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Obesity and Asthma
Semin Respir Crit Care Med DOI: 10.1055/s-0042-1742384Obesity is a major risk factor for the development of asthma, and the prevalence of obesity is higher in people with asthma than in the general population. Obese people often have severe asthma—recent studies in the United States suggest that 60% of adults with severe asthma are obese. Multiple mechanisms link obesity and asthma, which are discussed in this article, and these pathways contribute to different phenotypes of asthma among people with obesity. From a practical aspect, changes in physiology and immune markers affect diagnosis and monitoring of disease activ...
Source: Seminars in Respiratory and Critical Care Medicine - February 17, 2022 Category: Respiratory Medicine Authors: Dixon, Anne E. Que, Loretta G. Tags: Review Article Source Type: research

Infective Endocarditis: New Challenges in a Classic Disease
Semin Respir Crit Care Med 2022; 43: 150-172 DOI: 10.1055/s-0042-1742482Infective endocarditis is a relatively rare, but deadly infection, with an overall mortality of around 20% in most series. Clinical manifestations have evolved in response to significant epidemiological shifts in industrialized nations, with a move toward a nosocomial or health-care-related pattern, in older patients, with more episodes associated with prostheses and/or intravascular electronic devices and a predominance of staphylococcal and enterococcal etiology.Diagnosis is often challenging and is based on the conjunction of clinical, microbiologic...
Source: Seminars in Respiratory and Critical Care Medicine - February 16, 2022 Category: Respiratory Medicine Authors: Cuervo, Guillermo Hern ández-Meneses, Marta Falces, Carles Quintana, Eduard Vidal, B árbara Marco, Francesc Perissinotti, Andr és Carratal à, Jordi Miro, Jose M. Tags: Review Article Source Type: research

Antibiotic Decision-Making in the ICU
Semin Respir Crit Care Med 2022; 43: 141-149 DOI: 10.1055/s-0041-1741014It is well established that Intensive Care Units (ICUs) are a focal point in antimicrobial consumption with a major influence on the ecological consequences of antibiotic use. With the high prevalence and mortality of infections in critically ill patients, and the clinical challenges of treating patients with septic shock, the impact of real life clinical decisions made by intensivists becomes more significant. Both under- and over-treatment with unnecessarily broad spectrum antibiotics can lead to detrimental outcomes. Even though substantial progress...
Source: Seminars in Respiratory and Critical Care Medicine - February 16, 2022 Category: Respiratory Medicine Authors: Parra-Rodriguez, Luis Guillamet, M. Cristina Vazquez Tags: Review Article Source Type: research

Antimicrobial Stewardship in the ICU
Semin Respir Crit Care Med 2022; 43: 131-140 DOI: 10.1055/s-0041-1740977Increasing rates of infection and multidrug-resistant pathogens, along with a high use of antimicrobial therapy, make the intensive care unit (ICU) an ideal setting for implementing and supporting antimicrobial stewardship efforts. Overuse of antimicrobial agents is common in the ICU, as practitioners are challenged daily with achieving early, appropriate empiric antimicrobial therapy to improve patient outcomes. While early antimicrobial stewardship programs focused on the financial implications of antimicrobial overuse, current goals of stewardship p...
Source: Seminars in Respiratory and Critical Care Medicine - February 16, 2022 Category: Respiratory Medicine Authors: Murphy, Claire V. Reed, Erica E. Herman, Derrick D. Magrum, BrookeAnne Beatty, Julia J. Stevenson, Kurt B. Tags: Review Article Source Type: research

Antibiotic Optimization in the Intensive Care Unit
Semin Respir Crit Care Med 2022; 43: 125-130 DOI: 10.1055/s-0041-1740972Effective antimicrobial therapy remains paramount to successful treatment of patients with critical illness, such as pneumonia and sepsis. Unfortunately, critically ill patients often exhibit altered pharmacokinetics and pharmacodynamics (PK/PD) that make this endeavor challenging. Particularly in sepsis, alterations in volume of distribution (Vd) and protein binding lead to unpredictable effects on serum levels of various antimicrobials. Additionally, metabolic pathways and excretion may be significantly impacted due to end-organ failure. These dynami...
Source: Seminars in Respiratory and Critical Care Medicine - February 16, 2022 Category: Respiratory Medicine Authors: Lizza, Bryan D. Raush, Nick Micek, Scott T. Tags: Review Article Source Type: research

Infections Due to Acinetobacter baumannii –calcoaceticus Complex: Escalation of Antimicrobial Resistance and Evolving Treatment Options
Semin Respir Crit Care Med 2022; 43: 097-124 DOI: 10.1055/s-0041-1741019Bacteria within the genus Acinetobacter (principally A. baumannii–calcoaceticus complex [ABC]) are gram-negative coccobacilli that most often cause infections in nosocomial settings. Community-acquired infections are rare, but may occur in patients with comorbidities, advanced age, diabetes mellitus, chronic lung or renal disease, malignancy, or impaired immunity. Most common sites of infections include blood stream, skin/soft-tissue/surgical wounds, ventilator-associated pneumonia, orthopaedic or neurosurgical procedures, and urinary tract. Acinetob...
Source: Seminars in Respiratory and Critical Care Medicine - February 16, 2022 Category: Respiratory Medicine Authors: Lynch, Joseph P. Clark, Nina M. Zhanel, George G. Tags: Review Article Source Type: research

Microbiology Assessments in Critically Ill Patients
Semin Respir Crit Care Med 2022; 43: 075-096 DOI: 10.1055/s-0041-1741018The prevalence of suspected or proven infections in critically ill patients is high, with a substantial attributable risk to in-hospital mortality. Coordinated guidance and interventions to improve the appropriate microbiological assessment for diagnostic and therapeutic decisions are therefore pivotal. Conventional microbiology follows the paradigm of “best practice” of specimen selection and collection, governed by laboratory processing and standard operating procedures, and informed by the latest developments and trends. In this regard, the prea...
Source: Seminars in Respiratory and Critical Care Medicine - February 16, 2022 Category: Respiratory Medicine Authors: Brink, Adrian John Centner, Chad M. Opperman, Stefan Tags: Review Article Source Type: research

Severe Infections Due to Respiratory Viruses
Semin Respir Crit Care Med 2022; 43: 060-074 DOI: 10.1055/s-0041-1740982Severe viral infections may result in severe illnesses capable of causing acute respiratory failure that could progress rapidly to acute respiratory distress syndrome (ARDS), related to worse outcomes, especially in individuals with a higher risk of infection, including the elderly and those with comorbidities such as asthma, diabetes mellitus and chronic respiratory or cardiovascular disease. In addition, in cases of severe viral pneumonia, co-infection with bacteria such as Streptococcus pneumoniae and Staphylococcus aureus is related to worse outcom...
Source: Seminars in Respiratory and Critical Care Medicine - February 16, 2022 Category: Respiratory Medicine Authors: Cill óniz, Catia Peric às, Juan M. Rojas, Jorge R. Torres, Antoni Tags: Review Article Source Type: research

Diagnosis and Management of Invasive Candida Infections in Critically Ill Patients
Semin Respir Crit Care Med 2022; 43: 046-059 DOI: 10.1055/s-0041-1741009Invasive candidiasis (IC) has become a serious problem in the intensive care unit patients with an attributable mortality rate that can reach up to 51%. Multiple global surveillance studies have shown an increasing incidence of candidemia. Despite their limited sensitivity (21–71%), cultures remain the gold standard for the diagnosis of IC associated with candidemia. Many adjunct laboratory tests exist to support or rule out the diagnosis, each with its indications and limitations, including procalcitonin, 1,3-β-D-glucan, mannan and anti-mannan anti...
Source: Seminars in Respiratory and Critical Care Medicine - February 16, 2022 Category: Respiratory Medicine Authors: Zakhem, Aline El Istambouli, Rachid Jabbour, Jean-Francois Hindy, Joya-Rita Gharamti, Amal Kanj, Souha S. Tags: Review Article Source Type: research

Sepsis and Septic Shock: Evolving Evidence, Evolving Paradigms
Semin Respir Crit Care Med 2022; 43: 039-045 DOI: 10.1055/s-0041-1740975Sepsis and septic shock represent important infection-related medical emergencies that result in significant morbidity and mortality. The prevalence and microbiology of these processes are evolving. Nonetheless, timely and appropriate antibiotic therapy continues to represent the most important determinant of survival. Recent trials have clarified that crystalloids are preferred for initial resuscitation, and balanced crystalloids appear superior to 0.9% saline. Controversy remains regarding not only the rate and rapidity of fluid resuscitation but als...
Source: Seminars in Respiratory and Critical Care Medicine - February 16, 2022 Category: Respiratory Medicine Authors: Shorr, Andrew F. Zilberberg, Marya D. Tags: Review Article Source Type: research

Fulminant Clostridioides difficile Infection: A Review of Treatment Options for a Life-Threatening Infection
Semin Respir Crit Care Med 2022; 43: 028-038 DOI: 10.1055/s-0041-1740973Fulminant Clostridioides difficile infection (FCDI) encompasses 3 to 5% of all CDI cases with associated mortality rates between 30 and 40%. Major treatment modalities include surgery and medical management with antibiotic and nonantibiotic therapies. However, identification of patients with CDI that will progress to FCDI is difficult and makes it challenging to direct medical management and identify those who may benefit from surgery. Furthermore, since it is difficult to study such a critically ill population, data investigating treatment options are...
Source: Seminars in Respiratory and Critical Care Medicine - February 16, 2022 Category: Respiratory Medicine Authors: Carlson, Travis J. Gonzales-Luna, Anne J. Garey, Kevin W. Tags: Review Article Source Type: research

Intra-abdominal Infections
Semin Respir Crit Care Med 2022; 43: 010-027 DOI: 10.1055/s-0041-1741053Intra-abdominal infections (IAIs) are a common cause of sepsis, and frequently occur in intensive care unit (ICU) patients. IAIs include many diagnoses, including peritonitis, cholangitis, diverticulitis, pancreatitis, abdominal abscess, intestinal perforation, abdominal trauma, and pelvic inflammatory disease. IAIs are the second most common cause of infectious morbidity and mortality in the ICU after pneumonia. IAIs are also the second most common cause of sepsis in critically ill patients, and affect approximately 5% of ICU patients. Mortality with ...
Source: Seminars in Respiratory and Critical Care Medicine - February 16, 2022 Category: Respiratory Medicine Authors: Napolitano, Lena M. Tags: Review Article Source Type: research

Severe Skin and Soft-Tissue Infections
Semin Respir Crit Care Med 2022; 43: 003-009 DOI: 10.1055/s-0041-1740974Skin and soft-tissue infections (SSTIs) are a common reason for hospital admission. Severe SSTIs, particularly necrotizing infections, often require intensive care. Source control (often with surgical debridement) and broad-spectrum antimicrobials are paramount for minimizing significant morbidity and mortality. Rapid diagnostic tests may help in selection and de-escalation of antimicrobials for SSTIs. Besides early source control and early effective antimicrobial therapy, other patient-level factors such as comorbidities and immune status play a role ...
Source: Seminars in Respiratory and Critical Care Medicine - February 16, 2022 Category: Respiratory Medicine Authors: Stieferman, Addison E. Mazi, Patrick Burnham, Jason P. Tags: Review Article Source Type: research

Life-Threatening Infections: Pulmonary and Systemic Infections
Semin Respir Crit Care Med 2022; 43: 001-002 DOI: 10.1055/s-0041-1741013 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Respiratory and Critical Care Medicine)
Source: Seminars in Respiratory and Critical Care Medicine - February 16, 2022 Category: Respiratory Medicine Authors: Kollef, Marin H. Micek, Scott T. Tags: Preface Source Type: research

Methicillin-Resistant Staphylococcus aureus Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia
Semin Respir Crit Care Med DOI: 10.1055/s-0041-1740583Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). MRSA pneumonia is associated with significant morbidity and mortality. Several virulence factors allow S. aureus to become an effective pathogen. The polysaccharide intracellular adhesin allows for the production of biofilms, some strains can produce capsular polysaccharides that protect against phagocytosis, microbial surface components recognizing adhesive matrix molecules (MSCRAMMs) allow for colonization of epithelial s...
Source: Seminars in Respiratory and Critical Care Medicine - February 15, 2022 Category: Respiratory Medicine Authors: Pickens, Chiagozie I. Wunderink, Richard G. Tags: Review Article Source Type: research