116 results on '"J. Garbino"'
Search Results
2. New drugs, old drugs - dear drugs, cheap drugs
- Author
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B Hirschel and J Garbino
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Medicine - Published
- 2002
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3. 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)
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A. Kritikos, D. Neofytos, N. Khanna, P.W. Schreiber, K. Boggian, J. Bille, J. Schrenzel, K. Mühlethaler, R. Zbinden, T. Bruderer, D. Goldenberger, G. Pfyffer, A. Conen, C. Van Delden, S. Zimmerli, D. Sanglard, D. Bachmann, O. Marchetti, F. Lamoth, T. Bregenzer, U. Flückiger, C. Orasch, U. Heininger, M. Franciolli, L. Damonti, M. Rothen, C. Zellweger, P. Tarr, F. Fleisch, C. Chuard, V. Erard, S. Emonet, J. Garbino, C. van Delden, D. Genne, P. Bochud, T. Calandra, J. Chave, P. Graber, R. Monotti, O. Regionale, E. Bernasconi, O. Civico, M. Rossi, M. Krause, R. Piso, F. Bally, N. Troillet, G. Eich, J. Gubler, J. Fehr, A. Imhof, C. Ruef, C. Berger, H. Fankhauser, I. Heinzer, R. Frei, R. Hertel, M. Dolina, O. Petrini, O. Dubuis, S. Graf, M. Risch, E. Ritzler, D. Fracheboud, P. Rohner, R. Lienhardt, C. Andreutti-Zaugg, A. Gallusser, K. Herzog, U. Schibli, L. Tissière, D. Schultze, University of Zurich, and Lamoth, F
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0301 basic medicine ,Microbiology (medical) ,Antifungal Agents ,Candida albicans/genetics ,Echinocandin ,030106 microbiology ,Population ,Drug Resistance ,Candida glabrata ,610 Medicine & health ,Microbial Sensitivity Tests ,Candidiasis/microbiology ,2726 Microbiology (medical) ,Microbiology ,10234 Clinic for Infectious Diseases ,03 medical and health sciences ,chemistry.chemical_compound ,Echinocandins ,Switzerland/epidemiology ,Drug Resistance, Fungal ,Candida albicans ,polycyclic compounds ,medicine ,Humans ,education ,ddc:616 ,education.field_of_study ,biology ,Echinocandins/administration & dosage/pharmacology ,Micafungin ,Candidiasis ,General Medicine ,2725 Infectious Diseases ,bacterial infections and mycoses ,biology.organism_classification ,Fungal ,Infectious Diseases ,chemistry ,10036 Medical Clinic ,Population Surveillance ,Mutation ,Antifungal Agents/pharmacology ,Anidulafungin ,Caspofungin ,Switzerland ,medicine.drug - Abstract
Objectives Echinocandins represent the first-line treatment of candidaemia. Acquired echinocandin resistance is mainly observed among Candida albicans and Candida glabrata and is associated with FKS hotspot mutations. The commercial Sensititre YeastOne™ (SYO) kit is widely used for antifungal susceptibility testing, but interpretive clinical breakpoints are not well defined. We determined echinocandins epidemiological cut-off values (ECV) for C. albicans/glabrata tested by SYO and assessed their ability to identify FKS mutants in a national survey of candidaemia. Methods Bloodstream isolates of C. albicans and C. glabrata were collected in 25 Swiss hospitals from 2004 to 2013 and tested by SYO. FKS hotspot sequencing was performed for isolates with an MIC≥ECV for any echinocandin. Results In all, 1277 C. albicans and 347 C. glabrata were included. ECV 97.5% of caspofungin, anidulafungin and micafungin were 0.12, 0.06 and 0.03 μg/mL for C. albicans, and 0.25, 0.12 and 0.03 μg/mL for C. glabrata, respectively. FKS hotspot sequencing was performed for 70 isolates. No mutation was found in the 52 ‘limit wild-type' isolates (MIC=ECV for at least one echinocandin). Among the 18 ‘non-wild-type' isolates (MIC>ECV for at least one echinocandin), FKS mutations were recovered in the only two isolates with MIC>ECV for all three echinocandins, but not in those exhibiting a ‘non-wild-type' phenotype for only one or two echinocandins. Conclusion This 10-year nationwide survey showed that the rate of echinocandin resistance among C. albicans and C. glabrata remains low in Switzerland despite increased echinocandin use. SYO-ECV could discriminate FKS mutants from wild-type isolates tested by SYO in this population.
- Published
- 2018
4. Fluconazole Prophylaxis for Critically Ill Patients at High Risk for Candida Infection
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J. Garbino
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Microbiology (medical) ,medicine.medical_specialty ,business.industry ,Critically ill ,MEDLINE ,medicine.disease ,law.invention ,Infectious Diseases ,Randomized controlled trial ,law ,Critical illness ,Medicine ,business ,Intensive care medicine ,Fluconazole ,Fungemia ,medicine.drug - Published
- 2017
5. Posaconazole salvage treatment in paediatric patients: a multicentre survey
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J. H. Scholz, Andishe Attarbaschi, S. Lüer, U. Kontny, H. J. Wagner, Andreas H. Groll, R. Phillips, M. Duerken, B. Gruhn, Thomas Wiesel, J. Garbino, and Thomas Lehrnbecher
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Male ,Microbiology (medical) ,medicine.medical_specialty ,Posaconazole ,Antifungal Agents ,Time Factors ,Adolescent ,Salvage therapy ,Aspergillosis ,chemistry.chemical_compound ,Pharmacotherapy ,Internal medicine ,medicine ,Humans ,Child ,Adverse effect ,Salvage Therapy ,business.industry ,General Medicine ,Triazoles ,medicine.disease ,Surgery ,Treatment Outcome ,Infectious Diseases ,Mycoses ,El Niño ,chemistry ,Child, Preschool ,Female ,Caspofungin ,Zygomycosis ,business ,medicine.drug - Abstract
While a paediatric dosage has not been defined, posaconazole is occasionally being used in children. We conducted a multicentre retrospective survey and identified 15 patients (median age 10 years [range 3.6-17.5]) who received posaconazole salvage therapy for proven (9 patients) or probable (6 patients) invasive fungal infections. Posaconazole was administered for a median of 32 days (range 4-262) at a median dosage of 21 mg/kg (range 4.8-33.3). None of the patients discontinued therapy due to adverse events, which were mostly mild and observed in 11 patients. Complete or partial responses were observed in 4/7 patients with zygomycosis, 3/4 patients with invasive mould infection, 1/2 patients with invasive aspergillosis and 1/2 patients with chronic disseminated candidiasis. We conclude from the data that posaconazole displays favourable safety and tolerance and may be useful for management of individual paediatric patients with invasive infections.
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- 2010
6. Primary central nervous system aspergillosis: a case report and review of the literature
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J. Delavelle, Karim Burkhardt, Gianpaolo Pizzolato, L. Kaiser, A. Payot, and J. Garbino
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Microbiology (medical) ,medicine.medical_specialty ,Pathology ,business.industry ,Central nervous system ,General Medicine ,Aspergillosis ,medicine.disease ,Central nervous system disease ,medicine.anatomical_structure ,Infectious Diseases ,medicine ,Intensive care medicine ,business - Published
- 1999
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7. Candida infections in the ICU
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D Pittet and J Garbino
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medicine.medical_specialty ,business.industry ,Intensive care ,medicine ,Critical Care and Intensive Care Medicine ,Intensive care medicine ,business ,Candida infections - Abstract
(1997). Candida infections in the ICU. Clinical Intensive Care: Vol. 8, No. 4, pp. 187-200.
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- 1997
8. Disseminated Rhizopus microsporus infection cured by salvage allogeneic hematopoietic stem cell transplantation, antifungal combination therapy, and surgical resection
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O, Lebeau, C, Van Delden, J, Garbino, J, Robert, F, Lamoth, J, Passweg, and Y, Chalandon
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ddc:616 ,Salvage Therapy ,Antifungal Agents ,ddc:617 ,Antifungal Agents/ therapeutic use ,Amphotericin B/therapeutic use ,Hematopoietic Stem Cell Transplantation ,Triazoles ,Middle Aged ,Leukemia, Myeloid, Acute/complications/drug therapy ,Leukemia, Myeloid, Acute ,Treatment Outcome ,Amphotericin B ,hemic and lymphatic diseases ,Mucormycosis ,Humans ,Transplantation, Homologous ,Drug Therapy, Combination ,Female ,Rhizopus/classification/ drug effects/isolation & purification ,Triazoles/therapeutic use ,Rhizopus ,Mucormycosis/ drug therapy/immunology/microbiology/ surgery - Abstract
Invasive Zygomycetes infection complicating prolonged neutropenia is associated with high mortality in the absence of immune recovery. We report a patient who developed disseminated zygomycosis due to Rhizopus microsporus during induction chemotherapy for acute myeloid leukemia. Rescue allogeneic hematopoietic stem cell transplantation (allo-HSCT) was performed as her only chance of cure of this infection and to treat refractory leukemia. Posaconazole combined with liposomal amphotericin B contained the zygomycosis during prolonged neutropenia due to allo-HSCT followed by intense immunosuppression for grade IV acute graft-versus-host disease. Surgical removal of all infected sites after immune recovery, with prolonged posaconazole treatment, ultimately cured the infection. New combination antifungal therapies might sufficiently control disseminated zygomycosis to allow allo-HSCT to be performed, assuring life-saving immune recovery. Surgery appears to be necessary for definite cure of these infections.
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- 2010
9. Clinical and bacteriological outcomes in hospitalised patients with community-acquired pneumonia treated with azithromycin plus ceftriaxone, or ceftriaxone plus clarithromycin or erythromycin: a prospective, randomised, multicentre study
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J. Garbino, P. J. de Caprariis, P. Hogan, I.M. Hoepelman, Charles Feldman, Francesco Blasi, T. Todisco, and Michael Tamm
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Microbiology (medical) ,Male ,medicine.medical_specialty ,community-acquired pneumonia ,Pneumonia severity index ,Population ,Erythromycin ,Administration, Oral ,Azithromycin ,Random Allocation ,Community-acquired pneumonia ,Internal medicine ,Clarithromycin ,medicine ,Humans ,Prospective Studies ,education ,Antibacterial agent ,Aged ,Aged, 80 and over ,therapy ,education.field_of_study ,business.industry ,Ceftriaxone ,General Medicine ,Pneumonia ,Middle Aged ,medicine.disease ,Surgery ,Anti-Bacterial Agents ,Community-Acquired Infections ,Hospitalization ,Infectious Diseases ,Treatment Outcome ,Injections, Intravenous ,Drug Therapy, Combination ,Female ,business ,medicine.drug - Abstract
This study compared patients with moderate-to-severe community-acquired pneumonia (CAP) requiring hospitalisation, who received initial therapy with either intravenous ceftriaxone plus intravenous azithromycin, followed by step-down to oral azithromycin (n = 135), with patients who received intravenous ceftriaxone combined with either intravenous clarithromycin or erythromycin, followed by step-down to either oral clarithromycin or erythromycin (n = 143). Clinical and bacteriological outcomes were evaluated at the end of therapy (EOT; day 12–16) or at the end of study (EOS; day 28–35). At baseline, mean APACHE II scores were 13.3 and 12.6, respectively, with >50% of patients classified as Fine Pneumonia Severity Index (PSI) category IV or V. Clinical success rates (cure or improvement) in the modified intent-to-treat (MITT) population at EOT were 84.3% in the ceftriaxone/azithromycin group and 82.7% in the ceftriaxone/clarithromycin or erythromycin group. At EOS, MITT success rates (cure only) were 81.7% and 75.0%, respectively. Equivalent success rates in the clinically evaluable population were 83% and 87%, respectively, at EOT, and 79% and 78%, respectively, at EOS. MITT bacteriological eradication rates were 73.2% and 67.4%, respectively, at EOT, and 68.3% vs. 60.9%, respectively, at EOS. Mean length of hospital stay (LOS) was 10.7 and 12.6 days, and the mean duration of therapy was 9.5 and 10.5 days, respectively. The incidence of infusion-related adverse events was 16.3% and 25.2% (p 0.04), respectively. An intravenous-to-oral regimen of ceftriaxone/azithromycin was at least equivalent in efficacy and safety to the comparator regimen and appeared to be a suitable treatment option for hospitalised patients with CAP.
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- 2007
10. ARDS caused by herpes simplex virus pneumonia in a patient with Crohn's disease: a case report
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J. Garbino, B. Ricou, A. François-Dufresne, and W. Wunderli
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Adult ,Male ,ARDS ,Key words Viral pneumonia ,Complications ,medicine.medical_treatment ,Pneumonia, Viral ,Herpesvirus 1, Human ,Critical Care and Intensive Care Medicine ,Bronchoalveolar Lavage ,Immunocompromised Host ,Crohn Disease ,Risk Factors ,medicine ,Humans ,Respiratory Distress Syndrome ,Lung ,medicine.diagnostic_test ,business.industry ,Brief Report ,Respiratory disease ,Herpes Simplex ,Immunosuppression ,medicine.disease ,Pneumonia ,medicine.anatomical_structure ,Bronchoalveolar lavage ,Respiratory failure ,Immunology ,Viral disease ,business - Abstract
Pneumonia caused by herpes simplex virus type 1 (HSV1) is rare and occurs in severely immunosuppressed patients. HSV1 can be detected in bronchoalveolar lavage (BAL) from patients presenting with respiratory failure, but its direct effect on disease is difficult to prove. We demonstrate the causative role of HSV1 in the case of a 44-year-old male with Crohn's disease who presented to the intensive care unit with the acute respiratory distress syndrome after surgery. BAL cells were cultured and immunofluorescence confirmed the presence of HSV1 during the first weeks of illness. Increased IgG titers confirmed the diagnosis of a recurrent HSV1 infection. A lung biposy specimen showed fibroproliferation without pathogens. Immunosuppressive therapy had been stopped and acyclovir was introduced at this time. The diagnostic difficulties in this patient underline the importance of early recognition of viral infection as a potential cause of severe pneumonia in severely ill, immunocompromised patients.
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- 1997
11. Cefepime versus imipenem-cilastatin for treatment of nosocomial pneumonia in intensive care unit patients: a multicenter, evaluator-blind, prospective, randomized study
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L. Stratchounski, J. Garbino, Jacques-André Romand, Marie-Denise Schaller, Jacques Bille, Daniel Pablo Lew, A. Cometta, L. Krawczyk, Ethan Rubinstein, D. Aymon, Giorgio Zanetti, René Chioléro, Gilbert Greub, M. P. Glauser, T. Kinge, and Frank Bally
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Adult ,Male ,medicine.medical_specialty ,Imipenem ,Critical Care ,Endpoint Determination ,Cefepime ,Clinical Therapeutics ,law.invention ,Double-Blind Method ,law ,Multicenter trial ,Internal medicine ,Intensive care ,medicine ,polycyclic compounds ,Humans ,Pharmacology (medical) ,Protease Inhibitors ,Prospective Studies ,Antibacterial agent ,APACHE ,Aged ,Pharmacology ,Cross Infection ,Cilastatin ,business.industry ,Imipenem/cilastatin ,Middle Aged ,Pneumonia, Pneumococcal ,Intensive care unit ,Respiration, Artificial ,Surgery ,Cephalosporins ,Infectious Diseases ,Drug Therapy, Combination ,Female ,Thienamycins ,business ,medicine.drug - Abstract
In a randomized, evaluator-blind, multicenter trial, we compared cefepime (2 g three times a day) with imipenem-cilastatin (500 mg four times a day) for the treatment of nosocomial pneumonia in 281 intensive care unit patients from 13 centers in six European countries. Of 209 patients eligible for per-protocol analysis of efficacy, favorable clinical responses were achieved in 76 of 108 (70%) patients treated with cefepime and 75 of 101 (74%) patients treated with imipenem-cilastatin. The 95% confidence interval (CI) for the difference between these response rates (−16 to 8%) failed to exclude the predefined lower limit for noninferiority of −15%. In addition, therapy of pneumonia caused by an organism producing an extended-spectrum β-lactamase (ESBL) failed in 4 of 13 patients in the cefepime group but in none of 10 patients in the imipenem group. However, the clinical efficacies of both treatments appeared to be similar in a secondary intent-to-treat analysis (95% CI for difference, −9 to 14%) and a multivariate analysis (95% CI for odds ratio, 0.47 to 1.75). Furthermore, the all-cause 30-day mortality rates were 28 of 108 (26%) patients in the cefepime group and 19 of 101 (19%) patients in the imipenem group ( P = 0.25). Rates of documented or presumed microbiological eradication of the causative organism were similar with cefepime (61%) and imipenem-cilastatin (54%) (95% CI, −23 to 8%). Primary or secondary resistance of Pseudomonas aeruginosa was detected in 19% of the patients treated with cefepime and 44% of the patients treated with imipenem-cilastatin ( P = 0.05). Adverse events were reported in 71 of 138 (51%) and 62 of 141 (44%) patients eligible for safety analysis in the cefepime and imipenem groups, respectively ( P = 0.23). Although the primary end point for this study does not exclude the possibility that cefepime was inferior to imipenem, some secondary analyses showed that the two regimens had comparable clinical and microbiological efficacies. Cefepime appeared to be less active against organisms producing an ESBL, but primary and secondary resistance to imipenem was more common for P. aeruginosa . Selection of a single agent for therapy of nosocomial pneumonia should be guided by local resistance patterns.
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- 2003
12. Unusual association: Streptococcus bovis tricuspid endocarditis with atrial-septal aneurysm and patent foramen ovale
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R, Sommer, P, Dussoix, A, Anwar, and J, Garbino
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Endocarditis, Bacterial ,Penicillins ,Middle Aged ,Streptococcus bovis ,Echocardiography ,Streptococcal Infections ,Heart Septum ,Humans ,Drug Therapy, Combination ,Female ,Heart Atria ,Tricuspid Valve ,Gentamicins ,Heart Aneurysm - Abstract
Streptococcus bovis endocarditis is a frequent cause of streptococcal endocarditis and is associated with colonic tumours. The tricuspid valve is very rarely affected and its involvement is a complication which can lead to a less favourable outcome. We report the seventh case of tricuspid valve endocarditis due to S. bovis, and the first, to our knowledge, to be associated with an atrial-septal aneurysm and a patent foramen ovale. The underlying medical conditions and predisposing factors for development of tricuspid valve endocarditis are described and interesting new echocardiographic data are presented. The current guidelines on antibiotic therapy for S. bovis tricuspid valve endocarditis are reviewed.
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- 2000
13. p55 Tumor necrosis factor receptor fusion protein in the treatment of patients with severe sepsis and septic shock. A randomized controlled multicenter trial. Ro 45-2081 Study Group
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E, Abraham, M P, Glauser, T, Butler, J, Garbino, D, Gelmont, P F, Laterre, K, Kudsk, H A, Bruining, C, Otto, E, Tobin, C, Zwingelstein, W, Lesslauer, and A, Leighton
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Adult ,Male ,Interleukin-6 ,Tumor Necrosis Factor-alpha ,Immunoglobulin gamma-Chains ,Multiple Organ Failure ,Recombinant Fusion Proteins ,Middle Aged ,Shock, Septic ,Survival Analysis ,Receptors, Tumor Necrosis Factor ,Logistic Models ,Double-Blind Method ,Sepsis ,Humans ,Female ,Prospective Studies ,Immunoglobulin Heavy Chains ,APACHE ,Aged - Abstract
To evaluate the safety and efficacy of p55 tumor necrosis factor receptor fusion protein, a recombinant chimeric protein of human p55 (type I) tumor necrosis factor receptor (CD120a) extracellular domain and IgG1 sequences (referred to as p55-IgG), in the treatment of patients with severe sepsis or septic shock.Randomized, prospective, multicenter, double-blind, placebo-controlled clinical trial.Forty-four community and university-affiliated hospitals in the United States and Europe.There were 498 patients enrolled in this clinical trial.Patients prospectively stratified within each site into refractory shock or severe sepsis groups were randomized to receive a single infusion of p55-IgG, 0.083 mg/kg, 0.042 mg/kg, or 0.008 mg/kg, or placebo. Patients received standard aggressive medical/surgical care during the 28-day postinfusion period.Twenty-eight-day all-cause mortality.The distribution of variables describing demographics, organ system dysfunction or failure, infecting microorganisms, predicted mortality, plasma interleukin 6 levels, and plasma tumor necrosis factor alpha (TNF-alpha) levels were similar among patients in the p55-IgG and placebo treatment arms. A planned interim analysis was performed after 201 patients were enrolled. Because a statistically nonsignificant trend toward increased mortality was present in patients who had received 0.008 mg/kg, this treatment arm was discontinued, and the study continued with 3 arms. Among all infused patients, there was a statistically nonsignificant trend toward reduced 28-day all-cause mortality in those who received p55-IgG compared with placebo-treated patients (5% reduction, 0.042 mg/kg vs placebo; 15% reduction, 0.083 mg/kg vs placebo; P=.30). However, in patients with severe sepsis and early septic shock (n=247), therapy with p55-IgG, 0.083 mg/kg, was associated with a 36% reduction in 28-day all-cause mortality compared with placebo (P=.07): 20 (23%) of 87 patients died among those treated with p55-IgG, 0.083 mg/kg; 30 (37%) of 82 among those treated with p55-IgG, 0.042 mg/kg; and 28 (36%) of 78 in the placebo group. A prospectively planned logistic regression analysis to assess treatment effect on 28-day all-cause mortality by means of predicted mortality and serum interleukin 6 levels as continuous covariates demonstrated a significant improvement in outcome for the patients with severe sepsis treated with p55-IgG, 0.083 mg/kg, compared with placebo (P=.01). Serious adverse events, including death and the development of new organ system dysfunction, were reported in 65% of patients infused with placebo, with no increased frequency (56%) present in the 2 p55-IgG treatment arms. There were no reports of immediate hypersensitivity reactions caused by p55-IgG.In this dose-finding study, there was no decrease in mortality between placebo and p55-IgG in all infused patients. In the prospectively defined population of patients with severe sepsis who received p55-IgG, 0.083 mg/kg, there was a trend toward reduced mortality at day 28 that became significant when predicted mortality and plasma interleukin 6 levels were included in a logistic regression analysis.
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- 1997
14. [The use of aminoglycosides in Swiss university hospitals]
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P, Sudre, J, Garbino, and D P, Lew
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Hospitals, University ,Humans ,Drug Monitoring ,Gentamicins ,Amikacin ,Drug Utilization ,Switzerland ,Anti-Bacterial Agents - Abstract
In 1990, the Commission for Anti-infectious Agents of the Swiss Society for Infectious Diseases decided to monitor trends in hospital consumption of antibiotics to understand better and rationalize their use. This article describes and analyzes the evolution in the use of aminoglycosides in Swiss university hospitals.Annual consumption figures for four aminoglycosides were provided by pharmacists of participating hospitals for the period 1990-1993.Between 1990 and 1993, the overall consumption of oral and intravenous (i.v.) antibiotics increased by 22% and 38% respectively. On average, 38% of hospitalized patients were receiving antibiotics in 1993 (0.38 daily defined doses [DDD]/day). Aminoglycosides represented 11.3% of all i.v. antibiotics in 1990. There were wide differences between hospitals (range: 7.9 to 36.3% DDD per 1000 days). The four-year trend showed relative stability of use in four hospitals and wide variations in two. Overall, gentamycin remains the most commonly used aminoglycoside while amikacin is less used and retains its role of second line drug.The analysis of hospital consumption of aminoglycosides in Swiss university hospitals shows that the trend in use is not identical in all hospitals and that there are wide differences between hospitals (some hospitals use five times more than others). Although the reasons for these differences remain unclear, this monitoring system provides the data needed to formulate and evaluate recommendations designed to rationalize the use of aminoglycosides.
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- 1996
15. Use of antimicrobials in Swiss hospitals. Swiss Committee of Anti-Infective Agents
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D P, Lew, J, Garbino, A U, Gerber, and P, Sudre
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Hospitals, University ,Anti-Bacterial Agents/ therapeutic use ,Humans ,ddc:576.5 ,Drug Utilization ,Hospitals ,Switzerland ,Anti-Bacterial Agents - Published
- 1996
16. CASPOFUNGIN IN THE TREATMENT OF OROPHARYNGEAL CANDIDIASIS
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J, Garbino, D, Lew, B, Hirschel, and P, Rohner
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Male ,Antifungal Agents ,Peptides, Cyclic ,Lipopeptides ,Echinocandins ,Candidiasis, Oral ,Caspofungin ,Drug Resistance, Fungal ,Humans ,ddc:576.5 ,AIDS-Related Opportunistic Infections/ drug therapy ,Candidiasis/ drug therapy ,Candidiasis, Oral/ drug therapy ,AIDS-Related Opportunistic Infections ,Pharyngeal Diseases/ drug therapy ,Antifungal Agents/ therapeutic use ,Candidiasis ,Pharyngeal Diseases ,General Medicine ,Middle Aged ,bacterial infections and mycoses ,Anti-Bacterial Agents ,Anti-Bacterial Agents/ therapeutic use ,Treatment Outcome ,Peptides - Abstract
A patient with AIDS developed oropharyngeal candidiasis. Candida albicans and C. glabrata were isolated from the patient and found to be resistant to fluconazole and itraconazole in vitro. Voriconazole therapy was initiated, but discontinued when the C. albicans strain isolated from the patient was found to be resistant to it. The patient failed to respond to subsequent therapy with a combination of amphotericin B and 5-flucytosine. Therapy with caspofungin was then initiated (70 mg loading dose, followed by 50 mg/day). The patient responded favourably to caspofungin, with complete resolution of signs and symptoms.
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- 2003
17. P243 Prolonged Fusarium solani fungemia in a oncology patient due to a strain with intermediate resistance to amphotericin B
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M. Jossi, M. Macedo, J. Ambrosioni, and J. Garbino
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Microbiology (medical) ,biology ,Strain (chemistry) ,business.industry ,General Medicine ,biology.organism_classification ,medicine.disease ,Microbiology ,Infectious Diseases ,Amphotericin B ,medicine ,Pharmacology (medical) ,business ,Fusarium solani ,Fungemia ,medicine.drug - Published
- 2009
18. Respiratory viruses in bronchoalveolar lavage: a hospital-based cohort study in adults.
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J Garbino
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VIRUSES , *MICROORGANISMS , *GENETIC vectors , *MOBILE genetic elements - Abstract
BACKGROUND: The epidemiology of respiratory viruses and their potential clinical impact when recovered in lower respiratory specimens has not been established in the hospital setting. A study was performed to investigate the association between positive viral detection and respiratory infection in an at-risk population. METHODS: 299 adult patients who underwent bronchoalveolar lavage (BAL) procedures were enrolled in a hospital-based prospective cohort study. Descriptive epidemiology is presented of 17 different respiratory viruses detected by reverse transcription-polymerase chain reaction assays in BAL fluid specimens. Multivariate analysis was conducted to identify the clinical characteristics independently associated with the presence of virus. RESULTS: Of 522 BAL fluid specimens analysed, 81% were collected in adult transplant recipients or other immunocompromised patients. Overall, PCR assays identified viral nucleic acid in 91 BAL fluid samples (17.4%). Similar rates of virus-positive BAL fluid were found in the different subpopulations studied (p = 0.113). Coronaviruses were the most frequent (32.3%), followed by rhinovirus (22.6%), parainfluenza (19.5%), influenza (9.7%), respiratory synctial virus (8.6%), human metapneumovirus (4.2%) and bocavirus (3.1%). Multivariate analysis using mixed models showed that respiratory viral infections were associated with a lack of antibiotic treatment response (OR 2.2, 95% CI 1.2 to 4.1) and the absence of radiological infiltrate (OR 0.3, 95% CI 0.2 to 0.8). In lung transplant recipients in whom a respiratory infection was suspected, the respiratory viral detection rate was 24.4% compared with 13.8% overall in other patients (p = 0.02). CONCLUSIONS: In this cohort of hospitalised adults, respiratory viruses detected in BAL fluid specimens were associated with respiratory symptoms, absence of radiological infiltrates and a poor response to antibiotic therapy. [ABSTRACT FROM AUTHOR]
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- 2009
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19. Successful Treatment of Pulmonary Invasive Aspergillosis with Voriconazole in Patients who Failed Conventional Therapy.
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J. Garbino, P. Rohner, L. Kolarova, A. Ondrusova, and D. Lew
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ASPERGILLOSIS ,MYCOSES ,DISEASES ,MORTALITY - Abstract
Background: The incidence of fungal infections, including those due to Aspergillosis species has continued to increase in recent years. Invasive aspergillosis remains an important cause of morbidity and mortality, despite therapeutics interventions. Patients and Methods: We reported five cases of invasive pulmonary aspergillosis treated with voriconazole failing to respond to conventional treatments. Results: The clinical and radiological resolution of pulmonary aspergillosis reported in these cases following therapy with voriconazole is remarkable, considering the infections had proved refractory to standard antifungal therapies. Long-term therapy (in two cases = 1 year, in one case 6 months) was very well tolerated by patients who were unable to tolerate other antifungal agents. Conclusion: Therapy with voriconazole offers a new therapeutic option for otherwise difficult-to-treat infections and the potential to significantly improve the management of Aspergillosis infections. [ABSTRACT FROM AUTHOR]
- Published
- 2003
20. [Gas exchange in localized pneumopathies. Effects of posture]
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P, Prokocimer, J, Garbino, M, Wolff, and B, Regnier
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Lung Diseases ,Posture ,Ventilation-Perfusion Ratio ,Humans - Published
- 1981
21. Influence of posture on gas exchange in artificially ventilated patients with focal lung disease
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J. Garbino, Michel Wolff, B. Regnier, and P. Prokocimer
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Adult ,Lung Diseases ,medicine.medical_treatment ,Trendelenburg ,Trendelenburg position ,Posture ,Critical Care and Intensive Care Medicine ,Positive-Pressure Respiration ,Medicine ,Humans ,Lung ,business.industry ,respiratory system ,Carbon Dioxide ,Middle Aged ,medicine.disease ,Lateral position ,respiratory tract diseases ,Oxygen ,Pneumonia ,medicine.anatomical_structure ,Lung disease ,Anesthesia ,Breathing ,business ,Perfusion - Abstract
Six patients were artificially ventilated for a focal lung disease localized to one lung in four cases and to both lower lobes in two. Despite an inspired oxygen concentration of 100% the mean PaO2 was 115 mmHg. The addition of PEEP slightly improved PaO2 in two patients but led to deterioration in four. We therefore studied the effects of posture. Patients with unilateral disease were placed in the lateral position with the healthy lung dependent. The two patients with both lower lobes involved were tilted into the Trendelenburg position. The mean PaO2 rose from 98.4 to 199.5 mmHg. Posture was maintained as long as a beneficial effect was demonstrable. The disappearance of this effect was associated either with recovery (three patients) or with the extension of the pneumonia (three patients). The improvement of gas exchange can be accounted for by the rearrangement of ventilation/perfusion relationships. This management could avoid the need for differential lung ventilation.
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- 1983
22. Safety and tolerability of combination anidulafungin (ANID) and liposomal amphotericn B (LAmB) for the treatment of invasive aspergillosis (IA)
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J Maertens, D. Krause, Mindy G. Schuster, D. Graham, Denis Caillot, J. Schranz, John F. Reinhardt, J. Garbino, R. Herbrecht, and T. Henkel
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Transplantation ,Tolerability ,business.industry ,Medicine ,Anidulafungin ,Hematology ,Pharmacology ,business ,Aspergillosis ,medicine.disease ,medicine.drug - Full Text
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23. Diagnosis and management of Aspergillus diseases: Executive summary of the 2017 ESCMID-ECMM-ERS guideline
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János Sinkó, Roger J. M. Brüggemann, Catherine Beigelman-Aubry, Jesús Fortún, Olivier Lortholary, Livio Pagano, Donald C. Sheppard, J Maertens, Murat Akova, Werner J. Heinz, Claudio Viscoli, Florence Ader, O. Marchetti, Katrien Lagrou, Bart Jan Kullberg, Paul E. Verweij, Oliver A. Cornely, Christoph Lange, Russell E. Lewis, Maria J G T Vehreschild, Patricia Muñoz, Manuel Cuenca-Estrella, Emilio Bouza, Thomas Lehrnbecher, Stijn Blot, José María Aguado, Elio Castagnola, Claus Peter Heussel, Jacques Cadranel, Malcolm Richardson, Christopher C. Kibbler, Jean-Pierre Gangneux, S. Arikan-Akdagli, George Dimopoulos, Raoul Herbrecht, Cornelia Lass-Flörl, Maurizio Sanguinetti, Rosemary Ann Barnes, Jürgen Löffler, David W. Denning, Anna Skiada, Jorge Garbino, Jacques F. Meis, Maiken Cavling Arendrup, Andrew J. Ullmann, Andreas H. Groll, Patricia Ribaud, Adilia Warris, Nikolay Klimko, Arunaloke Chakrabarti, Dieter Buchheidt, Emmanuel Roilides, Markus Ruhnke, A J Ullmann, J M Aguado, S Arikan-Akdagli, D W Denning, A H Groll, K Lagrou, C Lass-Flörl, R E Lewis, P Munoz, P E Verweij, A Warris, F Ader, M Akova, M C Arendrup, R A Barnes, C Beigelman-Aubry, S Blot, E Bouza, R J M Brüggemann, D Buchheidt, J Cadranel, E Castagnola, A Chakrabarti, M Cuenca-Estrella, G Dimopoulos, J Fortun, J-P Gangneux, J Garbino, W J Heinz, R Herbrecht, C P Heussel, C C Kibbler, N Klimko, B J Kullberg, C Lange, T Lehrnbecher, J Löffler, O Lortholary, J Maertens, O Marchetti, J F Meis, L Pagano, P Ribaud, M Richardson, E Roilides, M Ruhnke, M Sanguinetti, D C Sheppard, J Sinkó, A Skiada, M, J G T Vehreschild, C Viscoli, O A Cornely, University Hospital of Würzburg, Division of Infectious Diseases (Department of Medicine), Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Faculty of Medicine [Hacettepe University], Hacettepe University = Hacettepe Üniversitesi, Wythenshawe Hospital Manchester UK, University Children's Hospital, Munster, Leuven University Hospital, Innsbruck Medical University [Austria] (IMU), University of Bologna, Hospital General Universitario 'Gregorio Marañón' [Madrid], Department of Medical Microbiology, Radboud University Medical Center [Nijmegen], Institute of Medical Sciences, University of Aberdeen, Pathogenèse des légionelles- Legionella pathogenesis (LegioPath), Centre International de Recherche en Infectiologie - UMR (CIRI), Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Hospices Civils de Lyon (HCL), Statens Serum Institute [Copenhagen], School of Medicine [Cardiff], Cardiff University-Institute of Medical Genetics [Cardiff], Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Faculty of Medicine and Health Science, University of Ghent, Ghent, Belgium, University Hospital Mannheim, CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Istituto Giannina Gaslini, Institute of Post Graduate Medical Education & Research [Calcutta] (IPGMER), Instituto de Salud Carlos III [Madrid] (ISC), 'Attikon' University Hospital, Hospital Universitario Ramón y Cajal [Madrid], Universidad de Alcalá - University of Alcalá (UAH), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), University Hospital of Geneva, University Hospital of Strasbourg (CIC), University Hospital of Strasbourg, Heidelberg University Hospital [Heidelberg], University College of London [London] (UCL), Russian State Medical University, Universität zu Lübeck [Lübeck], Clinic of Johann Wolfgang von Goethe University, Service des Maladies infectieuses et tropicales [CHU Necker], CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), University Hospitals Leuven [Leuven], Canisius-Wilhelmina Hospital [Nijmegen, The Netherlands], Università cattolica del Sacro Cuore [Roma] (Unicatt), Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Wythenshawe Hospital [Manchester, UK], University of South Manchester, Aristotle University of Thessaloniki, Paracelsus-Elena-Hospital, Department of Medecine [Montréal], McGill University = Université McGill [Montréal, Canada], Szent László Hospital, National and Kapodistrian University of Athens (NKUA), University Hospital of Cologne [Cologne], University of Genova [Genova, Italy], Actelion Pharmaceuticals, Astellas Pharma Canada, AstraZeneca, Bayer HealthCare, Cidara Therapeutics, NIH UM1AI104681, Duke University, Amplyx, Arsanis, Basilea, Innsbruck Medical University = Medizinische Universität Innsbruck (IMU), University of Bologna/Università di Bologna, Centre International de Recherche en Infectiologie (CIRI), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Universiteit Gent = Ghent University (UGENT), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Universität zu Lübeck = University of Lübeck [Lübeck], Università cattolica del Sacro Cuore = Catholic University of the Sacred Heart [Roma] (Unicatt), Pathogenèse des légionelles- Legionella pathogenesis, École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Tenon [APHP], Institute of Post Graduate Medical Education & Research, Calcutta, Instituto de Salud Carlos III (ISC), Universität zu Lübeck [Lübeck] - University of Lübeck [Lübeck], Université Paris Descartes - Paris 5 (UPD5)-CHU Necker - Enfants Malades [AP-HP]-Institut des Maladies Génétiques Imagine [Paris], Università Cattolica del Sacro Cuore [Roma] (Unicatt), Hopital Saint-Louis, Assistance Publique – Hôpitaux de Paris (AP-HP), McGill University, and National and Kapodistrian University of Athens
- Subjects
0301 basic medicine ,Myeloid ,Posaconazole ,Antifungal Agents ,Pyridines ,Biopsy ,Pyridine ,lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4] ,Flucytosine ,Aspergillosis ,Bronchoalveolar Lavage ,Mannans ,chemistry.chemical_compound ,0302 clinical medicine ,Invasive fungal infection ,Early Diagnosi ,Diagnosis ,Haematology ,Transplantation ,Treatment ,Antibodies, Fungal ,Aspergillus ,Early Diagnosis ,Humans ,Immunocompromised Host ,Immunologic Tests ,Invasive Pulmonary Aspergillosis ,Itraconazole ,Leukemia, Myeloid, Acute ,Magnetic Resonance Imaging ,Microbial Sensitivity Tests ,Myelodysplastic Syndromes ,Nitriles ,Tomography, X-Ray Computed ,Triazoles ,Voriconazole ,Disease Management ,Antifungal Agent ,Immunologic Test ,030212 general & internal medicine ,Tomography ,ComputingMilieux_MISCELLANEOUS ,Leukemia ,Microbial Sensitivity Test ,General Medicine ,Mannan ,3. Good health ,X-Ray Computed ,Fungal ,Infectious Diseases ,[SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology ,[SDV.IMM]Life Sciences [q-bio]/Immunology ,Nitrile ,medicine.drug ,Diagnosi ,Human ,Microbiology (medical) ,medicine.medical_specialty ,Echinocandin ,Aspergillosi ,030106 microbiology ,Invasive Pulmonary Aspergillosi ,Myelodysplastic Syndrome ,Acute ,Antibodies ,Settore MED/07 - MICROBIOLOGIA E MICROBIOLOGIA CLINICA ,03 medical and health sciences ,Internal medicine ,medicine ,business.industry ,Micafungin ,Induction chemotherapy ,Galactose ,medicine.disease ,Aspergillu ,[SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology ,Settore MED/15 - MALATTIE DEL SANGUE ,lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] ,chemistry ,Triazole ,Caspofungin ,business - Abstract
Contains fulltext : 193204.pdf (Publisher’s version ) (Closed access) The European Society for Clinical Microbiology and Infectious Diseases, the European Confederation of Medical Mycology and the European Respiratory Society Joint Clinical Guidelines focus on diagnosis and management of aspergillosis. Of the numerous recommendations, a few are summarized here. Chest computed tomography as well as bronchoscopy with bronchoalveolar lavage (BAL) in patients with suspicion of pulmonary invasive aspergillosis (IA) are strongly recommended. For diagnosis, direct microscopy, preferably using optical brighteners, histopathology and culture are strongly recommended. Serum and BAL galactomannan measures are recommended as markers for the diagnosis of IA. PCR should be considered in conjunction with other diagnostic tests. Pathogen identification to species complex level is strongly recommended for all clinically relevant Aspergillus isolates; antifungal susceptibility testing should be performed in patients with invasive disease in regions with resistance found in contemporary surveillance programmes. Isavuconazole and voriconazole are the preferred agents for first-line treatment of pulmonary IA, whereas liposomal amphotericin B is moderately supported. Combinations of antifungals as primary treatment options are not recommended. Therapeutic drug monitoring is strongly recommended for patients receiving posaconazole suspension or any form of voriconazole for IA treatment, and in refractory disease, where a personalized approach considering reversal of predisposing factors, switching drug class and surgical intervention is also strongly recommended. Primary prophylaxis with posaconazole is strongly recommended in patients with acute myelogenous leukaemia or myelodysplastic syndrome receiving induction chemotherapy. Secondary prophylaxis is strongly recommended in high-risk patients. We strongly recommend treatment duration based on clinical improvement, degree of immunosuppression and response on imaging.
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- 2018
24. Fluconazole non-susceptible breakthrough candidemia after prolonged low-dose prophylaxis: a prospective FUNGINOS study.
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Orasch C, Mertz D, Garbino J, van Delden C, Emonet S, Schrenzel J, Zimmerli S, Damonti L, Mühlethaler K, Imhof A, Ruef C, Fehr J, Zbinden R, Boggian K, Bruderer T, Flückiger U, Conen A, Khanna N, Frei R, Bregenzer T, Lamoth F, Erard V, Bochud PY, Calandra T, Bille J, and Marchetti O
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Candidemia microbiology, Candidemia mortality, Child, Child, Preschool, Epidemiological Monitoring, Female, Humans, Infant, Infant, Newborn, Male, Microbial Sensitivity Tests, Middle Aged, Prospective Studies, Young Adult, Antifungal Agents administration & dosage, Candida drug effects, Candidemia prevention & control, Drug Resistance, Fungal, Fluconazole administration & dosage
- Abstract
Objectives: Breakthrough candidemia (BTC) on fluconazole was associated with non-susceptible Candida spp. and increased mortality. This nationwide FUNGINOS study analyzed clinical and mycological BTC characteristics., Methods: A 3-year prospective study was conducted in 567 consecutive candidemias. Species identification and antifungal susceptibility testing (CLSI) were performed in the FUNGINOS reference laboratory. Data were analyzed according to STROBE criteria., Results: 43/576 (8%) BTC occurred: 37/43 (86%) on fluconazole (28 prophylaxis, median 200 mg/day). 21% BTC vs. 23% non-BTC presented severe sepsis/septic shock. Overall mortality was 34% vs. 32%. BTC was associated with gastrointestinal mucositis (multivariate OR 5.25, 95%CI 2.23-12.40, p < 0.001) and graft-versus-host-disease (6.25, 1.00-38.87, p = 0.05), immunosuppression (2.42, 1.03-5.68, p = 0.043), and parenteral nutrition (2.87, 1.44-5.71, p = 0.003). Non-albicans Candida were isolated in 58% BTC vs. 35% non-BTC (p = 0.005). 63% of 16 BTC occurring after 10-day fluconazole were non-susceptible (Candida glabrata, Candida krusei, Candida norvegensis) vs. 19% of 21 BTC (C. glabrata) following shorter exposure (7.10, 1.60-31.30, p = 0.007). Median fluconazole MIC was 4 mg/l vs. 0.25 mg/l (p < 0.001). Ten-day fluconazole exposure predicted non-susceptible BTC with 73% accuracy., Conclusions: Outcomes of BTC and non-BTC were similar. Fluconazole non-susceptible BTC occurred in three out of four cases after prolonged low-dose prophylaxis. This implies reassessment of prophylaxis duration and rapid de-escalation of empirical therapy in BTC after short fluconazole exposure., (Copyright © 2018 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)
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- 2018
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25. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline.
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Ullmann AJ, Aguado JM, Arikan-Akdagli S, Denning DW, Groll AH, Lagrou K, Lass-Flörl C, Lewis RE, Munoz P, Verweij PE, Warris A, Ader F, Akova M, Arendrup MC, Barnes RA, Beigelman-Aubry C, Blot S, Bouza E, Brüggemann RJM, Buchheidt D, Cadranel J, Castagnola E, Chakrabarti A, Cuenca-Estrella M, Dimopoulos G, Fortun J, Gangneux JP, Garbino J, Heinz WJ, Herbrecht R, Heussel CP, Kibbler CC, Klimko N, Kullberg BJ, Lange C, Lehrnbecher T, Löffler J, Lortholary O, Maertens J, Marchetti O, Meis JF, Pagano L, Ribaud P, Richardson M, Roilides E, Ruhnke M, Sanguinetti M, Sheppard DC, Sinkó J, Skiada A, Vehreschild MJGT, Viscoli C, and Cornely OA
- Subjects
- Antibodies, Fungal blood, Antifungal Agents pharmacology, Aspergillosis complications, Aspergillosis immunology, Aspergillus drug effects, Aspergillus immunology, Biopsy methods, Bronchoalveolar Lavage, Early Diagnosis, Flucytosine pharmacology, Flucytosine therapeutic use, Galactose analogs & derivatives, Humans, Immunocompromised Host, Immunologic Tests, Invasive Pulmonary Aspergillosis diagnosis, Itraconazole pharmacology, Itraconazole therapeutic use, Leukemia, Myeloid, Acute complications, Leukemia, Myeloid, Acute therapy, Magnetic Resonance Imaging, Mannans analysis, Microbial Sensitivity Tests, Myelodysplastic Syndromes complications, Myelodysplastic Syndromes therapy, Nitriles pharmacology, Nitriles therapeutic use, Pyridines pharmacology, Pyridines therapeutic use, Tomography, X-Ray Computed, Triazoles pharmacology, Triazoles therapeutic use, Voriconazole pharmacology, Voriconazole therapeutic use, Antifungal Agents therapeutic use, Aspergillosis diagnosis, Aspergillosis drug therapy, Aspergillus isolation & purification, Disease Management
- Abstract
The European Society for Clinical Microbiology and Infectious Diseases, the European Confederation of Medical Mycology and the European Respiratory Society Joint Clinical Guidelines focus on diagnosis and management of aspergillosis. Of the numerous recommendations, a few are summarized here. Chest computed tomography as well as bronchoscopy with bronchoalveolar lavage (BAL) in patients with suspicion of pulmonary invasive aspergillosis (IA) are strongly recommended. For diagnosis, direct microscopy, preferably using optical brighteners, histopathology and culture are strongly recommended. Serum and BAL galactomannan measures are recommended as markers for the diagnosis of IA. PCR should be considered in conjunction with other diagnostic tests. Pathogen identification to species complex level is strongly recommended for all clinically relevant Aspergillus isolates; antifungal susceptibility testing should be performed in patients with invasive disease in regions with resistance found in contemporary surveillance programmes. Isavuconazole and voriconazole are the preferred agents for first-line treatment of pulmonary IA, whereas liposomal amphotericin B is moderately supported. Combinations of antifungals as primary treatment options are not recommended. Therapeutic drug monitoring is strongly recommended for patients receiving posaconazole suspension or any form of voriconazole for IA treatment, and in refractory disease, where a personalized approach considering reversal of predisposing factors, switching drug class and surgical intervention is also strongly recommended. Primary prophylaxis with posaconazole is strongly recommended in patients with acute myelogenous leukaemia or myelodysplastic syndrome receiving induction chemotherapy. Secondary prophylaxis is strongly recommended in high-risk patients. We strongly recommend treatment duration based on clinical improvement, degree of immunosuppression and response on imaging., (Copyright © 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
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- 2018
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26. Correction to: Catheter retention as a consequence rather than a cause of unfavorable outcome in candidemia.
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Damonti L, Erard V, Garbino J, Schrenzel J, Zimmerli S, Mühlethaler K, Imhof A, Zbinden R, Fehr J, Boggian K, Bruderer T, Flückiger U, Frei R, Orasch C, Conen A, Khanna N, Bregenzer T, Bille J, Lamoth F, Marchetti O, and Bochud PY
- Abstract
In the original publication the members of the FUNGINOS network were provided in such a way that they could not be indexed as collaborators on PubMed.
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- 2018
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27. Efficacy of anidulafungin in 539 patients with invasive candidiasis: a patient-level pooled analysis of six clinical trials.
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Kullberg BJ, Vasquez J, Mootsikapun P, Nucci M, Paiva JA, Garbino J, Yan JL, Aram J, Capparella MR, Conte U, Schlamm H, Swanson R, and Herbrecht R
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- Administration, Intravenous, Adolescent, Adult, Aged, Aged, 80 and over, Anidulafungin, Clinical Trials as Topic, Female, Humans, Male, Middle Aged, Treatment Outcome, Young Adult, Antifungal Agents administration & dosage, Candidiasis, Invasive drug therapy, Echinocandins administration & dosage
- Abstract
Objectives: To evaluate the efficacy of anidulafungin for the treatment of candidaemia and invasive candidiasis in a large dataset, including patients with deep-seated tissue candidiasis, neutropenia and infection due to non- albicans Candida species., Methods: Data were pooled from six prospective, multicentre, multinational studies: four open-label, non-comparative studies of anidulafungin and two double-blind, double-dummy, randomized studies of anidulafungin versus caspofungin (clinical trial registrations: NCT00496197, NCT00548262, NCT00537329, NCT00689338, NCT00806351 and NCT00805740; ClinicalTrials.gov). In all studies, patients with culture-confirmed invasive candidiasis received a single intravenous (iv) loading dose of anidulafungin 200 mg on day 1, followed by 100 mg once-daily. Switch to oral fluconazole or voriconazole was permitted after 5-10 days of iv treatment in all studies except one. Antifungal treatment (iv plus oral therapy if applicable) was maintained for ≥14 days after the last positive Candida culture. The primary endpoint was successful global response at end of iv therapy (EOivT) in the modified ITT (mITT) population., Results: In total, 539 patients were included (mITT population). The most common baseline Candida species were Candida albicans (47.9%), Candida glabrata (21.0%), Candida tropicalis (13.7%), Candida parapsilosis (13.2%) and Candida krusei (3.5%). Median duration of anidulafungin iv treatment was 10.0 days. The global response success rate at EOivT was 76.4% (95% CI 72.9%-80.0%). All-cause mortality was 13.0% on day 14 and 19.1% on day 28. Adverse events (AEs) were consistent with the known AE profile for anidulafungin., Conclusions: These data demonstrate that anidulafungin is effective for treatment of candidaemia and invasive candidiasis in a broad patient population., (© The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
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- 2017
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28. Catheter retention as a consequence rather than a cause of unfavorable outcome in candidemia.
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Damonti L, Erard V, Garbino J, Schrenzel J, Zimmerli S, Mühlethaler K, Imhof A, Zbinden R, Fehr J, Boggian K, Bruderer T, Flückiger U, Frei R, Orasch C, Conen A, Khanna N, Bregenzer T, Bille J, Lamoth F, Marchetti O, and Bochud PY
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- Candidemia blood, Candidemia microbiology, Case-Control Studies, Catheter-Related Infections blood, Catheter-Related Infections microbiology, Device Removal statistics & numerical data, Humans, Intensive Care Units, Treatment Outcome, Candidemia mortality, Central Venous Catheters adverse effects, Device Removal adverse effects
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- 2017
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29. Assessment of panobacumab as adjunctive immunotherapy for the treatment of nosocomial Pseudomonas aeruginosa pneumonia.
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Que YA, Lazar H, Wolff M, François B, Laterre PF, Mercier E, Garbino J, Pagani JL, Revelly JP, Mus E, Perez A, Tamm M, Rouby JJ, Lu Q, Chastre J, and Eggimann P
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- Adult, Aged, Antibodies, Bacterial adverse effects, Antibodies, Monoclonal adverse effects, Antibodies, Monoclonal pharmacokinetics, Cross Infection microbiology, Cross Infection therapy, Female, Humans, Immunoglobulin M administration & dosage, Immunoglobulin M adverse effects, Immunologic Factors adverse effects, Immunologic Factors pharmacokinetics, Male, Middle Aged, Pneumonia, Bacterial microbiology, Prospective Studies, Pseudomonas aeruginosa classification, Serogroup, Treatment Outcome, Antibodies, Bacterial administration & dosage, Antibodies, Monoclonal administration & dosage, Immunologic Factors administration & dosage, Immunotherapy methods, Pneumonia, Bacterial therapy, Pseudomonas aeruginosa immunology
- Abstract
The fully human anti-lipopolysaccharide (LPS) immunoglobulin M (IgM) monoclonal antibody panobacumab was developed as an adjunctive immunotherapy for the treatment of O11 serotype Pseudomonas aeruginosa infections. We evaluated the potential clinical efficacy of panobacumab in the treatment of nosocomial pneumonia. We performed a post-hoc analysis of a multicenter phase IIa trial (NCT00851435) designed to prospectively evaluate the safety and pharmacokinetics of panobacumab. Patients treated with panobacumab (n = 17), including 13 patients receiving the full treatment (three doses of 1.2 mg/kg), were compared to 14 patients who did not receive the antibody. Overall, the 17 patients receiving panobacumab were more ill. They were an average of 72 years old [interquartile range (IQR): 64-79] versus an average of 50 years old (IQR: 30-73) (p = 0.024) and had Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of 17 (IQR: 16-22) versus 15 (IQR: 10-19) (p = 0.043). Adjunctive immunotherapy resulted in an improved clinical outcome in the group receiving the full three-course panobacumab treatment, with a resolution rate of 85 % (11/13) versus 64 % (9/14) (p = 0.048). The Kaplan-Meier survival curve showed a statistically significantly shorter time to clinical resolution in this group of patients (8.0 [IQR: 7.0-11.5] versus 18.5 [IQR: 8-30] days in those who did not receive the antibody; p = 0.004). Panobacumab adjunctive immunotherapy may improve clinical outcome in a shorter time if patients receive the full treatment (three doses). These preliminary results suggest that passive immunotherapy targeting LPS may be a complementary strategy for the treatment of nosocomial O11 P. aeruginosa pneumonia.
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- 2014
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30. Candida species distribution and antifungal susceptibility testing according to European Committee on Antimicrobial Susceptibility Testing and new vs. old Clinical and Laboratory Standards Institute clinical breakpoints: a 6-year prospective candidaemia survey from the fungal infection network of Switzerland.
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Orasch C, Marchetti O, Garbino J, Schrenzel J, Zimmerli S, Mühlethaler K, Pfyffer G, Ruef C, Fehr J, Zbinden R, Calandra T, and Bille J
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- Candida isolation & purification, Caspofungin, Drug Resistance, Fungal, Echinocandins pharmacology, Fluconazole pharmacology, Lipopeptides, Microbial Sensitivity Tests, Prospective Studies, Switzerland epidemiology, Voriconazole pharmacology, Antifungal Agents pharmacology, Candida classification, Candida drug effects, Candidemia epidemiology, Candidemia microbiology
- Abstract
We analyzed the species distribution of Candida blood isolates (CBIs), prospectively collected between 2004 and 2009 within FUNGINOS, and compared their antifungal susceptibility according to clinical breakpoints defined by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) in 2013, and the Clinical and Laboratory Standards Institute (CLSI) in 2008 (old CLSI breakpoints) and 2012 (new CLSI breakpoints). CBIs were tested for susceptiblity to fluconazole, voriconazole and caspofungin by microtitre broth dilution (Sensititre® YeastOne™ test panel). Of 1090 CBIs, 675 (61.9%) were C. albicans, 191 (17.5%) C. glabrata, 64 (5.9%) C. tropicalis, 59 (5.4%) C. parapsilosis, 33 (3%) C. dubliniensis, 22 (2%) C. krusei and 46 (4.2%) rare Candida species. Independently of the breakpoints applied, C. albicans was almost uniformly (>98%) susceptible to all three antifungal agents. In contrast, the proportions of fluconazole- and voriconazole-susceptible C. tropicalis and F-susceptible C. parapsilosis were lower according to EUCAST/new CLSI breakpoints than to the old CLSI breakpoints. For caspofungin, non-susceptibility occurred mainly in C. krusei (63.3%) and C. glabrata (9.4%). Nine isolates (five C. tropicalis, three C. albicans and one C. parapsilosis) were cross-resistant to azoles according to EUCAST breakpoints, compared with three isolates (two C. albicans and one C. tropicalis) according to new and two (2 C. albicans) according to old CLSI breakpoints. Four species (C. albicans, C. glabrata, C. tropicalis and C. parapsilosis) represented >90% of all CBIs. In vitro resistance to fluconazole, voriconazole and caspofungin was rare among C. albicans, but an increase of non-susceptibile isolates was observed among C. tropicalis/C. parapsilosis for the azoles and C. glabrata/C. krusei for caspofungin according to EUCAST and new CLSI breakpoints compared with old CLSI breakpoints., (© 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.)
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- 2014
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31. Pseudomonas aeruginosa serotypes in nosocomial pneumonia: prevalence and clinical outcomes.
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Lu Q, Eggimann P, Luyt CE, Wolff M, Tamm M, François B, Mercier E, Garbino J, Laterre PF, Koch H, Gafner V, Rudolf MP, Mus E, Perez A, Lazar H, Chastre J, and Rouby JJ
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- Adult, Aged, Cohort Studies, Cross Infection diagnosis, Cross Infection mortality, Female, Humans, Male, Middle Aged, Pneumonia, Bacterial diagnosis, Pneumonia, Bacterial mortality, Prevalence, Pseudomonas Infections diagnosis, Pseudomonas Infections mortality, Retrospective Studies, Treatment Outcome, Cross Infection blood, Pneumonia, Bacterial blood, Pseudomonas Infections blood, Pseudomonas aeruginosa isolation & purification
- Abstract
Introduction: Pseudomonas aeruginosa frequently causes nosocomial pneumonia and is associated with poor outcome. The purpose of this study was to assess the prevalence and clinical outcome of nosocomial pneumonia caused by serotype-specific P. aeruginosa in critically ill patients under appropriate antimicrobial therapy management., Methods: A retrospective, non-interventional epidemiological multicenter cohort study involving 143 patients with confirmed nosocomial pneumonia caused by P. aeruginosa. Patients were analyzed for a period of 30 days from time of nosocomial pneumonia onset. Fourteen patients fulfilling the same criteria from a phase IIa studyconducted at the same time/centers were included in the prevalence calculations but not in the clinical outcome analysis., Results: The prevalence of serotypes was: O6 (29%), O11 (23%), O10 (10%), O2 (9%), and O1 (8%). Serotypes with a prevalence of less than 5% were found in 13% of patients, 8% were classified as not typeable. Across all serotypes, 19% mortality, 70% clinical resolution, 11% clinical continuation, and 5% clinical recurrence were recorded. Age and higher APACHE II (Acute Physiology and Chronic Health Evaluation II) were predictive risk factors associated with probability of death and lower clinical resolution for P. aeruginosa nosocomial pneumonia. Mortality tends to be higher with O1 (40%) and lower with O2 (0%); clinical resolution tends to be better with O2 (82%) compared to other serotypes. Persisting pneumonia with O6 and O11 was, respectively, 8% and 21%; clinical resolution with O6 and O11 was, respectively, 75% and 57%., Conclusions: In P. aeruginosa nosocomial pneumonia, the most prevalent serotypes were O6 and O11. Further studies including larger group sizes are needed to correlate clinical outcome with virulence factors of P. aeruginosa in patients with nosocomial pneumonia caused by various serotypes; and to compare O6 and O11, the two serotypes most frequently encountered in critically ill patients.
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- 2014
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32. The safety and efficacy of high-dose daptomycin combined with rifampicin for the treatment of Gram-positive osteoarticular infections.
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Jugun K, Vaudaux P, Garbino J, Pagani L, Hoffmeyer P, Lew D, and Uçkay I
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- Adult, Aged, Aged, 80 and over, Dose-Response Relationship, Drug, Drug Therapy, Combination, Female, Follow-Up Studies, Humans, Male, Middle Aged, Osteoarthritis surgery, Prospective Studies, Treatment Outcome, Anti-Bacterial Agents therapeutic use, Daptomycin therapeutic use, Gram-Positive Bacterial Infections drug therapy, Prosthesis-Related Infections drug therapy, Rifampin therapeutic use
- Abstract
Purpose: Treatment of Gram-positive osteoarticular infections requires an adequate surgical approach combined with intensive antimicrobial therapy. The aim of this study was to evaluate the safety and efficacy of a combined regimen of high-dose daptomycin and rifampicin, in patients with various types of Gram-positive osteoarticular infections., Methods: This single centre, non-comparative, prospective study evaluated the safety and efficacy of a combined regimen of intravenous daptomycin (8 mg/kg/day) and oral rifampicin (600 mg/day) in patients with Gram-positive osteoarticular infections, with a minimal follow-up of one year. Creatine phosphokinase, transaminases, bilirubinaemia, and serum creatinine, were measured at baseline and regular intervals., Results: The median daily doses of daptomycin and rifampicin, administered for a median duration of 21 (range, 10-122) days to 16 patients (median age, 63.5 years; 11 males, five females) presenting with staphylococcal (n = 15) or streptococcal (n = 1) osteoarticular infections, were 8.15 (range, 6.6-8.9) mg/kg/day and 600 (range, 600-900) mg/day, respectively. The combined regimen of daptomycin and rifampicin was well tolerated by all except one patient, without requiring treatment adjustment or discontinuation. One patient developed allergic responses probably due to rifampicin after 42 days. Fifteen (94 %) patients showed favourable clinical and microbiological outcomes., Conclusions: The combined regimen of high-dose daptomycin and rifampicin was well tolerated and may provide a useful alternative to standard glycopeptide therapy for Gram-positive osteoarticular infections.
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- 2013
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33. Short parenteral antibiotic treatment for adult septic arthritis after successful drainage.
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Uçkay I, Tovmirzaeva L, Garbino J, Rohner P, Tahintzi P, Suvà D, Assal M, Hoffmeyer P, Bernard L, and Lew D
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- Adult, Aged, Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents therapeutic use, Arthritis, Infectious microbiology, Arthritis, Infectious therapy, Drug Administration Schedule, Female, Gram-Negative Bacteria drug effects, Gram-Positive Bacteria drug effects, Humans, Infusions, Parenteral, Male, Middle Aged, Retrospective Studies, Secondary Prevention, Treatment Outcome, Arthritis, Infectious drug therapy, Arthritis, Infectious epidemiology, Drainage methods
- Abstract
Objectives: To assess the risk factors for recurrence of septic arthritis with an emphasis on the duration of antibiotic treatment, to gather data for a prospective study on an optimized antibiotic treatment in adults with septic arthritis., Methods: This was a retrospective single-center study conducted for the period 1996-2008., Results: A total of 169 episodes of septic arthritis in 157 adult patients (median age 63 years; 65 females) were included. In 21 episodes (21/169, 12%), arthritis recurred after the end of antibiotic treatment. Multivariate analysis showed that Gram-negative infection (odds ratio (OR) 5.9, 95% confidence interval (CI) 1.4-25.3), immune suppression (OR 5.3, 95% CI 1.3-22.0), and lack of surgical intervention were associated with recurrence. The size of the infected joint, the number of surgical drainages (OR 1.3, 95% CI 1.0-1.7), arthrotomy vs. arthroscopic drainage (OR 0.5, 95% CI 0.2-1.8), duration of antibiotic therapy (OR 1.0, 95% CI 0.95-1.05), and duration of intravenous antibiotic therapy (OR 1.0, 95% CI 1.0-1.0) were not. Seven days of intravenous therapy had the same success rate as 8-21 days (OR 0.4, 95% CI 0.1-1.7) and >21 days (OR 1.1, 95% CI 0.4-3.1). Fourteen days or less of total antibiotic treatment had the same outcome as 15-28 days (OR 0.4, 95% CI 0.1-2.3) or >28 days (OR 0.4, 95% CI 0.1-1.6)., Conclusions: In this retrospective study of adults with septic arthritis, the duration of antibiotic therapy, or an early switch from intravenous to oral administration, did not statistically influence the risk of recurrence. Due to study limitations, the data cannot be used directly for antibiotic therapy recommendations for septic arthritis. Prospective randomized trials are warranted to optimize the antibiotic treatment of septic arthritis., (Copyright © 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
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- 2013
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34. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: developing European guidelines in clinical microbiology and infectious diseases.
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Ullmann AJ, Cornely OA, Donnelly JP, Akova M, Arendrup MC, Arikan-Akdagli S, Bassetti M, Bille J, Calandra T, Castagnola E, Garbino J, Groll AH, Herbrecht R, Hope WW, Jensen HE, Kullberg BJ, Lass-Flörl C, Lortholary O, Meersseman W, Petrikkos G, Richardson MD, Roilides E, Verweij PE, Viscoli C, and Cuenca-Estrella M
- Subjects
- Candidiasis complications, Europe, Expert Testimony, Humans, Candidiasis diagnosis, Evidence-Based Medicine standards, Practice Guidelines as Topic
- Abstract
The process to develop a guideline in a European setting remains a challenge. The ESCMID Fungal Infection Study Group (EFISG) successfully achieved this endeavour. After two face-to-face meetings, numerous telephone conferences, and email correspondence, an ESCMID task force (basically composed of members of the Society's Fungal Infection Study Group, EFISG) finalized the ESCMID diagnostic and management/therapeutic guideline for Candida diseases. By appreciating various patient populations at risk for Candida diseases, four subgroups were predefined, mainly ICU patients, paediatric, HIV/AIDS and patients with malignancies including haematopoietic stem cell transplantation. Besides treatment recommendations, the ESCMID guidelines provide guidance for diagnostic procedures. For the guidelines, questions were formulated to phrase the intention of a given recommendation, for example, outcome. The recommendation was the clinical intervention, which was graded by a score of A-D for the 'Strength of a recommendation'. The 'level of evidence' received a score of I-III. The author panel was approved by ESCMID, European Organisation for Research and Treatment of Cancer, European Group for Blood and Marrow Transplantation, European Society of Intensive Care Medicine and the European Confederation of Medical Mycology. The guidelines followed the framework of GRADE and Appraisal of Guidelines, Research, and Evaluation. The drafted guideline was presented at ECCMID 2011 and points of discussion occurring during that meeting were incorporated into the manuscripts. These ESCMID guidelines for the diagnosis and management of Candida diseases provide guidance for clinicians in their daily decision-making process., (© 2012 The Authors. Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases.)
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- 2012
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35. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT).
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Ullmann AJ, Akova M, Herbrecht R, Viscoli C, Arendrup MC, Arikan-Akdagli S, Bassetti M, Bille J, Calandra T, Castagnola E, Cornely OA, Donnelly JP, Garbino J, Groll AH, Hope WW, Jensen HE, Kullberg BJ, Lass-Flörl C, Lortholary O, Meersseman W, Petrikkos G, Richardson MD, Roilides E, Verweij PE, and Cuenca-Estrella M
- Subjects
- Adult, Candidiasis complications, Candidiasis diagnosis, Candidiasis therapy, Catheterization, Central Venous adverse effects, Evidence-Based Medicine standards, Humans, Neutropenia complications, Antifungal Agents therapeutic use, Candidiasis prevention & control, Hematologic Neoplasms complications, Hematopoietic Stem Cell Transplantation
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Fungal diseases still play a major role in morbidity and mortality in patients with haematological malignancies, including those undergoing haematopoietic stem cell transplantation. Although Aspergillus and other filamentous fungal diseases remain a major concern, Candida infections are still a major cause of mortality. This part of the ESCMID guidelines focuses on this patient population and reviews pertaining to prophylaxis, empirical/pre-emptive and targeted therapy of Candida diseases. Anti-Candida prophylaxis is only recommended for patients receiving allogeneic stem cell transplantation. The authors recognize that the recommendations would have most likely been different if the purpose would have been prevention of all fungal infections (e.g. aspergillosis). In targeted treatment of candidaemia, recommendations for treatment are available for all echinocandins, that is anidulafungin (AI), caspofungin (AI) and micafungin (AI), although a warning for resistance is expressed. Liposomal amphotericin B received a BI recommendation due to higher number of reported adverse events in the trials. Amphotericin B deoxycholate should not be used (DII); and fluconazole was rated CI because of a change in epidemiology in some areas in Europe. Removal of central venous catheters is recommended during candidaemia but if catheter retention is a clinical necessity, treatment with an echinocandin is an option (CII(t) ). In chronic disseminated candidiasis therapy, recommendations are liposomal amphotericin B for 8 weeks (AIII), fluconazole for >3 months or other azoles (BIII). Granulocyte transfusions are only an option in desperate cases of patients with Candida disease and neutropenia (CIII)., (© 2012 The Authors. Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases.)
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- 2012
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36. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: diagnostic procedures.
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Cuenca-Estrella M, Verweij PE, Arendrup MC, Arikan-Akdagli S, Bille J, Donnelly JP, Jensen HE, Lass-Flörl C, Richardson MD, Akova M, Bassetti M, Calandra T, Castagnola E, Cornely OA, Garbino J, Groll AH, Herbrecht R, Hope WW, Kullberg BJ, Lortholary O, Meersseman W, Petrikkos G, Roilides E, Viscoli C, and Ullmann AJ
- Subjects
- Antifungal Agents therapeutic use, Biomarkers analysis, Candida drug effects, Evidence-Based Medicine, Humans, Microbial Sensitivity Tests, Antifungal Agents pharmacology, Candida isolation & purification, Candidiasis diagnosis, Candidiasis drug therapy
- Abstract
As the mortality associated with invasive Candida infections remains high, it is important to make optimal use of available diagnostic tools to initiate antifungal therapy as early as possible and to select the most appropriate antifungal drug. A panel of experts of the European Fungal Infection Study Group (EFISG) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) undertook a data review and compiled guidelines for the clinical utility and accuracy of different diagnostic tests and procedures for detection of Candida infections. Recommendations about the microbiological investigation and detection of candidaemia, invasive candidiasis, chronic disseminated candidiasis, and oropharyngeal, oesophageal, and vaginal candidiasis were included. In addition, remarks about antifungal susceptibility testing and therapeutic drug monitoring were made., (© 2012 The Authors. Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases.)
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- 2012
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37. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp.
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Hope WW, Castagnola E, Groll AH, Roilides E, Akova M, Arendrup MC, Arikan-Akdagli S, Bassetti M, Bille J, Cornely OA, Cuenca-Estrella M, Donnelly JP, Garbino J, Herbrecht R, Jensen HE, Kullberg BJ, Lass-Flörl C, Lortholary O, Meersseman W, Petrikkos G, Richardson MD, Verweij PE, Viscoli C, and Ullmann AJ
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- Adolescent, Candida drug effects, Candidiasis, Invasive microbiology, Child, Child, Preschool, Humans, Infant, Infant, Newborn, Pediatrics, Antifungal Agents therapeutic use, Candida isolation & purification, Candidiasis, Invasive drug therapy, Candidiasis, Invasive prevention & control
- Abstract
Invasive candidiasis (IC) is a relatively common syndrome in neonates and children and is associated with significant morbidity and mortality. These guidelines provide recommendations for the prevention and treatment of IC in neonates and children. Appropriate agents for the prevention of IC in neonates at high risk include fluconazole (A-I), nystatin (B-II) or lactoferrin ± Lactobacillus (B-II). The treatment of IC in neonates is complicated by the high likelihood of disseminated disease, including the possibility of infection within the central nervous system. Amphotericin B deoxycholate (B-II), liposomal amphotericin B (B-II), amphotericin B lipid complex (ABLC) (C-II), fluconazole (B-II), micafungin (B-II) and caspofungin (C-II) can all be potentially used. Recommendations for the prevention of IC in children are largely extrapolated from studies performed in adults with concomitant pharmacokinetic data and models in children. For allogeneic HSCT recipients, fluconazole (A-I), voriconazole (A-I), micafungin (A-I), itraconazole (B-II) and posaconazole (B-II) can all be used. Similar recommendations are made for the prevention of IC in children in other risk groups. With several exceptions, recommendations for the treatment of IC in children are extrapolated from adult studies, with concomitant pharmacokinetic studies. Amphotericin B deoxycholate (C-I), liposomal amphotericin B (A-I), ABLC (B-II), micafungin (A-I), caspofungin (A-I), anidulafungin (B-II), fluconazole (B-I) and voriconazole (B-I) can all be used., (© 2012 The Authors. Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases.)
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- 2012
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38. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: patients with HIV infection or AIDS.
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Lortholary O, Petrikkos G, Akova M, Arendrup MC, Arikan-Akdagli S, Bassetti M, Bille J, Calandra T, Castagnola E, Cornely OA, Cuenca-Estrella M, Donnelly JP, Garbino J, Groll AH, Herbrecht R, Hope WW, Jensen HE, Kullberg BJ, Lass-Flörl C, Meersseman W, Richardson MD, Roilides E, Verweij PE, Viscoli C, and Ullmann AJ
- Subjects
- Antiretroviral Therapy, Highly Active, Candida isolation & purification, Candidiasis complications, Candidiasis diagnosis, Candidiasis prevention & control, Evidence-Based Medicine standards, Humans, Immunocompromised Host, Antifungal Agents therapeutic use, Candida drug effects, Candidiasis drug therapy, HIV Infections complications
- Abstract
Mucosal candidiasis is frequent in immunocompromised HIV-infected highly active antiretroviral (HAART) naive patients or those who have failed therapy. Mucosal candidiasis is a marker of progressive immune deficiency. Because of the frequently marked and prompt immune reconstitution induced by HAART, there is no recommendation for primary antifungal prophylaxis of mucosal candidiasis in the HIV setting in Europe, although it has been evidenced as effective in the pre-HAART era. Fluconazole remains the first line of therapy for both oropharyngeal candidiasis and oesophageal candidiasis and should be preferred to itraconazole oral solution (or capsules when not available) due to fewer side effects. For patients who still present with fluconazole-refractory mucosal candidiasis, oral treatment with any other azole should be preferred based on precise Candida species identification and susceptibility testing results in addition to the optimization of HAART when feasible. For vaginal candidiasis, topical therapy is preferred., (© 2012 The Authors. Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases.)
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- 2012
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39. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients.
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Cornely OA, Bassetti M, Calandra T, Garbino J, Kullberg BJ, Lortholary O, Meersseman W, Akova M, Arendrup MC, Arikan-Akdagli S, Bille J, Castagnola E, Cuenca-Estrella M, Donnelly JP, Groll AH, Herbrecht R, Hope WW, Jensen HE, Lass-Flörl C, Petrikkos G, Richardson MD, Roilides E, Verweij PE, Viscoli C, and Ullmann AJ
- Subjects
- Adult, Antifungal Agents adverse effects, Candida isolation & purification, Candidiasis diagnosis, Candidiasis prevention & control, Evidence-Based Medicine, Humans, Antifungal Agents therapeutic use, Candida drug effects, Candidiasis drug therapy
- Abstract
This part of the EFISG guidelines focuses on non-neutropenic adult patients. Only a few of the numerous recommendations can be summarized in the abstract. Prophylactic usage of fluconazole is supported in patients with recent abdominal surgery and recurrent gastrointestinal perforations or anastomotic leakages. Candida isolation from respiratory secretions alone should never prompt treatment. For the targeted initial treatment of candidaemia, echinocandins are strongly recommended while liposomal amphotericin B and voriconazole are supported with moderate, and fluconazole with marginal strength. Treatment duration for candidaemia should be a minimum of 14 days after the end of candidaemia, which can be determined by one blood culture per day until negativity. Switching to oral treatment after 10 days of intravenous therapy has been safe in stable patients with susceptible Candida species. In candidaemia, removal of indwelling catheters is strongly recommended. If catheters cannot be removed, lipid-based amphotericin B or echinocandins should be preferred over azoles. Transoesophageal echocardiography and fundoscopy should be performed to detect organ involvement. Native valve endocarditis requires surgery within a week, while in prosthetic valve endocarditis, earlier surgery may be beneficial. The antifungal regimen of choice is liposomal amphotericin B +/- flucytosine. In ocular candidiasis, liposomal amphotericin B +/- flucytosine is recommended when the susceptibility of the isolate is unknown, and in susceptible isolates, fluconazole and voriconazole are alternatives. Amphotericin B deoxycholate is not recommended for any indication due to severe side effects., (© 2012 The Authors. Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases.)
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- 2012
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40. Survey of aspergillosis in non-neutropenic patients in Swiss teaching hospitals.
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Garbino J, Fluckiger U, Elzi L, Imhof A, Bille J, and Zimmerli S
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- Adrenal Cortex Hormones therapeutic use, Age Factors, Aged, Analysis of Variance, Antifungal Agents therapeutic use, Aspergillosis blood, Aspergillosis drug therapy, Female, Hospitals, Teaching, Humans, Invasive Pulmonary Aspergillosis blood, Invasive Pulmonary Aspergillosis drug therapy, Invasive Pulmonary Aspergillosis epidemiology, Male, Middle Aged, Neutropenia epidemiology, Neutropenia microbiology, Opportunistic Infections blood, Opportunistic Infections drug therapy, Retrospective Studies, Risk Factors, Statistics, Nonparametric, Switzerland epidemiology, Aspergillosis epidemiology, Opportunistic Infections epidemiology
- Abstract
Invasive aspergillosis (IA) is a live-threatening opportunistic infection that is best described in haematological patients with prolonged neutropenia or graft-versus-host disease. Data on IA in non-neutropenic patients are limited. The aim of this study was to establish the incidence, disease manifestations and outcome of IA in non-neutropenic patients diagnosed in five Swiss university hospitals during a 2-year period. Case identification was based on a comprehensive screening of hospital records. All cases of proven and probable IA were retrospectively analysed. Sixty-seven patients were analysed (median age 60 years; 76% male). Sixty-three per cent of cases were invasive pulmonary aspergillosis (IPA), and 17% of these were disseminated aspergillosis. The incidence of IPA was 1.2/10 000 admissions. Six of ten cases of extrapulmonary IA affected the brain. There were six cases of invasive rhinosinusitis, six cases of chronic pulmonary aspergillosis, and cases three of subacute pulmonary aspergillosis. The most frequent underlying condition of IA was corticosteroid treatment (57%), followed by chronic lung disease (48%), and intensive-care unit stays (43%). In 38% of patients with IPA, the diagnosis was established at autopsy. Old age was the only risk factor for post-mortem diagnosis, whereas previous solid organ transplantation and chronic lung disease were associated with lower odds of post-mortem diagnosis. The mortality rate was 57%., (© 2010 The Authors. Clinical Microbiology and Infection © 2010 European Society of Clinical Microbiology and Infectious Diseases.)
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- 2011
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41. Pharmacokinetics and safety of panobacumab: specific adjunctive immunotherapy in critical patients with nosocomial Pseudomonas aeruginosa O11 pneumonia.
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Lu Q, Rouby JJ, Laterre PF, Eggimann P, Dugard A, Giamarellos-Bourboulis EJ, Mercier E, Garbino J, Luyt CE, Chastre J, Georgescu-Kyburz V, Rudolf MP, Gafner V, Lazar H, Koch H, Perez A, Krämer SD, and Tamm M
- Subjects
- Aged, Aged, 80 and over, Antibodies, Bacterial administration & dosage, Critical Illness, Female, Humans, Immunoglobulins, Intravenous administration & dosage, Male, Middle Aged, Prospective Studies, Pseudomonas aeruginosa immunology, Antibodies, Bacterial adverse effects, Cross Infection drug therapy, Immunoglobulins, Intravenous adverse effects, Immunoglobulins, Intravenous pharmacokinetics, Pneumonia, Bacterial drug therapy
- Abstract
Objectives: Nosocomial Pseudomonas aeruginosa pneumonia remains a major concern in critically ill patients. We explored the potential impact of microorganism-targeted adjunctive immunotherapy in such patients., Patients and Methods: This multicentre, open pilot Phase 2a clinical trial (NCT00851435) prospectively evaluated the safety, pharmacokinetics and potential efficacy of three doses of 1.2 mg/kg panobacumab, a fully human monoclonal anti-lipopolysaccharide IgM, given every 72 h in 18 patients developing nosocomial P. aeruginosa (serotype O11) pneumonia., Results: Seventeen out of 18 patients were included in the pharmacokinetic analysis. In 13 patients receiving three doses, the maximal concentration after the third infusion was 33.9 ± 8.0 μg/mL, total area under the serum concentration-time curve was 5397 ± 1993 μg h/mL and elimination half-life was 102.3 ± 47.8 h. Panobacumab was well tolerated, induced no immunogenicity and was detected in respiratory samples. In contrast to Acute Physiology and Chronic Health Evaluation II (APACHE II) prediction, all 13 patients receiving three doses survived, with a mean clinical resolution in 9.0 ± 2.7 days. Two patients suffered a recurrence at days 17 and 20., Conclusions: These data suggest that panobacumab is safe, with a pharmacokinetic profile similar to that in healthy volunteers. It was associated with high clinical cure and survival rates in patients developing nosocomial P. aeruginosa O11 pneumonia. We concluded that these promising results warrant further trials.
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- 2011
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42. Emerging invasive zygomycosis in a tertiary care center: epidemiology and associated risk factors.
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Ambrosioni J, Bouchuiguir-Wafa K, and Garbino J
- Subjects
- Adolescent, Adult, Aged, Antifungal Agents therapeutic use, Bone Marrow Transplantation adverse effects, Child, Communicable Diseases, Emerging drug therapy, Communicable Diseases, Emerging etiology, Communicable Diseases, Emerging microbiology, Female, Hematologic Neoplasms complications, Hospitals, Teaching, Humans, Male, Middle Aged, Retrospective Studies, Switzerland, Treatment Outcome, Zygomycosis drug therapy, Zygomycosis etiology, Zygomycosis microbiology, Communicable Diseases, Emerging epidemiology, Zygomycosis epidemiology
- Abstract
Objectives: Invasive zygomycosis is a rare fungal opportunistic disease with a high morbidity and mortality rate, predominantly affecting immunosuppressed patients. Presented herein is our investigation of the epidemiological factors associated with an increasing incidence of the disease at the University of Geneva Hospitals, Geneva, Switzerland, over the past five years., Methods: This was a retrospective study of the clinical charts and microbiology records of patients with a positive culture for zygomycetes, to evaluate predisposing factors and epidemiological characteristics., Results: Three of 19 proven/probable invasive infections were diagnosed during 1989-2003, and 16 during 2003-2008. While the number of positive isolates for zygomycetes remained mainly stable, the ratio between invasive infections and colonized patients increased after the introduction of voriconazole and caspofungin in 2003 at our institution (p<0.001). All cases were unrelated and no nosocomial source of exposure or seasonal aggregation was identified. The increase in cases was coincident with an incremented use of voriconazole and caspofungin, and with an increased number of immunosuppressed patients, especially allogeneic bone marrow transplant recipients., Conclusions: Invasive zygomycosis is an emerging infection at our center and is probably related to an increase in immunosuppressed patients and the wide use of newer antifungals. Changes in antifungal drug prophylaxis and treatment prescription may help to control this emergence., (Copyright © 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2010
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43. Posaconazole salvage treatment in paediatric patients: a multicentre survey.
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Lehrnbecher T, Attarbaschi A, Duerken M, Garbino J, Gruhn B, Kontny U, Lüer S, Phillips R, Scholz J, Wagner HJ, Wiesel T, and Groll AH
- Subjects
- Adolescent, Antifungal Agents adverse effects, Child, Child, Preschool, Female, Humans, Male, Time Factors, Treatment Outcome, Triazoles adverse effects, Antifungal Agents administration & dosage, Mycoses drug therapy, Salvage Therapy methods, Triazoles administration & dosage
- Abstract
While a paediatric dosage has not been defined, posaconazole is occasionally being used in children. We conducted a multicentre retrospective survey and identified 15 patients (median age 10 years [range 3.6-17.5]) who received posaconazole salvage therapy for proven (9 patients) or probable (6 patients) invasive fungal infections. Posaconazole was administered for a median of 32 days (range 4-262) at a median dosage of 21 mg/kg (range 4.8-33.3). None of the patients discontinued therapy due to adverse events, which were mostly mild and observed in 11 patients. Complete or partial responses were observed in 4/7 patients with zygomycosis, 3/4 patients with invasive mould infection, 1/2 patients with invasive aspergillosis and 1/2 patients with chronic disseminated candidiasis. We conclude from the data that posaconazole displays favourable safety and tolerance and may be useful for management of individual paediatric patients with invasive infections.
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- 2010
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44. Upper and lower respiratory tract viral infections and acute graft rejection in lung transplant recipients.
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Soccal PM, Aubert JD, Bridevaux PO, Garbino J, Thomas Y, Rochat T, Rochat TS, Meylan P, Tapparel C, and Kaiser L
- Subjects
- Adolescent, Adult, Aged, Bronchoalveolar Lavage Fluid virology, Child, Cohort Studies, Female, Humans, Male, Middle Aged, Nasopharynx virology, Respiratory Tract Infections virology, Viruses isolation & purification, Young Adult, Graft Rejection complications, Lung Transplantation, Respiratory Tract Infections complications, Transplantation, Virus Diseases complications
- Abstract
Background: Lung transplant recipients are frequently exposed to respiratory viruses and are particularly at risk for severe complications. The aim of this study was to assess the association among the presence of a respiratory virus detected by molecular assays in bronchoalveolar lavage (BAL) fluid, respiratory symptoms, and acute rejection in adult lung transplant recipients., Methods: Upper (nasopharyngeal swab) and lower (BAL) respiratory tract specimens from 77 lung transplant recipients enrolled in a cohort study and undergoing bronchoscopy with BAL and transbronchial biopsies were screened using 17 different polymerase chain reaction-based assays., Results: BAL fluid and biopsy specimens from 343 bronchoscopic procedures performed in 77 patients were analyzed. We also compared paired nasopharyngeal and BAL fluid specimens collected in a subgroup of 283 cases. The overall viral positivity rate was 29.3% in the upper respiratory tract specimens and 17.2% in the BAL samples (P < .001). We observed a significant association between the presence of respiratory symptoms and positive viral detection in the lower respiratory tract (P = .012). Conversely, acute rejection was not associated with the presence of viral infection (odds ratio, 0.41; 95% confidence interval, 0.20-0.88). The recovery of lung function was significantly slower when acute rejection and viral infection were both present., Conclusions: A temporal relationship exists between acute respiratory symptoms and positive viral nucleic acid detection in BAL fluid from lung transplant recipients. We provide evidence suggesting that respiratory viruses are not associated with acute graft rejection during the acute phase of infection.
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- 2010
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45. Disseminated Rhizopus microsporus infection cured by salvage allogeneic hematopoietic stem cell transplantation, antifungal combination therapy, and surgical resection.
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Lebeau O, Van Delden C, Garbino J, Robert J, Lamoth F, Passweg J, and Chalandon Y
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- Amphotericin B therapeutic use, Drug Therapy, Combination, Female, Humans, Leukemia, Myeloid, Acute complications, Leukemia, Myeloid, Acute drug therapy, Middle Aged, Mucormycosis immunology, Mucormycosis microbiology, Rhizopus classification, Rhizopus isolation & purification, Treatment Outcome, Triazoles therapeutic use, Antifungal Agents therapeutic use, Hematopoietic Stem Cell Transplantation, Mucormycosis drug therapy, Mucormycosis surgery, Rhizopus drug effects, Salvage Therapy, Transplantation, Homologous
- Abstract
Invasive Zygomycetes infection complicating prolonged neutropenia is associated with high mortality in the absence of immune recovery. We report a patient who developed disseminated zygomycosis due to Rhizopus microsporus during induction chemotherapy for acute myeloid leukemia. Rescue allogeneic hematopoietic stem cell transplantation (allo-HSCT) was performed as her only chance of cure of this infection and to treat refractory leukemia. Posaconazole combined with liposomal amphotericin B contained the zygomycosis during prolonged neutropenia due to allo-HSCT followed by intense immunosuppression for grade IV acute graft-versus-host disease. Surgical removal of all infected sites after immune recovery, with prolonged posaconazole treatment, ultimately cured the infection. New combination antifungal therapies might sufficiently control disseminated zygomycosis to allow allo-HSCT to be performed, assuring life-saving immune recovery. Surgery appears to be necessary for definite cure of these infections.
- Published
- 2010
- Full Text
- View/download PDF
46. Invasive fusariosis with prolonged fungemia in a patient with acute lymphoblastic leukemia: case report and review of the literature.
- Author
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Jossi M, Ambrosioni J, Macedo-Vinas M, and Garbino J
- Subjects
- Adult, Antifungal Agents therapeutic use, Dermatomycoses drug therapy, Dermatomycoses pathology, Fatal Outcome, Female, Humans, Precursor Cell Lymphoblastic Leukemia-Lymphoma drug therapy, Precursor Cell Lymphoblastic Leukemia-Lymphoma pathology, Dermatomycoses complications, Fusarium growth & development, Precursor Cell Lymphoblastic Leukemia-Lymphoma microbiology
- Abstract
Fusariumspp are rare but important opportunistic pathogens in immunocompromised patients. Disseminated fusarial infections occur mostly in patients with hematologic malignancies with myelosuppressive chemotherapy or in patients with severe immunodeficiency. Although more frequent than Aspergillus fungemia, Fusarium fungemia remains a rare event. We describe the case of a female patient with febrile neutropenia and persistent fungemia due to Fusarium solani, treated with posaconazole and liposomal amphotericin B. A review of the literature for Fusariumspp fungemia was carried out.
- Published
- 2010
- Full Text
- View/download PDF
47. Nocardiosis: updated clinical review and experience at a tertiary center.
- Author
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Ambrosioni J, Lew D, and Garbino J
- Subjects
- Anti-Bacterial Agents therapeutic use, Brain diagnostic imaging, Hospitals, Humans, Immunocompromised Host, Nocardia Infections epidemiology, Nocardia Infections microbiology, Radiography, Thoracic, Tomography, Nocardia isolation & purification, Nocardia Infections diagnosis, Nocardia Infections therapy
- Abstract
Nocardiosis is a rare opportunistic disease that affects mainly patients with deficient cell-mediated immunity, such as those with acquired immunodeficiency syndrome (AIDS) or transplant recipients. Pulmonary disease is the most common presentation in immunosuppressed patients and approximately one-third have a disseminated disease. Primary cutaneous nocardiosis is more frequently observed in immunocompetent patients with direct inoculation of the organism through professional exposure. The diagnosis can be challenging, as signs and symptoms are not specific and a high index of clinical of suspicion is necessary. Although gram stain, modified acid-fast stain, and cultures remain as the standard diagnostic tools, novel molecular techniques have changed the taxonomy of these organisms and, in some instances, have facilitated their identification. The disease has a marked tendency to recur and a high morbidity and mortality rate in immunosuppressed patients. Treatment is usually prolonged and an associated antibiotic treatment is preferred for severe disease. Although sulfonamides in combination with other antibiotics are still the treatment of choice, other associations such as imipenem plus amikacin are preferred in some centers. Linezolid is a useful alternative therapeutic agent due to its oral availability and activity against most of the isolates studied. Twenty-eight cases of nocardiosis were diagnosed at our center between January 1989 and April 2009. We report the epidemiologic characteristics of Nocardia spp. observed in our institution and discuss the risk factors, clinical features, diagnosis, and management of the disease.
- Published
- 2010
- Full Text
- View/download PDF
48. Report of a successful treatment of pulmonary Cunninghamella bertholletiae infection with liposomal amphotericin and posaconazole in a child with GvHD and review of the literature.
- Author
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Garbino J, Myers C, Ambrosioni J, and Gumy-Pause F
- Subjects
- Bone Marrow Transplantation adverse effects, Child, Drug Therapy, Combination, Female, Humans, Amphotericin B administration & dosage, Cunninghamella, Graft vs Host Disease drug therapy, Lung Diseases, Fungal drug therapy, Mucormycosis drug therapy, Triazoles administration & dosage
- Abstract
Zygomycosis is an emerging, opportunistic fungal infection particularly affecting immunocomprised patients. We report the case of a 10-year-old girl who developed pulmonary zygomycosis because of Cunninghamella bertholletiae 1 year after undergoing bone marrow transplantation complicated with severe cutaneous and digestive graft-versus-host disease. Treatment with surgery and liposomal amphotericin B followed by posaconazole successfully treated the infection.
- Published
- 2010
- Full Text
- View/download PDF
49. Respiratory viruses in bronchoalveolar lavage: a hospital-based cohort study in adults.
- Author
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Garbino J, Soccal PM, Aubert JD, Rochat T, Meylan P, Thomas Y, Tapparel C, Bridevaux PO, and Kaiser L
- Subjects
- Cohort Studies, Female, Hospitalization, Humans, Lung Transplantation, Male, Middle Aged, Opportunistic Infections virology, Respiratory Tract Infections diagnosis, Reverse Transcriptase Polymerase Chain Reaction, Seasons, Virus Diseases diagnosis, Bronchoalveolar Lavage Fluid virology, Cross Infection virology, Opportunistic Infections diagnosis, Respiratory Tract Infections virology, Virus Diseases virology, Viruses isolation & purification
- Abstract
Background: The epidemiology of respiratory viruses and their potential clinical impact when recovered in lower respiratory specimens has not been established in the hospital setting. A study was performed to investigate the association between positive viral detection and respiratory infection in an at-risk population., Methods: 299 adult patients who underwent bronchoalveolar lavage (BAL) procedures were enrolled in a hospital-based prospective cohort study. Descriptive epidemiology is presented of 17 different respiratory viruses detected by reverse transcription-polymerase chain reaction assays in BAL fluid specimens. Multivariate analysis was conducted to identify the clinical characteristics independently associated with the presence of virus., Results: Of 522 BAL fluid specimens analysed, 81% were collected in adult transplant recipients or other immunocompromised patients. Overall, PCR assays identified viral nucleic acid in 91 BAL fluid samples (17.4%). Similar rates of virus-positive BAL fluid were found in the different subpopulations studied (p = 0.113). Coronaviruses were the most frequent (32.3%), followed by rhinovirus (22.6%), parainfluenza (19.5%), influenza (9.7%), respiratory synctial virus (8.6%), human metapneumovirus (4.2%) and bocavirus (3.1%). Multivariate analysis using mixed models showed that respiratory viral infections were associated with a lack of antibiotic treatment response (OR 2.2, 95% CI 1.2 to 4.1) and the absence of radiological infiltrate (OR 0.3, 95% CI 0.2 to 0.8). In lung transplant recipients in whom a respiratory infection was suspected, the respiratory viral detection rate was 24.4% compared with 13.8% overall in other patients (p = 0.02)., Conclusions: In this cohort of hospitalised adults, respiratory viruses detected in BAL fluid specimens were associated with respiratory symptoms, absence of radiological infiltrates and a poor response to antibiotic therapy.
- Published
- 2009
- Full Text
- View/download PDF
50. Cerebrovascular complications of infective endocarditis.
- Author
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Garbino J and Ambrosioni J
- Subjects
- Humans, Risk Factors, Staphylococcal Infections microbiology, Staphylococcus aureus isolation & purification, Cerebrovascular Disorders epidemiology, Endocarditis complications, Staphylococcal Infections complications
- Published
- 2008
- Full Text
- View/download PDF
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