Strategies for implementation of a multidisciplinary approach to the treatment of nosocomial infections in critically ill patients

Clinical Differences Between Survivors and Non-Survivors of Ventilator-Associated Pneumonia: The Roles of Sulbactam/Ampicillin and Methicillin-Resistant Staphylococcus aureus

Background

Ventilator-associated pneumonia (VAP) is one of the most lethal complications in intensive care unit (ICU) patients. However, critical issues of non-survivors vary and are still unclear in VAP patients.

Methods

The clinical differences between survivors and non-survivors of VAP were retrospectively analyzed in patients hospitalized from April 2023 to March 2024.

Results

Of a total of 42 VAP patients, 22 (52.4%) survived, and 20 died. Survivors were significantly younger (69.1 vs 71.7 years, p < 0.01) and received sulbactam/ampicillin (SAM) as the initial antibiotics, significantly more (45.5% vs 10%, p = 0.006) than non-survivors. The male/female ratio and wards where they were managed were similar in both groups, but methicillin-resistant Staphylococcus aureus (MRSA) was detected significantly more frequently in non-survivors (4/4 = 100%).

Conclusion

These data suggest that VAP patients who survived were younger and received treatment with narrow-spectrum antibiotics, such as SAM. Isolation of MRSA might be critical. These findings could influence antibiotic protocols and ICU management strategies to prevent infection with resistant bacteria to improve the prognosis of patients with VAP.

Nosocomial infections in sickle cell anemia patients: Prevention through multi-disciplinary approach: A review

Sickle cell anemia (SCA), a hereditary blood disorder characterized by the presence of abnormal hemoglobin, poses a unique set of challenges for both patients and healthcare providers. One of the most pressing issues in the care of these individuals is the persistent threat of nosocomial infections, which are infections acquired during hospitalization. This abstract provides a concise overview of the ongoing challenge of nosocomial infections in SCA patients, highlighting the factors contributing to their vulnerability and the preventive measures in place. SCA patients face increased susceptibility to nosocomial infections due to their compromised immune systems, frequent hospitalizations, prolonged stays, and the need for invasive medical interventions. The emergence of multidrug-resistant pathogens further complicates the management of these infections. To address this challenge, healthcare facilities have implemented infection control protocols, vaccination strategies, and antimicrobial stewardship, emphasizing the importance of patient education. Recognizing the gravity of this issue and adopting comprehensive preventive measures is crucial to improving the quality of care and patient outcomes in this vulnerable population. Further research and ongoing efforts are essential to reducing the burden of nosocomial infections in SCA patients and enhancing their overall healthcare experience.

"HAP and VAP after Guidelines"

Nosocomial pneumonia is associated with worsened prognosis when diagnosed in intensive care unit (ICU), ranging from 12 to 48% mortality. The incidence rate of ventilation-acquired pneumonia tends to decrease below 15/1,000 intubation-day. Still, international guidelines are heterogeneous about diagnostic criteria because of inaccuracy of available methods. New entities have thus emerged concerning lower respiratory tract infection, namely ventilation-acquired tracheobronchitis (VAT), or ICU-acquired pneumonia (ICUAP), eventually requiring invasive ventilation (v-ICUAP), according to the type of ventilation support. The potential discrepancy with non-invasive methods could finally lead to underdiagnosis in almost two-thirds of non-intubated patients. Delayed diagnostic could explain in part the 2-fold increase in mortality of penumonia when invasive ventilation is initiated. Here we discuss the rationale underlying this new classification.Many situations can lead to misdiagnosis, even more when the invasive mechanical ventilation is initiated. The chest radiography lacks sntivity and specificity for diagnosing pneumonia. The place of chest computed tomography and lung ultrasonography for routine diagnostic of new plumonary infiltrate remain to be evaluated.Microbiological methods used to confirm the diagnostic can be heterogeneous. The development of molecular diagnostic tools may improve the adequacy of antimicrobial therapies of ventilated patients with pneumonia, but we need to further assess its impact in non-ventilated pneumonia.In this review we introduce distinction between hospital-acquired pneumonia according to the localization in the hospital and the oxygenation/ventilation mode. A clarification of definition is the first step to develop more accurate diagnostic strategies and to improve the patients' prognosis.