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The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the (1) setting of infection onset (community-acquired, early onset, or late-onset hospital-acquired), (2) presence or absence of either localized or diffuse peritonitis, and (3) severity of disease expression (infection, sepsis, or septic shock). This classification system demonstrated reliable risk stratification in intensive care unit (ICU) patients with intra-abdominal infection. This study aimed to describe the epidemiology of ICU patients with pancreatic infection and assess the relationship between the components of the AbSeS-classification and mortality.

Ventilator-associated pneumonia (VAP) represents a common hospital-acquired infection among mechanically ventilated patients. We summarized evidence concerning ventilator care bundles to prevent VAP.

Mechanical ventilation (MV) is a life-support therapy that may predispose to morbid and lethal complications, with ventilator-associated pneumonia (VAP) being the most prevalent. In 2013, the Center for Disease Control (CDC) defined criteria for ventilator-associated events (VAE). Ten years later, a growing number of studies assessing or validating its clinical applicability and the potential benefits of its inclusion have been published. Surveillance with VAE criteria is retrospective and the focus is often on a subset of patients with higher than lower severity. To date, it is estimated that around 30% of ventilated patients in the intensive care unit (ICU) develop VAE. While surveillance enhances the detection of infectious and non-infectious MV-related complications that are severe enough to impact the patient's outcomes, there are still many gaps in its classification and management. In this review, we provide an update by discussing VAE etiologies, epidemiology, and classification. Preventive strategies on optimizing ventilation, sedative and neuromuscular blockade therapy, and restrictive fluid management are warranted. An ideal VAE bundle is likely to minimize the period of intubation. We believe that it is time to progress from just surveillance to clinical care. Therefore, with this review, we have aimed to provide a roadmap for future research on the subject.

To describe whether contemporary dosing of antifungal drugs achieves therapeutic exposures in critically ill patients that are associated with optimal outcomes. Adequate antifungal therapy is a key determinant of survival of critically ill patients with fungal infections. Critical illness can alter an antifungal agents’ pharmacokinetics, increasing the risk of inappropriate antifungal exposure that may lead to treatment failure and/or toxicity.

Objective: Multiple guidelines exist to aid clinicians in choosing antibiotics to treat patients with severe community-acquired pneumonia (SCAP). Our goal was to assess the impact of following these guidelines, such [...]

Study objectives: To assess the implementation of selected ventilator-associated pneumonia (VAP) prevention strategies, and to learn how VAP is diagnosed in the ICUs of Southern Spain. Design: Multicentric survey. Setting: [...]

To the Editor: In response to Wunderink and colleagues, we would like to clarify some apparent misunderstandings of how the US Food and Drug Administration (FDA) utilizes data from subgroup [...]

In view of the high mortality rate of immunocompromised patients with ARDS, it is important to identify targets for improvement.

To determine incidences, risk factors and outcomes of VAE in Türkiye.

Determination of risk factors for sepsis, focus of sepsis, causative microorganisms and mortality in cancer patients

Objective: To determine the epidemiology of pneumonia in patients with tracheotomy receiving short-term mechanical ventilation. Design: Observational prospective study. Setting: A 14-bed medical-surgical ICU. Subjects: Ninety-nine critically ill acute patients [...]

Objective: To assess file effect of baseline variables, including treatment, on outcome in patients with nosocomial pneumonia due to methicilin-resistant Staphylococcus aureus (MRSA). Design: Retrospective analysis of data from two [...]

Key words: diagnosis; epidemiology; pathogenesis: prevention; prognosis; ventilator-associated pneumonia Abbreviations: PSPA = piperacillin susceptible Pseudomonas aeruginosa; VAP = ventilator-associated pneumonia INTERNATIONAL CONSENSUS 1. Hubmayr RD. Statement of the Fourth International [...]

Design: The objectives were to characterize the prognostic factors and evaluate the impact of inappropriate empiric antibiotic treatment and systemic response on the outcome of critically ill patients with community-acquired [...]

Study objectives: The study documents the impact of microbiological investigations on therapeutic decisions and outcome in patients with severe community-acquired pneumonia (SCAP). Design: Retrospective analysis of prospectively collected data. Setting: [...]

The aim of this article is to summarize published information on systemic infective complications of tattoos to gain an update of the current picture.

Objectives: To evaluate risk factors for ventilator-associated pneumonia (VAP), as well as its influence on in-hospital mortality, resource utilization, and hospital charges. Design: Retrospective matched cohort study using data from [...]

Objective: Adherence to clinical practice guidelines is highly variable. Our objective was to review barriers to physicians' adherence to evidence-based guidelines (EBGs) for preventing ventilator-associated pneumonia (VAP). Methods: A questionnaire [...]

ABSTRACT: While Legionella pneumophila is not a common cause of community-acquired pneumonia, it is an important pathogen to consider in patients who have severe pneumonia, particularly those with risk factors, [...]

Study objectives: To determine the clinical significance of Candida sp isolated from bronchoscopic samples in patients with suspected pneumonia. Design: A retrospective chart review was performed in all nonneutropenic adult [...]

All physicians attending to patients in the acute care context are familiar with community-acquired pneumonia (CAP). Streptococcus pneumoniae is the leading etiology in all series, but the perspectives presented by [...]

Study objective: To investigate the epidemiology of infection by Acinetobacter baumannii in patients with ventilator-associated pneumonia (VAP). Design: Prospective clinical study. Setting: Three medical-surgical ICUs in teaching hospitals. Patients: We [...]

We aimed to explore factors for optimizing antimicrobial treatment in emergency departments. A single-day point prevalence survey was conducted on January 18, 2020, in 53 referral/tertiary hospitals in 22 countries. 1957 (17%) of 11557 patients presenting to EDs had infections. The mean qSOFA score was 0.37 ± 0.74. Sepsis (qSOFA ≥ 2) was recorded in 218 (11.1%) patients. The mean qSOFA score was significantly higher in low-middle (1.48 ± 0.963) compared to upper-middle (0.17 ± 0.482) and high-income (0.36 ± 0.714) countries (P < 0.001). Eight (3.7%) patients with sepsis were treated as outpatients. The most common diagnoses were upper-respiratory (n = 877, 43.3%), lower-respiratory (n = 316, 16.1%), and lower-urinary (n = 201, 10.3%) infections. 1085 (55.4%) patients received antibiotics. The most-commonly used antibiotics were beta-lactam (BL) and BL inhibitors (n = 307, 15.7%), third-generation cephalosporins (n = 251, 12.8%), and quinolones (n = 204, 10.5%). Irrational antibiotic use and inappropriate hospitalization decisions seemed possible. Patients were more septic in countries with limited resources. Hence, a better organizational scheme is required.

* Objective: To determine whether continuous subglottic aspiration prevents nosocomial pneumonia in mechanically ventilated patients. * Design: A randomized, controlled, blinded study. * Setting: Medical-surgical intensive care unit. * Patients: 190 patients who were admitted to the intensive care unit during a 33-month period and whose condition suggested the need for prolonged intubation >3 days). * Intervention: 76 patients were randomly allocated to receive continuous aspiration of subglottic secretions, and 77 control patients were allocated to receive usual care. * Measurements: The numbers of cases of ventilator-associated pneumonia, ventilated days, days in intensive care unit, and deaths were recorded. The amount of subglottic secretions aspirated daily and surveillance cultures in the subglottic secretions were also obtained periodically. Etiologic diagnosis was based on the quantitative culture of secretions obtained by protected specimen brush or bronchoalveolar lavage. * Results: The incidence rate of ventilator-associated pneumonia was 19.9 episodes/1000 ventilator days in the patients receiving continuous aspiration of subglottic secretions and 39.6 episodes/1 000 ventilator days in the control patients (relative risk, 1.98; 95% CI, 1.03 to 3.82). This difference was due to a significant (P < 0.03) reduction in the number of gram-positive cocci and Haemophilus influenzae organisms in the patients receiving continuous aspiration. However, no differences were observed in the number of Pseudomonas aeruginosa or Enterobacteriaceae organisms. Episodes of ventilator-associated pneumonia occurred later in patients receiving continuous aspiration (1 2.0 [+ or -] 7.1 days) than in the control patients (5.9 [+ or -] 2.1 days) (P = 0.003). The same microorganisms isolated from protected specimen brush or bronchoalveolar lavage cultures in patients with ventilator-associated pneumonia were previously isolated from cultures of subglottic secretions in 85% of cases. No significant differences in outcome were found. * Conclusions: The incidence of nosocomial pneumonia in mechanically ventilated patients can be significantly reduced by using a simple method that decreases the chronic microaspirations through the cuff of endotracheal tubes., Continuous aspiration of throat secretions may reduce the incidence of ventilator-associated pneumonia. Pneumonia is common among mechanically ventilated patients, occurring when bacteria enter the lungs through the cuff of endotracheal tubes. Of 153 patients receiving mechanical ventilation with the same kind of tube, 76 also received continuous aspiration (suction) of secretions from below the voice box and 77 did not (control group). Fourteen (18.4%) of the patients receiving aspiration developed pneumonia, versus 25 (32.5%) of the control patients. Pneumonia developed later on average in the aspiration group than in the control group (12 days vs six days). Analysis of the aspirated secretions revealed microorganisms that often cause ventilator-associated pneumonia, suggesting that suctioning these secretions can help prevent the bacteria from entering the endotracheal tube, thus reducing the risk of pneumonia.

Objective: To define the influence of prior antibiotic use on the etiology and mortality of ventilator-associated pneumonia (VAP). Setting: A university hospital medical-surgical ICU. Design: Prospective clinical study. Methods: Over [...]

Fifty-eight consecutive patients with severe community-acquired pneumonia were studied prospectively during a three-year period. The group included 44 men and 14 women (mean age: 45.0 ± 15.7 years). The cause [...]

Sixty-nine consecutive pulmonary artery catheters (PACs) were prospectively studied in a medical-surgical intensive care unit. Fifteen (21.7 percent) and two (2.9 percent) of the PACs were associated with colonization and [...]

Incidence and potential risk factors for pneumonia due to Haemophilus influenzae in adults treated with mechanical ventilation in a medical-surgical ICU were investigated. Diagnosis was established in 91 episodes and [...]

Influence of Level of Consciousness with Implications for Therapy A prospective study of 161 multiple trauma patients was carried out to determine the incidence, the causative agents, and the outcome [...]

Nosocomial pneumonia is one of the most common causes of morbidity and mortality among inpatients. [1] The pathogenesis of this type of pneumonia is directly related to oropharyngeal and stomach [...]

•The most important issues in the care are monitoring respiratory status by direct observation and SpO2 continuous monitoring to decide whether endotracheal intubation is indicated.•In patients with silent hypoxemia, the administration of supplemental oxygen therapy is required but no significant injury should be expected with SpO2 above 80%.•Patients with symptomatic moderate-severe hypoxemia could benefit from the administration of supplemental oxygen through reservoir masks, or HFNC. A trial of awake prone position should be considered.•The decision of intubation and mechanical ventilation should not be considered based on a single isolated parameter, such as hypoxemia degree or the extent of pulmonary infiltrates in imaging tests.

Diabetics, drug addicts and patients with renal insufficiency have a high incidence of Staphylococcus aureus (S. aureus) infections. The development of pneumonia caused by the organism is often preceded by measles, influenza, or other viral respiratory infections in a community setting. Nosocomial (hospital-acquired) S. aureus pneumonia has a high mortality rate and affects patients with cystic fibrosis, chronic lung disorders, or those receiving antibiotic therapy. Previous studies have shown that S. aureus is a common cause of nosocomial pneumonia in hospital intensive care units, especially in patients requiring mechanical respirators. In order to determine factors that influence the development of S. aureus nosocomial pneumonia, 50 episodes of pneumonia were evaluated in hospitalized, critically ill patients. Of the 50 episodes, 13 involved S. aureus. This form of pneumonia was linked to coma, nonuse of corticosteroids, age younger than 25 years, or prior trauma. Coma was associated with the highest risk for developing S. aureus pneumonia in the hospital. Antimicrobial therapy against S. aureus is recommended for patients in a coma. Identification of factors that influence the development of S. aureus nosocomial pneumonia is important for improving the prognosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

To the Editor: Wunderink et al (November 2003) (1) claim that initial therapy with linezolid was associated with significantly better survival and clinical cure rates compared to that with vancomycin [...]

Background:Nosocomial pneumonia in the critical care setting is associated with increased morbidity, significant crude mortality rates and high health care costs. Ventilator-associated pneumonia represents about 80% of nosocomial pneumonia cases in intensive care units (ICUs). Wide variance in incidence of nosocomial pneumonia and diagnostic techniques used has been reported, while successful treatment remains complex and a matter of debate.

Key words: antibiotics; mortality; pneumonia Abbreviations: VAP = ventilator-associated pneumonia; VRE = vancomycin-resistant enterococci ********** STRATEGIES FOR IMPROVING ANTIMICROBIAL PRESCRIPTION 1. Kollef MH, Ward S, Sherman G, et al. Inadequate [...]

Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role.

COVID-19 is a new infectious disease causing severe respiratory failure and death for which optimal treatment is currently unclear. Many therapies have been proven to be ineffective; however, promising findings related to corticosteroid therapy have been published. Analysis of published data including in this issue suggests that therapy with corticosteroids in the range of 6 mg of dexamethasone (or equivalent) per day likely has a positive effect in patients requiring mechanical ventilation but there remains considerable doubt in patients over the age of 70, in patients with diabetes and patients with milder disease. Clinicians must consider the individual potential risks and benefits of corticosteroid in patients with COVID-19 rather than routinely using them until more data is available.

Community-acquired pneumonia (CAP) guidelines have improved the treatment and outcomes of patients with CAP, primarily by standardization of initial empirical therapy. But current society-published guidelines exclude immunocompromised patients.

Patients with severe bacterial infections often experience delay in receiving appropriate treatment. Consolidated evidence of the impact of delayed appropriate treatment is needed to guide treatment and improve outcomes.

Aminoglycosides are concentration-dependent antibiotics exerting a bactericidal effect when concentrations at the site of infection are equal to or greater than 5 times the minimum inhibitory concentrations (MIC). When administered intravenously, they exhibit poor lung penetration and high systemic renal and ototoxicity, imposing to restrict their administration to 5 days. Experimental studies conducted in anesthetized and mechanically ventilated sheep and pigs provide evidence that high doses of nebulized aminoglycosides induce a rapid and potent bacterial killing in the infected lung parenchyma. They also confirm that the alveolar-capillary membrane, either normal or injured by the infectious process, restricts the penetration of intravenous aminoglycosides in the infected lung parenchyma, precluding a bactericidal effect at the site of infection. However, injury of the alveolar-capillary membrane promotes the systemic diffusion of nebulized aminoglycosides. Based on experimental data obtained in animals with inoculation pneumonia, it challenges the classical belief that nebulization protects against systemic toxicity. Loss of lung aeration decreases the lung penetration of nebulized aminoglycosides. Nevertheless, lung tissue concentrations measured in non-aerated lung regions with severe and extended pneumonia are most often greater than 5 times the MICs, resulting in a bactericidal effect followed by a progressive pulmonary reaeration. It is likely that the penetration into the consolidated lung, results from the bronchial diffusion of nebulized aminoglycosides toward adjacent non-aerated infected alveolar spaces and their penetration into mechanical ventilation-induced intraparenchymal pseudocysts and distended bronchioles. In animals receiving nebulized aminoglycosides, epithelial lining fluid concentrations grossly overestimate lung interstitial fluid concentrations because of the bronchial contamination of the distal tip of the bronchoscope during the bronchoalveolar procedures. Lung microdialysis is the only technique able to accurately assess lung pharmacokinetics in animals with inoculation pneumonia treated by nebulized aminoglycosides. In 2024, the European Investigators Network for Nebulized Antibiotics in Ventilator-associated Pneumonia (ENAVAP) called for the creation of an international research network for Lung Microdialysis applied to Nebulized Antibiotics (LUMINA) to promote multicentered, experimental, randomized, and controlled studies addressing lung pharmacokinetics of intravenous vs. nebulized antibiotics, using different dosing and ventilator settings.