Enhancing sepsis biomarker development: key considerations from public and private perspectives

Critical Care, Год журнала: 2024, Номер 28(1)

Опубликована: Июль 13, 2024

Implementation of biomarkers in sepsis and septic shock emergency situations, remains highly challenging. This viewpoint arose from a public-private 3-day workshop aiming to facilitate the transition into clinical practice. The authors consist international academic researchers clinician-scientists industry experts who gathered (i) identify current obstacles impeding biomarker research sepsis, (ii) outline important milestones critical path development (iii) discuss novel avenues discovery implementation. To define more appropriately potential place better understanding pathophysiology is mandatory, particular patient's trajectory early inflammatory onset late persisting immunosuppression phase. time-varying host response urges develop time-resolved test characterize persistence immunological dysfunctions. Furthermore, age-related difference has be considered between adult paediatric patients. In this context, numerous barriers adoption practice, such as lack consensus about diagnostic performances, absence strict recommendations for development, cost resources implications, methodological validation challenges or limited awareness education have been identified. Biomarker-guided interventions patients that would benefit therapy, sTREM-1-guided Nangibotide treatment Adrenomedullin-guided Enibarcimab treatment, appear promising but require further evaluation. Artificial intelligence also great field through capability analyse high volume complex data multiparametric patient endotypes trajectories. conclude, requires comprehensive multidisciplinary approach employing most advanced analytical tools, creation platform collaboratively merges scientific commercial needs support an expedited regulatory approval process.

Язык: Английский

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What intensivists need to know about cytomegalovirus infection in immunocompromised ICU patients

Intensive Care Medicine, Год журнала: 2025, Номер 51(1), С. 39 - 61

Опубликована: Янв. 1, 2025

Язык: Английский

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Association Between Type of Immunosuppression and the Incidence, Microbiology, and Outcomes of Bacterial Ventilator-Associated Lower Respiratory Tract Infections: A Retrospective Multicenter Study

Critical Care Medicine, Год журнала: 2025, Номер unknown

Опубликована: Фев. 21, 2025

Objectives: Ventilator-associated lower respiratory tract infections (VALRTIs) are among the most common ICU-acquired in patients receiving invasive mechanical ventilation (IMV). Immunocompromised may have a incidence of VALRTI when compared with nonimmunocompromised patients, but influence type immunosuppression on epidemiology has not been investigated. The study objectives were to assess association incidence, microbiology, and outcomes (ICU mortality, ICU length stay, duration IMV) related bacterial pathogens. Design: Multicenter, international retrospective cohort study. Setting: One hundred eighteen ICUs (118) nine countries. Patients: Eight fifty-four immunocompromised adult (median age, 65 yr; 57.6% males) requiring IMV for greater than 48 hours, including 162 hematologic malignancies. Interventions: None. Measurements Main Results: Patients malignancies had 28-day cumulative other types (13.6% vs. 20.1%; adjusted cause-specific hazard ratio, 0.61; 95% CI, 0.37–0.97), mostly due ventilator-associated pneumonia (9.3% 13.9%). proportion cases multidrug-resistant bacteria was similar between groups. Occurrence associated an increased mortality longer this effect independent immunosuppression. Conclusions: immunosuppression, mainly pneumonia.

Язык: Английский

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Practical Lessons on Antimicrobial Therapy for Critically Ill Patients

Antibiotics, Год журнала: 2024, Номер 13(2), С. 162 - 162

Опубликована: Фев. 6, 2024

Sepsis stands as a formidable global health challenge, with persistently elevated mortality rates in recent decades. Each year, sepsis not only contributes to heightened morbidity but also imposes substantial healthcare costs on survivors. This narrative review aims highlight the targeted measures that can be instituted alleviate incidence and impact of intensive care. Here we discuss reduce nosocomial infections prevention equipment patient colonisation by resilient pathogens. The overarching crisis bacterial resistance newly developed antimicrobial agents intensifies imperative for stewardship de-escalation. urgency has been accentuated years, notably during COVID-19 pandemic, high-dose steroids opportunistic presented escalating challenges. Ongoing research into airway colonisation’s role influencing disease outcomes among critically ill patients underscores importance tailoring treatments endotypes within heterogeneous populations, which are important lessons intensivists training. Looking ahead, significance novel delivery systems drug monitoring is poised increase. delves multifaceted barriers facilitators inherent effectively treating vulnerable infections. future trajectory care medicine hinges meticulous implementation vigilant programs, robust infection control measures, continued exploration innovative efficient technological solutions this demanding landscape.

Язык: Английский

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Metabolic regulation of the host–fungus interaction: from biological principles to therapeutic opportunities

Journal of Leukocyte Biology, Год журнала: 2024, Номер 116(3), С. 469 - 486

Опубликована: Март 18, 2024

Abstract Fungal infections present a significant global public health concern, impacting over 1 billion individuals worldwide and resulting in more than 3 million deaths annually. Despite considerable progress recent years, the management of fungal remains challenging. The limited development novel diagnostic therapeutic approaches is largely attributed to our incomplete understanding pathogenetic mechanisms involved these diseases. Recent research has highlighted pivotal role cellular metabolism regulating interaction between fungi their hosts. In response infection, immune cells undergo complex metabolic adjustments meet energy demands necessary for an effective response. A comprehensive circuits governing antifungal immunity, combined with integration individual host traits, holds potential inform medical interventions infections. This review explores insights into immunometabolic regulation host–fungal interactions infection outcome discusses how repurposing cell function could be exploited innovative personalized approaches.

Язык: Английский

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The clinical application of metagenomic next-generation sequencing in immunocompromised patients with severe respiratory infections in the ICU

Respiratory Research, Год журнала: 2024, Номер 25(1)

Опубликована: Окт. 5, 2024

Early targeted antibiotic therapy is crucial for improving the prognosis of immunocompromised patients with severe respiratory infections (SRIs) in intensive care unit (ICU). Metagenomic next-generation sequencing (mNGS) has shown significant value pathogen detection, but research on lower tract microorganisms remains limited. This study enrolled 234 SRIs ICU, and individuals were categorized into immunocompetent groups. We compared diagnostic performance mNGS using bronchoalveolar lavage fluid (BALF) conventional microbiological tests (CMTs) analyzed ICU. Among all patients, pathogenic microorganism detection rate was higher than that CMTs (94.02% vs 66.67%, P < 0.05), both group (95.0% 58.75%, 0.05) (93.51% 71.43%, 0.05). detected more pathogens did (167 51), identifying 116 organisms missed by CMTs. The proportion regimen adjustments based results significantly to (70.00% 17.50%, groups (48.70% 15.58%, In group, who had their treatment adjusted improved prognosis, ICU mortality (8.93% 50%, 28-day rates (30.36% 68.75%, no statistically differences observed or (20.00% 33.33%, > 0.05; 42.67% 45.83%, shows detecting For respond poorly empirical treatment, can provide an etiological basis, helping adjust regimens precisely thereby patient prognosis.

Язык: Английский

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Vaccine Specifically for Immunocompromised Individuals against Superbugs

ACS Nano, Год журнала: 2025, Номер unknown

Опубликована: Янв. 10, 2025

Immunocompromised populations, including cancer patients, elderly individuals, and those with chronic diseases, are the primary targets of superbugs. Traditional vaccines less effective due to insufficient or impaired immune cells. Inspired by "vanguard" effect neutrophils (NE) during natural infection, this project leverages ability NE initiate NETosis program recruit monocytes DC cells, designing that can rapidly cells enhance response. The PLGA microsphere vaccine platform (MSV) a high level safety contains whole-bacterial antigens both internally externally, providing initial booster effects through programmed distribution release after single injection. Experimental data indicate immunizing mice mixture MSV induces formation spontaneous gel-like neutrophil extracellular traps (NETs) at inoculation site. These NETs prevent diffusion components, thereby reducing damage from bacterial toxins enhancing biosafety. This strategy shows excellent efficacy against MRSA-induced infections in not only healthy but also immunocompromised mice.

Язык: Английский

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PCT/ALB Ratio in Initial Three days for the Prediction of Secondary Infection in Septic Patients

Infection and Drug Resistance, Год журнала: 2025, Номер Volume 18, С. 625 - 633

Опубликована: Фев. 1, 2025

Background: Procalcitonin (PCT) to albumin (ALB) ratio (PAR) in initial three days is a rapidly available indicator assess the prognosis of patients with sepsis. This study aims explore correlation between changes PAR during 72 hours and incidence secondary infections. Methods: A total 147 sepsis were included this study. Patients divided into infection without group, according whether they had infection. was calculated as serum PCT (ng/mL)/ALB (mg/mL). All statistical analyses performed using package SPSS 20.0. Results: Compared median APACHE II (22[17– 30] vs 16[11– 25]; p=0.009) significantly higher group. And ΔPCT/ALB adm-72h (0.10[0.02– 0.48] 0.17[0.03– 0.65]; p=0.011) lower On multiple logistic regression, independently associated Decreasing quartile statistically infection, particularly among survivors. Conclusion: The decline PCT/ALB over acute phase serves an association for onset infections septic patient's hospitalization. Keywords: sepsis, PCT, biomarker

Язык: Английский

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Polymyxin B in The Treatment of Infections Caused by Multidrug-Resistant Gram-Negative Bacteria in Children: A Retrospective Case Series and A Literature Review

Infection and Drug Resistance, Год журнала: 2025, Номер Volume 18, С. 965 - 977

Опубликована: Фев. 1, 2025

Multidrug-resistant Gram-negative bacteria (MRGN) pose a significant threat and require priority attention. Polymyxin B (PMB) retains substantial activity against MRGN makes it potentially the last resort therapy for infections in children. To assess effectiveness safety of PMB treating Chinese Paediatric patients aged 0-18 years who were treated with enrolled study. These cases then compared those identified literature review. In logistic regression, three independent variables used analyzing clinical effectiveness, two nephrotoxicity. A cohort 54 children was included study 24 eligible 259 Out patients, 53.7% showed favorable responses, while 13.0% died during their hospitalization, which 3.7% within 30 days after receiving PMB. AKI observed 25.9% 11.1% risk stage, 7.4% injury stage failure stage. The co-administration carbapenems associated significantly higher (odds rate [OR] = 3.16, 95% confidence interval [CI]: 1.02-9.86, P 0.05) potent diuretic (furosemide) may increase (OR 4.91, CI: 0.96-24.98, 0.05). has advantages paediatric showing responses pathogen clearance. is notable concern. small sample size might hinder reliable identification factors affecting adverse effects.

Язык: Английский

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Study on the application value of “micro-aspiration” in prevention and control of ventilator-related pneumonia in severely ill patients: A randomized controlled trial

AIP Advances, Год журнала: 2025, Номер 15(2)

Опубликована: Фев. 1, 2025

Background: Micro-aspiration is a significant risk factor for ventilator-associated pneumonia (VAP) in critically ill patients. Recent guidelines have increasingly recommended micro-aspiration prevention strategies; however, the practical application and guidance value of these recommendations still require further evaluation. This study aims to analyze “micro-aspiration prevention” concept control VAP Methods: We conducted randomized controlled trial involving 94 patients at our hospital from April 2021 May 2023, all whom received mechanical ventilation. The conventional group followed standard protocol, while implemented additional intervention measures guided by addition protocol. Results: had significantly lower rates incidence (2.13% vs 14.89%, P &lt; 0.05), (0% 17.02%, = 0.017), reflux not specified, 0.004), tracheal mucosal injury 0.017) compared group. also showed scores (P 0.006) shorter intensive care unit length stay 0.036). Conclusion: Our results demonstrate that applying reduces approach only lowers but dramatically hospitalization costs complications.

Язык: Английский

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