiring intubation and ICU admission. Mortality rate was 14.2 percent and was attributed to septic complications and irreversible brain damage.