The Role of Adjunctive Therapies in Septic Shock by Gram Negative MDR/XDR Infections

Busani, Stefano; Roat, Erika; Serafini, Giulia; Mantovani, E.; Biagioni, Emanuela; Girardis, Massimo

doi:10.1155/2017/2808203

Cited by 10 publications

(8 citation statements)

References 57 publications

(53 reference statements)

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“…Moreover, delayed and/or inappropriate antibiotic administration seems responsible for the developing of multidrug resistance gram-negative sepsis [ 87 ]. Indeed, gram-negative sepsis (Enterobacteriaceae, Pseudomonas aeruginosa, and Klebsiella pneumonia) has the highest incidence of multidrug resistance sepsis [ 88 ]. The most common drugs associated with AKI are aminoglycosides, vancomycin, radiocontrast media, cisplatin, amphotericin B, foscarnet, and osmotically active agents [ 89 ].…”

Section: Renal Replacement Therapy In Si-akimentioning

confidence: 99%

New Frontiers in Sepsis-Induced Acute Kidney Injury and Blood Purification Therapies: The Role of Polymethylmethacrylate Membrane Hemofilter

et al. 2023

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Acute kidney injury (AKI) is a common consequence of sepsis with a mortality rate of up to 40%. The pathogenesis of septic AKI is complex and involves several mechanisms leading to exacerbated inflammatory response associated with renal injury. A large body of evidence suggests that inflammation is tightly linked to AKI through bidirectional interaction between renal and immune cells. Preclinical data from our and other laboratories have identified in complement system activation a crucial mediator of AKI. Partial recovery following AKI could lead to long-term consequences that predispose to chronic dysfunction and may also accelerate the progression of preexisting chronic kidney disease. Recent findings have revealed striking morphological and functional changes in renal parenchymal cells induced by mitochondrial dysfunction, cell cycle arrest via the activation of signaling pathways involved in aging process, microvascular rarefaction, and early fibrosis. Although major advances have been made in our understanding of the pathophysiology of AKI, there are no available preventive and therapeutic strategies in this field. The identification of ideal clinical biomarkers for AKI enables prompt and effective therapeutic strategy that could prevent the progression of renal injury and promote repair process. Therefore, the use of novel biomarkers associated with clinical and functional criteria could provide early interventions and better outcome. Several new drugs for AKI are currently being investigated; however, the complexity of this disease might explain the failure of pharmacological intervention targeting just one of the many systems involved. The hypothesis that blood purification could improve the outcome of septic AKI has attracted much attention. New relevant findings on the role of polymethylmethacrylate-based continuous veno-venous hemofiltration in septic AKI have been reported. Herein, we provide a comprehensive literature review on advances in the pathophysiology of septic AKI and potential therapeutic approaches in this field.

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Section: Renal Replacement Therapy In Si-akimentioning

confidence: 99%

New Frontiers in Sepsis-Induced Acute Kidney Injury and Blood Purification Therapies: The Role of Polymethylmethacrylate Membrane Hemofilter

et al. 2023

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“…The IVIg usage in patients with sepsis is very appealing not only because of their effect on bacteria and toxin elimination, but also because a reduction of circulating IgG and IgM was demonstrated in non-survivors patients. Busani demonstrated in its meta-analysis that the therapy of IVIg in adult patients with severe sepsis and SS seems to be connected with a reduction in the mortality [51]. The mechanisms of action are still not completely understood, but several studies show Ig supplementation should have a role in modulating host response to infection.…”

Section: Igm Enriched Immunoglobulinmentioning

confidence: 99%

Adjuvant therapies and sepsis from multidrug resistant bacteria: a narrative review

2023

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Sepsis represents one of the major health problem due to the high mortality rate and elevated health care costs. An important role in the genesis and the mechanisms sustaining sepsis has been found in the release of pro-inflammatory mediators. They are able to induce hemodynamic instability, end-organ dysfunction, and coagulation abnormalities. The host immune response involves a first extreme response to infective process that leads to tissue damage, organ failure and endothelial dysfunction. It was recently described the existence of a contrasting process, that is directed to restore homeostasis and it’s related with the release of anti-inflammatory mediators. The treatment of sepsis and septic shock could therefore benefit from the association of source control and antibiotic therapy with the use of drugs and other techniques, that act by modulating the cytokine storm. This approach is referred to an adjuvant therapy. The goal of this narrative review is to examine the various adjuvant therapies in the treatment of sepsis and septic shock.

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“…Despite the use of supportive therapy and timely administration, antibiotics are often ineffective and show little impact on lowering the mortality rate due to sepsis [55]. The immune paralysis associated with sepsis predisposes critically ill patients to secondary infections, including breakthrough infections, by multidrug-resistant (MDR) bacteria.…”

Section: Management Of Sepsis and Challengesmentioning

confidence: 99%

“…Therefore, these patients require specific strategies directed to restore the function of immune response beyond the antibiotic therapy and standard supportive treatments. These adjuvant therapies can, therefore help the immune system by preventing immune-paralysis or attenuating inflammatory responses [23,55]. Emerging data on adjuvant therapies ranging from extracorporeal blood purification techniques to various pharmacological approaches, including inhibition of proinflammatory cytokines, immunomodulation and antioxidant activity, presents novel sepsis research and in preclinical models found to be potentially active.…”

Section: Management Of Sepsis and Challengesmentioning

confidence: 99%

Advances in sepsis diagnosis and management: a paradigm shift towards nanotechnology

2021

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Sepsis, a dysregulated immune response due to life-threatening organ dysfunction, caused by drug-resistant pathogens, is a major global health threat contributing to high disease burden. Clinical outcomes in sepsis depend on timely diagnosis and appropriate early therapeutic intervention. There is a growing interest in the evaluation of nanotechnology-based solutions for sepsis management due to the inherent and unique properties of these nano-sized systems. This review presents recent advancements in nanotechnology-based solutions for sepsis diagnosis and management. Development of nanosensors based on electrochemical, immunological or magnetic principals provide highly sensitive, selective and rapid detection of sepsis biomarkers such as procalcitonin and C-reactive protein and are reviewed extensively. Nanoparticle-based drug delivery of antibiotics in sepsis models have shown promising results in combating drug resistance. Surface functionalization with antimicrobial peptides further enhances efficacy by targeting pathogens or specific microenvironments. Various strategies in nanoformulations have demonstrated the ability to deliver antibiotics and anti-inflammatory agents, simultaneously, have been reviewed. The critical role of nanoformulations of other adjuvant therapies including antioxidant, antitoxins and extracorporeal blood purification in sepsis management are also highlighted. Nanodiagnostics and nanotherapeutics in sepsis have enormous potential and provide new perspectives in sepsis management, supported by promising future biomedical applications included in the review.

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The Role of Adjunctive Therapies in Septic Shock by Gram Negative MDR/XDR Infections

Cited by 10 publications

References 57 publications

New Frontiers in Sepsis-Induced Acute Kidney Injury and Blood Purification Therapies: The Role of Polymethylmethacrylate Membrane Hemofilter

New Frontiers in Sepsis-Induced Acute Kidney Injury and Blood Purification Therapies: The Role of Polymethylmethacrylate Membrane Hemofilter

Adjuvant therapies and sepsis from multidrug resistant bacteria: a narrative review

Advances in sepsis diagnosis and management: a paradigm shift towards nanotechnology

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