Search results for " anestesiologia"
showing 10 items of 158 documents
From bedside to bench: The missing brick for patients with fungal sepsis
2016
We read with great interest the article by Spec et al. [1] investigating the immunophenotype of T cells from patients with Candida spp. sepsis. This is the first observational study describing the altered immune response of patients with candidemia. The authors included non-neutropenic critically ill patients with candidemia and non-septic controls, and excluded patients with human immunodeficiency virus infection, who had undergone solid or bone marrow transplantation or with other known causes of impaired immune response. The authors hypothesized that their findings may help explain why patients with fungal sepsis show a high mortality despite appropriate antifungal therapy. In our opinio…
Uncertainty about the evidence on untargeted antifungal treatment
2016
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Dying with or because of invasive fungal infection? The role of immunity exhaustion on patient outcome
2016
De Rosa et al. considered clinical scores, biomarkers and their combination as useful aids for an early antifungal treatment and advocated the adoption of de-escalation therapy in an antifungal stewardship approach as a possible key for a better management of these patients. Authors considered the high burden of invasive fungal infections in terms of patient outcomes and costs and focused on current strategies for their optimization.
Should we continue to use prediction tools to identify patients at risk of Candida spp. infection? If yes, why?
2016
Background Given the predominance of invasive fungal disease (IFD) amongst the non-immunocompromised adult critically ill population, the potential benefit of antifungal prophylaxis and the lack of generalisable tools to identify high risk patients, the aim of the current study was to describe the epidemiology of IFD in UK critical care units, and to develop and validate a clinical risk prediction tool to identify non-neutropenic, critically ill adult patients at high risk of IFD who would benefit from antifungal prophylaxis. Methods Data on risk factors for, and outcomes from, IFD were collected for consecutive admissions to adult, general critical care units in the UK participating in the…
Use of Cepheid Xpert Carba-R® for Rapid Detection of Carbapenemase-Producing Bacteria in Abdominal Septic Patients Admitted to Intensive Care Unit.
2016
Abstract Early institution of effective antibiotic therapy and source control are pivotal to improve survival of abdominal septic patients. Xpert® Carba-R is a real time polymerase chain reaction assay for rapid detection and differentiation of five genes (blaKPC, blaVIM, blaOXA-48, blaIMP-1, blaNDM) responsible for carbapenem resistance. We performed an observational study investigating the clinical usefulness and applicability of Xpert® Carba-R to detect carbapenem resistance in abdominal septic patients admitted to intensive care unit. We compared the results of Xpert® Carba-R with standard microbiological culture. We collected a set of two rectal/stomia swabs and two swabs from abdomina…
Antifungal prophylaxis: update on an old strategy.
2016
What is the risk of acquiring bacteria from prior intensive care unit bed occupants?
2017
Epidemiology, clinical characteristics, resistance, and treatment of infections by Candida auris
2018
Abstract Candida spp. infections are a major cause of morbidity and mortality in critically ill patients. Candida auris is an emerging multi-drug-resistant fungus that is rapidly spreading worldwide. Since the first reports in 2009, many isolates across five continents have been identified as agents of hospital-associated infections. Independent and simultaneous outbreaks of C. auris are becoming a major concern for healthcare and scientific community. Moreover, laboratory misidentification and multi-drug-resistant profiles, rarely observed for other non-albicans Candida species, result in difficult eradication and frequent therapeutic failures of C. auris infections. The aim of this review…
Is it time to combine untargeted antifungal strategies to reach the goal of 'early' effective treatment?
2016
A recently published retrospective study by Posteraro et al. [1] investigated the use of (1–3)-β-D-glucan (BDG) as a strategy for antifungal drug administration in patients at high risk of candidemia. The strategy consisted of the administration of antifungals (anidulafungin in most cases) to septic patients with a Candida score ≥ 3a nd a positive BDG result (≥80 pg/ml). This untargeted strategy led to better selection of patients, avoiding exposure to antifungals in approximately 73 % of patients with negative BDG results and leading to shortened treatment duration in another 20 % of patients. Untargeted antifungal treatments (including prophylaxis, pre-emptive and empiric approaches) are …