9 results on '"Jürgen Prattes"'
Search Results
2. Simulation-based training and assessment of mobile pre-hospital SARS-CoV-2 diagnostic teams in Styria, Austria
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Jürgen Prattes, Lukas P. Mileder, Thomas Wegscheider, and Gerhilde Schüttengruber
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Male ,Objective structured clinical examination ,polymerase chain reaction ,Health Personnel ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Ambulances ,Pneumonia, Viral ,education ,MEDLINE ,Observational Study ,Specimen Handling ,coronavirus disease 2019 ,Betacoronavirus ,03 medical and health sciences ,0302 clinical medicine ,Pandemic ,diagnostics ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Pandemics ,Personal Protective Equipment ,Simulation Training ,Personal protective equipment ,Curriculum ,SARS-CoV-2 ,business.industry ,Gold standard ,COVID-19 ,General Medicine ,simulation ,medicine.disease ,Body Fluids ,Austria ,030220 oncology & carcinogenesis ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Female ,Observational study ,Medical emergency ,Coronavirus Infections ,business ,Research Article ,severe acute respiratory syndrome coronavirus 2 - Abstract
Supplemental Digital Content is available in the text, The World Health Organization has declared coronavirus disease 2019 (COVID-19) a pandemic. Polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the diagnostic gold standard of COVID-19. We have developed a simulation-based training program for mobile prehospital diagnostic teams in the province of Styria, Austria, and performed a prospective observational study on its applicability and effectivity. The 1-day curriculum uses theoretical instruction, technical skills training, and simulator-based algorithm training to teach and train prehospital patient identification and communication, donning the personal protective equipment, collection of naso-/oropharyngeal swabs for SARS-CoV-2 polymerase chain reaction testing, doffing the personal protective equipment, and sample logistics. Trainings were conducted at the SIM CAMPUS simulation hospital, Eisenerz, using high-fidelity patient simulation. To ensure achievement of predefined learning outcomes, participants had to undergo a final simulator-based objective structured clinical examination. In March 2020, 45 emergency medical assistants and 1 physician of the Austrian Red Cross participated on a voluntary basis. Forty-five of the 46 participants (97.8%) completed the curriculum successfully, with mean objective structured clinical examination ratings of 98.6%. Using several proven educational concepts, we have successfully drafted and implemented a training program for mobile prehospital SARS-CoV-2 diagnostic teams. Based on simulation-based objective structured examinations, it has prepared participants effectively for preclinical duties.
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- 2020
3. Antifungal Prophylaxis with Posaconazole Delayed-Release Tablet and Oral Suspension in a Real-Life Setting: Plasma Levels, Efficacy, and Tolerability
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Wilma Zinke-Cerwenka, Robert Krause, Hildegard Greinix, Jürgen Prattes, Timothy C Lin, Martin Hoenigl, Andreas Meinitzer, Albert Wölfler, Ines Zollner-Schwetz, Thomas Valentin, and David Lenczuk
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0301 basic medicine ,Antifungal ,Adult ,Male ,medicine.medical_specialty ,Posaconazole ,Antifungal Agents ,medicine.drug_class ,030106 microbiology ,plasma concentration ,Clinical Therapeutics ,Gastroenterology ,Microbiology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Pharmacology ,medicine.diagnostic_test ,business.industry ,Liter ,Breakthrough infection ,Plasma levels ,Pharmacology and Pharmaceutical Sciences ,Middle Aged ,Triazoles ,posaconazole ,Infectious Diseases ,Tolerability ,Therapeutic drug monitoring ,Medical Microbiology ,Plasma concentration ,Female ,business ,Infection ,medicine.drug - Abstract
We continuously determined posaconazole plasma concentrations (PPCs) in 61 patients with hematological malignancies receiving posaconazole (PCZ) delayed-release tablets (DRT; 48 patients; median duration of intake, 92 days) and PCZ oral solution (OS; 13 patients; median duration of intake, 124 days). PCZ DRT and OS antifungal prophylaxis was efficient and well tolerated. Thirty-four of 48 patients (71%) receiving DRT always had PPCs of >0.7 mg/liter, while 14 of 48 patients (29%) had at least one PPC of ≤0.7 mg/liter. In patients receiving OS, 4 of 13 patients (31%) always had PPCs of >0.7 mg/liter, 6 of 13 patients (46%) had at least one PPC of ≤0.7 mg/liter, and 3 (23%) patients never reached a PPC of 0.7 mg/liter. In patients with at least one determined PPC, the mean proportion of all PPCs of >0.7 mg/liter was 91% for PCZ DRT, whereas it was 52% for PCZ OS ( P = 0.001). In the per sample analysis, PPCs were significantly more likely to be >0.7 mg/liter in patients receiving DRT than in patients receiving OS (PPCs were >0.7 mg/liter in 91.4% [297/325] of patients receiving DRT versus 70.3% [85/121] of patients receiving OS; P < 0.001). Patients receiving PCZ DRT had higher proportions of PPCs of >0.7 mg/liter than patients receiving OS both in the per patient and in the per sample analyses. Two patients (3%) had side effects during PCZ prophylaxis, and one (2%) had fungal breakthrough infection. Therapeutic drug monitoring enables detection of extended periods of PPCs of ≤0.7 mg/liter (e.g., due to nonadherence or graft-versus-host disease), which may also be associated with the loss of protective intracellular PCZ concentrations, regardless of the PCZ formulation.
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- 2017
4. The Toxin-Producing Pathobiont Klebsiella oxytoca Is Not Associated with Flares of Inflammatory Bowel Diseases
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Gebhard Feierl, Jürgen Prattes, Gregor Gorkiewicz, Georg Schneditz, Ellen L. Zechner, Wolfgang Petritsch, Hanna Sprenger, Heimo H. Wenzl, Eva Leitner, Kathrin A. T. Herzog, Ines Zollner-Schwetz, Patrizia Kump, and Christoph Högenauer
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Adult ,DNA, Bacterial ,Male ,medicine.medical_specialty ,Physiology ,medicine.disease_cause ,Microbiology ,Pathogenesis ,Feces ,Young Adult ,fluids and secretions ,Crohn Disease ,Risk Factors ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Benzodiazepinones ,biology ,Toxin ,Klebsiella oxytoca ,Gastroenterology ,Inflammatory Bowel Diseases ,Middle Aged ,biochemical phenomena, metabolism, and nutrition ,Hepatology ,bacterial infections and mycoses ,biology.organism_classification ,digestive system diseases ,Bacterial Typing Techniques ,Klebsiella Infections ,Intestines ,Case-Control Studies ,Immunology ,Disease Progression ,bacteria ,Multilocus sequence typing ,Colitis, Ulcerative ,Female ,Asymptomatic carrier ,Multilocus Sequence Typing - Abstract
Alterations in the intestinal microbiota are thought to be involved in the pathogenesis of inflammatory bowel diseases (IBD). Klebsiella oxytoca is an intestinal pathobiont that can produce a cytotoxin (tillivaline). We aimed to elucidate the pathogenetic relevance of toxin-producing K. oxytoca in patients with IBD flares and investigated the clonal relationship of K. oxytoca isolates from IBD patients using multilocus sequence typing (MLST). Fecal samples of 235 adult IBD patients were collected from January 2008 to May 2009 and were tested for K. oxytoca, C. difficile toxin, and other pathogens by standard microbiological methods. Clinical data and disease activity scores were collected. K. oxytoca isolates were tested for toxin production using cell culture assays. A total of 45 K. oxytoca isolates from IBD patients, healthy, asymptomatic carriers and from patients with antibiotic-associated hemorrhagic colitis in part from our strain collection were tested for their clonal relationship using MLST. The prevalence of K. oxytoca in IBD overall was 4.7 %. Eleven K. oxytoca isolates were detected. Two of 11 isolates were tested positive for toxin production. There was no significant difference in the distribution of K. oxytoca isolates between the groups (active vs. remission in UC and CD). MLST yielded 33 sequence types. K. oxytoca isolates from IBD did not cluster separately from isolates from asymptomatic carriers. Our data demonstrate that toxin (tilivalline)-producing K. oxytoca is not associated with IBD flares.
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- 2015
5. Impact of structured personal on-site patient education on low posaconazole plasma concentrations in patients with haematological malignancies
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Jasmin Wagner, Jürgen Prattes, Bianca Huber-Krassnitzer, Albert Wölfler, Wiebke Duettmann, Georg Theiler, Martin Hoenigl, Robert Krause, Reinhard B. Raggam, Katharina Seeber, Ines Zollner-Schwetz, and Florian Prueller
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Adult ,Male ,Microbiology (medical) ,Posaconazole ,medicine.medical_specialty ,Antifungal Agents ,Adolescent ,Nausea ,Chemoprevention ,Medication Adherence ,Cohort Studies ,Plasma ,Young Adult ,Patient Education as Topic ,Interquartile range ,Internal medicine ,Humans ,Medicine ,Pharmacology (medical) ,Aged ,Aged, 80 and over ,Hematology ,medicine.diagnostic_test ,business.industry ,General Medicine ,Middle Aged ,Triazoles ,Surgery ,Infectious Diseases ,Mycoses ,Therapeutic drug monitoring ,Austria ,Hematologic Neoplasms ,Plasma concentration ,Vomiting ,Female ,Drug Monitoring ,medicine.symptom ,business ,Patient education ,medicine.drug - Abstract
Low posaconazole plasma concentrations (PPCs) are associated with breakthrough invasive mould infections among patients with haematological malignancies. This study evaluated the influence of structured personal on-site patient education on low PPCs. The study was conducted from July 2012 to May 2013 at the Division of Hematology, Medical University Hospital of Graz (Graz, Austria). PPCs were measured in all patients with haematological malignancies receiving the drug prophylactically. Concentrations above the target of 0.5 mg/L were defined as satisfactory and those below this concentration as low. In patients with low PPCs, structured personal on-site education regarding the intake of posaconazole (e.g. intake with fatty/acid food, prevention of nausea and vomiting) was performed. In total, 258 steady-state PPCs were measured in 65 patients [median PPC 0.59 mg/L, interquartile range 0.25-0.92 mg/L; 141/258 (54.7%) satisfactory]. Diarrhoea was the strongest predictor of low PPCs in the multivariate analysis. Initial steady-state PPCs were sufficient in 29 patients and low in 36 patients. Of the 36 patients with low initial steady-state PPCs, 8 were either discharged or antifungal therapy was modified before a follow-up PPC was obtained; in the remaining 28 patients, personal on-site education was performed. In 12/28 patients (43%) the personal on-site education led to sufficient levels, whilst in 16 (57%) PPCs stayed below the target, although increasing from0.2 mg/L to0.3 mg/L in 6 of these patients. In conclusion, personal education appears to be a promising tool to increase low PPCs.
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- 2014
6. Posaconazole Plasma Concentrations on Days Three to Five Predict Steady-State Levels
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Wiebke Duettmann, Martin Hoenigl, and Jürgen Prattes
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Oral ,0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Posaconazole ,Steady state (electronics) ,Antifungal Agents ,030106 microbiology ,Administration, Oral ,Hematologic Neoplasms ,Clinical Therapeutics ,Microbiology ,Gastroenterology ,03 medical and health sciences ,Internal medicine ,80 and over ,medicine ,Humans ,Pharmacology (medical) ,Aged ,Pharmacology ,Aged, 80 and over ,Receiver operating characteristic ,business.industry ,Curve analysis ,Area under the curve ,Pharmacology and Pharmaceutical Sciences ,Middle Aged ,Triazoles ,Confidence interval ,Infectious Diseases ,Mycoses ,ROC Curve ,Medical Microbiology ,Area Under Curve ,Administration ,Plasma concentration ,Female ,Drug Monitoring ,business ,medicine.drug - Abstract
Low posaconazole plasma concentrations (PPCs) have been associated with breakthrough invasive fungal infections. We assessed the correlation between pre-steady-state PPCs (obtained between days 3 and 5) and PPCs obtained during steady state in 48 patients with underlying hematological malignancies receiving posaconazole oral-solution prophylaxis. Pre-steady-state PPCs correlated significantly with PPCs obtained at steady state (Spearman r = 0.754; P < 0.001). Receiver operating characteristic (ROC) curve analysis of pre-steady-state PPCs revealed an area under the curve (AUC) of 0.884 (95% confidence interval [CI], 0.790 to 0.977) for predicting satisfactory PPCs at steady state.
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- 2016
7. Elevated levels of interleukin 17A and kynurenine in candidemic patients, compared with levels in noncandidemic patients in the intensive care unit and those in healthy controls
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Dirk Strunk, Helmut J.F. Salzer, Martin Hoenigl, Ines Zollner-Schwetz, Robert Krause, Florian Prüller, Franz Quehenberger, Jasmin Rabensteiner, Jürgen Prattes, Walter Buzina, Reinhard B. Raggam, Katharina Heidrich, Andreas Meinitzer, Heimo Strohmaier, Thomas Valentin, and Beate Rinner
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Adult ,Male ,Adolescent ,T-Lymphocytes, Regulatory ,law.invention ,Interleukin 22 ,chemistry.chemical_compound ,Interferon-gamma ,Young Adult ,law ,Interleukin 23 ,Immunology and Allergy ,Humans ,Lectins, C-Type ,Prospective Studies ,Interleukin 6 ,Kynurenine ,Aged ,Candida ,Aged, 80 and over ,biology ,Interleukin-17 ,Candidiasis ,Tryptophan ,Interleukin ,Middle Aged ,Intensive care unit ,Toll-Like Receptor 2 ,Toll-Like Receptor 4 ,Interleukin 10 ,Intensive Care Units ,Infectious Diseases ,chemistry ,Case-Control Studies ,Immunology ,biology.protein ,Female ,Interleukin 17 - Abstract
BACKGROUND: The interplay between Candida species and pattern recognition receptors, interleukins, kynurenine, and T cells has been studied in murine and ex vivo human studies, but data are lacking from patients with invasive fungal infections. Interleukin 17A (IL-17A) is considered an important component in host defense against Candida infections and is modulated by Candida-induced impairment of tryptophan-kynurenine metabolism. METHODS: Dectin-1, Toll-like receptor 2, and Toll-like receptor 4 expression; regulatory T cell (Treg) percentages; and interleukin 6, interleukin 10, IL-17A, interleukin 22, interleukin 23, interferon γ, kynurenine, and tryptophan levels were determined in candidemic patients and compared to levels in noncandidemic patients who are in the intensive care unit (ICU) and receiving antibiotic therapy and those in healthy controls, both with and without Candida colonization. RESULTS: Candidemic patients had significantly higher IL-17A and kynurenine levels, compared with noncandidemic patients, including Candida-colonized ICU patients and healthy controls. Within candidemic patients, time-dependent elevation of IL-17A and kynurenine levels was detected. IL-17A areas under the curve for differentiation between patients with early candidemia and those without candidemia (ICU patients, including Candida-colonized patients, and healthy controls) were between 0.94 (95% confidence interval [CI], .89-.99) and 0.99 (95% CI, .99-1). CONCLUSIONS: Candidemic patients had significantly higher IL-17A and kynurenine levels, compared with noncandidemic patients. The statistically significant association between IL-17A and kynurenine levels and candidemia suggests their potential as biomarkers for anticipation of invasive candidiasis. CLINICAL TRIALS REGISTRATION: NCT00786903.
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- 2014
8. Bronchoalveolar lavage lateral-flow device test for invasive pulmonary aspergillosis in solid organ transplant patients: a semiprospective multicenter study
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Christoph Koidl, Katharina Hönigl, Birgit Willinger, Brigitte Selitsch, Cornelia Lass-Flörl, Jürgen Prattes, Reinhard B. Raggam, Stephan Eschertzhuber, Robert Krause, Michaela Lackner, Verena Posch, Martin Hoenigl, Michael Sereinigg, and Christopher R. Thornton
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Adult ,Male ,medicine.medical_specialty ,Pathology ,Adolescent ,medicine.medical_treatment ,Point-of-Care Systems ,Cross Reactions ,Gastroenterology ,Galactomannan ,chemistry.chemical_compound ,Positive predicative value ,Internal medicine ,medicine ,Lung transplantation ,Humans ,Prospective Studies ,skin and connective tissue diseases ,Prospective cohort study ,Aged ,Heart transplantation ,Invasive Pulmonary Aspergillosis ,Transplantation ,medicine.diagnostic_test ,business.industry ,Organ Transplantation ,Middle Aged ,Confidence interval ,respiratory tract diseases ,Bronchoalveolar lavage ,chemistry ,Diagnostic odds ratio ,Female ,business ,Bronchoalveolar Lavage Fluid - Abstract
Background Invasive pulmonary aspergillosis (IPA) remains an important cause of morbidity and mortality among patients undergoing solid organ transplantation (SOT). Because of the crude mortality of 80% to 90% in the absence of adequate treatment, timely diagnosis and early intervention with antifungal drugs are key factors in the successful treatment of IPA. Diagnosis, however, remains difficult. Therefore, new diagnostic tests are urgently needed. The Lateral-Flow Device (LFD) test is a rapid (15 min) single-sample point-of-care test that is based on the detection of an Aspergillus extracellular glycoprotein antigen by monoclonal antibody JF5. Methods This semiprospective multicenter study evaluated the LFD test for IPA diagnosis (established by galactomannan and culture results) by using bronchoalveolar lavage (BAL) samples from patients after SOT. Participating centers were the three Austrian Medical Universities of Innsbruck, Vienna, and Graz. Results Forty-seven BAL samples from 47 SOT patients were included (26 patients had undergone lung transplantation, 13 liver, 6 kidney, and 2 heart transplantation; 11 probable or proven IPA, 11 possible IPA, 25 no IPA) at the three Austrian Medical Universities of Innsbruck, Vienna, and Graz. Sensitivity and specificity, positive and negative predictive values, as well as diagnostic odds ratio of BAL LFD tests for probable IPA were 91%, 83%, 63%, 97%, and 50% (95% confidence interval, 5.4%-467%), respectively. Conclusion To conclude, the LFD test of BAL specimens is performed easily and provides accurate and rapidly available results in patients after SOT. Therefore, this new point-of-care test may be a promising diagnostic approach for detecting IPA using BAL specimens from SOT patients.
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- 2014
9. Serum 1,3-beta-d-glucan for antifungal treatment stratification at the intensive care unit and the influence of surgery
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Jürgen Prattes, Sonja Fruhwald, Katharina Hönigl, Jasmin Rabensteiner, Robert Krause, Martin Hoenigl, Florian Prueller, Reinhard B. Raggam, Thomas Valentin, and Ines Zollner-Schwetz
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Antifungal ,Adult ,Male ,medicine.medical_specialty ,Antifungal Agents ,beta-Glucans ,Adolescent ,medicine.drug_class ,Dermatology ,law.invention ,Young Adult ,law ,Intensive care ,medicine ,Retrospective analysis ,Humans ,In patient ,Aged ,Candida ,Retrospective Studies ,Aged, 80 and over ,biology ,business.industry ,General Medicine ,Surgical procedures ,Middle Aged ,Intensive care unit ,Discontinuation ,Surgery ,Intensive Care Units ,Infectious Diseases ,1,3-Beta-glucan synthase ,Aspergillus ,Mycoses ,biology.protein ,Female ,business - Abstract
The purpose of this study was to evaluate a preemptive approach with serum 1,3-beta-d-glucan (BDG) as a marker for treatment stratification of systemic antifungal (AF) therapy in patients with clinical suspected invasive fungal infections (IFI) at intensive care units (ICU), and the impact of surgical procedures. A total of 66 ICU patients with clinical suspected IFI were included in this retrospective analysis. Serum BDG testing was performed prior to initiation of AF treatment and in addition to routine diagnostic measures. Based on the BDG results the initial clinical decision whether or not to start systemic AF therapy was re-evaluated. Impact of surgical procedures on clinical utility of serum BDG was evaluated in a sub-group of 25 patients who had undergone surgical procedures prior to BDG evaluation. BDG test results led to discontinuation of AF therapy in 13 patients, and initiation of AF therapy in seven patients. In 46 patients the clinical decision was confirmed by BDG. The majority of suspected, probable and proven IFI cases (10/13, 77%) was predicted by the test. BDG testing turned out positive in 9/25 (36%) of patients that had undergone recent surgery and levels correlated with clinical findings. Serum BDG evaluation seems to be a promising tool to guide AF therapy in ICU patients even after recent surgical procedures.
- Published
- 2014
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