Pharmacologic Management of MDR Respiratory and Bacteraemic Infections

Dear Colleagues,

Nosocomial infections such as ventilator-associated pneumonia (VAP) and bacteraemia cause serious morbidity in critical care patients [1–3]. Patients with no previous infections may be at an increased risk of a severe infection and adverse outcomes [1, 4–6]. Moreover, recent exposure either to antibiotics or healthcare settings can predispose patients to multidrug-resistant (MDR) infections, which are associated with adverse outcomes in intensive care units (ICUs) [4, 7]. Several strategies have been suggested to prevent or to manage MDR infections in the ICU [8–11]. Some of these interventions have led to reduced pneumonia or bacteraemia rates or improvements in the clinical course of these infections [9, 10, 11]. However, other studies have reported increased incidences of MDR infections after the implementation of strategies for their prevention [12]. Hence, there is scepticism about the role that antibiotics topically applied to the bronchial tree play in strategies aimed at preventing VAP and bacteraemia.

In the present Special Issue, we highlight strategies used for the pharmacological prevention or therapy of pneumonia or bacteraemia caused by MDR bacteria. These may be based on the use of antibiotics that are applied either topically or via a systemic route.

References

1. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002; 165:867–903.
2. Rello J, Ollendorf DA, Oster G, et al. VAP Outcomes Scientific Advisory Group: Epidemiology and Outcomes of Ventilator-Associated Pneumonia in a Large US Database. Chest 2002; 122:2115-2121.
3. Bercault N and Boulain T. Mortality rate attributable to ventilator-associated nosocomial pneumonia in an adult intensive care unit: A prospective case-control study. Crit Care Med 2001; 29:2303–2309.
4. ATS: Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia. Am J Respir Crit Care Med 2005: 171:388–416.
5. Bouderka MA, Fakhir B, Bouaggad A, et al. Early Tracheostomy versus Prolonged Endotracheal Intubation in Head Injury. J Trauma 2004; 57:251–254.
6. Karvouniaris M, Makris D, Manoulakas E, et al. Ventilator-Associated Tracheobronchitis Increases the Length of Intensive Care Unit Stay. Infect Control Hosp Epidemiol 2013; 34(8): 800-808.
7. Nseir S, Blazejewski C, Lubret R, et al. Risk of acquiring multidrug resistant Gram-negative bacilli from prior room occupants in the intensive care unit. Clin Microbiol Infect 2011; 17: 1201–1208.
8. Palmer LB, Smaldone GC, Chen JJ, et al. Aerosolized antibiotics and ventilator-associated tracheobronchitis in the ICU. Crit Care Med 2008; 36: 2008-13.
9. Karvouniaris M, Makris D, Zygoulis P, Triantaris A, Xitsas S, Mantzarlis K, Petinaki E, Zakynthinos E. Nebulised colistin for ventilator-associated pneumonia prevention. Eur Respir J. 2015 Dec;46(6):1732-9. 
10. Klick JM, du Moulin GC, Hedley-Whyte J, et al. Prevention of gram-negative bacillary pneumonia using polymyxin aerosol as prophylaxis. II. Effect on the incidence of pneumonia in seriously ill patients. J Clin Invest 1975; 55(3): 514–519.
11. Tsolaki V,  Mantzarlis K , Mpakalis, et al. Ceftazidime-Avibactam To Treat Life-Threatening Infections by Carbapenem-Resistant Pathogens in Critically Ill Mechanically Ventilated Patients Antimicrob Agents Chemothepy 2020 Feb 21;64(3):e02320-19.
12. Feeley TW, Du Moulin GC, Hedley-Whyte J,et al. Aerosol polymyxin and pneumonia in seriously ill patients. N Engl J Med 1975; 293:471-475.

Prof. Dr. Demosthènes A. Makris
Dr. Konstantinos D. Mantzarlis
Guest Editors

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• pneumonia
• bacteraemia
• intensive care
• MDR infections
• antibiotics