The Role of Risk Assessment in ICU Nosocomial Infection Management: A Comprehensive Review of Clinical Outcomes and Biomarker Dynamics
https://doi.org/10.22034/thr.2025.236689
Trupti Rekha Pradhan
Abstract Background: Nosocomial infections remain a significant challenge in intensive care units (ICUs), contributing to increased morbidity, mortality, and healthcare costs. Emerging evidence suggests that structured risk assessment strategies may not only improve infection control but also modulate inflammatory and immune responses.
Methods: A comprehensive literature review was conducted, querying PubMed, Cochrane Library, EMBASE, and Web of Science for studies published through 2025. Eligible studies evaluated risk assessment tools or protocols in ICU settings and reported on outcomes including infection incidence, clinical parameters, and biomarker levels (e.g., inflammatory cytokines).
Results: The integration of structured risk assessment frameworks into ICU infection prevention protocols is associated with substantial benefits. These include reduced infection rates, improved clinical outcomes, and favorable alterations in key biomarker profiles, indicating a potential systemic immunomodulatory effect.
Conclusion: Implementing risk assessment in ICU infection control is advantageous for both clinical outcomes and biomarker patterns. Future research should focus on longitudinal biomarker monitoring and the development of personalized, dynamic risk assessment models to further optimize prevention strategies.
Targeted Antimicrobial Therapy in Urosepsis: A Review of Clinical Evidence and Inflammatory Marker Dynamics
https://doi.org/10.22034/thr.2025.557936.1020
Behkam Rezaiemehr, Reza Laripour, Ahmad Alikhani, Mohsen Yadollahi, Amirsaleh Abdollahi, Mehdi Younesi Rostami, Ahmad Deylami
Abstract Urosepsis is a severe, life-threatening condition caused by the rapid dissemination of urinary-tract pathogens into the bloodstream and an uncontrolled host inflammatory response. The emergence of multidrug-resistant organisms and the variability of immune activation in critically ill patients have made its management increasingly complex. Targeted antimicrobial therapy (TAT)—defined as the selection of antibiotics based on microbiological identification and susceptibility testing—embodies the principles of precision medicine, aiming to optimize treatment effectiveness while minimizing broad-spectrum exposure and the spread of resistance.
This review synthesizes the current evidence regarding the role of TAT in urosepsis, highlighting its effects on systemic inflammation, organ function, and clinical outcomes. Special attention is given to novel biomarkers such as Presepsin, neutrophil CD64 index, and Copeptin, examined alongside classical inflammatory mediators including tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6), and C-reactive protein (CRP). Collectively, these markers provide valuable insights into the interplay between pathogen control and immune modulation. The review also discusses diagnostic and operational barriers to implementing TAT, the variability of antimicrobial stewardship across institutions, and future research directions aimed at integrating biomarker-guided targeted therapy into individualized sepsis management.