Pub Date : 2023-10-26DOI: 10.1007/s11908-023-00816-6
Laura Baptista, Inês Moura, Catarina Mendes Silva, João Pedro Baptista
Abstract Purpose of Review In this narrative review encompassing relevant scientific publications regarding critically ill patients in the last 5 years, we discuss key questions regarding the concept, pathophysiology, identification, epidemiology, and implications of augmented renal clearance (ARC) in the treatment of sepsis. Recent Findings Mathematical estimates of renal function show low accuracy when evaluating renal function in the intensive care unit, jeopardizing the correct dosing of antimicrobials. The description of ARC in critically ill patients in several, distant geographical areas worldwide reveals that this condition is more frequent than anticipated. Several new risk factors have been recently reported, needing future confirmation. Pathophysiology is still largely unknown; however, intact kidney physiology, inflammatory mediators, and tubular secretion seem to play a role. Several studies have demonstrated the association between ARC and subtherapeutic levels of several β-lactams, vancomycin, and fluconazole. Lately, there have been recommendations of dosage regimen adjustments for patients with ARC, namely, through increases in total daily dose or prolonged infusion for various antimicrobials. Literature is scarce describing the influence of ARC on clinical outcomes of patients receiving antibiotics, and results are contradictory. Summary Growing body of evidence supports that measured creatinine clearance based on time-defined urine output is strongly recommended for the identification of ARC and for reliable evaluation of its prevalence and risk factors. Clinicians should be alert for the need to use off-label dosing of antimicrobials in septic patients showing ARC. Concise recommendations for antibiotic dosage regimens, based on clinical data, are still needed.
{"title":"What is New in Augmented Renal Clearance in Septic Patients?","authors":"Laura Baptista, Inês Moura, Catarina Mendes Silva, João Pedro Baptista","doi":"10.1007/s11908-023-00816-6","DOIUrl":"https://doi.org/10.1007/s11908-023-00816-6","url":null,"abstract":"Abstract Purpose of Review In this narrative review encompassing relevant scientific publications regarding critically ill patients in the last 5 years, we discuss key questions regarding the concept, pathophysiology, identification, epidemiology, and implications of augmented renal clearance (ARC) in the treatment of sepsis. Recent Findings Mathematical estimates of renal function show low accuracy when evaluating renal function in the intensive care unit, jeopardizing the correct dosing of antimicrobials. The description of ARC in critically ill patients in several, distant geographical areas worldwide reveals that this condition is more frequent than anticipated. Several new risk factors have been recently reported, needing future confirmation. Pathophysiology is still largely unknown; however, intact kidney physiology, inflammatory mediators, and tubular secretion seem to play a role. Several studies have demonstrated the association between ARC and subtherapeutic levels of several β-lactams, vancomycin, and fluconazole. Lately, there have been recommendations of dosage regimen adjustments for patients with ARC, namely, through increases in total daily dose or prolonged infusion for various antimicrobials. Literature is scarce describing the influence of ARC on clinical outcomes of patients receiving antibiotics, and results are contradictory. Summary Growing body of evidence supports that measured creatinine clearance based on time-defined urine output is strongly recommended for the identification of ARC and for reliable evaluation of its prevalence and risk factors. Clinicians should be alert for the need to use off-label dosing of antimicrobials in septic patients showing ARC. Concise recommendations for antibiotic dosage regimens, based on clinical data, are still needed.","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134909304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Infection Prevention in Remote or Resource-Limited Settings: Deploying Technology While Preserving the Human Touch","authors":"Rachel Pryor, Yashasvisai Veeramasu, Gonzalo Bearman","doi":"10.1007/s11908-023-00814-8","DOIUrl":"https://doi.org/10.1007/s11908-023-00814-8","url":null,"abstract":"","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135273709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-14DOI: 10.1007/s11908-023-00817-5
Robin T. Saggers, Lesego M. Mothibi, Adam D. Irwin, Kuban D. Naidoo
Abstract Purpose of Review Antimicrobial resistance continues to increase throughout the world, with the impact on critically ill children in low- and middle-income paediatric intensive care units largely unknown. Recent Findings There has been a global shift indicating a predominance of Gram-negative bacilli among multidrug-resistant isolates. A 4-year review (2019 to 2022) found a progressive and substantial increase in the incidence of carbapenem-resistant Klebsiella pneumoniae (29% to 51%) alongside high levels of carbapenem-resistant Acinetobacter baumannii (93%) within the paediatric intensive care unit at the Chris Hani Baragwanath Academic Hospital in South Africa. The pharmacological treatment of these infections relies heavily on the continued use of carbapenems, often in combination with colistin. Summary The burden of antimicrobial resistance is disproportionately borne, particularly within sub-Saharan Africa and South Asia. The resource-constrained South African public healthcare system, already significantly burdened by both HIV and TB, continues to face several challenges in combating the growth in antimicrobial resistance. Limited access, largely driven by prohibitive costs, to sophisticated laboratory techniques and newer pharmacological agents, leaves the implementation of effective infection prevention and control and antimicrobial stewardship programmes as the most pragmatic options to address the problem.
{"title":"Challenges Facing PICUs in Low- and Middle-Income Countries in the Treatment of Emerging Multidrug-Resistant Organisms: a Review and Perspective from a South African PICU","authors":"Robin T. Saggers, Lesego M. Mothibi, Adam D. Irwin, Kuban D. Naidoo","doi":"10.1007/s11908-023-00817-5","DOIUrl":"https://doi.org/10.1007/s11908-023-00817-5","url":null,"abstract":"Abstract Purpose of Review Antimicrobial resistance continues to increase throughout the world, with the impact on critically ill children in low- and middle-income paediatric intensive care units largely unknown. Recent Findings There has been a global shift indicating a predominance of Gram-negative bacilli among multidrug-resistant isolates. A 4-year review (2019 to 2022) found a progressive and substantial increase in the incidence of carbapenem-resistant Klebsiella pneumoniae (29% to 51%) alongside high levels of carbapenem-resistant Acinetobacter baumannii (93%) within the paediatric intensive care unit at the Chris Hani Baragwanath Academic Hospital in South Africa. The pharmacological treatment of these infections relies heavily on the continued use of carbapenems, often in combination with colistin. Summary The burden of antimicrobial resistance is disproportionately borne, particularly within sub-Saharan Africa and South Asia. The resource-constrained South African public healthcare system, already significantly burdened by both HIV and TB, continues to face several challenges in combating the growth in antimicrobial resistance. Limited access, largely driven by prohibitive costs, to sophisticated laboratory techniques and newer pharmacological agents, leaves the implementation of effective infection prevention and control and antimicrobial stewardship programmes as the most pragmatic options to address the problem.","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135802074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-11DOI: 10.1007/s11908-023-00815-7
Kevin B. Laupland, Alexis Tabah, Kyle C. White, Mahesh Ramanan
Abstract Purpose of Review To identify opportunities and recent advances in the use of multicentric digital data sources and networks to investigate the epidemiology and management of patients with infections admitted to intensive care units (ICUs). Recent Findings Electronic surveillance systems for a range of serious infections have been reported from large cohorts with evident improvements in efficiency, objectivity, and comprehensiveness of coverage as compared to traditional methods. Electronic data, most notably from electronic health records, has been used to define the epidemiology and outcomes of severe infections in several settings and conditions and has facilitated population-based evaluation. Automated alerts and notifications hold promise to identify patients at risk for sepsis and bloodstream infection although demonstration of efficacy in interventional trials is needed. Summary Exploitation of electronic data in ICUs has led to a better understanding of the epidemiology of severe infections and holds promise for future interventional clinical trials.
{"title":"Exploiting Electronic Data to Advance Knowledge and Management of Severe Infections","authors":"Kevin B. Laupland, Alexis Tabah, Kyle C. White, Mahesh Ramanan","doi":"10.1007/s11908-023-00815-7","DOIUrl":"https://doi.org/10.1007/s11908-023-00815-7","url":null,"abstract":"Abstract Purpose of Review To identify opportunities and recent advances in the use of multicentric digital data sources and networks to investigate the epidemiology and management of patients with infections admitted to intensive care units (ICUs). Recent Findings Electronic surveillance systems for a range of serious infections have been reported from large cohorts with evident improvements in efficiency, objectivity, and comprehensiveness of coverage as compared to traditional methods. Electronic data, most notably from electronic health records, has been used to define the epidemiology and outcomes of severe infections in several settings and conditions and has facilitated population-based evaluation. Automated alerts and notifications hold promise to identify patients at risk for sepsis and bloodstream infection although demonstration of efficacy in interventional trials is needed. Summary Exploitation of electronic data in ICUs has led to a better understanding of the epidemiology of severe infections and holds promise for future interventional clinical trials.","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136210687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Monkeypox 2022 vs. COVID-19: a Review on a National Health Emergency with Emphasis on Cutaneous Manifestations","authors":"Mohammad Rezaei Zadeh Rukerd, Pouria Pourzand, Nasir Arefinia, Davood Bashash, Amin Sayyadi, Mohsen Nakhaie, Simin Shamsi Meymandi","doi":"10.1007/s11908-023-00813-9","DOIUrl":"https://doi.org/10.1007/s11908-023-00813-9","url":null,"abstract":"","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135153748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-02DOI: 10.1007/s11908-023-00812-w
S. Barkati, Luke B. Harrison, Marina B. Klein, Francesca F. Norman
{"title":"Mpox in 2023: Current Epidemiology and Management","authors":"S. Barkati, Luke B. Harrison, Marina B. Klein, Francesca F. Norman","doi":"10.1007/s11908-023-00812-w","DOIUrl":"https://doi.org/10.1007/s11908-023-00812-w","url":null,"abstract":"","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47028292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1007/s11908-023-00810-y
E. Meltzer, Eli Schwartz
{"title":"Ebola and Marburg Virus Infections in Resource-Rich Countries: Implications for Future Outbreaks","authors":"E. Meltzer, Eli Schwartz","doi":"10.1007/s11908-023-00810-y","DOIUrl":"https://doi.org/10.1007/s11908-023-00810-y","url":null,"abstract":"","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42345326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-23DOI: 10.1007/s11908-023-00811-x
Sonia Menon, A. Wilder-Smith
{"title":"New Vaccines on the Immediate Horizon for Travelers: Chikungunya and Dengue Vaccines","authors":"Sonia Menon, A. Wilder-Smith","doi":"10.1007/s11908-023-00811-x","DOIUrl":"https://doi.org/10.1007/s11908-023-00811-x","url":null,"abstract":"","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41837260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-03DOI: 10.1007/s11908-023-00809-5
A. Hou, G. Pang, K. Mills, K. Bayudan, Danielle M. Moore, L. P. Medina, Lorrin W. Pang
{"title":"Airport COVID-19 Testing of Travelers: An Island Destination Perspective","authors":"A. Hou, G. Pang, K. Mills, K. Bayudan, Danielle M. Moore, L. P. Medina, Lorrin W. Pang","doi":"10.1007/s11908-023-00809-5","DOIUrl":"https://doi.org/10.1007/s11908-023-00809-5","url":null,"abstract":"","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46845776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-03DOI: 10.1007/s11908-023-00807-7
Y. M. Matran, A. Al-Haddad, D. Sharma, N. Kalia, Saurabh Sharma, Manoj Kumar, Sandeep Sharma
{"title":"Prevalence and Resistance Patterns of Streptococcus pneumoniae Recovered from Children in Western Asia","authors":"Y. M. Matran, A. Al-Haddad, D. Sharma, N. Kalia, Saurabh Sharma, Manoj Kumar, Sandeep Sharma","doi":"10.1007/s11908-023-00807-7","DOIUrl":"https://doi.org/10.1007/s11908-023-00807-7","url":null,"abstract":"","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48480483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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