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The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the (1) setting of infection onset (community-acquired, early onset, or late-onset hospital-acquired), (2) presence or absence of either localized or diffuse peritonitis, and (3) severity of disease expression (infection, sepsis, or septic shock). This classification system demonstrated reliable risk stratification in intensive care unit (ICU) patients with intra-abdominal infection. This study aimed to describe the epidemiology of ICU patients with pancreatic infection and assess the relationship between the components of the AbSeS-classification and mortality.

To describe whether contemporary dosing of antifungal drugs achieves therapeutic exposures in critically ill patients that are associated with optimal outcomes. Adequate antifungal therapy is a key determinant of survival of critically ill patients with fungal infections. Critical illness can alter an antifungal agents’ pharmacokinetics, increasing the risk of inappropriate antifungal exposure that may lead to treatment failure and/or toxicity.

The unacceptable high mortality of severe infections and sepsis led over the years to understand the need for adjunctive immunotherapy to modulate the dysregulated host response of the host. However, not all patients should receive the same type of treatment. The immune function may largely differ from one patient to the other. The principles of precision medicine require that some biomarker is used to capture the immune function of the host and guide the best candidate therapy. This is the approach of the ImmunoSep randomized clinical trial (NCT04990232) where patients are allocated to treatment with anakinra or recombinant interferon gamma tailored to immune signs of macrophage activation-like syndrome and immunoparalysis respectively. ImmunoSep is a first-in-class paradigm of precision medicine for sepsis. Other approaches need to consider classification by sepsis endotypes, targeting T cell and application of stem cells. Basic principle for any trial to be successful is the delivery of appropriate antimicrobial therapy as standard-of-care taking into consideration not just the likelihood for resistant pathogens but also the pharmacokinetic/pharmacodynamic mode of action of the administered antimicrobial.

Malaria is initiated as Plasmodiumsporozoites are injected into the dermis when an infected mosquito probes on a vertebrate host for a blood meal. Factors in the mosquito saliva, such as AgTRIO, can alter the ability of Anopheles gambiaeto transmit Plasmodium. We therefore used CRISPR-Cas9-mediated genome editing to generate AgTRIOknockout (KO) A. gambiaeand examined the ability of these mosquitoes to probe on a vertebrate host. AgTRIOKO mosquitoes showed a diminished host probing capacity and required repetitive probing to locate a blood resource to complete a blood meal. This increased probing resulted in enhanced Plasmodiumtransmission to the vertebrate host. Our data demonstrate the importance of the A. gambiaesaliva protein AgTRIO in probing and its influence on the ability of mosquitoes to transmit malaria.

Introduction: Intra-abdominal infections represent the second most frequently acquired infection in the intensive care unit (ICU), with mortality rates ranging from 20% to 50%. Candidaspp. may be responsible for up to 10–30% of cases. This study assesses risk factors for development of intra-abdominal candidiasis (IAC) among patients admitted to ICU. Methods: We performed a case–control study in 26 European ICUs during the period January 2015–December 2016. Patients at least 18 years old who developed an episode of microbiologically documented IAC during their stay in the ICU (at least 48 h after admission) served as the case cohort. The control group consisted of adult patients who did not develop episodes of IAC during ICU admission. Matching was performed at a ratio of 1:1 according to time at risk (i.e. controls had to have at least the same length of ICU stay as their matched cases prior to IAC onset), ICU ward and period of study. Results: During the study period, 101 case patients with a diagnosis of IAC were included in the study. On univariate analysis, severe hepatic failure, prior receipt of antibiotics, prior receipt of parenteral nutrition, abdominal drain, prior bacterial infection, anastomotic leakage, recurrent gastrointestinal perforation, prior receipt of antifungal drugs and higher median number of abdominal surgical interventions were associated with IAC development. On multivariate analysis, recurrent gastrointestinal perforation (OR 13.90; 95% CI 2.65–72.82, p= 0.002), anastomotic leakage (OR 6.61; 95% CI 1.98–21.99, p= 0.002), abdominal drain (OR 6.58; 95% CI 1.73–25.06, p= 0.006), prior receipt of antifungal drugs (OR 4.26; 95% CI 1.04–17.46, p= 0.04) or antibiotics (OR 3.78; 95% CI 1.32–10.52, p= 0.01) were independently associated with IAC. Conclusions: Gastrointestinal perforation, anastomotic leakage, abdominal drain and prior receipt of antifungals or antibiotics may help to identify critically ill patients with higher probability of developing IAC. Prospective studies are needed to identify which patients will benefit from early antifungal treatment.

Introduction: Invasive pulmonary aspergillosis is an emerging complication among intensive care unit (ICU) patients with COVID-19 (CAPA). In the present study, all CAPA cases during the first year of the pandemic were reviewed in critically ill patients at a 650-bed tertiary Greek COVID-19 reference hospital. Methods: Data regarding patients admitted to the ICU of Attikon Hospital in Athens, Greece, between 22 March 2020 and 28 February 2021 with a positive PCR for SARS-CoV-2 infection were reviewed. Clinical and microbiological records were analysed including demographic, clinical, laboratory and radiological features, treatment and outcomes. CAPA was determined according to the recent 2020 ECMM/ISHAM definitions. Results: A total of 179 patients were admitted in the ICU and 6 (3.3%) patients were diagnosed with CAPA (4 probable and 2 possible CAPA) with 5/6 with co-infection with multidrug-resistant (MDR) gram-negative pathogens. No patient had a history of immunosuppression. All suffered from acute respiratory distress syndrome. The median (range) time from intubation to diagnosis was 6 (1–14) days. Five patients had positive Aspergilluscultures in bronchial secretions (1 A. fumigatus, 1 A. flavus, 1 A. fumigatus+ A. flavus, 1 A. fumigatus+ A. terreusand 1 A. terreus) while culture was negative in one patient. All isolates were susceptible to antifungal drugs. Serum galactomannan (GM), pan-AspergillusPCR and (1,3)-β-d-glucan (BDG) were positive in 4/6 (67%), 5/6 (83%, 3/5 in two consecutive samples) and 4/6 (67%, in consecutive samples) patients, respectively. GM and PCR positive bronchial secretions had GM indices > 9.95 and PCRCt< 34. All were treated with antifungal drugs with 5 out of 6 receiving isavuconazole. Mortality was 67% (4/6) with 1/4 attributed to CAPA (two died as a result of bacterial septic shock and one as a result of multiorgan failure). Conclusion: The incidence of CAPA in ICU patients was 3.3% and it was associated with approximately a 17% attributable mortality in the setting of MDR gram-negative pathogen co-infections.

Background:Macrophage activation-like syndrome (MALS) and complex immune dysregulation (CID) often underlie acute respiratory distress (ARDS) in COVID-19. We aimed to investigate the effect of personalized immunotherapy on clinical improvement of critical COVID-19. Methods:In this open-label prospective trial, 102 patients with ARDS by SARS-CoV-2 were screened for MALS (ferritin >4,420 ng/mL) and CID (ferritin ≤4,420 ng/mL and low human leukocyte antigen (HLA)-DR expression on CD14-monocytes). Patients with MALS or CID with increased aminotransferases received intravenous anakinra; those with CID and normal aminotransferases received tocilizumab. The primary outcome was ≥25% decrease in the Sequential Organ Failure Assessment (SOFA) score and/or 50% increase in the respiratory ratio by day 8; 28-day mortality, change of SOFA score by day 28, serum biomarkers, and cytokine production by mononuclear cells were secondary endpoints. Results:The primary study endpoint was met in 58.3% of anakinra-treated patients and in 33.3% of tocilizumab-treated patients (p: 0.01). Most patients in both groups received dexamethasone as standard of care. No differences were found in secondary outcomes, mortality, and SOFA score changes. Ferritin decreased among anakinra-treated patients; interleukin-6, soluble urokinase plasminogen activator receptor, and HLA-DR expression increased among tocilizumab-treated patients. Survivors by day 28 who received anakinra were distributed to lower severity levels of the WHO clinical progression scale. Greater incidence of secondary infections was found with tocilizumab treatment. Conclusion:Immune assessment resulted in favorable anakinra responses among critically ill patients with COVID-19 and features of MALS.

In light of the accumulating evidence on the negative predictive value of soluble urokinase plasminogen activator receptor (suPAR), a group of experts from the fields of intensive care medicine, emergency medicine, internal medicine and infectious diseases frame a position statement on the role of suPAR in the screening of patients admitted to the emergency department. The statement is framed taking into consideration existing publications and our own research experience. The main content of this statement is that sUPAR is a non-specific marker associated with a high negative predictive value for unfavourable outcomes; levels < 4 ng/ml indicate that it is safe to discharge the patient, whereas levels > 6 ng/ml are an alarming sign of risk for unfavourable outcomes. However, the suPAR levels should always be interpreted in light of the patient's history.

Fetuin-A and adiponectin, major hepatokine and adipokine respectively, have been implicated in systematic inflammation. Our aim was to jointly investigate whether kinetics of circulating fetuin-A, adiponectin and its isoform HMWA predict 28-day mortality in sepsis.

Clinical failures in ventilator-associated pneumonia (VAP) caused by gram-negative bacteria are common and associated with substantial morbidity, mortality, and resource utilization.

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The state of immune activation may guide targeted immunotherapy in sepsis. In a double-blind, double-dummy randomized clinical study, 240 patients with sepsis due to lung infection, bacteremia, or acute cholangitis were subjected to measurements of serum ferritin and HLA-DR/CD14. Patients with macrophage activation-like syndrome (MALS) or immunoparalysis were randomized to treatment with anakinra or recombinant interferon-gamma or placebo. Twenty-eight-day mortality was the primary endpoint; sepsis immune classification was the secondary endpoint. Using ferritin >4,420 ng/mL and <5,000 HLA-DR receptors/monocytes as biomarkers, patients were classified into MALS (20.0%), immunoparalysis (42.9%), and intermediate (37.1%). Mortality was 79.1%, 66.9%, and 41.6%, respectively. Survival after 7 days with SOFA score decrease was achieved in 42.9% of patients of the immunotherapy arm and 10.0% of the placebo arm (p = 0.042). Three independent immune classification strata are recognized in sepsis. MALS and immunoparalysis are proposed as stratification for personalized adjuvant immunotherapy. Clinicaltrials.govregistration NCT03332225.

BACKGROUNDHealthcare workers (HCWs) lack familiarity with evidence-based guidelines for the prevention of healthcare-associated infections (HAIs). There is good evidence that effective educational interventions help to facilitate guideline implementation, so we investigated whether e-learning could enhance HCW knowledge of HAI prevention guidelines.METHODSWe developed an electronic course (e-course) and tested its usability and content validity. An international sample of voluntary learners submitted to a pretest (T0) that determined their baseline knowledge of guidelines, and they subsequently studied the e-course. Immediately after studying the course, posttest 1 (T1) assessed the immediate learning effect. After 3 months, during which participants had no access to the course, a second posttest (T2) evaluated the residual learning effect.RESULTSA total of 3,587 HCWs representing 79 nationalities enrolled: 2,590 HCWs (72%) completed T0; 1,410 HCWs (39%) completed T1; and 1,011 HCWs (28%) completed T2. The median study time was 193 minutes (interquartile range [IQR], 96–306 minutes)The median scores were 52% (IQR, 44%–62%) for T0, 80% (IQR, 68%–88%) for T1, and 74% (IQR, 64%–84%) for T2. The immediate learning effect (T0 vs T1) was +24% (IQR, 12%–34%; P<.001), and a residual effect (T0 vs T2) of +18% (IQR 8–28) remained (P<.001). A 200-minute study time was associated with a maximum immediate learning effect (28%). A study time >300 minutes yielded the greatest residual effect (24%).CONCLUSIONSModerate time invested in e-learning yielded significant immediate and residual learning effects. Decision makers could consider promoting e-learning as a supporting tool in HAI prevention.Infect Control Hosp Epidemiol2016;37:1052–1059

During infection, the human pathogenic fungus Candida albicansundergoes a yeast-to-hypha transition, secretes numerous proteins for invasion of host tissues, and modulates the host’s immune response. Little is known about the interplay of C. albicanssecreted proteins and the host adaptive immune system. Here, we applied a combined 2D gel- and LC–MS/MS-based approach for the characterization of C. albicansextracellular proteins during the yeast-to-hypha transition, which led to a comprehensive C. albicanssecretome map. The serological responses to C. albicansextracellular proteins were investigated by a 2D-immunoblotting approach combined with MS for protein identification. On the basis of the screening of sera from candidemia and three groups of noncandidemia patients, a core set of 19 immunodominant antibodies against secreted proteins of C. albicanswas identified, seven of which represent potential diagnostic markers for candidemia (Xog1, Lip4, Asc1, Met6, Tsa1, Tpi1, and Prx1). Intriguingly, some secreted, strongly glycosylated protein antigens showed high cross-reactivity with sera from noncandidemia control groups. Enzymatic deglycosylation of proteins secreted from hyphae significantly impaired sera antibody recognition. Furthermore, deglycosylation of the recombinantly produced, secreted aspartyl protease Sap6 confirmed a significant contribution of glycan epitopes to the recognition of Sap6 by antibodies in patient’s sera.

Exhaust gas scrubber is one of the options to comply with the new regulations for sulphur emissions in the shipping industry. This article presents a model-based approach to assess the energy and environmental performance effects from the installation of a seawater flue gas desulphurisation scrubber on a marine two-stroke diesel engine propulsion plant. A mathematical model was built that describes the governing physical and chemical behaviour of the integrated machinery system. The model was used to examine the impact of main scrubber design characteristics on the engine fuel consumption under different engine loads. The results indicate that the desulphurisation system causes an increase in the engine fuel consumption, for constant power output. This is due to the increased back-pressure to the turbocharging system caused by the pressure drops in the desulphurisation system. This effect can be partly mitigated by the installation of forced-draft fans after the desulphurisation system limiting the negative impact on the overall system efficiency to half of its initial value.

ABSTRACTThis study describes the population pharmacokinetics of fosfomycin in critically ill patients. In this observational study, serial blood samples were taken over several dosing intervals of intravenous fosfomycin treatment. Blood samples were analyzed using a validated liquid chromatography-tandem mass spectrometry technique. A population pharmacokinetic analysis was performed using nonlinear mixed-effects modeling. Five hundred fifteen blood samples were collected over one to six dosing intervals from 12 patients. The mean (standard deviation) age was 62 (17) years, 67% of patients were male, and creatinine clearance (CLCR) ranged from 30 to 300 ml/min. A two-compartment model with between-subject variability on clearance and volume of distribution of the central compartment (Vc) described the data adequately. Calculated CLCRwas supported as a covariate on fosfomycin clearance. The mean parameter estimates for clearance on the first day were 2.06 liters/h, Vcof 27.2 liters, intercompartmental clearance of 19.8 liters/h, and volume of the peripheral compartment of 22.3 liters. We found significant pharmacokinetic variability for fosfomycin in this heterogeneous patient sample, which may be explained somewhat by the observed variations in renal function.

•The midgut of mosquito disease vectors contains a diverse microbial flora.•The microbiota can modulate the mosquito immune response and influence vector competence to human pathogens.•The microbiota can alter susceptibility to infection through either immune priming or direct inhibition.•The tripartite relationship between mosquito, its microbiota, and human pathogens is critical to disease transmission.•Dissection of this tripartite interaction may lead to novel powerful tools that can complement current strategies for disease control.

AbstractThe multifaceted innate immune system of insects is capable of fighting infection by a variety of pathogens including those causing human malaria. Malaria transmission by the Anophelesmosquito depends on the Plasmodiumparasite's successful completion of its lifecycle in the insect vector, a process that involves interactions with several tissues and cell types as well as with the mosquito's innate immune system. This review will discuss our current understanding of the Anophelesmosquito's innate immune responses against the malaria parasite Plasmodiumand the influence of the insect's intestinal microbiota on parasite infection.Copyright © 2013 S. Karger AG, Basel

To describe the characteristics and determinants of outcome of hospital-acquired bloodstream infection (HA-BSI) due to respiratory infection among patients admitted to intensive care units (ICUs). We performed a post hoc analysis of the EUROBACT multicenter cohort study, conducted in 162 ICUs in 24 countries. The HA-BSIs due to candidemia and from mixed respiratory and nonrespiratory sources were excluded. From the overall 1156 included in EUROBACT, 230 patients were classified as having HA-BSI respiratory infections (HA-BSI requiring ICU admission, n=40; ICU-acquired noninvasively ventilated respiratory BSI, n=30; and ICU-acquired invasively ventilated BSI, n=160) and were compared with 749 patients with HA-BSI not related to respiratory infections. HA-BSI respiratory infections were more frequently due to gram negatives (76.3 vs. 56.7, P<0.0001), mainly Acinetobacter baumannii(18.3 vs. 10.4, P=0.0007), Klebsiellaspp. (18.7 vs. 11, P=0.0013), and were less frequently because of gram-positive cocci (23.3 vs. 41.2, P<0.0001), with the exception of Staphylococcus aureus(11.3 vs. 9.5, P=0.39). HA-BSI respiratory infections were more frequently associated with multiple drug-resistant pathogens (53.9 vs. 42.7, P=0.0003), were more common in medical patients, and were more likely to be ICU-acquired as compared with nonrespiratory infections. After adjustment for severity and other risk factors, HA-BSI of respiratory origin was a risk factor for day-28 mortality (odds ratio=1.52 1.02-2.27, P=0.04). Among the cohort of 230 patients with HA-BSI of respiratory origin, those with HA-BSI requiring ICU admission presented more often with septic shock (2440=60) as compared with ICU-acquired HA-BSI episodes occurring in noninvasively (930=30) and invasively (71160=44, P=0.04) ventilated patients. Recovered microorganisms were similar between the 3 groups of HA-BSI of respiratory origin. When adjusted for confounding factors, the risk of death was lower for ICU-acquired HA-BSI occurring among invasive ventilated patients (odds ratio=0.41 0.19-0.92, P=0.03) than for patients not invasively ventilated before HA-BSI of respiratory origin. The EUROBACT multicenter study confirms that the lung as a respiratory source of infection is associated with more gram-negative resistant pathogen and a poorer prognosis. When associated with BSI, lung infections occurring in noninvasively mechanical ventilated patients are associated with more septic shock and a worse prognosis than patients with bacteremic ventilator-associated pneumonia.

The aim of this study was to investigate the impact of polymicrobial bloodstream infections (pBSIs) on the outcome of sepsis in an area where antimicrobial resistance is of concern. This was a retrospective analysis of data collected prospectively from patients developing BSI outside of an intensive care unit (non-ICU patients) or after ICU admission. Demographics and clinical characteristics were compared for patients with pBSI versus monomicrobial BSI (mBSI) and following stratification by ICU or non-ICU and severity of sepsis status. Possible risk factors for adverse outcome were explored by multivariate analysis, and outcomes were measured by Cox regression analysis. Among 412 patients with BSI, 47 patients (11.4%) with pBSI were recorded; compared with patients with mBSI, they had significantly higher APACHE II scores and presented more frequently with severe sepsis/septic shock. The all-cause 28-day mortality was significantly higher for pBSI versus mBSI (38.3% vs. 24.7%; P=0.033), whereas appropriateness of treatment was comparable (78.7% vs. 86.6%). Primary bacteraemia by combinations of Enterococcus faecalis, Klebsiella pneumoniaeand Acinetobacter baumanniiwas predominant among pBSIs; in mBSIs, urinary tract infections by Escherichia coli, K. pneumoniaeor Pseudomonas aeruginosapredominated. Multivariate analysis demonstrated pBSI as a significant contributor to 28-day mortality (HR=1.86; P=0.039), along with presence of two or more co-morbidities (HR=2.35; P=0.004). In conclusion, pBSIs differed epidemiologically from mBSIs, with the emergence of enterococcal species, and portended an almost two-fold increased risk of 28-day mortality. Prospective studies are warranted to elucidate possibly modifiable factors.

We performed a systematic review and meta-analysis of short- vs long-duration antibiotic regimens for ventilator-associated pneumonia (VAP).

ABSTRACTThe aim of this study was the assessment of the utilization of two methods, i.e. the Thornthwaite and the Turc equations, for the analysis of the water balance in an environmentally sensitive area. The hydrologic balance of a basin consisting in two lakes (Zazari and Cheimaditida) in northern Greece, and covering an area of 228 km2has been estimated. The Thornthwaite method was applied in the study area, for the calculation of the evapotranspiration factor and was compared to the results obtained by the application of the Turc method in the same area. For the development of these equations and the calculation of the evapotranspiration rates, monthly temperature and precipitation values collected from meteorological stations over a period of 30 years were used. The utilization of monthly average temperatures in the Thornthwaite equation resulted to an actual evapotranspiration rate of ΕT = 412.7 mm (80.23%) for p = 514.4 mm and a runoff rate of Q = 101.7 mm (19.77%). However, the Turc equation gave slightly higher values i.e. ET = 428.8 mm. Nevertheless, the application of the Turc equation, using the corrected temperature factor Tc, resulted to the calculation of an evapotranspiration value similar to the corresponding estimated by the Thornthwaite equation, indicating that the utilization of the former method could be favored, due to its simplicity over the latter one.

The aim of this study was the assessment of the utilization of two methods, i.e. the Thornthwaite and the Turc equations, for the analysis of the water balance in an environmentally sensitive area. The hydrologic balance of a basin consisting in two lakes (Zazari and Cheimaditida) in northern Greece, and covering an area of 228 km2has been estimated. The Thornthwaite method was applied in the study area, for the calculation of the evapotranspiration factor and was compared to the results obtained by the application of the Turc method in the same area. For the development of these equations and the calculation of the evapotranspiration rates, monthly temperature and precipitation values collected from meteorological stations over a period of 30 years were used. The utilization of monthly average temperatures in the Thornthwaite equation resulted to an actual evapotranspiration rate of ΕT = 412.7mm (80.23%) for p = 514.4mm and a runoff rate of Q = 101.7mm (19.77%). However, the Turc equation gave slightly higher values i.e. ET = 428.8 mm. Nevertheless, the application of the Turc equation, using the corrected temperature factor Tc, resulted to the calculation of an evapotranspiration value similar to the corresponding estimated by the Thornthwaite equation, indicating that the utilization of the former method could be favored, due to its simplicity over the latter one.

Malaria is one of todays most serious diseases with an enormous socioeconomic impact. While anti- malarial drugs have existed for some time and vaccines development may be underway, the most successful malaria eradication programs have thus far relied on attacking the mosquito vector that spreads the disease causing agent Plasmodium. Here we will review past, current and future perspectives of malaria vector control strategies and how these approaches have taken a promising turn thanks recent advances in functional genomics and molecular biology.

Aspergillus, a ubiquitous fungus, may cause a variety of clinical syndromes in the lung, depending on immune status of the host as well as the presence of underlying lung disease. The clinical spectrum of pulmonary aspergillosis ranges from aspergilloma in patients with cavitary lung disease and allergic bronchopulmonary aspergillosis in patients with hypersensitivity to Aspergillusantigens to invasive pulmonary aspergillosis in immunocompromised patients and chronic necrotizing aspergillosis in patients with chronic lung disease or mild immunosuppression. Organ transplantation, immunosuppressive therapy, chronic lung disease, and critical illness are considered risk factors for pulmonary aspergillosis. During the last years, major advances have taken place in the diagnosis and management of these diseases with the development of newer noninvasive diagnostic techniques and antifungal agents, such as derivatives of azoles and echinocandins.

Tigecycline is a novel antibacterial agent with a wide spectrum of antimicrobial activity that includes pathogens with clinically significant resistance patterns. The clinical effectiveness of tigecycline has been evaluated in several non-inferiority, phase III, randomized, double-blind, controlled clinical trials regarding, mainly, complicated skin and skin structure infections and complicated intraabdominal infections. Clinical data regarding the effectiveness of tigecycline against infections caused by multidrug-resistant pathogens that commonly affect severely ill patients as well as community acquired pneumonia are favorable, yet limited. The consideration of the pharmacokinetic and pharmacodynamic properties of tigecycline may aid in further understanding the therapeutic role of this agent. Respectively, the utility of tigecycline in the treatment of severe infections involving the bloodstream has not been substantiated, particularly regarding pathogens with borderline susceptibility. Moreover, the fact that a relatively small proportion of the administered tigecycline dose is excreted unchanged in the urine may compromise the effectiveness of this agent in serious urinary tract infections. Increasing the dose of tigecycline to maximize effectiveness against severe infections appears as an appealing therapeutic option, considering the linear pharmacokinetics exhibited by this agent. However, gastrointestinal toxicity (nausea and vomiting) is usually dose-limiting. Further research is recommended on therapeutic strategies to optimize the effectiveness and safety of tigecycline therapy in severely ill patients.

The epidemiological and clinical relevance of Candidain the ICU is reviewed. Three issues were appraised. First is the prevalence of Candida. Second is the relevance of nonblood cultures positive for Candidaand multisite colonization. Third is the importance of invasive candidiasis in terms of mortality.

Clinical resolution of ventilator-associated pneumonia (VAP) determines the duration of treatment and mechanical ventilation. The aim of this study was to evaluate the influence of organisms and their susceptibility to treatment on outcomes.