29 results on '"Orasch C"'
Search Results
2. Accuracy of Sensititre YeastOne echinocandins epidemiological cut-off values for identification of FKS mutant Candida albicans and Candida glabrata: a ten year national survey of the Fungal Infection Network of Switzerland (FUNGINOS)
- Author
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Kritikos, A., primary, Neofytos, D., additional, Khanna, N., additional, Schreiber, P.W., additional, Boggian, K., additional, Bille, J., additional, Schrenzel, J., additional, Mühlethaler, K., additional, Zbinden, R., additional, Bruderer, T., additional, Goldenberger, D., additional, Pfyffer, G., additional, Conen, A., additional, Van Delden, C., additional, Zimmerli, S., additional, Sanglard, D., additional, Bachmann, D., additional, Marchetti, O., additional, Lamoth, F., additional, Bregenzer, T., additional, Flückiger, U., additional, Orasch, C., additional, Heininger, U., additional, Franciolli, M., additional, Damonti, L., additional, Rothen, M., additional, Zellweger, C., additional, Tarr, P., additional, Fleisch, F., additional, Chuard, C., additional, Erard, V., additional, Emonet, S., additional, Garbino, J., additional, van Delden, C., additional, Genne, D., additional, Bochud, P., additional, Calandra, T., additional, Chave, J., additional, Graber, P., additional, Monotti, R., additional, Regionale, O., additional, Bernasconi, E., additional, Civico, O., additional, Rossi, M., additional, Krause, M., additional, Piso, R., additional, Bally, F., additional, Troillet, N., additional, Eich, G., additional, Gubler, J., additional, Fehr, J., additional, Imhof, A., additional, Ruef, C., additional, Berger, C., additional, Fankhauser, H., additional, Heinzer, I., additional, Frei, R., additional, Hertel, R., additional, Dolina, M., additional, Petrini, O., additional, Dubuis, O., additional, Graf, S., additional, Risch, M., additional, Ritzler, E., additional, Fracheboud, D., additional, Rohner, P., additional, Lienhardt, R., additional, Andreutti-Zaugg, C., additional, Gallusser, A., additional, Herzog, K., additional, Schibli, U., additional, Tissière, L., additional, and Schultze, D., additional
- Published
- 2018
- Full Text
- View/download PDF
3. Re: 'Comparison of antipseudomonal betalactams for febrile neutropenia empiric therapy: systematic review and network metaanalysis' by Horita et al
- Author
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Averbuch, D., Orasch, C., Mikulska, M., Livermore, D.M., Viscoli, C., Gyssens, I.C., Kern, W.V., Klyasova, G., Marchetti, O., Engelhard, D., Akova, M., Calandra, T., Cordonnier, C., Averbuch, D., Orasch, C., Mikulska, M., Livermore, D.M., Viscoli, C., Gyssens, I.C., Kern, W.V., Klyasova, G., Marchetti, O., Engelhard, D., Akova, M., Calandra, T., and Cordonnier, C.
- Abstract
Item does not contain fulltext
- Published
- 2018
4. 53-jähriger Patient mit Fieber und Husten
- Author
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Orasch, C., Battegay, M., Orasch, C., and Battegay, M.
- Abstract
Zusammenfassung: Wir beschreiben einen Patienten mit später HIV-Präsentation, Meningitis tuberculosa und offener Lungentuberkulose bei Miliartuberkulose unter schwerer HIV-assoziierter Immunsuppression. Im Verlauf tritt eine weitere opportunistische Infektion (Pneumocystis-jiroveci-Pneumonie) und im Rahmen der antiretroviralen Therapie ein Immunrekonstitutionssyndrom (IRIS) auf. Letzteres führt zu weiteren Organmanifestationen der Miliartuberkulose (urogenital, gastrointestinal). Mit der späten HIV-Präsentation assoziierte Probleme sind opportunistische Infektionen und das IRIS zu Beginn der antiretroviralen Therapie. Die Wahl des Behandlungszeitpunkts der HIV-Infektion bei gleichzeitiger opportunistischer Infektion ist entscheidend
- Published
- 2018
5. Re: “Comparison of antipseudomonal betalactams for febrile neutropenia empiric therapy: systematic review and network metaanalysis” by Horita et al.
- Author
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Averbuch, D., primary, Orasch, C., additional, Mikulska, M., additional, Livermore, D.M., additional, Viscoli, C., additional, Gyssens, I.C., additional, Kern, W.V., additional, Klyasova, G., additional, Marchetti, O., additional, Engelhard, D., additional, Akova, M., additional, Calandra, T., additional, and Cordonnier, C., additional
- Published
- 2018
- Full Text
- View/download PDF
6. Discontinuation of empirical antibiotic therapy in neutropenic leukaemia patients with fever of unknown origin is ethical
- Author
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Orasch, C., Averbuch, D., Mikulska, M., Cordonnier, C., Livermore, D.M., Gyssens, I.C., Klyasova, G., Engelhard, D., Kern, W., Viscoli, C., Akova, M., and Marchetti, O.
- Published
- 2015
- Full Text
- View/download PDF
7. Accuracy of Sensititre YeastOne echinocandins epidemiological cut-off values for identification of FKS mutant Candida albicans and Candida glabrata: a ten year national survey of the Fungal Infection Network of Switzerland (FUNGINOS)
- Author
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Bregenzer, T., Conen, A., Flückiger, U., Khanna, N., Orasch, C., Heininger, U., Franciolli, M., Damonti, L., Zimmerli, S., Rothen, M., Zellweger, C., Tarr, P., Fleisch, F., Chuard, C., Erard, V., Emonet, S., Garbino, J., van Delden, C., Genne, D., Bochud, P., Calandra, T., Lamoth, F., Marchetti, O., Chave, J., Graber, P., Monotti, R., Regionale, O., Bernasconi, E., Civico, O., Rossi, M., Krause, M., Piso, R., Bally, F., Troillet, N., Boggian, K., Eich, G., Gubler, J., Fehr, J., Imhof, A., Ruef, C., Berger, C., Fankhauser, H., Heinzer, I., Frei, R., Hertel, R., Dolina, M., Petrini, O., Dubuis, O., Mühlethaler, K., Graf, S., Risch, M., Ritzler, E., Fracheboud, D., Schrenzel, J., Rohner, P., Lienhardt, R., Bille, J., Andreutti-Zaugg, C., Gallusser, A., Pfyffer, G., Herzog, K., Schibli, U., Tissière, L., Bruderer, T., Schultze, D., Zbinden, R., Kritikos, A., Neofytos, D., Schreiber, P.W., Goldenberger, D., Van Delden, C., Sanglard, D., and Bachmann, D.
- Published
- 2018
- Full Text
- View/download PDF
8. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia
- Author
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Averbuch, D., Orasch, C., Cordonnier, C., Livermore, D.M., Mikulska, M., Viscoli, C., Gyssens, I.C.J., Kern, W.V., Klyasova, G., Marchetti, O., Engelhard, D., Akova, M., Ecil, a.j.v.o.E.E.I.E.E., Eln, ., İç Hastalıkları, ECIL4 a joint venture of EBMT EORTC ICHS ESGICH/ESCMID, and ELN
- Subjects
medicine.medical_specialty ,business.industry ,medicine.drug_class ,Antibiotics ,Drug resistance ,Hematology ,Neutropenia ,medicine.disease ,Pathogenesis and modulation of inflammation [N4i 1] ,Regimen ,Absolute neutrophil count ,Medicine ,Infection control ,Errata Corrige ,Fever of unknown origin ,business ,Intensive care medicine ,Guideline Articles ,Febrile neutropenia - Abstract
Owing to increasing resistance and the limited arsenal of new antibiotics, especially against Gram-negative pathogens, carefully designed antibiotic regimens are obligatory for febrile neutropenic patients, along with effective infection control. The Expert Group of the 4th European Conference on Infections in Leukemia has developed guidelines for initial empirical therapy in febrile neutropenic patients, based on: i) the local resistance epidemiology; and ii) the patient's risk factors for resistant bacteria and for a complicated clinical course. An 'escalation' approach, avoiding empirical carbapenems and combinations, should be employed in patients without particular risk factors. A 'deescalation' approach, with initial broad-spectrum antibiotics or combinations, should be used only in those patients with: i) known prior colonization or infection with resistant pathogens; or ii) complicated presentation; or iii) in centers where resistant pathogens are prevalent at the onset of febrile neutropenia. In the latter case, infection control and antibiotic stewardship also need urgent review. Modification of the initial regimen at 72-96 h should be based on the patient's clinical course and the microbiological results. Discontinuation of antibiotics after 72 h or later should be considered in neutropenic patients with fever of unknown origin who are hemodynamically stable since presentation and afebrile for at least 48 h, irrespective of neutrophil count and expected duration of neutropenia. This strategy aims to minimize the collateral damage associated with antibiotic overuse, and the further selection of resistance. The ECIL-4 meeting has been supported by unrestricted educational grants from Astellas Pharma, Gilead Sciences, Merck, Novartis, and Pfizer.
- Published
- 2013
9. Toxic Megacolon due to Fulminant Amebic Colitis in a non Endemic Area
- Author
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Hugelshofer, S., Petermann, D., Orasch, C., and Liaudet, L.
- Published
- 2013
10. Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011)
- Author
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Averbuch, D., Cordonnier, C., Livermore, D.M., Mikulska, M., Orasch, C., Viscoli, C., Gyssens, I.C.J., Kern, W.V., Klyasova, G., Marchetti, O., Engelhard, D., Akova, M., Ecil, a.j.v.o.E.E.I.E.E., Eln, ., and İç Hastalıkları
- Subjects
medicine.medical_treatment ,Hematology ,Tigecycline ,Fosfomycin ,Biology ,medicine.disease ,Targeted therapy ,Pathogenesis and modulation of inflammation [N4i 1] ,Leukemia ,chemistry.chemical_compound ,chemistry ,Linezolid ,Immunology ,medicine ,Colistin ,Stem cell ,Guideline Articles ,Polymyxin B ,medicine.drug - Abstract
The detection of multi-resistant bacterial pathogens, particularly those to carbapenemases, in leukemic and stem cell transplant patients forces the use of old or non-conventional agents as the only remaining treatment options. These include colistin/polymyxin B, tigecycline, fosfomycin and various anti-gram-positive agents. Data on the use of these agents in leukemic patients are scanty, with only linezolid subjected to formal trials. The Expert Group of the 4th European Conference on Infections in Leukemia has developed guidelines for their use in these patient populations. Targeted therapy should be based on (i) in vitro susceptibility data, (ii) knowledge of the best treatment option against the particular species or phenotype of bacteria, (iii) pharmacokinetic/pharmacodynamic data, and (iv) careful assessment of the risk-benefit balance. For infections due to resistant Gram-negative bacteria, these agents should be preferably used in combination with other agents that remain active in vitro, because of suboptimal efficacy (e.g., tigecycline) and the risk of emergent resistance (e.g., fosfomycin). The paucity of new antibacterial drugs in the near future should lead us to limit the use of these drugs to situations where no alternative exists. The ECIL-4 meeting has been supported by unrestricted educational grants from Astellas Pharma, Gilead Sciences, Merck, Novartis and Pfizer.
- Published
- 2013
11. Identification of Propionibacterium avidum from a breast abscess: an overlooked etiology of clinically significant infections
- Author
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Kritikos, A., primary, Pagin, M., additional, Borens, O., additional, Voide, C., additional, and Orasch, C., additional
- Published
- 2015
- Full Text
- View/download PDF
12. Progrediente Knochenschmerzen bei einer jungen Patientin
- Author
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Egli, A, primary, GollerWittekind, U, additional, Vetter, M, additional, Bucher, C, additional, Dirnhofer, S, additional, and Orasch, C, additional
- Published
- 2010
- Full Text
- View/download PDF
13. The farmer who didn't need a wheel barrow
- Author
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Hochholzer, W., primary, Orasch, C., additional, Huber, S., additional, Arranto, C., additional, and Hunziker, S., additional
- Published
- 2009
- Full Text
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14. La fièvre dangereuse, ou aussi bénéfique?
- Author
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Tschudin, S, primary, Orasch, C, additional, and Flückiger, U, additional
- Published
- 2009
- Full Text
- View/download PDF
15. Fieber gefährlich oder auch nützlich?
- Author
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Tschudin, S, primary, Orasch, C, additional, and Flückiger, U, additional
- Published
- 2009
- Full Text
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16. Lyme-Borreliose in der Schweiz
- Author
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Orasch, C, primary, Peter, I, additional, and Flückiger, U, additional
- Published
- 2007
- Full Text
- View/download PDF
17. Borréliose de Lyme en Suisse
- Author
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Orasch, C, primary, Peter, I, additional, and Flückiger, U, additional
- Published
- 2007
- Full Text
- View/download PDF
18. 53-jähriger Patient mit Fieber und Husten
- Author
-
Orasch, C., Battegay, M., Orasch, C., and Battegay, M.
- Abstract
Zusammenfassung: Wir beschreiben einen Patienten mit später HIV-Präsentation, Meningitis tuberculosa und offener Lungentuberkulose bei Miliartuberkulose unter schwerer HIV-assoziierter Immunsuppression. Im Verlauf tritt eine weitere opportunistische Infektion (Pneumocystis-jiroveci-Pneumonie) und im Rahmen der antiretroviralen Therapie ein Immunrekonstitutionssyndrom (IRIS) auf. Letzteres führt zu weiteren Organmanifestationen der Miliartuberkulose (urogenital, gastrointestinal). Mit der späten HIV-Präsentation assoziierte Probleme sind opportunistische Infektionen und das IRIS zu Beginn der antiretroviralen Therapie. Die Wahl des Behandlungszeitpunkts der HIV-Infektion bei gleichzeitiger opportunistischer Infektion ist entscheidend
19. Trends of the Epidemiology of Candidemia in Switzerland: A 15-Year FUNGINOS Survey
- Author
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Kai-Manuel, Adam, Michael, Osthoff, Frédéric, Lamoth, Anna, Conen, Véronique, Erard, Katia, Boggian, Peter W, Schreiber, Stefan, Zimmerli, Pierre-Yves, Bochud, Dionysios, Neofytos, Mapi, Fleury, Hans, Fankhauser, Daniel, Goldenberger, Konrad, Mühlethaler, Arnaud, Riat, Reinhard, Zbinden, Andreas, Kronenberg, Chantal, Quiblier, Oscar, Marchetti, Nina, Khanna, University of Zurich, Khanna, Nina, Fungal Infection Network of Switzerland (FUNGINOS), Bregenzer, T., Conen, A., Adam, K.M., Flückiger, U., Khanna, N., Orasch, C., Heininger, U., Franciolli, M., San Giovanni, O., Damonti, L., Zimmerli, S., Rothen, M., Zellweger, C., Tarr, P., Fleisch, F., Chuard, C., Erard, V., Emonet, S., Garbino, J., Neofytos, D., van Delden, C., Genne, D., Bochud, P.Y., Calandra, T., Lamoth, F., Marchetti, O., Chave, J.P., Bois-Cerf, C., Cécil, C., La Source, C., Graber, P., Monotti, R., Regionale, O., Bernasconi, E., Civico, O., Rossi, M., Krause, M., Piso, R.J., Bally, F., Troillet, N., Boggian, K., Eich, G., Gubler, J., Fehr, J., Imhof, A., Ruef, C., Werner Schreiber, P., Berger, C., Fankhauser, H., Heinzer, I., Goldenberger, D., Frei, R., Hertel, R., Dolina, M., Petrini, O., Dubuis, O., Mühlethaler, K., Graf, S., Risch, M., Ritzler, E., Fracheboud, D., Riat, A., Rohner, P., Schrenzel, J., Lienhardt, R., Bille, J., Andreutti-Zaugg, C., Gallusser, A., Pfyffer, G., Herzog, K., Schibli, U., Tissière, L., Bruderer, T., and Zbinden, R.
- Subjects
medicine.medical_specialty ,Population ,610 Medicine & health ,resistance ,10234 Clinic for Infectious Diseases ,Internal medicine ,Intensive care ,medicine ,Major Article ,education ,Candida albicans ,education.field_of_study ,biology ,Candida glabrata ,business.industry ,10179 Institute of Medical Microbiology ,Incidence (epidemiology) ,candidemia ,Micafungin ,biology.organism_classification ,bacterial infections and mycoses ,Infectious Diseases ,AcademicSubjects/MED00290 ,2728 Neurology (clinical) ,Oncology ,antifungals ,candida ,epidemiology ,Anidulafungin ,570 Life sciences ,2730 Oncology ,business ,Fluconazole ,medicine.drug - Abstract
Background The increasing incidence of candidemia and emergence of drug-resistant Candida species are major concerns worldwide. Long-term surveillance studies are needed. Methods The Fungal Infection Network of Switzerland (FUNGINOS) conducted a 15-year (2004–2018), nationwide, epidemiological study of candidemia. Hospital-based incidence of candidemia, Candida species distribution, antifungal susceptibility, and consumption were stratified in 3 periods (2004–2008, 2009–2013, 2014–2018). Population-based incidence over the period 2009–2018 derived from the Swiss Antibiotic Resistance Surveillance System (ANRESIS). Results A total of 2273 Candida blood isolates were studied. Population and hospital-based annual incidence of candidemia increased from 2.96 to 4.20/100 000 inhabitants (P = .022) and 0.86 to 0.99/10 000 patient-days (P = .124), respectively. The proportion of Candida albicans decreased significantly from 60% to 53% (P = .0023), whereas Candida glabrata increased from 18% to 27% (P < .0001). Other non-albicans Candida species remained stable. Candida glabrata bloodstream infections occurred predominantly in the age group 18–40 and above 65 years. A higher proportional increase of C glabrata was recorded in wards (18% to 29%, P < .0001) versus intensive care units (19% to 24%, P = .22). According to Clinical and Laboratory Standards Institute, nonsusceptibility to fluconazole in C albicans was observed in 1% of isolates, and anidulafungin and micafungin nonsusceptibility was observed in 2% of C albicans and C glabrata. Fluconazole consumption, the most frequently used antifungal, remained stable, whereas use of mold-active triazoles and echinocandins increased significantly in the last decade (P < .0001). Conclusions Over the 15-year period, the incidence of candidemia increased. A species shift toward C glabrata was recently observed, concurring with increased consumption of mold-active triazoles., The incidence of candidemia increased in Switzerland from 2004 to 2018. A species shift toward C glabrata was observed after 2013, now accounting for one fourth of all candidemia, concurring with increased consumption of mold-active triazoles.
- Published
- 2021
20. Performance of the T2Candida Panel for the Diagnosis of Intra-abdominal Candidiasis.
- Author
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Lamoth F, Clancy CJ, Tissot F, Squires K, Eggimann P, Flückiger U, Siegemund M, Orasch C, Zimmerli S, Calandra T, Marchetti O, Nguyen MH, and Bochud PY
- Abstract
Performance of T2Candida for detecting intra-abdominal candidiasis (IAC) was assessed in 48 high-risk patients. T2Candida sensitivity/specificity and positive/negative predictive values were 33%/93% and 71%/74%, respectively. IAC was present in 100% of cases with concordant positive T2Candida/1,3-beta-d-glucan and absent in 90% of concordant negative results. Combination T2Candida/1,3-beta-d-glucan may help guide treatment decisions., (© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
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- 2020
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21. The J-Curve in HIV: Low and Moderate Alcohol Intake Predicts Mortality but Not the Occurrence of Major Cardiovascular Events.
- Author
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Wandeler G, Kraus D, Fehr J, Conen A, Calmy A, Orasch C, Battegay M, Schmid P, Bernasconi E, and Furrer H
- Subjects
- Adult, Alcoholic Beverages, Cohort Studies, Dose-Response Relationship, Drug, Female, HIV Infections epidemiology, Humans, Male, Middle Aged, Switzerland epidemiology, Alcohol Drinking, Cardiovascular Diseases epidemiology, HIV Infections complications, HIV Infections mortality
- Abstract
Objectives: In HIV-negative populations, light-to-moderate alcohol consumption is associated with a lower cardiovascular morbidity and mortality than alcohol abstention. Whether the same holds true for HIV-infected individuals has not been evaluated in detail., Design: Cohort study., Methods: Adults on antiretroviral therapy in the Swiss HIV Cohort Study with follow-up after August 2005 were included. We categorized alcohol consumption into: abstention or very low (<1 g/d), low (1-9 g/d), moderate (10-29 g/d in women and 10-39 g/d in men), and high alcohol intake. Cox proportional hazards models were used to describe the association between alcohol consumption and cardiovascular disease-free survival (combined endpoint), cardiovascular disease events (CADE) and overall survival. Baseline and time-updated risk factors for CADE were included in the models., Results: Among 9741 individuals included, there were 788 events of major CADE or death during 46,719 patient-years of follow-up, corresponding to an incidence of 1.69 events/100 person-years. Follow-up according to alcohol consumption level was 51% no or very low, 20% low, 23% moderate, and 6% high intake. As compared with no or very low alcohol intake, low (hazard ratio 0.79, 95% confidence interval 0.63 to 0.98) and moderate alcohol intakes (0.78, 0.64 to 0.95) were associated with a lower incidence of the combined endpoint. There was no significant association between alcohol consumption and CADE., Conclusions: Compared with no or very low alcohol consumption, low and moderate intake associated with a better CADE-free survival. However, this result was mainly driven by mortality and the specific impact of drinking patterns and type of alcoholic beverage on this outcome remains to be determined.
- Published
- 2016
- Full Text
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22. Identification of Propionibacterium avidum from a breast abscess: an overlooked etiology of clinically significant infections.
- Author
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Kritikos A, Pagin M, Borens O, Voide C, and Orasch C
- Abstract
We report the case of a 37-year-old previously healthy woman diagnosed with a breast abscess due to Propionibacterium avidum after breast reduction surgery. This case emphasizes the potential pathogenicity and morbidity associated with this commensal skin organism.
- Published
- 2014
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23. Weekly use of fluconazole as prophylaxis in haematological patients at risk for invasive candidiasis.
- Author
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Vuichard D, Weisser M, Orasch C, Frei R, Heim D, Passweg JR, and Widmer AF
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- Adult, Candida classification, Candida drug effects, Drug Resistance, Fungal, Female, Hematologic Neoplasms microbiology, Hospitals, Humans, Incidence, Male, Middle Aged, Retrospective Studies, Switzerland, Antifungal Agents administration & dosage, Candida isolation & purification, Candidemia prevention & control, Candidiasis, Invasive prevention & control, Fluconazole administration & dosage
- Abstract
Background: The goal was to determine whether one medical centres' unique antifungal prophylactic regimen for patients at high risk for invasive candidiasis because of their haematological malignancies, haematopoietic stem cell transplants, or high-dose chemotherapy might lead ultimately to a higher incidence of infection, to increasing fluconazole resistance, or to a shift in the predominant strain of Candida in invasive fungal episodes., Methods: Data were collected retrospectively, for a ten-year period from ONKO-KISS surveillance records, and from hospital, medical, and pharmacy records and then evaluated with respect to incidence of fungal infection episodes, emergence of antifungal drug resistance, and predominance of specific Candida strains in isolate cultures. Fisher's exact test and linear regression were used to compare minimum inhibitory concentrations and to compare the incidence of different Candida isolates, respectively., Results: The incidence of infection remained quite stable over 10 years with a median of 0.67 episodes/1000 bed days. Overall, Candida glabrata was the predominant species with 29% followed by C. albicans and C. krusei (14% each). No significant increment of non-albicans Candida species with decreased fluconazole susceptibility was perceived over this decade., Conclusions: Once weekly administration of 400 mg of fluconazole to prevent candidaemia appears to have no negative impact on the efficacy as a prophylaxis when compared to standard of care (400 mg of fluconazole daily).
- Published
- 2014
- Full Text
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24. Association of alcohol consumption and HIV surrogate markers in participants of the swiss HIV cohort study.
- Author
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Conen A, Wang Q, Glass TR, Fux CA, Thurnheer MC, Orasch C, Calmy A, Bernasconi E, Vernazza P, Weber R, Bucher HC, Battegay M, and Fehr J
- Subjects
- Adult, Biomarkers, CD4 Lymphocyte Count, Cohort Studies, Female, HIV Infections drug therapy, HIV Infections virology, Humans, Male, Medication Adherence statistics & numerical data, Middle Aged, Switzerland epidemiology, Viral Load, Alcohol Drinking adverse effects, Anti-Retroviral Agents therapeutic use, HIV Infections epidemiology
- Abstract
Background: Alcohol consumption may affect the course of HIV infection and/or antiretroviral therapy (ART). The authors investigated the association between self-reported alcohol consumption and HIV surrogate markers in both treated and untreated individuals., Design: Prospective cohort study., Methods: Over a 7-year period, the authors analyzed 2 groups of individuals in the Swiss HIV Cohort Study: (1) ART-naïve individuals remaining off ART and (2) individuals initiating first ART. For individuals initiating first ART, time-dependent Cox proportional hazards models were used to assess the association between alcohol consumption, virological failure, and ART interruption. For both groups, trajectories of log-transformed CD4 cell counts were analyzed using linear mixed models with repeated measures., Results: The authors included 2982 individuals initiating first ART and 2085 ART naives. In individuals initiating first ART, 241 (8%) experienced virological failure. Alcohol consumption was not associated with virological failure. ART interruption was noted in 449 (15%) individuals and was more prevalent in severe compared with none/light health risk drinkers [hazard ratio: 2.24, 95% confidence interval: 1.42 to 3.52]. The association remained significant even after adjusting for nonadherence. The authors did not find an association between alcohol consumption and change in CD4 cell count over time in either group., Conclusions: No effect of alcohol consumption on either virological failure or CD4 cell count in both groups of ART-initiating and ART-naive individuals was found. However, severe drinkers were more likely to interrupt ART. Efforts on ART continuation should be especially implemented in individuals reporting high alcohol consumption.
- Published
- 2013
- Full Text
- View/download PDF
25. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia.
- Author
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Averbuch D, Orasch C, Cordonnier C, Livermore DM, Mikulska M, Viscoli C, Gyssens IC, Kern WV, Klyasova G, Marchetti O, Engelhard D, and Akova M
- Subjects
- Anti-Bacterial Agents pharmacology, Drug Resistance, Bacterial drug effects, Europe epidemiology, Fever epidemiology, Fever microbiology, Humans, Leukemia epidemiology, Leukemia microbiology, Neutropenia epidemiology, Neutropenia microbiology, Anti-Bacterial Agents therapeutic use, Drug Resistance, Bacterial physiology, Fever drug therapy, Leukemia drug therapy, Neutropenia drug therapy, Practice Guidelines as Topic standards
- Abstract
Owing to increasing resistance and the limited arsenal of new antibiotics, especially against Gram-negative pathogens, carefully designed antibiotic regimens are obligatory for febrile neutropenic patients, along with effective infection control. The Expert Group of the 4(th) European Conference on Infections in Leukemia has developed guidelines for initial empirical therapy in febrile neutropenic patients, based on: i) the local resistance epidemiology; and ii) the patient's risk factors for resistant bacteria and for a complicated clinical course. An 'escalation' approach, avoiding empirical carbapenems and combinations, should be employed in patients without particular risk factors. A 'de-escalation' approach, with initial broad-spectrum antibiotics or combinations, should be used only in those patients with: i) known prior colonization or infection with resistant pathogens; or ii) complicated presentation; or iii) in centers where resistant pathogens are prevalent at the onset of febrile neutropenia. In the latter case, infection control and antibiotic stewardship also need urgent review. Modification of the initial regimen at 72-96 h should be based on the patient's clinical course and the microbiological results. Discontinuation of antibiotics after 72 h or later should be considered in neutropenic patients with fever of unknown origin who are hemodynamically stable since presentation and afebrile for at least 48 h, irrespective of neutrophil count and expected duration of neutropenia. This strategy aims to minimize the collateral damage associated with antibiotic overuse, and the further selection of resistance.
- Published
- 2013
- Full Text
- View/download PDF
26. Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011).
- Author
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Averbuch D, Cordonnier C, Livermore DM, Mikulska M, Orasch C, Viscoli C, Gyssens IC, Kern WV, Klyasova G, Marchetti O, Engelhard D, and Akova M
- Subjects
- Drug Resistance, Multiple, Bacterial physiology, Europe epidemiology, Gram-Negative Bacterial Infections drug therapy, Gram-Negative Bacterial Infections microbiology, Gram-Positive Bacterial Infections drug therapy, Gram-Positive Bacterial Infections microbiology, Humans, Leukemia epidemiology, Leukemia microbiology, Anti-Bacterial Agents administration & dosage, Drug Delivery Systems methods, Drug Resistance, Multiple, Bacterial drug effects, Hematopoietic Stem Cell Transplantation adverse effects, Leukemia drug therapy, Practice Guidelines as Topic standards
- Abstract
The detection of multi-resistant bacterial pathogens, particularly those to carbapenemases, in leukemic and stem cell transplant patients forces the use of old or non-conventional agents as the only remaining treatment options. These include colistin/polymyxin B, tigecycline, fosfomycin and various anti-gram-positive agents. Data on the use of these agents in leukemic patients are scanty, with only linezolid subjected to formal trials. The Expert Group of the 4(th) European Conference on Infections in Leukemia has developed guidelines for their use in these patient populations. Targeted therapy should be based on (i) in vitro susceptibility data, (ii) knowledge of the best treatment option against the particular species or phenotype of bacteria, (iii) pharmacokinetic/pharmacodynamic data, and (iv) careful assessment of the risk-benefit balance. For infections due to resistant Gram-negative bacteria, these agents should be preferably used in combination with other agents that remain active in vitro, because of suboptimal efficacy (e.g., tigecycline) and the risk of emergent resistance (e.g., fosfomycin). The paucity of new antibacterial drugs in the near future should lead us to limit the use of these drugs to situations where no alternative exists.
- Published
- 2013
- Full Text
- View/download PDF
27. β-glucan antigenemia anticipates diagnosis of blood culture-negative intraabdominal candidiasis.
- Author
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Tissot F, Lamoth F, Hauser PM, Orasch C, Flückiger U, Siegemund M, Zimmerli S, Calandra T, Bille J, Eggimann P, and Marchetti O
- Subjects
- Adult, Aged, Aged, 80 and over, Candidiasis complications, Candidiasis immunology, Cohort Studies, Colony Count, Microbial, Female, Humans, Intensive Care Units, Intestinal Perforation complications, Intraabdominal Infections complications, Intraabdominal Infections diagnosis, Male, Middle Aged, Pancreatitis, Acute Necrotizing complications, Prospective Studies, Recurrence, Sensitivity and Specificity, Young Adult, Candidiasis diagnosis, Intraabdominal Infections blood, beta-Glucans immunology
- Abstract
Rationale: Life-threatening intraabdominal candidiasis (IAC) occurs in 30 to 40% of high-risk surgical intensive care unit (ICU) patients. Although early IAC diagnosis is crucial, blood cultures are negative, and the role of Candida score/colonization indexes is not established., Objectives: The aim of this prospective Fungal Infection Network of Switzerland (FUNGINOS) cohort study was to assess accuracy of 1,3-β-d-glucan (BG) antigenemia for diagnosis of IAC., Methods: Four hundred thirty-four consecutive adults with abdominal surgery or acute pancreatitis and ICU stay 72 hours or longer were screened: 89 (20.5%) at high risk for IAC were studied (68 recurrent gastrointestinal tract perforation, 21 acute necrotizing pancreatitis). Diagnostic accuracy of serum BG (Fungitell), Candida score, and colonization indexes was compared., Measurements and Main Results: Fifty-eight of 89 (65%) patients were colonized by Candida; 29 of 89 (33%) presented IAC (27 of 29 with negative blood cultures). Nine hundred twenty-one sera were analyzed (9/patient): median BG was 253 pg/ml (46-9,557) in IAC versus 99 pg/ml (8-440) in colonization (P < 0.01). Sensitivity and specificity of two consecutive BG measurements greater than or equal to 80 pg/ml were 65 and 78%, respectively. In recurrent gastrointestinal tract perforation it was 75 and 77% versus 90 and 38% (Candida score ≥ 3), 79 and 34% (colonization index ≥ 0.5), and 54 and 63% (corrected colonization index ≥ 0.4), respectively. BG positivity anticipated IAC diagnosis (5 d) and antifungal therapy (6 d). Severe sepsis/septic shock and death occurred in 10 of 11 (91%) and 4 of 11 (36%) patients with BG 400 pg/ml or more versus 5 of 18 (28%, P = 0.002) and 1 of 18 (6%, P = 0.05) with BG measurement less than 400 pg/ml. β-Glucan decreased in IAC responding to therapy and increased in nonresponse., Conclusions: BG antigenemia is superior to Candida score and colonization indexes and anticipates diagnosis of blood culture-negative IAC. This proof-of-concept observation in strictly selected high-risk surgical ICU patients deserves investigation of BG-driven preemptive therapy.
- Published
- 2013
- Full Text
- View/download PDF
28. Hypervariability of biofilm formation and oxacillin resistance in a Staphylococcus epidermidis strain causing persistent severe infection in an immunocompromised patient.
- Author
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Weisser M, Schoenfelder SM, Orasch C, Arber C, Gratwohl A, Frei R, Eckart M, Flückiger U, and Ziebuhr W
- Subjects
- Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Bacteremia microbiology, Fatal Outcome, Humans, Male, Microbial Sensitivity Tests, Oxacillin therapeutic use, Precursor B-Cell Lymphoblastic Leukemia-Lymphoma, Staphylococcal Infections diagnosis, Staphylococcal Infections drug therapy, Stem Cell Transplantation, Young Adult, Biofilms growth & development, Immunocompromised Host, Oxacillin pharmacology, Staphylococcal Infections microbiology, Staphylococcus epidermidis drug effects, Staphylococcus epidermidis pathogenicity, beta-Lactam Resistance
- Abstract
We report on a leukemic patient who suffered from a persistent, generalized, and eventually fatal Staphylococcus epidermidis infection during prolonged aplasia. Over a 6-week period, we isolated a genetically and phenotypically unstable S. epidermidis strain related to an epidemic clone associated with hospital infections worldwide. Strikingly, the strain showed a remarkable degree of variability, with evidence of selection and increasing predominance of biofilm-producing and oxacillin-resistant variants over time. Thus, in the early stages of the infection, the strain was found to generate subpopulations which had spontaneously lost the biofilm-mediating ica locus along with the oxacillin resistance-conferring mecA gene. These deletion mutants were obviously outcompeted by the ica- and mecA-positive wild-type genotype, with the selection and predominance of strongly biofilm-forming and oxacillin-resistant variants in the later stages of the infection. Also, a switch from protein- to polysaccharide intercellular adhesin/poly-N-acetylglucosamine (PIA/PNAG)-mediated-biofilm production was detected among ica-positive variants in the course of the infection. The data highlight the impact of distinct S. epidermidis clonal lineages as serious nosocomial pathogens that, through the generation and selection of highly pathogenic variants, may critically determine disease progression and outcome.
- Published
- 2010
- Full Text
- View/download PDF
29. The farmer who didn't need a wheel barrow.
- Author
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Hochholzer W, Orasch C, Huber S, Arranto C, and Hunziker S
- Abstract
We report the difficulties encountered in diagnosing leptospirosis in an 85-year-old man who presented with non-specific signs and symptoms. Initially, a wide haematologic and oncologic work-up without significant results was performed, as symptoms of several organ dysfunctions emerged and the clinical course showed a rapid deterioration. After several days without a definite diagnosis, the infection was finally detected after reviewing all results and considering the patient's profession as a farmer. After receiving appropriate antibiotic treatment the patient recovered fully.
- Published
- 2009
- Full Text
- View/download PDF
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