Update of the treatment of nosocomial pneumonia in the ICU.

In accordance with the recommendations of, amongst others, the Surviving Sepsis Campaign and the recently published European treatment guidelines for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), in the event of a patient with such infections, empirical antibiotic treatment must be appropriate and administered as early as possible. The aim of this manuscript is to update treatment protocols by reviewing recently published studies on the treatment of nosocomial pneumonia in the critically ill patients that require invasive respiratory support and patients with HAP from hospital wards that require invasive mechanical ventilation. An interdisciplinary group of experts, comprising specialists in anaesthesia and resuscitation and in intensive care medicine, updated the epidemiology and antimicrobial resistance and established clinical management priorities based on patients' risk factors. Implementation of rapid diagnostic microbiological techniques available and the new antibiotics recently added to the therapeutic arsenal has been reviewed and updated. After analysis of the categories outlined, some recommendations were suggested, and an algorithm to update empirical and targeted treatment in critically ill patients has also been designed. These aspects are key to improve VAP outcomes because of the severity of patients and possible acquisition of multidrug-resistant organisms (MDROs).

Clinical Cure of a Difficult-to-Treat Resistant Pseudomonas aeruginosa Ventriculitis Using Cefiderocol: A Case Report and Literature Review.

Ventriculitis is a complication of meningitis (community-acquired or nosocomial) or other central nervous system (CNS) infections such as brain abscess. They are associated with a different spectrum of microorganisms, from resistant gram-negative bacilli to staphylococci, that can lead serious illness with high mortality. Difficult-to-treat resistance (DTR) gram-negative bacilli may increase to 20% of deaths respective to susceptible isolates of the same bacteria. We present the first report of a clinical cured case of DTR Pseudomonas aeruginosa ventriculitis in which cefiderocol penetration into the CNS has been confirmed in blood and cerebrospinal fluid. Cefiderocol might be considered for difficult-to-treat CNS infections in view of the recent new cases published as well as our case.

New evidence on the use of fosfomycin for bacteremia and infectious endocarditis / Nuevas evidencias del uso de fosfomicina en la bacteriemia y endocarditis infecciosa

There is growing concern regarding the increased resistance rates of numerous pathogens and the limited availability of new antibiotics against these pathogens. In this context, fosfomycin is of considerable interest due to its activity against a wide spectrum of these microorganisms. We will review the encouraging data on this issue regarding the use of fosfomycin in treating Gram-negative bacterial infections. We will also cover fosfomycin's role against 2 of the main causal agents of bacteremia and endocarditis worldwide (nosocomial and community-acquired): enterococci, whose growing resistance to glycopeptides and aminoglycosides represents a serious threat, and methicillin-resistant Staphylococcus aureus, whose infection, despite efforts, continues to be associated with high morbidity and mortality and a high risk of complications. Thanks also to its considerable synergistic capacity with various antibiotics, fosfomycin is a tool for extending the therapeutic arsenal against these types of infections

Existe una creciente preocupación por el aumento de las tasas de resistencia de múltiples patógenos y la limitada disponibilidad de nuevos antibióticos frente a ellos. En este contexto fosfomicina resulta de gran interés por su actividad frente a una amplia gama de estos microorganismos. En concreto en este tema repasaremos los alentadores datos en cuanto a su uso en el tratamiento de infecciones bacteriemicas por gramnegativos, así como su papel frente a dos de los principales causantes de bacteriemias y endocarditis a nivel mundial, tanto de origen nosocomial como de la comunidad, como son los enterococos, cuya creciente resistencia a glucopéptidos y aminoglucósidos supone una seria amenaza, y Staphylococcus aureus resistente a meticilina, cuya infección, a pesar de los esfuerzos, sigue asociándose a una elevada morbi-mortalidad y un alto riesgo de complicaciones. Fosfomicina por tanto, supone en este sentido, y gracias además a su gran capacidad sinérgica con diversos antibióticos, una herramienta en la ampliación del armamentario terapéutico frente a este tipo de infecciones