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New Diagnostic and Therapeutic Approach of Severe Infection Caused by MDR Pathogens: The Antimicrobial Stewardship after Pandemic

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Diagnostic Microbiology and Infectious Disease".

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 4117

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Special Issue Editor

Prof. Dr. Alessandro Russo

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Guest Editor

Department of Medical and Surgical Sciences, Infectious and Tropical Disease Unit, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy
Interests: infection; MDR pathogens; bacteria; fungal infection; aepsis; antimicrobials
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

During the coronavirus disease 2019 (COVID-19) pandemic, a huge number of patients have required admission to hospital and intensive care units (ICU). The data from literature suggest that COVID-19 was associated with a less effective implementation of infection control procedures with a lower application of antimicrobial stewardship programs. As a matter of fact, diagnosis of severe infection caused by multidrug-resistant (MDR) pathogens is challenging for physicians considering the importance of an early assessment of infection, the role of colonization and its interpretation, and the importance of an early appropriate antimicrobial therapy. MDR infections are associated with a high mortality rate and a considerable burden on length of hospital stay, ICU admission and healthcare costs. To date, despite the wide choice of antibiotic therapy, knowledge of the local epidemiology, patient’s risk stratification, and infection control policies (mainly antimicrobial stewardship programs) remain the key elements for the effective management of infections caused by MDR microorganisms.

On these bases, physicians should recognize peculiar clinical characteristics and treat MDR infections appropriately in hospitalized patients. This Special Issue aims to collect papers on antimicrobial stewardship after pandemic, with a focus on new diagnostic and therapeutic approach of severe infection caused by MDR pathogens to better define the management and treatment of this difficult-to-treat infection. For this Special Issue, we invite to submit research articles, review articles, case series and clinical cases, especially in critically-ill patients.

Prof. Dr. Alessandro Russo
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

MDR pathogens
diagnosis
rapid microbiology
antibiotic resistance
therapy

Published Papers (3 papers)

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Research

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13 pages, 315 KiB

Open AccessArticle

Upraising Stenotrophomonas maltophilia in Critically Ill Patients: A New Enemy?

by George Dimopoulos, José Garnacho-Montero, Elisabeth Paramythiotou, Antonio Gutierrez-Pizarraya, Charalambos Gogos, Maria Adriansen-Pérez, Chrysa Diakaki, Dimitrios K. Matthaiou, Garyphalia Poulakou and Karolina Akinosoglou

Diagnostics 2023, 13(6), 1106; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics13061106 - 15 Mar 2023

Cited by 3 | Viewed by 1455

Abstract

Stenotrophomonas maltophilia (S. maltophilia), an important pathogen in immuno-compromised patients, has recently gained attention in patients admitted in intensive care units (ICU). We sought to investigate clinical features of infections caused by S. maltophilia in ICU patients and identify risk factors for mortality. We conducted a retrospective study in two multivalent non-COVID-19 ICUs of tertiary-teaching hospitals in Greece and Spain, including patients with isolated S. maltophilia from at least one clinical specimen along with clinical signs of infection. A total of 103 patients (66% male) were analyzed. Median age was 65.5 (54–73.3) years and mean APACHE II and SOFA scores upon ICU admission were 18.36 (±7.22) and 18.17 (±6.95), respectively. Pneumonia was the predominant clinical syndrome (72.8%), while 22% of cases were among hemato/oncology patients. Crude 28-day mortality rate was 54.8%, even though, 14-day clinical and microbiological response was 96%. Age, APACHE II on ICU admission, hemato-oncologic disease, and multi-organ failure were initially identified as potential predictors of mortality. In the multivariable analysis, only increasing age and hemato-oncologic disease were shown to be independent risk factors for 28-day mortality. High all-cause mortality was observed in critically ill patients with predominantly respiratory infections by S. maltophilia, despite initial clinical and laboratory response after targeted treatment. The study elucidates a potentially worrisome emerging pathogen in the ICU. Full article

(This article belongs to the Special Issue New Diagnostic and Therapeutic Approach of Severe Infection Caused by MDR Pathogens: The Antimicrobial Stewardship after Pandemic)

9 pages, 907 KiB

Open AccessCommunication

Validation of an Automated System for the Extraction of a Wide Dataset for Clinical Studies Aimed at Improving the Early Diagnosis of Candidemia

by Daniele Roberto Giacobbe, Sara Mora, Alessio Signori, Chiara Russo, Giorgia Brucci, Cristina Campi, Sabrina Guastavino, Cristina Marelli, Alessandro Limongelli, Antonio Vena, Malgorzata Mikulska, Anna Marchese, Antonio Di Biagio, Mauro Giacomini and Matteo Bassetti

Diagnostics 2023, 13(5), 961; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics13050961 - 03 Mar 2023

Cited by 3 | Viewed by 1183

Abstract

There is increasing interest in assessing whether machine learning (ML) techniques could further improve the early diagnosis of candidemia among patients with a consistent clinical picture. The objective of the present study is to validate the accuracy of a system for the automated extraction from a hospital laboratory software of a large number of features from candidemia and/or bacteremia episodes as the first phase of the AUTO-CAND project. The manual validation was performed on a representative and randomly extracted subset of episodes of candidemia and/or bacteremia. The manual validation of the random extraction of 381 episodes of candidemia and/or bacteremia, with automated organization in structured features of laboratory and microbiological data resulted in ≥99% correct extractions (with confidence interval < ±1%) for all variables. The final automatically extracted dataset consisted of 1338 episodes of candidemia (8%), 14,112 episodes of bacteremia (90%), and 302 episodes of mixed candidemia/bacteremia (2%). The final dataset will serve to assess the performance of different ML models for the early diagnosis of candidemia in the second phase of the AUTO-CAND project. Full article

(This article belongs to the Special Issue New Diagnostic and Therapeutic Approach of Severe Infection Caused by MDR Pathogens: The Antimicrobial Stewardship after Pandemic)

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15 pages, 662 KiB

Open AccessBrief Report

Whole-Genome Sequence-Based Characterization of Pre-XDR M. tuberculosis Clinical Isolates Collected in Kazakhstan

by Asset Daniyarov, Ainur Akhmetova, Saule Rakhimova, Zhannur Abilova, Dauren Yerezhepov, Lyailya Chingissova, Venera Bismilda, Nurlan Takenov, Ainur Akilzhanova, Ulykbek Kairov and Ulan Kozhamkulov

Diagnostics 2023, 13(12), 2005; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics13122005 - 08 Jun 2023

Cited by 3 | Viewed by 1137

Abstract

Background: Kazakhstan has a high burden of multidrug-resistant tuberculosis in the Central Asian region. This study aimed to perform genomic characterization of Mycobacterium tuberculosis strains obtained from Kazakhstani patients with pre-extensively drug-resistant tuberculosis diagnosed in Kazakhstan. Methods: Whole-genome sequencing was performed on 10 pre-extensively drug-resistant M. tuberculosis strains from different regions of Kazakhstan. All strains had high-confidence resistance mutations according to the resistance grading system previously established by the World Health Organization. The genome analysis was performed using TB-Profiler, Mykrobe, CASTB, and ResFinder. Results: Valuable information for understanding the genetic diversity of tuberculosis in Kazakhstan can also be obtained from whole-genome sequencing. The results from the Phenotypic Drug Susceptibility Testing (DST) of bacterial strains were found to be consistent with the drug resistance information obtained from genomic data that characterized all isolates as pre-XDR. This information can help in developing targeted prevention and control strategies based on the local epidemiology of tuberculosis. Furthermore, the data obtained from whole-genome sequencing can help in tracing the transmission pathways of tuberculosis and facilitating early detection of outbreaks. Conclusions: The results from whole-genome sequencing of tuberculosis clinical samples in Kazakhstan provide important insights into the drug resistance patterns and genetic diversity of tuberculosis in the country. These results can contribute to the improvement of tuberculosis control and management programs in Kazakhstan. Full article

(This article belongs to the Special Issue New Diagnostic and Therapeutic Approach of Severe Infection Caused by MDR Pathogens: The Antimicrobial Stewardship after Pandemic)

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