1,721,180 research outputs found
Cefepime-taniborbactam and CERTAIN-1: Can we treat carbapenem-resistant infections?
No full textWagenlehner and colleagues 1 demonstrated non-inferiority and superiority with respect to a primary endpoint of composite success (microbiological plus clinical) of cefepime/taniborbactam vs. meropenem in treating complicated urinary tract infections and acute pyelonephritis caused by carbapenem-susceptible gram-negative bacteria in adults. A major area of interest in real-world application of cefepime/taniborbactam is its potential role in treating carbapenem-resistant infections, which deserves further investigation
Valutazione dei fattori di rischio per lo sviluppo di candidemia dopo interventi di cardiochirurgia maggiore
No full textBackground: Candida species are among the most frequent causative agents of healthcare-associated bloodstream infections, with mortality higher than 40% in critically ill patients. Specific populations of critically ill patients may present peculiar risk factors related to their reason for intensive care unit admission. The primary objective of the present study was to assess the predictors of candidemia after open heart surgery.
Methods: This retrospective, matched, case-control study was conducted in 8 Italian hospitals from 2009 to 2016. The primary study endpoint was development of candidemia after open surgery. Crude mortality within 30 days after the onset of candidemia in cases was a secondary study endpoint.
Results: Overall, 222 patients (74 cases and 148 controls) were included in the study. Candidemia developed at a median time of 23 days after surgery (interquartile range 14-36). In multivariable analysis, independent predictors of candidemia were New York Heart Association class equal or greater than III (odds ratio [OR] 23.81, 95% confidence intervals [CI] 5.73-98.95, p<0.001), previous therapy with carbapenems (OR 8.87, 95% CI 2.57-30.67, p=0.001), and previous therapy with fluoroquinolones (OR 5.73, 95% CI 1.61-20.41, p=0.007). Crude 30-day mortality of candidemia was 53% (39/74). Septic shock was independently associated with mortality in the multivariable model (OR 5.64, 95% CI 1.91-16.63, p=0.002). No association between prolonged cardiopulmonary bypass time and candidemia was observed in this study.
Conclusions: Previous broad-spectrum antibiotic therapy and high NYHA class were independent predictors of candidemia in cardiac surgery patients with prolonged postoperative ICU stay
Clinical trials that could change the management of severe multidrug-resistant Gram-negative infections
No full textPurpose of review – This article reviews recent and ongoing randomized controlled trials (RCTs) investigating novel antibiotics and treatment strategies for severe Gram-negative infections, particularly those caused by multidrug-resistant (MDR) organisms. It discusses how these trials are reshaping clinical practice and outlines current limitations in their applicability to real-world scenarios. Recent findings – Several novel β-lactams and β-lactam/β-lactamase inhibitor combinations have shown efficacy in RCTs targeting infections like complicated urinary tract infections, intra-abdominal infections, and hospital-acquired pneumonia. Additional considerations on the results of recent RCTs challenge the necessity of combination regimens, and a growing body of evidence from other RCTs support shorter treatment durations for selected Gram-negative infections, overall potentially reinforcing antimicrobial stewardship. However, limitations include small sample sizes in pathogen-specific subgroups, frequent exclusion of critically ill or immunocompromised patients, and a focus on sites and types of infections within narrow regulatory definitions. Summary – Current RCTs have enriched clinical management of severe Gram-negative infections by validating new agents and supporting more personalized, safer, and shorter treatments. Nevertheless, gaps persist regarding their generalizability to high-risk populations and real-world infections. Complementary pathogen-focused trials, adaptive designs, and observational studies are needed to expand the evidence base, also for treatment duration in MDR infections, combination regimens, and resistance development. Integrating trial data with clinical judgment remains essential in bridging the gap between trial conditions and bedside care in line with the principles of precision medicine
How do we optimize the prescribing of intravenous polymyxins to increase their longevity and efficacy in critically ill patients?
No full textRe: 'Comparing large language models for antibiotic prescribing in different clinical scenarios' by De Vito et al
No full textRole of artificial intelligence in ICU therapeutic decision-making for severe infections
No full textPurpose of reviewTo discuss current and future role of artificial intelligence in predicting severe infections and supporting decisions on antibiotic treatment in critically ill patients in intensive care units (ICU), focusing in particular on some relevant conceptual changes compared to classical clinical reasoning.Recent findingsSeveral studies have evaluated the ability of machine learning techniques for severe infection prediction, while other studies have explored the potential of large language models (LLM)-based tools to assist clinicians in deciding which antimicrobial agent(s) to prescribe to patients with severe infections.SummaryThe support of artificial intelligence for infection prediction and antimicrobial prescribing has shown the potential to improve the treatment of severe infections in ICU. However, the limited number of studies focused on ICU should be highlighted, along with the need to thoroughly address the issue of patients' privacy and to improve the ethical and legal frameworks for decision accountability, as well as the transparency and quality of training data. A standardized approach to the accuracy-interpretability trade-off would also be essential to outline a correct and shared approach both for the future conduct of studies and for the interpretation of their evidence for clinical practice
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