Intra-abdominal candidiasis (IAC), with or without candidemia, is a common condition in patients in intensive care units (ICUs). Early diagnosis of IAC remains a challenge for clinicians despite new biomarkers. Early and appropriate antifungal treatment, which is associated with better clinical outcomes, is negatively affected by the increased isolation of non-albicans Candida strains that are resistant to the commonly used azoles and echinocandins. Based on the pharmacokinetic (PK) and pharmacodynamic (PD) properties of the different treatment options, liposomal amphotericin B, rezafungin or high doses of anidulafungin appear to be the most appropriate first-line options for complicated IAC in ICUs.

Background/Objectives: Ventilator-associated pneumonia (VAP) is the main nosocomial infection in intensive care units (ICUs) that causes the highest morbidity and mortality. The aim of our study is to investigate variations in crude ICU mortality among patients with VAP over the past decade. We also wish to identify associated risk factors, evaluate changes in the etiology, and assess the incidence and impact of inappropriate empirical antibiotic treatment (IEAT). Methods: We conducted a retrospective, observational, single-center study over a 10-year period (2014–2024), including critically ill patients who developed VAP. The population was divided into three periods: (P1) from 2014 to 2018 (pre-COVID-19); (P2) from 2019 to 2021 (COVID-19); and (P3) from 2022 to 2024 (post-COVID-19). Binary logistic regression was used to identify which variables were independently associated with ICU mortality. Results: A total of 220 patients were included in the study (P1 = 47, P2 = 96, and P3 = 77 patients). The most prevalent microorganisms identified were P. aeruginosa, Klebsiella spp., and S. aureus. Significant variations in etiology were not observed over the years. The incidence of IEAT was 4.5%, with no observed differences between the study periods. Crude ICU mortality was 33.6%, with higher rates observed in IEAT (40% vs. 33.3%, p = 0.73). In patients with appropriate empiric antibiotic treatment (AEAT), there was a significant decrease in crude mortality over the years from 42.2% in P1 to 22.2% in P3 (p < 0.001). Age (OR = 1.04; 95% CI = 1.01–1.08) and P2 (OR = 2.8; 95% CI = 1.1–7.4) were found to be independently associated with an increased risk of mortality. Conversely, a lower risk of death was associated with mean arterial pressure (OR = 0.94; 95% CI = 0.69–0.99) and the use of syndromic respiratory panel (OR = 0.23; 95% CI = 0.07–0.68). Conclusions: A reduction in crude VAP mortality over the years was observed, with no change in the etiology or rate of IEAT. The implementation of protocols using respiratory syndromic panels could be a measure to implement to reduce VAP mortality.

Complicated intra-abdominal infections are a major cause of sepsis-related mortality, with intra-abdominal candidiasis (IAC) as a knowing cause. Patients in intensive care units (ICU) are at the highest risk of invasive candidiasis and treatment focuses on intra-abdominal source control and appropriate antimicrobial therapy to reduce mortality. The management of complicated intraabdominal infection is a complex scenario where other conditions, beyond antifungal treatment, play a significant role. The patient's specific conditions, as well as early and proper control of the source of infection, are key factors in determining the outcome for these patients. However, despite prevention, advancements in diagnosis and treatment, mortality rates remain high up to 60%. This review provides updates on key concepts regarding the epidemiology and impact of Candida spp. in the peritoneal cavity, as well as risk factors for managing patients with intra-abdominal complications. Finally, it discusses antifungal treatment strategies based on pharmacokinetic/pharmacodynamic (PK/PD) parameters.

Background: During the influenza A(H1N1) and COVID-19 pandemics, empirical antibiotic treatment (EAT) was widely administered to critically ill patients despite low rates of confirmed bacterial co-infection (COI). The clinical benefit of this practice remains uncertain and may contradict antimicrobial stewardship principles. Objective: To evaluate whether EAT at ICU admission reduces ventilator-associated pneumonia (VAP) incidence or ICU mortality in critically ill patients with pandemic viral pneumonia, stratified by presence of COI. Methods: This retrospective analysis combined two national multicentre ICU registries in Spain, including 4197 adult patients requiring invasive mechanical ventilation for influenza A(H1N1) or COVID-19 between 2009 and 2021. Primary outcomes were ICU mortality and VAP incidence. Analyses were stratified by microbiologically confirmed bacterial COI. Propensity score matching, Cox regression, General Linear (GLM), and random forest models were applied. Results: Among patients without COI (n = 3543), EAT was not associated with lower ICU mortality (OR = 1.02, 95%CI 0.81–1.28, p = 0.87) or VAP (OR = 1.02, 95%CI 0.79–1.39, p = 0.89). In patients with confirmed COI (n = 654), appropriate EAT was associated with reduced VAP (17.4% vs. 36.3%, p < 0.001) and ICU mortality (38.4% vs. 49.6%, OR = 1.89, 95%CI 1.13–3.14, p = 0.03) compared to inappropriate EAT. Conclusions: EAT was not associated with a lower incidence of VAP or higher survival rates and could be harmful if administered incorrectly. These findings support a more targeted approach to antibiotic use, guided by microbiology, biomarkers and stewardship principles.

Background: The aim of our study is to investigate variations in crude ICU mortality among patients with ventilator-associated pneumonia (VAP) over the past decade. We also wish to identify associated risk factors, evaluate changes in the aetiology, and assess the incidence and impact of inappropriate empirical antibiotic treatment (IEAT). Methods: We conducted a retrospective, observational, single-centre study over a 10-year period (2014-2024), including critically ill patients who developed VAP. The population was divided into three periods: P1) from 2014 to 2018 (pre-covid-19); P2) from 2019 to 2021 (covid-19); and P3) from 2022 to 2024 (post-covid-19). Binary logistic regression was used to identify which variables were independently associated with ICU mortality. Results: A total of 220 patients were included in the study (P1=47, P2=96 and P3=77 patients). The most prevalent microorganisms identified were P. aeruginosa, Klebsiella spp. and S.aureus. Significant variations in etiology were not observed over the years. The incidence of IEAT was 4.5%, with no observed differences between the study periods. Crude ICU mortality was 33.6%, with higher rates observed in IEAT (40% vs. 33.3%, p=0.73). In patients with AEAT, there was a significant decrease in crude mortality over the years from 42.2% in P1 to 22.2% in P3 (p<0.001). Age (OR=1.04; 95% CI=1.01-1.08) and P2 (OR=2.8; 95% CI=1.1-7.4) were found to be independently associated with an increased risk of mortality. Conversely, lower risk of death was associated with mean arterial pressure (OR=0.94; 95% CI=0.69-0.99) and the use of syndromic respiratory panel (OR=0.23; 95% CI=0.07-0.68). Conclusion: A reduction in crude VAP mortality over the years was observed, with no change in the aetiology or rate of IEAT. The implementation of protocols using respiratory syndromic panels could be a measure to implement to reduce VAP mortality.