Monitoring Immune Dysfunction in Critically Ill Patients with Carbapenem-Resistant <i>Acinetobacter baumannii</i> Sepsis Treated with Regimens Including Cefiderocol: A Pilot Study to Identify Accessible Biomarkers to Stratify Patients’ Prognosis
<b>Background:</b> Multidrug-resistant <i>Acinetobacter baumannii</i> (CRAB) infections are a serious problem in critical care. This study aims to develop an early prognostic score for immune paralysis, using practical and cost-effective parameters, to predict ICU mortality i...
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MDPI AG
2024-10-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/13/11/1001 |
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| author | Antonella Frattari Ennio Polilli Laura Timelli Francesca Spagnuolo Paolo Fazii Giustino Parruti |
| author_facet | Antonella Frattari Ennio Polilli Laura Timelli Francesca Spagnuolo Paolo Fazii Giustino Parruti |
| author_sort | Antonella Frattari |
| collection | DOAJ |
| description | <b>Background:</b> Multidrug-resistant <i>Acinetobacter baumannii</i> (CRAB) infections are a serious problem in critical care. This study aims to develop an early prognostic score for immune paralysis, using practical and cost-effective parameters, to predict ICU mortality in patients with CRAB infections being treated with Cefiderocol. <b>Methods:</b> We carried out an observational pilot study on consecutive patients hospitalized in the ICU with ensuing septic <i>Acinetobacter baumannii</i> infections treated with Cefiderocol monotherapy or Cefiderocol including combinations. We investigated the predictive power of lymphocyte counts, lymphocyte subpopulations, serum cholinesterase levels, and reactivation of herpes viruses. <b>Results:</b> Overall, 36 of 39 patients entered in our analysis: 20 survivors and 16 deceased. A total of 12 patients developed bacteremia, 19 patients had HAP/VAP, and 5 patients had a soft tissue infection. Univariate analyses of factors associated with unfavorable outcome revealed a significant association for age (OR: 1.5, CI: 1.11–2.02), SAPS II (OR: 1.05, CI: 1.01–1.1), SOFA score (OR: 1.37, CI: 1.06–1.76), lymphocytopenia (OR: 32.5, CI: 3.45–306.4), viral reactivation (OR: 9.75, CI: 1.72–55.4), and cholinesterase drop <1600 U/L (OR: 39.7, CI: 5.8–271.6). At variance, monotherapy or associations with Cefiderocol were not associated. In the final multivariable model, the only independent predictors of death were age (OR: 1.42, CI: 0.98–2.05), lymphocytopenia (OR: 18.2, CI: 0.87–371), and cholinesterase drop to below 1600 U/L (OR: 9.7, CI: 0.77–123.7). <b>Conclusions:</b> Age, lymphocytopenia, and serum cholinesterase drops, which were nearly significantly associated with an unfavorable outcome, may help pinpoint patients with acute immune paralysis during sepsis. Knowledge of such an immune state may in turn directly influence patients’ care. |
| format | Article |
| id | doaj-art-913dbfa012ec456b98f1170a3c089f64 |
| institution | Kabale University |
| issn | 2079-6382 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | MDPI AG |
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| series | Antibiotics |
| spelling | doaj-art-913dbfa012ec456b98f1170a3c089f642024-11-26T17:46:19ZengMDPI AGAntibiotics2079-63822024-10-011311100110.3390/antibiotics13111001Monitoring Immune Dysfunction in Critically Ill Patients with Carbapenem-Resistant <i>Acinetobacter baumannii</i> Sepsis Treated with Regimens Including Cefiderocol: A Pilot Study to Identify Accessible Biomarkers to Stratify Patients’ PrognosisAntonella Frattari0Ennio Polilli1Laura Timelli2Francesca Spagnuolo3Paolo Fazii4Giustino Parruti5Intensive Care Unit, Pescara General Hospital, 65100 Pescara, ItalyClinical Laboratory Unit, Pescara General Hospital, 65100 Pescara, ItalyIndependent Researcher, 00100 Rome, ItalyIntensive Care Unit, Pescara General Hospital, 65100 Pescara, ItalyClinical Microbiology Unit, Pescara General Hospital, 65100 Pescara, ItalyInfectious Diseases Unit, Pescara General Hospital, 65100 Pescara, Italy<b>Background:</b> Multidrug-resistant <i>Acinetobacter baumannii</i> (CRAB) infections are a serious problem in critical care. This study aims to develop an early prognostic score for immune paralysis, using practical and cost-effective parameters, to predict ICU mortality in patients with CRAB infections being treated with Cefiderocol. <b>Methods:</b> We carried out an observational pilot study on consecutive patients hospitalized in the ICU with ensuing septic <i>Acinetobacter baumannii</i> infections treated with Cefiderocol monotherapy or Cefiderocol including combinations. We investigated the predictive power of lymphocyte counts, lymphocyte subpopulations, serum cholinesterase levels, and reactivation of herpes viruses. <b>Results:</b> Overall, 36 of 39 patients entered in our analysis: 20 survivors and 16 deceased. A total of 12 patients developed bacteremia, 19 patients had HAP/VAP, and 5 patients had a soft tissue infection. Univariate analyses of factors associated with unfavorable outcome revealed a significant association for age (OR: 1.5, CI: 1.11–2.02), SAPS II (OR: 1.05, CI: 1.01–1.1), SOFA score (OR: 1.37, CI: 1.06–1.76), lymphocytopenia (OR: 32.5, CI: 3.45–306.4), viral reactivation (OR: 9.75, CI: 1.72–55.4), and cholinesterase drop <1600 U/L (OR: 39.7, CI: 5.8–271.6). At variance, monotherapy or associations with Cefiderocol were not associated. In the final multivariable model, the only independent predictors of death were age (OR: 1.42, CI: 0.98–2.05), lymphocytopenia (OR: 18.2, CI: 0.87–371), and cholinesterase drop to below 1600 U/L (OR: 9.7, CI: 0.77–123.7). <b>Conclusions:</b> Age, lymphocytopenia, and serum cholinesterase drops, which were nearly significantly associated with an unfavorable outcome, may help pinpoint patients with acute immune paralysis during sepsis. Knowledge of such an immune state may in turn directly influence patients’ care.https://www.mdpi.com/2079-6382/13/11/1001sepsisCefiderocoltreatment failuremultidrug-resistant <i>Acinetobacter baumannii</i>immune paralysis |
| spellingShingle | Antonella Frattari Ennio Polilli Laura Timelli Francesca Spagnuolo Paolo Fazii Giustino Parruti Monitoring Immune Dysfunction in Critically Ill Patients with Carbapenem-Resistant <i>Acinetobacter baumannii</i> Sepsis Treated with Regimens Including Cefiderocol: A Pilot Study to Identify Accessible Biomarkers to Stratify Patients’ Prognosis Antibiotics sepsis Cefiderocol treatment failure multidrug-resistant <i>Acinetobacter baumannii</i> immune paralysis |
| title | Monitoring Immune Dysfunction in Critically Ill Patients with Carbapenem-Resistant <i>Acinetobacter baumannii</i> Sepsis Treated with Regimens Including Cefiderocol: A Pilot Study to Identify Accessible Biomarkers to Stratify Patients’ Prognosis |
| title_full | Monitoring Immune Dysfunction in Critically Ill Patients with Carbapenem-Resistant <i>Acinetobacter baumannii</i> Sepsis Treated with Regimens Including Cefiderocol: A Pilot Study to Identify Accessible Biomarkers to Stratify Patients’ Prognosis |
| title_fullStr | Monitoring Immune Dysfunction in Critically Ill Patients with Carbapenem-Resistant <i>Acinetobacter baumannii</i> Sepsis Treated with Regimens Including Cefiderocol: A Pilot Study to Identify Accessible Biomarkers to Stratify Patients’ Prognosis |
| title_full_unstemmed | Monitoring Immune Dysfunction in Critically Ill Patients with Carbapenem-Resistant <i>Acinetobacter baumannii</i> Sepsis Treated with Regimens Including Cefiderocol: A Pilot Study to Identify Accessible Biomarkers to Stratify Patients’ Prognosis |
| title_short | Monitoring Immune Dysfunction in Critically Ill Patients with Carbapenem-Resistant <i>Acinetobacter baumannii</i> Sepsis Treated with Regimens Including Cefiderocol: A Pilot Study to Identify Accessible Biomarkers to Stratify Patients’ Prognosis |
| title_sort | monitoring immune dysfunction in critically ill patients with carbapenem resistant i acinetobacter baumannii i sepsis treated with regimens including cefiderocol a pilot study to identify accessible biomarkers to stratify patients prognosis |
| topic | sepsis Cefiderocol treatment failure multidrug-resistant <i>Acinetobacter baumannii</i> immune paralysis |
| url | https://www.mdpi.com/2079-6382/13/11/1001 |
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