Infection

Sepsis and Severe Infections

• Format: Virtual
• Dates: February 22-23, 2024

This 2-day e-course blends techniques that encourage maximum learning. Special attention is given to interactive activities, case-based discussions, workshops and problem-oriented approaches.

Antimicrobial Stewardship for Severe Infections Learning Pathway

If you are interested in AMS, do not hesitate to register, watch the recordings of the 3 thematic sessions and complete the related quizzes. Upon their completion, you may also download your certificate.

An Immersive Workshop through Virtual Reality will be carried out at LIVES 2023 in Milan. You will face complex clinical scenarios to be solved with the help of tools such as the ESICM Airspace WebApp, with the ultimate objective of improving patients’ outcomes and positively impacting Antimicrobial Stewardship.

Certificates with CME credits will be issued for those who attend the workshop at LIVES.

Fungal Sepsis Training Programme

The incidence of invasive fungal infections has increased steadily over the past decade due to increased numbers of immunocompromised and ICU patients. They represent a matter of concern in ICUs as they can produce infections that range from non-life-threatening superficial disorders to severe invasive diseases involving any organ.

To improve the outcomes of patients with fungal infections, intensivists need to be aware of the inherent challenges.

Past webinars

• Optimising antibiotic therapy in COVID-19 patients
• Practical use of fast AST methods for managing BSI & positive blood cultures
• What really matters in septic patients?
• Lessons from COVID-19 experience for the management of (non-viral) sepsis
• New risk factors for invasive fungal infections
• Practical microbiology diagnosis & management of blood stream infections (/sepsis) in icu
• Antibiotic de-escalation: how, why, what and how

Educational webinar series on sepsis management

This initiative covered the management of patients suffering from sepsis with a strong focus on the role & value of diagnostic tests. It was designed as an educational journey from the early signs of sepsis to the post-sepsis syndrome. 

Programme

• Clinical presentation of sepsis, early signs & patients at risk
• Sepsis: early diagnosis & management
• Sepsis complications
• Sepsis and Antimicrobial Resistance: two sides of the same coin
• Post-Sepsis Syndrome (PSS) & life after sepsis: the patient voice

• Top Sessions from LIVES 2021 selected for you:
• When do I stop antibiotic therapy in severe infections? I use omics
• Empirical therapy in carbapenem-resistant Enterobacteriaceae
• Optimising the antimicrobial therapy to improve the prognosis
• The role of “old antibiotics” for MDR-GNB
• Approach of severe respiratory infections in immunocompromised patients – DIRECT approach
• Early bacterial co-infection in COVID-19 patients
• Immunotherapy/immunostimulation for control of infections in ICU
• Novel antibiotics for infections by Gram-negative pathogens
• CMV and HSV infection in immunocompetent critically ill patients
• When do I stop antibiotic therapy in severe infections? I use a fixed duration

In Development

DALI-2

The continuation of DALI study aiming to define β-lactam concentration levels in ICU patients and their impact on patient outcome.

PIs: Jason Roberts, Paul Williams, Jeffrey Lipman

Ongoing

SKIN-ICU

A retrospective observational study of antimicrobial use across ESICM nations, with the investigation of variation by type of ICU and antimicrobial resistance.

PIs: Fredrik Sjövall / Jeroen Schouten

AB-ICU

A retrospective observational study of antimicrobial use across ESICM nations, with the investigation of variation by type of ICU and antimicrobial resistance.

PIs: Fredrik Sjövall / Jeroen Schouten

BLING-3

A phase III randomised controlled trial of continuous beta-lactam infusion compared with intermittent beta-lactam dosing in critically ill patients, to determine whether continuous infusion of a beta-lactam antibiotic (piperacillin-tazobactam or meropenem) results in decreased all-cause day 90 mortality compared with intermittent beta-lactam antibiotic infusion in critically ill patients with sepsis (NCT03213990).

PIs: Jeff Lippman / Jan De Waele / Stephen Brett

Results: Data collection is ongoing. > 7000 patients have been recruited worldwide.

COVIDHGE

The “COVID Human Genetic Effort” is an international consortium aiming to discover monogenic inborn errors of immunity, rare or common, underlying severe forms of COVID-19 in previously healthy individuals (< 50 years without co-morbidity).

This programme is inspired by previous genetic studies of other severe viral infections such as life-threatening influenza pneumonitis or herpes simplex encephalitis.

PIs: Jean-Laurent Casanova / Laurent Abel

Publications

• Bastard P. et al. Autoantibodies neutralizing type I IFNs are present in ~4% of uninfected individuals over 70 years old and account for ~20% of COVID-19 deaths. Sci Immunol. 2021 Aug 19;6(62):eabl4340.
• Asano T. et al. X-linked recessive TLR7 deficiency in ~1% of men under 60 years old with life-threatening COVID-19. Sci Immunol. 2021 Aug 19;6(62):eabl4348.

HAP2

Host-targeted Approaches for the prevention and the treatment of Hospital-Acquired Pneumonia, a project investigating immunostimulatory therapies in pneumonia (Home – Hap2 (hap2-project.com)).

1st project (PREV-HAP trial): 109 patients included; analyses ongoing.

2d project (TREAT-HAP trial): under development.

PI: Antoine Roquilly

Completed

UNITE-COVID

The ESICM COVID-19 Project is an observational study of ICU management of COVID-19.

2020 edition (Feb 2020-June 2020): Data collection and initial analysis are completed. 4994 patients were included, from 280 ICUs in 46 countries. Further sub-studies are underway.

2021 edition, for wave 2 (January 2021-June 2021): Data collection is completed. > 2500 patients were included. Initial analysis is ongoing.

PI: Jan De Waele

Publications :

• Greco M. et al. ESICM UNITE-COVID investigators. Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study. Intensive Care Med. 2022 Jun;48(6):690-705. doi: 10.1007/s00134-022-06705-1. Epub 2022 May 21. Erratum in: Intensive Care Med. 2022 Aug;48(8):1130-1131. PMID: 35596752; PMCID: PMC9123859.
• Conway Morris A. et al. ESICM UNITE COVID investigators. Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set. Crit Care. 2022 Aug 3;26(1):236. doi: 10.1186/s13054-022-04108-8. Erratum in: Crit Care. 2022 Aug 17;26(1):249. PMID: 35922860; PMCID: PMC9347163.

EUROBACT II

Epidemiology and determinants of outcomes of Hospital Acquired Blood Stream Infections in the Intensive Care.

PIs: Jean-François Timsit / Alexis Tabah

Results: Data collection and initial analysis are completed. 2600 patients were included across 333 centres from 52 countries. Further sub-studies are underway.

Publications :

• Buetti N. et al. Eurobact 2 study group. Different epidemiology of bloodstream infections in COVID-19 compared to non-COVID-19 critically ill patients: a descriptive analysis of the Eurobact II study. Crit Care. 2022 Oct 18;26(1):319. doi: 10.1186/s13054-022-04166-y. PMID: 36258239; PMCID: PMC9578203.
• Tabah A. et al. EUROBACT-2 Study Group, ESICM, ESCMID ESGCIP and the OUTCOMEREA Network. Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study. Intensive Care Med. 2023 Feb;49(2):178-190. doi: 10.1007/s00134-022-06944-2. Epub 2023 Feb 10. PMID: 36764959; PMCID: PMC9916499.

PneumoINSPIRE

The International study on NoSocomial Pneumonia in Intensive CaRE (PneumoINSPIRE) is a prospective, international, multicentre, observational, cohort study. The study aims to provide up-to-date and generalisable information on current worldwide epidemiology and clinical practice associated with the diagnosis and management of nosocomial pneumonia in Intensive Care Unit (ICU) patients.

PI: Despoina Koulenti

Results: Data collection is completed, with 1400 patients included, and analysis is ongoing.

EURECA

The EURopean study on Encephalitis in intensive CAre units is a prospective, cross-sectional, multinational, cohort study aiming at evaluating epidemiology and outcomes of patients admitted to the ICU with all-cause (meningo-)encephalitis (NCT03144570).

PI: Romain Sonneville

Results: Data collection and initial analysis are completed. 2600 patients were included across 333 centres from 52 countries. Further sub-studies are underway.

Publication :

• Sonneville R. et al. EURECA Investigator Study Group. Clinical features, etiologies, and outcomes in adult patients with meningoencephalitis requiring intensive care (EURECA): an international prospective multicenter cohort study. Intensive Care Med. 2023 May;49(5):517-529. doi: 10.1007/s00134-023-07032-9. Epub 2023 Apr 6. PMID: 37022378.

DIANA

DetermInants of Antimicrobial use aNd de-escalAtion in critical care

PI: Jan De Waele

Publication :

• De Bus L. et al. Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study. Intensive Care Med. 2020 Jul;46(7):1404-1417.

PROSAFE

The aim of the project was to promote patient safety and quality improvement in critical care towards a significant reduction of observed mortality rates and economic costs.

Publication :

• Finazzi S. et al. PROSAFE: a European endeavor to improve quality of critical care medicine in seven countries. Minerva Anestesiol. 2020 Dec;86(12):1305-1320.

EPIC III

The aim of EPIC III was to provide information about the prevalence and outcomes of infection and the available resources in ICUs worldwide.

Publication :

• Vincent J-L. et al. Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017. JAMA. 21 avr 2020;323(15):1478‑87.

Decolonisation strategies

This European-wide multicentre ICU trial aimed to determine the effect and safety of three decolonisation strategies: Selective Digestive tract Decontamination (SDD), Selective Oropharyngeal Decontamination (SOD), Chlorhexidine mouthwash (Oro-CHX).

Publication :

• Wittekamp B.H. et al. Decontamination Strategies and Bloodstream Infections With Antibiotic-Resistant Microorganisms in Ventilated Patients: A Randomized Clinical Trial. JAMA. 2018 Nov 27;320(20):2087-2098.

Completed

D-PRISM

Diagnostic approaches in severe pneumonia, a multi-national survey.

PI: Andrew Conway Morris

Results: Data collection is completed, with 1325 survey responders. Initial analysis is ongoing.

ISOREA

International survey aiming to evaluate the structures and the organization systems of the ICUs in a big sample from high, middle, and low-income countries.

PI: Armand Mekontso Dessap

Results: Survey ended, currently under analysis.

PRACT-INF-ICU

Current Practice of infectious disease management in the ICU – International survey.

PI: Ashraf Roshdy

Publication: Roshdy A. et al. Intensivists’ perceptions and attitudes towards infectious diseases management in the ICU: An international survey. Med Intensiva (Engl Ed). 2021 Aug 17:S0210-5691(21)00174-1. English, Spanish.

A-TEAMICU

Antibiotic Stewardship, Therapeutic Drug Monitoring and Early Appropriate infection Management in European ICUs.

PIs: Hendrik Bracht / Christian Lanckohr

Publication: Lanckohr C. et al. Antimicrobial stewardship, therapeutic drug monitoring and infection management in the ICU: results from the international A- TEAMICU survey. Ann Intensive Care. 2021 Aug 26;11(1):131.

• Dequin P.F. et al. CRICS-TriGGERSep Network. Hydrocortisone in Severe Community-Acquired Pneumonia. N Engl J Med. 2023 May 25;388(21):1931-1941. doi: 10.1056/NEJMoa2215145. Epub 2023 Mar 21. PMID: 36942789.
• Kreitmann L. et al. Relationship between immunosuppression and intensive care unit-acquired colonization and infection related to multidrug-resistant bacteria: a prospective multicenter cohort study. Intensive Care Med. 2023 Feb;49(2):154-165. doi: 10.1007/s00134-022-06954-0. Epub 2023 Jan 2. PMID: 36592202.
• SuDDICU Investigators for the Australian and New Zealand Intensive Care Society Clinical Trials Group; Effect of Selective Decontamination of the Digestive Tract on Hospital Mortality in Critically Ill Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial. JAMA. 2022 Nov 15;328(19):1911-1921. doi: 10.1001/jama.2022.17927. PMID: 36286097; PMCID: PMC9607966.
• Fish M. et al. REMAP-CAP Immunoglobulin Domain UK Investigators. Coronavirus disease 2019 subphenotypes and differential treatment response to convalescent plasma in critically ill adults: secondary analyses of a randomized clinical trial. Intensive Care Med. 2022 Nov;48(11):1525-1538. doi: 10.1007/s00134-022-06869-w. Epub 2022 Sep 14. PMID: 36102943; PMCID: PMC9472738.
• Ewoldt T.M.J. et al. Model-informed precision dosing of beta-lactam antibiotics and ciprofloxacin in critically ill patients: a multicentre randomised clinical trial. Intensive Care Med. 2022 Dec;48(12):1760-1771. doi: 10.1007/s00134-022-06921-9. Epub 2022 Nov 9. PMID: 36350354; PMCID: PMC9645317.
• Bloos F. et SepNet Study Group. (1 → 3)-β-D-Glucan-guided antifungal therapy in adults with sepsis: the CandiSep randomized clinical trial. Intensive Care Med. 2022 Jul;48(7):865-875.
• Bouglé A. et iDIAPASON Trial Investigators. Comparison of 8 versus 15 days of antibiotic therapy for Pseudomonas aeruginosa ventilator-associated pneumonia in adults: a randomized, controlled, open-label trial. Intensive Care Med. 2022 Jul;48(7):841-849.
• Meduri G.U. et ESCAPe Study Group. Low-dose methylprednisolone treatment in critically ill patients with severe community-acquired pneumonia. Intensive Care Med. 2022 Aug;48(8):1009-1023.
• Kousathanas A. et al. Whole-genome sequencing reveals host factors underlying critical COVID-19. Nature. 2022 Jul;607(7917):97-103.
• WHO Solidarity Trial Consortium. Remdesivir and three other drugs for hospitalised patients with COVID-19: final results of the WHO Solidarity randomised trial and updated meta-analyses. Lancet. 2022 May 21;399(10339):1941-1953.
• Jarvis J.N. et al. Ambition Study Group. Single-Dose Liposomal Amphotericin B Treatment for Cryptococcal Meningitis. N Engl J Med. 2022 Mar 24;386(12):1109-1120.
• Hagel S. et al. TARGET Trial Investigators. Effect of therapeutic drug monitoring-based dose optimization of piperacillin/tazobactam on sepsis-related organ dysfunction in patients with sepsis: a randomized controlled trial. Intensive Care Med. 2022 Mar;48(3):311-321.
• Gangneux J.P. et al. Fungal infections in mechanically ventilated patients with COVID-19 during the first wave: the French multicentre MYCOVID study. Lancet Respir Med. 2022 Feb;10(2):180-190.
• Darkoh C. et al. Emergence of Clinical Clostridioides difficile Isolates With Decreased Susceptibility to Vancomycin. Clin Infect Dis. 2022 Jan 7;74(1):120-126.
• Peters-Sengers H. et al. MARS consortium. Source-specific host response and outcomes in critically ill patients with sepsis: a prospective cohort study. Intensive Care Med. 2022 Jan;48(1):92-102.
• Meghraoui-Kheddar A. et al. Two New Neutrophil Subsets Define a Discriminating Sepsis Signature. Am J Respir Crit Care Med. 2022 Jan 1;205(1):46-59.

Ventilator-associated complications in patients with ESBLE infections

Augmented renal clearance, antibiotic exposure & clinical outcome: What is the impact on septic patients receiving high doses of β-lactams in ICU?

Procalcitonin-guided antibiotic therapy in intensive care unit patients: a systematic review and meta-analysis

Reducing CRBSIs in ICUs: What’s the best strategy?
Hospitals in 11 European countries were computer-randomised to receive one of three interventions in the Prevention of Hospital Infections by Intervention and Training (PROHIBIT) project.

Prevention and Control of Multidrug-Resistant Gram-Negative Bacteria in ICUs
This Systematic Review of Clinical Studies compared  Prevention & Control interventions for Multidrug Resistant Gram-Negative Bacteria in adults admitted to ICUs including RCTs, Cohort Studies, Interrupted time-series studies and before-and-after studies.

Invasive Candida infections
Invasive Candida infections are leading causes of mortality among critically ill patients. The diagnosis of such diseases is challenging and a delayed start of the appropriate antifungal therapy was associated with a poor prognosis.

Optimising Infection Care
ICU environment requires existing antimicrobial agents to be used more judiciously with the aim at the reduction of antimicrobial resistance.

Evaluating new antibiotic therapy endpoints
Antimicrobial resistance is a growing problem in medicine.