Current Opinion in Critical Care最新文献

{"title":"The role of microbiological results in driving inappropriate antibiotic prescriptions.","authors":"Patricia Munoz, Antonio Vena, Almudena Burillo, Emilio Bouza","doi":"10.1097/MCC.0000000000001314","DOIUrl":"10.1097/MCC.0000000000001314","url":null,"abstract":"<p><strong>Purpose of review: </strong>To highlight the unintended consequences of microbiological test results in driving inappropriate antimicrobial prescriptions, and to evaluate strategies - particularly from the perspective of diagnostic stewardship - that may mitigate this issue.</p><p><strong>Recent findings: </strong>Despite the critical role of microbiological data in guiding appropriate antimicrobial therapy, several studies have demonstrated that misinterpretation of such results frequently leads to unnecessary treatments. Common pitfalls include overinterpretation of positive cultures from poorly collected or clinically unwarranted samples, misclassification of colonization vs. infection, and excessive reliance on test results in the absence of supporting clinical evidence. Emerging diagnostic stewardship interventions - ranging from restricting sample processing and modifying test reporting to implementing decision support tools - have shown promising outcomes in reducing overtreatment without compromising patient safety. Specific examples include urine and wound cultures, respiratory specimens, and the diagnosis of Clostridioides difficile infection. Furthermore, educational and system-level strategies such as the BLADDER score or selective result reporting can improve decision-making at various stages of the diagnostic process.</p><p><strong>Summary: </strong>Microbiology laboratories play a pivotal role in antimicrobial stewardship and must actively support clinicians in avoiding diagnostic and therapeutic errors. While evidence supports multiple approaches to mitigate inappropriate prescriptions driven by microbiology results, their successful implementation requires interdisciplinary collaboration, tailored interventions, and ongoing evaluation of clinical impact. Diagnostic stewardship, when aligned with clinician education and robust reporting practices, is a crucial component in enhancing the accuracy of infection diagnosis and reducing antimicrobial overuse.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"505-512"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update on infection prevention in the ICU.","authors":"Filippo Medioli, Erica Franceschini, Cristina Mussini, Marianna Meschiari","doi":"10.1097/MCC.0000000000001313","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001313","url":null,"abstract":"<p><strong>Purpose of review: </strong>Healthcare-associated infections (HAIs) remain a critical challenge in intensive care units (ICUs) due to the high prevalence of invasive procedures, vulnerable patient populations, and the increasing threat of antimicrobial-resistant organisms (MDROs). This review synthesizes current evidence on infection prevention and control (IPC) strategies in the ICU setting, highlighting recent findings and innovations in this evolving field, particularly in light of the impact of the COVID-19 pandemic.</p><p><strong>Recent findings: </strong>The review outlines ten key IPC strategies for ICUs, categorizing them into horizontal (universal) and vertical (pathogen-specific) approaches. Recent literature emphasizes the importance of enhanced hand hygiene compliance through motivational interventions and feedback. The role of selective decontamination strategies remains debated, with evidence suggesting potential benefits in specific patient subgroups. Vertical strategies, including active screening for MDROs and per-pathogen bundles, are increasingly being tailored based on local epidemiology and pathogen characteristics. Studies suggest that de-escalating routine contact precautions for certain MDROs like Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Enterococcus may be safe in settings with robust horizontal measures. Conversely, intensified \"search and destroy\" strategies show promise in controlling carbapenem-resistant Acinetobacter baumannii outbreaks.</p><p><strong>Summary: </strong>Effective IPC in the ICU requires a multifaceted and adaptable approach, integrating both universal precautions and targeted interventions against specific pathogens. While consistent implementation of horizontal strategies like hand hygiene is foundational, tailoring vertical strategies based on local MDRO epidemiology and patient risk profiles is crucial. Future research should focus on harmonizing IPC policies, optimizing screening methods, and evaluating the long-term impact of combined IPC and antimicrobial stewardship programs to improve patient outcomes and mitigate the spread of antimicrobial resistance in critical care settings.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":"31 5","pages":"529-538"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Next-level intensive care: integrating technology and personalized treatment across the continuum.","authors":"Jozef Kesecioglu","doi":"10.1097/MCC.0000000000001306","DOIUrl":"https://doi.org/10.1097/MCC.0000000000001306","url":null,"abstract":"","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":"31 5","pages":"554-556"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastrointestinal function and nutritional interventions in septic shock.","authors":"Kaspar F Bachmann, Antonella Cotoia, Annika Reintam Blaser","doi":"10.1097/MCC.0000000000001302","DOIUrl":"10.1097/MCC.0000000000001302","url":null,"abstract":"<p><strong>Purpose of review: </strong>Gastrointestinal (GI) dysfunction significantly impacts patient outcomes in septic shock, complicating clinical management due to its central role in systemic inflammation, barrier integrity, and nutrient assimilation. This review summarizes the evolving understanding of GI dysfunction during septic shock and provides an updated framework for clinical management.</p><p><strong>Recent findings: </strong>New insights from recent studies focus on individualized nutritional strategies over standardized calorie-driven targets, highlighting risks associated with aggressive enteral nutrition, such as exacerbation of gut ischemia and bowel distension, and microbial dysbiosis. Maintaining splanchnic perfusion, monitoring GI dysfunction with standardized tools, and advancing nutritional support progressively based on patient-specific gastrointestinal tolerance are current strategies. Novel adjunctive therapies targeting gut permeability and microbiome restoration have been proposed, yet robust clinical data remain limited.</p><p><strong>Summary: </strong>Clinical management should prioritize hemodynamic stabilization and organ support rather than immediately targeting any nutritional goals. Monitoring GI function systematically and tailoring nutritional interventions may prevent complications and support recovery. Future research should validate monitoring tools, refine individual patient assessment, and evaluate novel therapeutic interventions to improve patient-centered outcomes in septic shock.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"599-607"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12419005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of functional outcome after traumatic brain injury: a narrative review.","authors":"Carolina Iaquaniello, Emanuela Scordo, Chiara Robba","doi":"10.1097/MCC.0000000000001290","DOIUrl":"10.1097/MCC.0000000000001290","url":null,"abstract":"<p><strong>Purpose of review: </strong>To synthesize current evidence on prognostic factors, tools, and strategies influencing functional outcomes in patients with traumatic brain injury (TBI), with a focus on the acute and postacute phases of care.</p><p><strong>Recent findings: </strong>Key early predictors such as Glasgow Coma Scale (GCS) scores, pupillary reactivity, and computed tomography (CT) imaging findings remain fundamental in guiding clinical decision-making. Prognostic models like IMPACT and CRASH enhance early risk stratification, while outcome measures such as the Glasgow Outcome Scale-Extended (GOS-E) provide structured long-term assessments. Despite their utility, heterogeneity in assessment approaches and treatment protocols continues to limit consistency in outcome predictions. Recent advancements highlight the value of fluid biomarkers like neurofilament light chain (NFL) and glial fibrillary acidic protein (GFAP), which offer promising avenues for improved accuracy. Additionally, artificial intelligence models are emerging as powerful tools to integrate complex datasets and refine individualized outcome forecasting.</p><p><strong>Summary: </strong>Neurological prognostication after TBI is evolving through the integration of clinical, radiological, molecular, and computational data. Although standardized models and scales remain foundational, emerging technologies and therapies - such as biomarkers, machine learning, and neurostimulants - represent a shift toward more personalized and actionable strategies to optimize recovery and long-term function.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"591-598"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualized fluid optimization and de-escalation in critically ill patients with septic shock.","authors":"Antonio Messina, Guia Margherita Matronola, Maurizio Cecconi","doi":"10.1097/MCC.0000000000001301","DOIUrl":"10.1097/MCC.0000000000001301","url":null,"abstract":"<p><strong>Purpose of review: </strong>To provide an updated and practical overview of individualized fluid optimization and de-escalation strategies in critically ill patients with septic shock, integrating the most recent evidence and recommendations on fluid responsiveness and fluid stewardship.</p><p><strong>Recent findings: </strong>Emerging evidence reinforces the importance of dynamic, patient-tailored fluid management strategies over standardized protocols. Trials such as ANDROMEDA, CLASSIC, have highlighted the need for fluid responsiveness assessment, restricted fluid strategies, and early vasopressor use. The concept of fluid stewardship, structured across four phases - resuscitation, optimization, stabilization, and de-escalation - has gained recognition as a rational approach to avoid fluid overload and improve outcomes. Recent ESICM guidelines also stress the use of balanced crystalloids and individualized volume targets.</p><p><strong>Summary: </strong>Septic shock fluid therapy is evolving from a one-size-fits-all model toward individualized, phase-based management. By incorporating hemodynamic monitoring, dynamic reassessment, and structured clinical phases, fluid administration can be better tailored to each patient's evolving condition. This review emphasizes the critical role of personalized approaches in each phase of fluid therapy and highlights how fluid stewardship may enhance recovery and reduce complications associated with fluid overload.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"582-590"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors affecting critical care outcomes in the emergency department.","authors":"Taylor M Fontenot, Ioana Antonescu, Heatherlee Bailey","doi":"10.1097/MCC.0000000000001300","DOIUrl":"10.1097/MCC.0000000000001300","url":null,"abstract":"<p><strong>Purpose of review: </strong>Emergency department (ED) outcomes of the critically ill and injured patient are intricately linked with timeliness of care, advances in resuscitation skills and technology, and the cohesive function of a dedicated team of multiprofessionals. This review highlights the most recent developments in ED resuscitation and their impact on outcomes for critically ill and injured patients, emphasizing the crucial interplay between technological advancements, organizational strategies, and team dynamics in optimizing emergency care.</p><p><strong>Recent findings: </strong>The literature reveals notable enhancements in resuscitation techniques and protocols, integrating technologic advances, such as artificial intelligence and machine learning, which have shown promising improvement in efficiency, diagnostics, and timeliness to therapeutics. Optimization of the physical ED environment to expedite delivery of care, with an emphasis on effective communication, standardized protocols and guidelines, and teamwork are crucial elements in improving overall patient outcomes. Significant challenges persist, despite these advancements, particularly in ED overcrowding, clinician burnout, and delays in definitive treatment.</p><p><strong>Summary: </strong>The findings highlight the importance of a collaborative multidisciplinary approach to resuscitation in the ED. Implementing a multifaceted approach involving technology, diagnostic accuracy, therapeutic interventions, and education offers an opportunity to improve outcomes in the ED. Future research should continue to focus strategies to address the systematic issues that impact overall patient care in the emergency setting.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"566-574"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infection risks in patients treated by continuous renal replacement therapy and extracorporeal membrane oxygenation.","authors":"Antoine Gaillet, Jean-François Timsit","doi":"10.1097/MCC.0000000000001315","DOIUrl":"10.1097/MCC.0000000000001315","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review addresses the growing concern over nosocomial infections in patients undergoing extracorporeal membrane oxygenation (ECMO) and/or continuous renal replacement therapy (CRRT). As the use of these modalities increases, particularly in critically ill patients, infection-related complications remain frequent, underdiagnosed, and inadequately addressed in existing guidelines. This review is timely given the urgent need to standardize diagnostic and preventive strategies in this high-risk population.</p><p><strong>Recent findings: </strong>Recent studies highlight the multifactorial origin of infection risk in ECMO/CRRT patients, including device-related immunoparalysis. In patients on ECMO, nosocomial infections - particularly ventilator-associated pneumonia (VAP), bloodstream infections (BSIs), and cannula-related infections (CRIs) - are among the most frequent complications, with incidence rates ranging from 9% to 64%. VAP and BSIs occur at rates up to 61 and 38 per 1000 ECMO-days, respectively. Predominant pathogens include Enterobacterales, nonfermenting Gram-negative bacilli, Enterococcus spp., and fungi. Enterococcus-related BSIs are notably underrecognized and often inadequately treated. Duration of ECMO support is the most consistent infection risk factor, along with illness severity and CRRT co-initiation. Nosocomial infections are associated with a 32% relative increase in mortality.</p><p><strong>Summary: </strong>Nosocomial infections in ECMO/CRRT patients are common, diagnostically challenging, and strongly linked to poor outcomes. Their prevention and management require an integrated, tailored strategy. Standardized definitions, improved surveillance, and targeted antimicrobial stewardship are urgently needed to mitigate risks in this vulnerable population.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"539-546"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corticosteroids in septic shock: a double-edged sword.","authors":"Jane Y Wang, Marin H Kollef","doi":"10.1097/MCC.0000000000001297","DOIUrl":"10.1097/MCC.0000000000001297","url":null,"abstract":"<p><strong>Purpose of review: </strong>Corticosteroid therapy remains controversial in the management of septic shock. The putative benefits of glucocorticoids on immunomodulation and rescue of hypothalamic-pituitary-adrenal (HPA) axis dysregulation has made it an attractive target for clinical research. However, conflicting trial results have introduced uncertainty into clinical guidance, while risk of harm continues to be a concern. This review summarizes and interprets the current body of evidence for the role of corticosteroid therapy in septic shock and suggests future directions for continued investigation.</p><p><strong>Recent findings: </strong>Updated guidelines continue to recommend corticosteroids in septic shock, but more robust data for corticosteroids have emerged in community acquired pneumonia (CAP) and acute respiratory distress syndrome (ARDS), which may account for some of the benefit seen in trials on septic shock. Systematic reviews have suggested potential benefits of combination therapy with fludrocortisone, but further research is needed. Significant variation exists in corticosteroid prescribing practices across providers and ICU settings.</p><p><strong>Summary: </strong>Many uncertainties remain regarding utility of corticosteroids in septic shock. However, they remain a tool for refractory shock in appropriate patients where benefits outweigh harm. Future research should focus on individualized approaches to corticosteroid therapy.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"497-504"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of artificial intelligence in ICU therapeutic decision-making for severe infections.","authors":"Daniele Roberto Giacobbe, Antonio Vena, Matteo Bassetti","doi":"10.1097/MCC.0000000000001304","DOIUrl":"10.1097/MCC.0000000000001304","url":null,"abstract":"<p><strong>Purpose of review: </strong>To discuss current and future role of artificial intelligence in predicting severe infections and supporting decisions on antibiotic treatment in critically ill patients in intensive care units (ICU), focusing in particular on some relevant conceptual changes compared to classical clinical reasoning.</p><p><strong>Recent findings: </strong>Several studies have evaluated the ability of machine learning techniques for severe infection prediction, while other studies have explored the potential of large language models (LLM)-based tools to assist clinicians in deciding which antimicrobial agent(s) to prescribe to patients with severe infections.</p><p><strong>Summary: </strong>The support of artificial intelligence for infection prediction and antimicrobial prescribing has shown the potential to improve the treatment of severe infections in ICU. However, the limited number of studies focused on ICU should be highlighted, along with the need to thoroughly address the issue of patients' privacy and to improve the ethical and legal frameworks for decision accountability, as well as the transparency and quality of training data. A standardized approach to the accuracy-interpretability trade-off would also be essential to outline a correct and shared approach both for the future conduct of studies and for the interpretation of their evidence for clinical practice.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"547-553"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}