Download PDF
Semin Respir Crit Care Med 2022; 43(01): 001-002
DOI: 10.1055/s-0041-1741013
Preface

Life-Threatening Infections: Pulmonary and Systemic Infections

Marin H. Kollef
1   Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri
,
Scott T. Micek
2   Department of Pharmacy Practice and Center for Health Outcomes Research and Education, University of Health Sciences and Pharmacy, St. Louis, Missouri
› Author Affiliations
› Further Information
    Permissions and Reprints
Zoom Image
Marin H. Kollef, MD
Zoom Image
Scott T. Micek, PharmD

Infections are among the most common indications for hospitalization around the world to include admission to an intensive care unit (ICU) for life-threatening infections (LTIs). Increasingly the management of LTIs has become more complex due to the emergence of new infections not previously recognized, escalating antimicrobial resistance among pathogens causing LTIs, and host changes increasing the predisposition to and worsening the outcomes of LTIs due to either increasing immunosuppression or the application of artificial devices such as tunneled intravascular catheters, ventricular assist devices, and intracranial monitoring devices. The emergence of novel LTIs is of particular importance as difficulties in establishing the diagnosis of such infections and the lack of available therapies hinder effective treatment of these infections. Candida auris, Middle Eastern respiratory syndrome coronavirus, novel coronavirus (COVID-19, Wuhan, China), pan-resistant Escherichia coli, and Zika virus are recent examples of such infections that have resulted in significant morbidity and mortality.[1] [2] [3] [4] [5] [6] COVID-19 is a novel respiratory virus infection that already is estimated to have accounted for 7 million deaths globally.[7] Moreover, the recent COVID-19 pandemic has resulted in significant economic distress with the global economy contracting by 3.5% in 2020.[8]

Escalating resistance of pathogens to available antimicrobial agents is also of paramount importance, as the outcome of LTIs is generally most influenced by the timing of an appropriate antimicrobial regimen (i.e., an antimicrobial regimen that has activity against the causative pathogens based on in vitro susceptibility assessment). The administration of an inappropriate antimicrobial regimen can be associated with more than a doubling of the mortality risk especially for LTIs such as septic shock.[9] [10] [11] [12] [13] The Extended Study on Prevalence of Infection in Intensive Care III study found that among the 15,165 qualifying patients, 8,135 (54%) had at least one suspected or proven infection on the study day.[14] Interestingly, multilevel analysis demonstrated that infection with antibiotic-resistant pathogens including vancomycin-resistant Enterococcus, Klebsiella species resistant to β-lactam antibiotics, or carbapenem-resistant Acinetobacter species were associated with a higher risk of in-hospital death compared with infection with other microorganisms.[14] The concern over escalating antimicrobial resistance is present for all types of infections (bacterial, fungal, viral). The World Health Organization considers antimicrobial resistance to be a major threat to human health and a recent Wellcome Trust report suggests that nearly 300 million individuals will die over the next several decades as a direct result of antimicrobial resistance.[15] [16] Similarly, in the United States, antibiotic-resistant pathogens cause more than 2 million infections and 23,000 deaths per year as reported by the Centers for Disease Control and Prevention.[17] The IDSA launched a “10 by 20” initiative in 2010 to have at least 10 original antibiotics developed and approved for use by 2020.[18] Although this initiative succeeded, the IDSA working committee recently noted that antibiotic drug development might have peaked during the last decade for years to come and that without continued advances, the historical problem of antibiotic resistance is likely to intensify leading to future drug inadequacies.[19]

In this issue of Seminars in Respiratory and Critical Care Medicine, we have brought together an international group of authors to discuss the problem of LTIs. The goal of this seminar is to provide a succinct series of articles not only reviewing the most important LTIs as described by the World Health Organization ([Table 1]) but also describing updates in terms of their diagnosis and treatment.[20] As recent experience has shown, LTIs will continue to evolve over time posing serious threats to health and the global economy. Therefore, as a medical community we must maintain a state of preparedness to deal with current LTIs as well as novel threats in the future.

Table 1

Major infectious disease threats to global health according to the World Health Organization

Viruses

 Crimean-Congo hemorrhagic fever

 Dengue

 Ebola virus

 Human immunodeficiency virus

 Influenza

 Lassa fever

 Marburg virus

 Middle East respiratory syndrome coronavirus (MERS-CoV)

 Severe acute respiratory syndrome (SARS)

 Zika virus

Bacteria

 Acinetobacter baumannii carbapenem resistant

 Enterobacteriaceae carbapenem resistant

 Mycobacterium tuberculosis isoniazid and rifampin resistant

 Plague (Yersinia pestis)

 Pseudomonas aeruginosa carbapenem resistant

 Salmonella species fluoroquinolone resistant

 Shigella species fluoroquinolone resistant

 Staphylococcus aureus methicillin resistant, vancomycin intermediate and resistant

Others

 Malaria


Publication History

Article published online:
16 February 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA