Antimicrobial Multidrug Resistance: Clinical Implications for Infection Management in Critically Ill Patients

Kalın, Gamze; Alp, Emine; Chouaikhi, Arthur; Roger, Claire

doi:10.3390/microorganisms11102575

Cited by 13 publications

(3 citation statements)

References 136 publications

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“…Consequently, in the face of MDR infections and delayed microbiological results, the widespread use of broad-spectrum antibiotics in empirical antimicrobial therapy has become a common practice. However, this reliance on broad-spectrum antibiotics further risks individual health by continuing the overuse and misuse of these drugs, consequently exacerbating the development of antimicrobial resistance [230].…”

Section: Discussionmentioning

confidence: 99%

Multidrug-Resistant Sepsis: A Critical Healthcare Challenge

Kumar,

Balraj,

Kempegowda

et al. 2024

Antibiotics

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Sepsis globally accounts for an alarming annual toll of 48.9 million cases, resulting in 11 million deaths, and inflicts an economic burden of approximately USD 38 billion on the United States healthcare system. The rise of multidrug-resistant organisms (MDROs) has elevated the urgency surrounding the management of multidrug-resistant (MDR) sepsis, evolving into a critical global health concern. This review aims to provide a comprehensive overview of the current epidemiology of (MDR) sepsis and its associated healthcare challenges, particularly in critically ill hospitalized patients. Highlighted findings demonstrated the complex nature of (MDR) sepsis pathophysiology and the resulting immune responses, which significantly hinder sepsis treatment. Studies also revealed that aging, antibiotic overuse or abuse, inadequate empiric antibiotic therapy, and underlying comorbidities contribute significantly to recurrent sepsis, thereby leading to septic shock, multi-organ failure, and ultimately immune paralysis, which all contribute to high mortality rates among sepsis patients. Moreover, studies confirmed a correlation between elevated readmission rates and an increased risk of cognitive and organ dysfunction among sepsis patients, amplifying hospital-associated costs. To mitigate the impact of sepsis burden, researchers have directed their efforts towards innovative diagnostic methods like point-of-care testing (POCT) devices for rapid, accurate, and particularly bedside detection of sepsis; however, these methods are currently limited to detecting only a few resistance biomarkers, thus warranting further exploration. Numerous interventions have also been introduced to treat MDR sepsis, including combination therapy with antibiotics from two different classes and precision therapy, which involves personalized treatment strategies tailored to individual needs. Finally, addressing MDR-associated healthcare challenges at regional levels based on local pathogen resistance patterns emerges as a critical strategy for effective sepsis treatment and minimizing adverse effects.

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Section: Discussionmentioning

confidence: 99%

Multidrug-Resistant Sepsis: A Critical Healthcare Challenge

Kumar,

Balraj,

Kempegowda

et al. 2024

Antibiotics

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“…Previous studies have shown that length of hospital or ICU stay is an important risk factor for acquiring a nosocomial MDRGN infection [ 22 , 23 ]. Moreover, infections by CRGN pathogens are associated with an increased risk of mortality [ 24 – 27 ]. Therefore, the present study was designed to address the question of contribution of CRGN bacterial infections in the mortality of COVID-19 critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Carbapenem‐Resistant Gram‐Negative Bacterial Infections in Critically Ill Patients with COVID‐19 as Compared to Non‐COVID‐19 Patients: A Prospective Case‐Control Study

Aretha,

Rizopoulou,

Leonidou

et al. 2024

Critical Care Research and Practice

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Introduction. Critically ill COVID‐19 patients hospitalized in intensive care units (ICU) are immunosuppressed due to SARSCoV‐2‐related immunological effects and are administered immunomodulatory drugs. This study aimed to determine whether these patients carry an increased risk of multi‐drug resistant (MDR) and especially carbapenem‐resistant Gram‐negative (CRGN) bacterial infections compared to other critically ill patients without COVID‐19. Materials and Methods. A prospective case‐control study was conducted between January 2022 and August 2023. The ICU patients were divided into two groups (COVID‐19 and non‐COVID‐19). Differences in the incidence of CRGN infections from Klebsiella pneumoniae, Acinetobacter spp., and Pseudomonas aeruginosa were investigated. In addition, an indicator of the infection rate of the patients during their ICU stay was calculated. Factors independently related to mortality risk were studied. Results. Forty‐two COVID‐19 and 36 non‐COVID‐19 patients were analyzed. There was no statistically significant difference in the incidence of CRGN between COVID‐19 and non‐COVID‐19 patients. The infection rate was similar in the two groups. Regarding the aetiological agents of CRGN infections, Pseudomonas aeruginosa was significantly more common in non‐COVID‐19 patients (p = 0.007). COVID‐19 patients had longer hospitalisation before ICU admission (p = 0.003) and shorter ICU length of stay (LOS) (p = 0.005). ICU COVID‐19 patients had significantly higher mortality (p < 0.001) and sequential organ failure assessment (SOFA) score (p < 0.001) compared to non‐COVID‐19 patients. Μortality secondary to CRGN infections was also higher in COVID‐19 patients compared to non‐COVID‐19 patients (p = 0.033). Male gender, age, ICU LOS, and hospital LOS before ICU admission were independent risk factors for developing CRGN infections. Independent risk factors for patients’ mortality were COVID‐19 infection, obesity, SOFA score, total number of comorbidities, WBC count, and CRP, but not infection from CRGN pathogens. Conclusions. The incidence of CRGN infections in critically ill COVID‐19 patients is not different from that of non‐COVID‐19 ICU patients. The higher mortality of COVID‐19 patients in the ICU is associated with higher disease severity scores, a higher incidence of obesity, and multiple underlying comorbidities, but not with CRGN infections.

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“…1 Conventional antibiotics are becoming increasingly ineffective against a burgeoning array of resistant bacterial strains, underscoring the critical need for alternative approaches. 2 The widespread misuse and overuse of antibiotics have expedited the emergence of multidrug-resistant pathogens, 3 exemplified by notorious strains like methicillin-resistant S. aureus (MRSA) and vancomycin-resistant Enterococcus (VREF). 4,5 This proliferation of resistant strains has severely curtailed the efficacy of conventional treatments for various infections.…”

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confidence: 99%