{"title":"Ceftazidime-avibactam plus aztreonam for extensively drug-resistant gram-negative infections in critically ill patients","authors":"Debasish Biswal , Aayush Chawla , Pankhuri Kumari , Sandeep Mangla , Ripenmeet Salhotra","doi":"10.1016/j.jcrc.2025.155207","DOIUrl":"10.1016/j.jcrc.2025.155207","url":null,"abstract":"<div><h3>Background</h3><div>Extensively drug-resistant (XDR) gram-negative pathogens represent a critical therapeutic challenge in intensive care units, with mortality rates exceeding 50 %. The synergistic combination of ceftazidime-avibactam with aztreonam offers a novel therapeutic approach, particularly in carbapenemase-producing Enterobacterales.</div></div><div><h3>Methods</h3><div>This prospective observational study analysed 24 critically ill adult ICU patients with confirmed XDR gram-negative infections from October 2024 to April 2025. Comprehensive antimicrobial susceptibility testing, carbapenemase detection, and <em>E</em>- strip based synergy testing of ceftazidime-avibactam (CZA) with aztreonam (ATM), cefepime-enmetazobactam (FEP-ENM) testing were performed. Primary outcomes included clinical response, microbiological clearance, and 30-day mortality. Statistical analysis included descriptive statistics, Fisher's exact test, Mann-Whitney <em>U</em> test, logistic regression analysis and Kaplan-Meier survival analysis.</div></div><div><h3>Results</h3><div>Twenty-four XDR isolates were analysed: <em>Klebsiella pneumoniae</em> (<em>n</em> = 18, 75 %) and <em>Escherichia coli</em> (<em>n</em> = 6, 25 %). All demonstrated resistance to individual agents (CZA; MIC >16 μg/ml), (ATM; MIC >256 μg/mL) and FEP-ENM (zone size <6 mm). Carbapenemase detection revealed NDM in 91.7 % (22/24), with NDM + OXA-48 co- production in 66.7 % (16/24). Synergy was demonstrated in 62.5 % (15/24) cases with significant MIC reduction (median 0.5 μg/mL, IQR 0.25–1.0). Clinical improvement occurred in 31.3 % (5/16) of synergy-positive versus 12.5 % (1/8) of synergy-negative cases (<em>p</em> = 0.631). Microbiological clearance was achieved exclusively in synergy- positive cases (18.8 % vs 0 %, <em>p</em> = 0.534). Independent predictors of mortality included septic shock presentation (OR 3.5, 95 % CI 0.7–17.8, <em>p</em> = 0.134).</div></div><div><h3>Conclusion</h3><div>Ceftazidime-avibactam plus aztreonam combination demonstrated significant in vitro synergy against XDR pathogens with promising trends toward improved clinical outcomes in critically ill patients, representing a crucial salvage therapy option warranting larger randomized controlled trials.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"90 ","pages":"Article 155207"},"PeriodicalIF":2.9,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721307","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":"Letter to the editor: \"Risk factors for transitions and outcomes of subsyndromal delirium in the ICU: Post-hoc analysis of a prospective multicenter cohort study\"","authors":"Jidong Liu","doi":"10.1016/j.jcrc.2025.155201","DOIUrl":"10.1016/j.jcrc.2025.155201","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"90 ","pages":"Article 155201"},"PeriodicalIF":2.9,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721309","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":"Measuring intensive care performance to attain collaborative quality improvement: Work in progress but much to be done","authors":"José-Artur Paiva , José Manuel Pereira","doi":"10.1016/j.jcrc.2025.155209","DOIUrl":"10.1016/j.jcrc.2025.155209","url":null,"abstract":"<div><div>Intensive Care Medicine must be viewed as an organized system of care that ensures delivery of timely and expert treatment to critically ill patients. Like any system, it needs a matrix of continuous quality improvement. The development of robust indicators covering all domains of quality is crucial for that matrix. The combined use of standardized mortality ratio and of standardized resource use ratio may allow the assessment of ICU performance and efficiency. ICU length of stay is a good proxy of resource use. Data driven models, possibly fueled by machine learning, may predict length of stay in all and in subpopulations of ICU patients.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"90 ","pages":"Article 155209"},"PeriodicalIF":2.9,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721308","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":"Effects of levosimendan on weaning from mechanical ventilation: A systematic review and meta-analysis","authors":"Cang Li, Fei Guo, Zengfeng Wang, Liang Shan","doi":"10.1016/j.jcrc.2025.155195","DOIUrl":"10.1016/j.jcrc.2025.155195","url":null,"abstract":"<div><h3>Background</h3><div>There remains ongoing controversy and debate regarding the effect of levosimendan on weaning from mechanical ventilation in critical ill patients relying on ventilator. The objective of this study is to assess the specific effect of levosimendan on weaning from mechanical ventilation and to ascertain whether levosimendan can indeed improve the prognosis.</div></div><div><h3>Methods</h3><div>This meta-analysis was proactively registered on PROSPERO platform. The PubMed, Web of Science, Embase, ScienceDirect and Cochrane were searched from inception to June 2024. The primary outcome of interest was duration of mechanical ventilation. Secondary outcomes included mortality rates, as well as length of stay in both intensive care unit (ICU) and the hospital.</div></div><div><h3>Results</h3><div>Six studies (<em>n</em> = 1069 patients) were included in the analysis ultimately. In relation to the primary outcome, the findings revealed that patients who received levosimendan experienced a significantly earlier successful weaning from mechanical ventilation compared to those who did not receive the medication [Mean Difference (MD) = −1.86 (95 %CI, −2.71 to −1.01, <em>P</em> < 0.01]. For the secondary outcomes, levosimendan was associated with a notable in both length of ICU stay [MD = -36.89 (95 %CI, −70.68 to −3.11, <em>P</em> < 0.01] and the total in-hospital stay [MD = -51.77 (95 %CI, −92.34 to −11.20, P < 0.01]. Levosimendan did not demonstrate a statistically effect in reducing mortality rates [Relative Risk(RR) =0.65 (95 %CI, 0.27 to 1.57, <em>P</em> = 0.40].</div></div><div><h3>Conclusion</h3><div>Levosimendan helps patients weaning from mechanical ventilation occuring earlier and reduces length of stay (ICU and hospital), but does not affect mortality.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"90 ","pages":"Article 155195"},"PeriodicalIF":3.2,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144713374","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}
Thibault Gennart , Julien Moury , Sydney Blackman , Nathan De Lissnyder , Ilann Oueslati , Patrick M. Honore
{"title":"Letter to the Editor: Cystatin C-derived measures of renal function as risk factors for mortality and renal replacement therapy in the critically ill - an analysis of the SWECRIT cohort","authors":"Thibault Gennart , Julien Moury , Sydney Blackman , Nathan De Lissnyder , Ilann Oueslati , Patrick M. Honore","doi":"10.1016/j.jcrc.2025.155206","DOIUrl":"10.1016/j.jcrc.2025.155206","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"90 ","pages":"Article 155206"},"PeriodicalIF":3.2,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711166","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":"One score to rule them all? The search for the “best” mortality prediction model continues","authors":"Ryan Ruiyang Ling","doi":"10.1016/j.jcrc.2025.155192","DOIUrl":"10.1016/j.jcrc.2025.155192","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"90 ","pages":"Article 155192"},"PeriodicalIF":3.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687187","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}
Carolina Gomes , Maria Inês Proença Pereira , Patrícia Valério , João Barbosa Barroso , Tânia Mendes , João Gonçalves Pereira
{"title":"Incidence of kidney toxicity of non-steroidal anti-inflammatory drugs in critically ill patients","authors":"Carolina Gomes , Maria Inês Proença Pereira , Patrícia Valério , João Barbosa Barroso , Tânia Mendes , João Gonçalves Pereira","doi":"10.1016/j.jcrc.2025.155202","DOIUrl":"10.1016/j.jcrc.2025.155202","url":null,"abstract":"<div><h3>Background</h3><div>Analgesia is paramount to improving critically ill patients recovery and preventing complications, especially during the post-operative time. Nonsteroidal anti-inflammatory drugs (NSAIDs) provide cost-effective analgesia but also carry risks, including gastrointestinal bleeding and acute kidney injury (AKI). Their safety in this setting is poorly understood.</div></div><div><h3>Methods</h3><div>All patients admitted to the Hospital Vila Franca de Xira ICU for more than 24 h, from January 1st 2015, to December 31st 2023, were included. Acute kidney injury was tracked throughout the ICU and hospital stay for all included patients, using the serum creatinine and urine output. Patients already with kidney dysfunction on admission to the ICU, either chronic or acute, were excluded. Short- and long-term outcomes (until 2 years of follow-up) were retrieved.</div></div><div><h3>Results</h3><div>The study included 1157 patients. NSAIDs were more commonly used among surgical patients (62. in non-scheduled and 61. in scheduled surgery) than medical patients (23., <em>p</em> < 0.001). Its use was associated with higher AKI rates (67. vs. 51., <em>p</em> = 0.009), including severe AKI (stage 3, 34. vs. 26., <em>p</em> = 0.008). Notably, while non-severe AKI had no significant impact on 2-year survival, severe AKI was associated with significantly worse survival (adjusted hazard ratio 1.42, confidence interval 1.09–1.86, <em>p</em> = 0.011). Recovery of renal function did not significantly decrease the long-term survival (80. vs. 78., log-rank test, <em>p</em> = 0.636).</div></div><div><h3>Conclusion</h3><div>In critically ill patients, the use of NSAIDs is associated with AKI and may lead to a worse prognosis.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"90 ","pages":"Article 155202"},"PeriodicalIF":3.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686978","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":"Letter to the editor: “Evaluating extreme temperature values and patient outcomes in aneurysmal subarachnoid hemorrhage: Post-hoc insights from the earlydrain trial”","authors":"Sheng Huang , Jiawei Ma","doi":"10.1016/j.jcrc.2025.155203","DOIUrl":"10.1016/j.jcrc.2025.155203","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"90 ","pages":"Article 155203"},"PeriodicalIF":3.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686979","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}