92 results on '"Orasch C"'
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2. 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
- Author
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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.
- Published
- 2014
- Full Text
- View/download PDF
3. Comparison of infectious complications during induction/consolidation chemotherapy versus allogeneic hematopoietic stem cell transplantation
- Author
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Orasch, C, Weisser, M, Mertz, D, Conen, A, Heim, D, Christen, S, Gratwohl, A, Battegay, M, Widmer, A, and Flückiger, U
- Published
- 2010
- Full Text
- View/download PDF
4. 53-jähriger Patient mit Fieber und Husten
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Orasch, C. and Battegay, M.
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- 2009
- Full Text
- View/download PDF
5. ECIL guidelines for bacterial resistance in the haematology ward: 257
- Author
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Cordonnier, C., Averbuch, D., Mikulska, M., Orasch, C., Engelhard, D., Viscoli, C., Gyssens, I. C., Kern, W., Klyasova, G., Marchetti, O., Livermore, D. M., and Akova, M.
- Published
- 2013
6. Outcome of smoking cessation counselling of HIV-positive persons by HIV care physicians
- Author
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Huber, M, Ledergerber, B, Sauter, R, Young, J, Fehr, J, Cusini, A, Battegay, M, Calmy, A, Orasch, C, Nicca, D, Bernasconi, E, Jaccard, R, Held, L, and Weber, R
- Published
- 2012
- Full Text
- View/download PDF
7. T-cell reaction to local anaesthetics: relationship to angioedema and urticaria after subcutaneous application - patch testing and LTT in patients with adverse reaction to local anaesthetics
- Author
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ORASCH, C. E., HELBLING, A., ZANNI, M. P., YAWALKAR, N., HARI, Y., and PICHLER, W. J.
- Published
- 1999
8. Accuracy of Sensititre YeastOne echinocandins epidemiological cut-off values for identification of FKS mutant Candida albicans and Candida glabrata: a ten year national survey of the Fungal Infection Network of Switzerland (FUNGINOS)
- Author
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Kritikos, A., primary, Neofytos, D., additional, Khanna, N., additional, Schreiber, P.W., additional, Boggian, K., additional, Bille, J., additional, Schrenzel, J., additional, Mühlethaler, K., additional, Zbinden, R., additional, Bruderer, T., additional, Goldenberger, D., additional, Pfyffer, G., additional, Conen, A., additional, Van Delden, C., additional, Zimmerli, S., additional, Sanglard, D., additional, Bachmann, D., additional, Marchetti, O., additional, Lamoth, F., additional, Bregenzer, T., additional, Flückiger, U., additional, Orasch, C., additional, Heininger, U., additional, Franciolli, M., additional, Damonti, L., additional, Rothen, M., additional, Zellweger, C., additional, Tarr, P., additional, Fleisch, F., additional, Chuard, C., additional, Erard, V., additional, Emonet, S., additional, Garbino, J., additional, van Delden, C., additional, Genne, D., additional, Bochud, P., additional, Calandra, T., additional, Chave, J., additional, Graber, P., additional, Monotti, R., additional, Regionale, O., additional, Bernasconi, E., additional, Civico, O., additional, Rossi, M., additional, Krause, M., additional, Piso, R., additional, Bally, F., additional, Troillet, N., additional, Eich, G., additional, Gubler, J., additional, Fehr, J., additional, Imhof, A., additional, Ruef, C., additional, Berger, C., additional, Fankhauser, H., additional, Heinzer, I., additional, Frei, R., additional, Hertel, R., additional, Dolina, M., additional, Petrini, O., additional, Dubuis, O., additional, Graf, S., additional, Risch, M., additional, Ritzler, E., additional, Fracheboud, D., additional, Rohner, P., additional, Lienhardt, R., additional, Andreutti-Zaugg, C., additional, Gallusser, A., additional, Herzog, K., additional, Schibli, U., additional, Tissière, L., additional, and Schultze, D., additional
- Published
- 2018
- Full Text
- View/download PDF
9. Re: 'Comparison of antipseudomonal betalactams for febrile neutropenia empiric therapy: systematic review and network metaanalysis' by Horita et al
- Author
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Averbuch, D., Orasch, C., Mikulska, M., Livermore, D.M., Viscoli, C., Gyssens, I.C., Kern, W.V., Klyasova, G., Marchetti, O., Engelhard, D., Akova, M., Calandra, T., Cordonnier, C., Averbuch, D., Orasch, C., Mikulska, M., Livermore, D.M., Viscoli, C., Gyssens, I.C., Kern, W.V., Klyasova, G., Marchetti, O., Engelhard, D., Akova, M., Calandra, T., and Cordonnier, C.
- Abstract
Item does not contain fulltext
- Published
- 2018
10. 53-jähriger Patient mit Fieber und Husten
- Author
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Orasch, C., Battegay, M., Orasch, C., and Battegay, M.
- Abstract
Zusammenfassung: Wir beschreiben einen Patienten mit später HIV-Präsentation, Meningitis tuberculosa und offener Lungentuberkulose bei Miliartuberkulose unter schwerer HIV-assoziierter Immunsuppression. Im Verlauf tritt eine weitere opportunistische Infektion (Pneumocystis-jiroveci-Pneumonie) und im Rahmen der antiretroviralen Therapie ein Immunrekonstitutionssyndrom (IRIS) auf. Letzteres führt zu weiteren Organmanifestationen der Miliartuberkulose (urogenital, gastrointestinal). Mit der späten HIV-Präsentation assoziierte Probleme sind opportunistische Infektionen und das IRIS zu Beginn der antiretroviralen Therapie. Die Wahl des Behandlungszeitpunkts der HIV-Infektion bei gleichzeitiger opportunistischer Infektion ist entscheidend
- Published
- 2018
11. Re: “Comparison of antipseudomonal betalactams for febrile neutropenia empiric therapy: systematic review and network metaanalysis” by Horita et al.
- Author
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Averbuch, D., primary, Orasch, C., additional, Mikulska, M., additional, Livermore, D.M., additional, Viscoli, C., additional, Gyssens, I.C., additional, Kern, W.V., additional, Klyasova, G., additional, Marchetti, O., additional, Engelhard, D., additional, Akova, M., additional, Calandra, T., additional, and Cordonnier, C., additional
- Published
- 2018
- Full Text
- View/download PDF
12. Pied Diabétique Infecté
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Voide C, Orasch C, and Trampuz A
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,Osteomyelitis ,Surgical debridement ,Medicine ,General Medicine ,business ,medicine.disease - Abstract
Für die Entstehung von Fussläsionen verantwortliche Mechanismen sind unter anderen eine Störung im lokalen Immunsystem, Diabetes, Neuropathie, Durchblutungsstörungen und Druckstellen. Mikrobiologische Untersuchungen sind nur indiziert bei Zeichen einer infizierten Fussläsion, d.h. bei gleichzeitigem Vorhandensein einer Läsion und mindestens zwei der folgenden sechs Zeichen: Rötung, Überwärmung, Schmerz, Schwellung, Induration oder eitrige Sekretion. Die empirische Antibiotika-Therapie sollte angepasst werden an die Schwere der Affektion und die lokale Epidemiologie bezüglich Antibiotika-Resistenzen.
- Published
- 2012
13. Discontinuation of empirical antibiotic therapy in neutropenic leukaemia patients with fever of unknown origin is ethical
- Author
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Orasch, C., Averbuch, D., Mikulska, M., Cordonnier, C., Livermore, D.M., Gyssens, I.C., Klyasova, G., Engelhard, D., Kern, W., Viscoli, C., Akova, M., and Marchetti, O.
- Published
- 2015
- Full Text
- View/download PDF
14. Accuracy of Sensititre YeastOne echinocandins epidemiological cut-off values for identification of FKS mutant Candida albicans and Candida glabrata: a ten year national survey of the Fungal Infection Network of Switzerland (FUNGINOS)
- Author
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Bregenzer, T., Conen, A., Flückiger, U., Khanna, N., Orasch, C., Heininger, U., Franciolli, M., Damonti, L., Zimmerli, S., Rothen, M., Zellweger, C., Tarr, P., Fleisch, F., Chuard, C., Erard, V., Emonet, S., Garbino, J., van Delden, C., Genne, D., Bochud, P., Calandra, T., Lamoth, F., Marchetti, O., Chave, J., Graber, P., Monotti, R., Regionale, O., Bernasconi, E., Civico, O., Rossi, M., Krause, M., Piso, R., Bally, F., Troillet, N., Boggian, K., Eich, G., Gubler, J., Fehr, J., Imhof, A., Ruef, C., Berger, C., Fankhauser, H., Heinzer, I., Frei, R., Hertel, R., Dolina, M., Petrini, O., Dubuis, O., Mühlethaler, K., Graf, S., Risch, M., Ritzler, E., Fracheboud, D., Schrenzel, J., Rohner, P., Lienhardt, R., Bille, J., Andreutti-Zaugg, C., Gallusser, A., Pfyffer, G., Herzog, K., Schibli, U., Tissière, L., Bruderer, T., Schultze, D., Zbinden, R., Kritikos, A., Neofytos, D., Schreiber, P.W., Goldenberger, D., Van Delden, C., Sanglard, D., and Bachmann, D.
- Published
- 2018
- Full Text
- View/download PDF
15. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia
- Author
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Averbuch, D., Orasch, C., Cordonnier, C., Livermore, D.M., Mikulska, M., Viscoli, C., Gyssens, I.C.J., Kern, W.V., Klyasova, G., Marchetti, O., Engelhard, D., Akova, M., Ecil, a.j.v.o.E.E.I.E.E., Eln, ., İç Hastalıkları, ECIL4 a joint venture of EBMT EORTC ICHS ESGICH/ESCMID, and ELN
- Subjects
medicine.medical_specialty ,business.industry ,medicine.drug_class ,Antibiotics ,Drug resistance ,Hematology ,Neutropenia ,medicine.disease ,Pathogenesis and modulation of inflammation [N4i 1] ,Regimen ,Absolute neutrophil count ,Medicine ,Infection control ,Errata Corrige ,Fever of unknown origin ,business ,Intensive care medicine ,Guideline Articles ,Febrile neutropenia - Abstract
Owing to increasing resistance and the limited arsenal of new antibiotics, especially against Gram-negative pathogens, carefully designed antibiotic regimens are obligatory for febrile neutropenic patients, along with effective infection control. The Expert Group of the 4th European Conference on Infections in Leukemia has developed guidelines for initial empirical therapy in febrile neutropenic patients, based on: i) the local resistance epidemiology; and ii) the patient's risk factors for resistant bacteria and for a complicated clinical course. An 'escalation' approach, avoiding empirical carbapenems and combinations, should be employed in patients without particular risk factors. A 'deescalation' approach, with initial broad-spectrum antibiotics or combinations, should be used only in those patients with: i) known prior colonization or infection with resistant pathogens; or ii) complicated presentation; or iii) in centers where resistant pathogens are prevalent at the onset of febrile neutropenia. In the latter case, infection control and antibiotic stewardship also need urgent review. Modification of the initial regimen at 72-96 h should be based on the patient's clinical course and the microbiological results. Discontinuation of antibiotics after 72 h or later should be considered in neutropenic patients with fever of unknown origin who are hemodynamically stable since presentation and afebrile for at least 48 h, irrespective of neutrophil count and expected duration of neutropenia. This strategy aims to minimize the collateral damage associated with antibiotic overuse, and the further selection of resistance. The ECIL-4 meeting has been supported by unrestricted educational grants from Astellas Pharma, Gilead Sciences, Merck, Novartis, and Pfizer.
- Published
- 2013
16. Toxic Megacolon due to Fulminant Amebic Colitis in a non Endemic Area
- Author
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Hugelshofer, S., Petermann, D., Orasch, C., and Liaudet, L.
- Published
- 2013
17. Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011)
- Author
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Averbuch, D., Cordonnier, C., Livermore, D.M., Mikulska, M., Orasch, C., Viscoli, C., Gyssens, I.C.J., Kern, W.V., Klyasova, G., Marchetti, O., Engelhard, D., Akova, M., Ecil, a.j.v.o.E.E.I.E.E., Eln, ., and İç Hastalıkları
- Subjects
medicine.medical_treatment ,Hematology ,Tigecycline ,Fosfomycin ,Biology ,medicine.disease ,Targeted therapy ,Pathogenesis and modulation of inflammation [N4i 1] ,Leukemia ,chemistry.chemical_compound ,chemistry ,Linezolid ,Immunology ,medicine ,Colistin ,Stem cell ,Guideline Articles ,Polymyxin B ,medicine.drug - Abstract
The detection of multi-resistant bacterial pathogens, particularly those to carbapenemases, in leukemic and stem cell transplant patients forces the use of old or non-conventional agents as the only remaining treatment options. These include colistin/polymyxin B, tigecycline, fosfomycin and various anti-gram-positive agents. Data on the use of these agents in leukemic patients are scanty, with only linezolid subjected to formal trials. The Expert Group of the 4th European Conference on Infections in Leukemia has developed guidelines for their use in these patient populations. Targeted therapy should be based on (i) in vitro susceptibility data, (ii) knowledge of the best treatment option against the particular species or phenotype of bacteria, (iii) pharmacokinetic/pharmacodynamic data, and (iv) careful assessment of the risk-benefit balance. For infections due to resistant Gram-negative bacteria, these agents should be preferably used in combination with other agents that remain active in vitro, because of suboptimal efficacy (e.g., tigecycline) and the risk of emergent resistance (e.g., fosfomycin). The paucity of new antibacterial drugs in the near future should lead us to limit the use of these drugs to situations where no alternative exists. The ECIL-4 meeting has been supported by unrestricted educational grants from Astellas Pharma, Gilead Sciences, Merck, Novartis and Pfizer.
- Published
- 2013
18. Identification of Propionibacterium avidum from a breast abscess: an overlooked etiology of clinically significant infections
- Author
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Kritikos, A., primary, Pagin, M., additional, Borens, O., additional, Voide, C., additional, and Orasch, C., additional
- Published
- 2015
- Full Text
- View/download PDF
19. Progrediente Knochenschmerzen bei einer jungen Patientin
- Author
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Egli, A, primary, GollerWittekind, U, additional, Vetter, M, additional, Bucher, C, additional, Dirnhofer, S, additional, and Orasch, C, additional
- Published
- 2010
- Full Text
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20. Comparison of infectious complications during induction/consolidation chemotherapy versus allogeneic hematopoietic stem cell transplantation
- Author
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Orasch, C, primary, Weisser, M, additional, Mertz, D, additional, Conen, A, additional, Heim, D, additional, Christen, S, additional, Gratwohl, A, additional, Battegay, M, additional, Widmer, A, additional, and Flückiger, U, additional
- Published
- 2009
- Full Text
- View/download PDF
21. The farmer who didn't need a wheel barrow
- Author
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Hochholzer, W., primary, Orasch, C., additional, Huber, S., additional, Arranto, C., additional, and Hunziker, S., additional
- Published
- 2009
- Full Text
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22. La fièvre dangereuse, ou aussi bénéfique?
- Author
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Tschudin, S, primary, Orasch, C, additional, and Flückiger, U, additional
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- 2009
- Full Text
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23. Fieber gefährlich oder auch nützlich?
- Author
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Tschudin, S, primary, Orasch, C, additional, and Flückiger, U, additional
- Published
- 2009
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24. Lyme-Borreliose in der Schweiz
- Author
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Orasch, C, primary, Peter, I, additional, and Flückiger, U, additional
- Published
- 2007
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25. Borréliose de Lyme en Suisse
- Author
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Orasch, C, primary, Peter, I, additional, and Flückiger, U, additional
- Published
- 2007
- Full Text
- View/download PDF
26. Kopfschmerzen und Wortfindungsstörungen bei einem immunsupprimierten Patienten.
- Author
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Tschudin, S., Laifer, G., Orasch, C., and Nüesch, R.
- Subjects
HEADACHE ,APHASIA ,LISTERIA ,ABSCESSES ,MAGNETIC resonance imaging ,CENTRAL nervous system diseases - Abstract
Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2009
- Full Text
- View/download PDF
27. 53-jähriger Patient mit Fieber und Husten
- Author
-
Orasch, C., Battegay, M., Orasch, C., and Battegay, M.
- Abstract
Zusammenfassung: Wir beschreiben einen Patienten mit später HIV-Präsentation, Meningitis tuberculosa und offener Lungentuberkulose bei Miliartuberkulose unter schwerer HIV-assoziierter Immunsuppression. Im Verlauf tritt eine weitere opportunistische Infektion (Pneumocystis-jiroveci-Pneumonie) und im Rahmen der antiretroviralen Therapie ein Immunrekonstitutionssyndrom (IRIS) auf. Letzteres führt zu weiteren Organmanifestationen der Miliartuberkulose (urogenital, gastrointestinal). Mit der späten HIV-Präsentation assoziierte Probleme sind opportunistische Infektionen und das IRIS zu Beginn der antiretroviralen Therapie. Die Wahl des Behandlungszeitpunkts der HIV-Infektion bei gleichzeitiger opportunistischer Infektion ist entscheidend
28. Trends of the Epidemiology of Candidemia in Switzerland: A 15-Year FUNGINOS Survey
- Author
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Kai-Manuel, Adam, Michael, Osthoff, Frédéric, Lamoth, Anna, Conen, Véronique, Erard, Katia, Boggian, Peter W, Schreiber, Stefan, Zimmerli, Pierre-Yves, Bochud, Dionysios, Neofytos, Mapi, Fleury, Hans, Fankhauser, Daniel, Goldenberger, Konrad, Mühlethaler, Arnaud, Riat, Reinhard, Zbinden, Andreas, Kronenberg, Chantal, Quiblier, Oscar, Marchetti, Nina, Khanna, University of Zurich, Khanna, Nina, Fungal Infection Network of Switzerland (FUNGINOS), Bregenzer, T., Conen, A., Adam, K.M., Flückiger, U., Khanna, N., Orasch, C., Heininger, U., Franciolli, M., San Giovanni, O., Damonti, L., Zimmerli, S., Rothen, M., Zellweger, C., Tarr, P., Fleisch, F., Chuard, C., Erard, V., Emonet, S., Garbino, J., Neofytos, D., van Delden, C., Genne, D., Bochud, P.Y., Calandra, T., Lamoth, F., Marchetti, O., Chave, J.P., Bois-Cerf, C., Cécil, C., La Source, C., Graber, P., Monotti, R., Regionale, O., Bernasconi, E., Civico, O., Rossi, M., Krause, M., Piso, R.J., Bally, F., Troillet, N., Boggian, K., Eich, G., Gubler, J., Fehr, J., Imhof, A., Ruef, C., Werner Schreiber, P., Berger, C., Fankhauser, H., Heinzer, I., Goldenberger, D., Frei, R., Hertel, R., Dolina, M., Petrini, O., Dubuis, O., Mühlethaler, K., Graf, S., Risch, M., Ritzler, E., Fracheboud, D., Riat, A., Rohner, P., Schrenzel, J., Lienhardt, R., Bille, J., Andreutti-Zaugg, C., Gallusser, A., Pfyffer, G., Herzog, K., Schibli, U., Tissière, L., Bruderer, T., and Zbinden, R.
- Subjects
medicine.medical_specialty ,Population ,610 Medicine & health ,resistance ,10234 Clinic for Infectious Diseases ,Internal medicine ,Intensive care ,medicine ,Major Article ,education ,Candida albicans ,education.field_of_study ,biology ,Candida glabrata ,business.industry ,10179 Institute of Medical Microbiology ,Incidence (epidemiology) ,candidemia ,Micafungin ,biology.organism_classification ,bacterial infections and mycoses ,Infectious Diseases ,AcademicSubjects/MED00290 ,2728 Neurology (clinical) ,Oncology ,antifungals ,candida ,epidemiology ,Anidulafungin ,570 Life sciences ,2730 Oncology ,business ,Fluconazole ,medicine.drug - Abstract
Background The increasing incidence of candidemia and emergence of drug-resistant Candida species are major concerns worldwide. Long-term surveillance studies are needed. Methods The Fungal Infection Network of Switzerland (FUNGINOS) conducted a 15-year (2004–2018), nationwide, epidemiological study of candidemia. Hospital-based incidence of candidemia, Candida species distribution, antifungal susceptibility, and consumption were stratified in 3 periods (2004–2008, 2009–2013, 2014–2018). Population-based incidence over the period 2009–2018 derived from the Swiss Antibiotic Resistance Surveillance System (ANRESIS). Results A total of 2273 Candida blood isolates were studied. Population and hospital-based annual incidence of candidemia increased from 2.96 to 4.20/100 000 inhabitants (P = .022) and 0.86 to 0.99/10 000 patient-days (P = .124), respectively. The proportion of Candida albicans decreased significantly from 60% to 53% (P = .0023), whereas Candida glabrata increased from 18% to 27% (P < .0001). Other non-albicans Candida species remained stable. Candida glabrata bloodstream infections occurred predominantly in the age group 18–40 and above 65 years. A higher proportional increase of C glabrata was recorded in wards (18% to 29%, P < .0001) versus intensive care units (19% to 24%, P = .22). According to Clinical and Laboratory Standards Institute, nonsusceptibility to fluconazole in C albicans was observed in 1% of isolates, and anidulafungin and micafungin nonsusceptibility was observed in 2% of C albicans and C glabrata. Fluconazole consumption, the most frequently used antifungal, remained stable, whereas use of mold-active triazoles and echinocandins increased significantly in the last decade (P < .0001). Conclusions Over the 15-year period, the incidence of candidemia increased. A species shift toward C glabrata was recently observed, concurring with increased consumption of mold-active triazoles., The incidence of candidemia increased in Switzerland from 2004 to 2018. A species shift toward C glabrata was observed after 2013, now accounting for one fourth of all candidemia, concurring with increased consumption of mold-active triazoles.
- Published
- 2021
29. Serial monitoring of pancreatic stone protein for the detection of sepsis in intensive care unit patients with complicated abdominal surgery: A prospective, longitudinal cohort study.
- Author
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Filippidis P, Hovius L, Tissot F, Orasch C, Flückiger U, Siegemund M, Pagani JL, Eggimann P, Marchetti O, and Lamoth F
- Subjects
- Humans, Prospective Studies, Male, Female, Middle Aged, Aged, Longitudinal Studies, Abdomen surgery, Biomarkers blood, Postoperative Complications diagnosis, Sensitivity and Specificity, Sepsis diagnosis, Sepsis blood, Lithostathine blood, Intensive Care Units
- Abstract
Purpose: The objective of this study was to assess the performance of pancreatic stone protein (PSP) monitoring for the detection of sepsis, prediction of outcome and distinction between bacterial and fungal infections in intensive care unit (ICU) patients with complicated abdominal surgery., Materials and Methods: In this prospective multicenter cohort study, patients with complicated abdominal surgery had serial PSP measurements during their ICU stay. Infectious episodes were classified as bacterial, fungal or mixed. PSPmax (maximal PSP value within 48 h of the diagnosis of infection) and ΔPSP (difference between PSPmax and the preceding PSP value) were used for analyses., Results: PSPmax was obtained for 118 infectious episodes (68 patients). ΔPSP was available for 73 episodes (48 patients). Both PSPmax and ΔPSP were significantly higher in patients with sepsis and in patients with a fatal outcome. A PSPmax ≥124 ng/ml and a ΔPSP ≥34 ng/ml could detect sepsis with a sensitivity/specificity of 84%/54% and 69%/76%, respectively. There was no significant difference of PSPmax or ΔPSP between patients with bacterial/mixed versus fungal infections., Conclusions: Serial PSP monitoring may be an additional tool for the early detection of sepsis in patients with complicated abdominal surgery who are at high risk of severe infections., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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30. Performance of the T2Candida Panel for the Diagnosis of Intra-abdominal Candidiasis.
- Author
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Lamoth F, Clancy CJ, Tissot F, Squires K, Eggimann P, Flückiger U, Siegemund M, Orasch C, Zimmerli S, Calandra T, Marchetti O, Nguyen MH, and Bochud PY
- Abstract
Performance of T2Candida for detecting intra-abdominal candidiasis (IAC) was assessed in 48 high-risk patients. T2Candida sensitivity/specificity and positive/negative predictive values were 33%/93% and 71%/74%, respectively. IAC was present in 100% of cases with concordant positive T2Candida/1,3-beta-d-glucan and absent in 90% of concordant negative results. Combination T2Candida/1,3-beta-d-glucan may help guide treatment decisions., (© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
- Published
- 2020
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31. Would it be safe to have a dog in the MRI scanner before your own examination? A multicenter study to establish hygiene facts related to dogs and men.
- Author
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Gutzeit A, Steffen F, Gutzeit J, Gutzeit J, Kos S, Pfister S, Berlinger L, Anderegg M, Reischauer C, Funke I, Froehlich JM, Koh DM, and Orasch C
- Subjects
- Animal Fur microbiology, Animals, Bacteria isolation & purification, Bacterial Load, Colony Count, Microbial, Cross Infection prevention & control, Cross Infection transmission, Disinfection, Equipment Contamination prevention & control, Humans, Male, Dogs microbiology, Hair microbiology, Hygiene, Magnetic Resonance Imaging instrumentation
- Abstract
Objectives: To determine whether it would be hygienic to evaluate dogs and humans in the same MRI scanner., Methods: We compared the bacterial load in colony-forming units (CFU) of human-pathogenic microorganisms in specimens taken from 18 men and 30 dogs. In addition, we compared the extent of bacterial contamination of an MRI scanner shared by dogs and humans with two other MRI scanners used exclusively by humans., Results: Our study shows a significantly higher bacterial load in specimens taken from men's beards compared with dogs' fur (p = 0.036). All of the men (18/18) showed high microbial counts, whereas only 23/30 dogs had high microbial counts and 7 dogs moderate microbial counts. Furthermore, human-pathogenic microorganisms were more frequently found in human beards (7/18) than in dog fur (4/30), although this difference did not reach statistical significance (p = 0.074). More microbes were found in human oral cavities than in dog oral cavities (p < 0.001). After MRI of dogs, routine scanner disinfection was undertaken and the CFU found in specimens isolated from the MRI scanning table and receiver coils showed significantly lower bacteria count compared with "human" MRI scanners (p < 0.05)., Conclusion: Our study shows that bearded men harbour significantly higher burden of microbes and more human-pathogenic strains than dogs. As the MRI scanner used for both dogs and humans was routinely cleaned after animal scanning, there was substantially lower bacterial load compared with scanners used exclusively for humans., Key Points: • Bearded men harbour significantly more microbes than dogs. • Dogs are no risk to humans if they use the same MRI. • Deficits in hospital hygiene are a relevant risk for patients.
- Published
- 2019
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32. Fluconazole non-susceptible breakthrough candidemia after prolonged low-dose prophylaxis: a prospective FUNGINOS study.
- Author
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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.)
- Published
- 2018
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33. 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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- View/download PDF
34. Bacterial contamination of ultrasound probes in different radiological institutions before and after specific hygiene training: do we have a general hygienical problem?
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Sartoretti T, Sartoretti E, Bucher C, Doert A, Binkert C, Hergan K, Meissnitzer M, Froehlich J, Kolokythas O, Matoori S, Orasch C, Kos S, Sartoretti-Schefer S, and Gutzeit A
- Subjects
- Colony Count, Microbial, Cross Infection prevention & control, Humans, Bacteria isolation & purification, Disinfectants therapeutic use, Disinfection standards, Equipment Contamination prevention & control, Hygiene education, Transducers microbiology, Ultrasonography instrumentation
- Abstract
Objectives: Aim was to investigate hygienic conditions of ultrasound probes before and after hygiene training in radiology institutions in comparison to bacterial contamination in public places., Methods: In three radiology departments, bacterial contamination was evaluated using baseline agar plates for cultures taken from 36 ultrasound probes. Afterwards teams were trained by a hygiene service centre and 36 ultrasound probes were routinely disinfected with regular disinfecting wipes and then evaluated. In comparison, bacterial contamination in public places (bus poles, n = 11; toilet seats, n = 10) were analysed. Plates were routinely incubated and the number of colony forming units (CFU) analysed., Results: Cultures taken from the probes showed a median of 53 CFU before and 0 CFU after training (p < 0.001). Cultures taken from public places showed a median of 4 CFU from toilets and 28 from bus poles and had lower bacterial load in comparison to ultrasound probes before training (p = 0.055, toilets; p = 0.772, bus poles), without statistical significance., Conclusions: Bacterial contamination of ultrasound probes prior to hygiene training proved to be high and showed higher bacterial load than toilets seats or bus poles. Radiologists should be aware that the lack of hygiene in the field of ultrasound diagnostics puts patients at risk of healthcare-associated infections., Key Points: • Hospital-associated infections are a problem for patient care. • Hygiene training of staff prevents bacterial contamination of ultrasound probes. • Disinfection of ultrasound probes is an easy method to protect patients.
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- 2017
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35. 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
- Subjects
- 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
- Published
- 2017
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- View/download PDF
36. Aktuelle Diagnose- und Therapiestrategie bei Gelenksprothesen-Infektionen.
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Biasca N, Brinkmann O, Bungartz M, and Orasch C
- Subjects
- Biofilms, Combined Modality Therapy, Humans, Interdisciplinary Communication, Intersectoral Collaboration, Prosthesis Failure, Prosthesis-Related Infections microbiology, Reoperation, Anti-Bacterial Agents therapeutic use, Joint Prosthesis, Prosthesis-Related Infections diagnosis, Prosthesis-Related Infections therapy
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- 2017
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37. The J-Curve in HIV: Low and Moderate Alcohol Intake Predicts Mortality but Not the Occurrence of Major Cardiovascular Events.
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Wandeler G, Kraus D, Fehr J, Conen A, Calmy A, Orasch C, Battegay M, Schmid P, Bernasconi E, and Furrer H
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- Adult, Alcoholic Beverages, Cohort Studies, Dose-Response Relationship, Drug, Female, HIV Infections epidemiology, Humans, Male, Middle Aged, Switzerland epidemiology, Alcohol Drinking, Cardiovascular Diseases epidemiology, HIV Infections complications, HIV Infections mortality
- Abstract
Objectives: In HIV-negative populations, light-to-moderate alcohol consumption is associated with a lower cardiovascular morbidity and mortality than alcohol abstention. Whether the same holds true for HIV-infected individuals has not been evaluated in detail., Design: Cohort study., Methods: Adults on antiretroviral therapy in the Swiss HIV Cohort Study with follow-up after August 2005 were included. We categorized alcohol consumption into: abstention or very low (<1 g/d), low (1-9 g/d), moderate (10-29 g/d in women and 10-39 g/d in men), and high alcohol intake. Cox proportional hazards models were used to describe the association between alcohol consumption and cardiovascular disease-free survival (combined endpoint), cardiovascular disease events (CADE) and overall survival. Baseline and time-updated risk factors for CADE were included in the models., Results: Among 9741 individuals included, there were 788 events of major CADE or death during 46,719 patient-years of follow-up, corresponding to an incidence of 1.69 events/100 person-years. Follow-up according to alcohol consumption level was 51% no or very low, 20% low, 23% moderate, and 6% high intake. As compared with no or very low alcohol intake, low (hazard ratio 0.79, 95% confidence interval 0.63 to 0.98) and moderate alcohol intakes (0.78, 0.64 to 0.95) were associated with a lower incidence of the combined endpoint. There was no significant association between alcohol consumption and CADE., Conclusions: Compared with no or very low alcohol consumption, low and moderate intake associated with a better CADE-free survival. However, this result was mainly driven by mortality and the specific impact of drinking patterns and type of alcoholic beverage on this outcome remains to be determined.
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- 2016
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38. Identification of Propionibacterium avidum from a breast abscess: an overlooked etiology of clinically significant infections.
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Kritikos A, Pagin M, Borens O, Voide C, and Orasch C
- Abstract
We report the case of a 37-year-old previously healthy woman diagnosed with a breast abscess due to Propionibacterium avidum after breast reduction surgery. This case emphasizes the potential pathogenicity and morbidity associated with this commensal skin organism.
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- 2014
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39. Daptomycin-associated eosinophilic pneumonia in two patients with prosthetic joint infection.
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Yusuf E, Perrottet N, Orasch C, Borens O, and Trampuz A
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- Anti-Bacterial Agents administration & dosage, Bronchoalveolar Lavage Fluid cytology, Daptomycin administration & dosage, Humans, Male, Middle Aged, Pulmonary Eosinophilia diagnosis, Radiography, Thoracic, Staphylococcal Infections drug therapy, Staphylococcal Infections microbiology, Staphylococcus epidermidis isolation & purification, Tomography, X-Ray Computed, Anti-Bacterial Agents adverse effects, Daptomycin adverse effects, Prosthesis-Related Infections drug therapy, Pulmonary Eosinophilia chemically induced, Pulmonary Eosinophilia pathology
- Abstract
Background: Daptomycin is used increasingly to treat prosthetic joint infection (PJI). A possible side effect of this drug is eosinophilic pneumonia. We describe two patients with PJI treated with daptomycin who had this side effect with different clinical presentations., Methods: Case reports and review of the literature., Results: The first case was a 64-year-old male who received daptomycin as a part of the treatment for PJI caused by methicillin-resistant Staphylococcus epidermidis (MRSE). He developed fever without other symptoms; bronchoalveolar lavage (BAL) revealed eosinophils. The second was a 61-year-old male who also used daptomycin as part of the treatment of PJI caused by MRSE and developed severe lung symptoms. Bronchoalveolar lavage and pleural fluid showed an increased number of eosinophils., Conclusion: Daptomycin-induced pneumonia can present with a wide range of symptoms, from fever alone to severe lung symptoms. Surgeons should be aware of this possible side effect when prescribing daptomycin.
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- 2014
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40. Weekly use of fluconazole as prophylaxis in haematological patients at risk for invasive candidiasis.
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Vuichard D, Weisser M, Orasch C, Frei R, Heim D, Passweg JR, and Widmer AF
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- Adult, Candida classification, Candida drug effects, Drug Resistance, Fungal, Female, Hematologic Neoplasms microbiology, Hospitals, Humans, Incidence, Male, Middle Aged, Retrospective Studies, Switzerland, Antifungal Agents administration & dosage, Candida isolation & purification, Candidemia prevention & control, Candidiasis, Invasive prevention & control, Fluconazole administration & dosage
- Abstract
Background: The goal was to determine whether one medical centres' unique antifungal prophylactic regimen for patients at high risk for invasive candidiasis because of their haematological malignancies, haematopoietic stem cell transplants, or high-dose chemotherapy might lead ultimately to a higher incidence of infection, to increasing fluconazole resistance, or to a shift in the predominant strain of Candida in invasive fungal episodes., Methods: Data were collected retrospectively, for a ten-year period from ONKO-KISS surveillance records, and from hospital, medical, and pharmacy records and then evaluated with respect to incidence of fungal infection episodes, emergence of antifungal drug resistance, and predominance of specific Candida strains in isolate cultures. Fisher's exact test and linear regression were used to compare minimum inhibitory concentrations and to compare the incidence of different Candida isolates, respectively., Results: The incidence of infection remained quite stable over 10 years with a median of 0.67 episodes/1000 bed days. Overall, Candida glabrata was the predominant species with 29% followed by C. albicans and C. krusei (14% each). No significant increment of non-albicans Candida species with decreased fluconazole susceptibility was perceived over this decade., Conclusions: Once weekly administration of 400 mg of fluconazole to prevent candidaemia appears to have no negative impact on the efficacy as a prophylaxis when compared to standard of care (400 mg of fluconazole daily).
- Published
- 2014
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41. [Breast infections].
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Merz L, De Courten C, and Orasch C
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- Anti-Bacterial Agents therapeutic use, Diagnosis, Differential, Female, Humans, Inflammatory Breast Neoplasms diagnosis, Abscess therapy, Breast Diseases therapy, Breast Implants adverse effects, Mastitis therapy, Prosthesis-Related Infections therapy
- Abstract
Breast infections such as mastitis and breast abscesses are frequent. They are usually caused by the same microorganisms as those that cause other soft tissue infections. For a simple mastitis, a treatment with antibiotics alone is usually sufficient, whereas drainage is necessary when an abscess is present. While ultrasound-assisted puncture and aspiration is the best approach for breast abscesses of less than 3 cm, surgery is recommended for more extended infection. Infections of breast implants have to be treated applying a mixed surgical-medical approach with removal of the implant (usually in one stage exchange) and antibiotics adapted to the microorganism identified.
- Published
- 2014
42. Aetiology and resistance in bacteraemias among adult and paediatric haematology and cancer patients.
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Mikulska M, Viscoli C, Orasch C, Livermore DM, Averbuch D, Cordonnier C, and Akova M
- Subjects
- Adult, Bacteremia epidemiology, Bacteria isolation & purification, Child, Child, Preschool, Humans, Surveys and Questionnaires, Bacteremia etiology, Bacteremia microbiology, Bacteria classification, Bacteria drug effects, Drug Resistance, Bacterial, Hematologic Neoplasms complications, Neoplasms complications
- Abstract
Objectives: A knowledge of current epidemiology and resistance patterns is crucial to the choice of empirical treatment for bacteraemias in haematology and cancer patients., Methods: A literature review on bacteraemias in cancer patients considered papers published between January 1st 2005 and July 6th 2011. Additionally, in 2011, a questionnaire on the aetiology and resistance in bacteraemias, and empirical treatment, was sent to participants of the European Conference on Infections in Leukemia (ECIL) meetings; recipients were from 80 haematology centres., Results: For the literature review, data from 49 manuscripts were analysed. The questionnaire obtained responses from 39 centres in 18 countries. Compared with the published data, the questionnaire reported more recent data, and showed a reduction of the Gram-positive to Gram-negative ratio (55%:45% vs. 60%:40%), increased rates of enterococci (8% vs. 5%) and Enterobacteriaceae (30% vs. 24%), a decreased rate of Pseudomonas aeruginosa (5% vs. 10%), and lower resistance rates for all bacteria. Nevertheless the median rates of ESBL-producers (15-24%), aminoglycoside-resistant Gram-negatives (5-14%) and carbapenem-resistant P. aeruginosa (5-14%) were substantial, and significantly higher in South-East vs. North-West Europe., Conclusions: The published epidemiological data on bacteraemias in haematology are scanty and mostly dated. Important differences in aetiology and resistance exist among centres. Updated analyses of the local epidemiology are mandatory to support appropriate empirical therapy., (Copyright © 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)
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- 2014
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43. Polymorphisms in tumor necrosis factor-α increase susceptibility to intra-abdominal Candida infection in high-risk surgical ICU patients*.
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Wójtowicz A, Tissot F, Lamoth F, Orasch C, Eggimann P, Siegemund M, Zimmerli S, Flueckiger UM, Bille J, Calandra T, Marchetti O, and Bochud PY
- Subjects
- Adult, Age Factors, Aged, Aged, 80 and over, Female, Genotype, Humans, Male, Middle Aged, Polymorphism, Single Nucleotide, Prospective Studies, Sex Factors, Switzerland, Candidiasis epidemiology, Intensive Care Units, Intraabdominal Infections epidemiology, Postoperative Complications epidemiology, Tumor Necrosis Factor-alpha genetics
- Abstract
Objectives: To evaluate the influence of genetic polymorphisms on the susceptibility to Candida colonization and intra-abdominal candidiasis, a blood culture-negative life-threatening infection in high-risk surgical ICU patients., Design: Prospective observational cohort study., Setting: Surgical ICUs from two University hospitals of the Fungal Infection Network of Switzerland., Patients: Eighty-nine patients at high risk for intra-abdominal candidiasis (68 with recurrent gastrointestinal perforation and 21 with acute necrotizing pancreatitis)., Measurements and Main Results: Eighteen single-nucleotide polymorphisms in 16 genes previously associated with development of fungal infections were analyzed from patient's DNA by using an Illumina Veracode genotyping platform. Candida colonization was defined by recovery of Candida species from at least one nonsterile site by twice weekly monitoring of cultures from oropharynx, stools, urine, skin, and/or respiratory tract. A corrected colonization index greater than or equal to 0.4 defined "heavy" colonization. Intra-abdominal candidiasis was defined by the presence of clinical symptoms and signs of peritonitis or intra-abdominal abscess and isolation of Candida species either in pure or mixed culture from intraoperatively collected abdominal samples. Single-nucleotide polymorphisms in three innate immune genes were associated with development of a Candida corrected colonization index greater than or equal to 0.4 (Toll-like receptor rs4986790, hazard ratio = 3.39; 95% CI, 1.45-7.93; p = 0.005) or occurrence of intra-abdominal candidiasis (tumor necrosis factor-α rs1800629, hazard ratio = 4.31; 95% CI, 1.85-10.1; p= 0.0007; β-defensin 1 rs1800972, hazard ratio = 3.21; 95% CI, 1.36-7.59; p = 0.008)., Conclusion: We report a strong association between the promoter rs1800629 single-nucleotide polymorphism in tumor necrosis factor-α and an increased susceptibility to intra-abdominal candidiasis in a homogenous prospective cohort of high-risk surgical ICU patients. This finding highlights the relevance of the tumor necrosis factor-α functional polymorphism in immune response to fungal pathogens. Immunogenetic profiling in patients at clinical high risk followed by targeted antifungal interventions may improve the prevention or preemptive management of this life-threatening infection.
- Published
- 2014
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44. [Infectious diseases].
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Voide C, Asner S, Giulieri S, Cavassini M, Merz L, Tissot F, and Orasch C
- Subjects
- China epidemiology, Drug Contamination, Drug Resistance, Microbial, Gonorrhea drug therapy, Gonorrhea microbiology, Humans, Influenza A Virus, H7N9 Subtype, Influenza, Human epidemiology, Influenza, Human virology, Mycoses etiology, United States epidemiology, Communicable Diseases, Emerging epidemiology, Communicable Diseases, Emerging etiology, Communicable Diseases, Emerging therapy
- Abstract
The recommendations for the treatment of gonorrhea have been changed: ceftriaxone 500 mg IM plus azithromycin 1 g PO is recommended. Prophylaxis of recurrent cellulitis with penicillin 250 mg 2 x/d PO may be considered. E. coli ESBL does not require contact isolation anymore. Fecal transplantation seems so far to be the most effective treatment of recurrent C. dificile. Two new respiratory viruses, Middle East Coronavirus (MERS-CoV) and avian-origin Influenza A (H7N9) have been reported. Oral valganciclovir treatment reduces the risk of hearing loss in congenital CMV infection. An outbreak of mould infections of the central nervous system has been described in the United States following injection of contaminated steroids.
- Published
- 2014
45. Association of alcohol consumption and HIV surrogate markers in participants of the swiss HIV cohort study.
- Author
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Conen A, Wang Q, Glass TR, Fux CA, Thurnheer MC, Orasch C, Calmy A, Bernasconi E, Vernazza P, Weber R, Bucher HC, Battegay M, and Fehr J
- Subjects
- Adult, Biomarkers, CD4 Lymphocyte Count, Cohort Studies, Female, HIV Infections drug therapy, HIV Infections virology, Humans, Male, Medication Adherence statistics & numerical data, Middle Aged, Switzerland epidemiology, Viral Load, Alcohol Drinking adverse effects, Anti-Retroviral Agents therapeutic use, HIV Infections epidemiology
- Abstract
Background: Alcohol consumption may affect the course of HIV infection and/or antiretroviral therapy (ART). The authors investigated the association between self-reported alcohol consumption and HIV surrogate markers in both treated and untreated individuals., Design: Prospective cohort study., Methods: Over a 7-year period, the authors analyzed 2 groups of individuals in the Swiss HIV Cohort Study: (1) ART-naïve individuals remaining off ART and (2) individuals initiating first ART. For individuals initiating first ART, time-dependent Cox proportional hazards models were used to assess the association between alcohol consumption, virological failure, and ART interruption. For both groups, trajectories of log-transformed CD4 cell counts were analyzed using linear mixed models with repeated measures., Results: The authors included 2982 individuals initiating first ART and 2085 ART naives. In individuals initiating first ART, 241 (8%) experienced virological failure. Alcohol consumption was not associated with virological failure. ART interruption was noted in 449 (15%) individuals and was more prevalent in severe compared with none/light health risk drinkers [hazard ratio: 2.24, 95% confidence interval: 1.42 to 3.52]. The association remained significant even after adjusting for nonadherence. The authors did not find an association between alcohol consumption and change in CD4 cell count over time in either group., Conclusions: No effect of alcohol consumption on either virological failure or CD4 cell count in both groups of ART-initiating and ART-naive individuals was found. However, severe drinkers were more likely to interrupt ART. Efforts on ART continuation should be especially implemented in individuals reporting high alcohol consumption.
- Published
- 2013
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46. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia.
- Author
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Averbuch D, Orasch C, Cordonnier C, Livermore DM, Mikulska M, Viscoli C, Gyssens IC, Kern WV, Klyasova G, Marchetti O, Engelhard D, and Akova M
- Subjects
- Anti-Bacterial Agents pharmacology, Drug Resistance, Bacterial drug effects, Europe epidemiology, Fever epidemiology, Fever microbiology, Humans, Leukemia epidemiology, Leukemia microbiology, Neutropenia epidemiology, Neutropenia microbiology, Anti-Bacterial Agents therapeutic use, Drug Resistance, Bacterial physiology, Fever drug therapy, Leukemia drug therapy, Neutropenia drug therapy, Practice Guidelines as Topic standards
- Abstract
Owing to increasing resistance and the limited arsenal of new antibiotics, especially against Gram-negative pathogens, carefully designed antibiotic regimens are obligatory for febrile neutropenic patients, along with effective infection control. The Expert Group of the 4(th) European Conference on Infections in Leukemia has developed guidelines for initial empirical therapy in febrile neutropenic patients, based on: i) the local resistance epidemiology; and ii) the patient's risk factors for resistant bacteria and for a complicated clinical course. An 'escalation' approach, avoiding empirical carbapenems and combinations, should be employed in patients without particular risk factors. A 'de-escalation' approach, with initial broad-spectrum antibiotics or combinations, should be used only in those patients with: i) known prior colonization or infection with resistant pathogens; or ii) complicated presentation; or iii) in centers where resistant pathogens are prevalent at the onset of febrile neutropenia. In the latter case, infection control and antibiotic stewardship also need urgent review. Modification of the initial regimen at 72-96 h should be based on the patient's clinical course and the microbiological results. Discontinuation of antibiotics after 72 h or later should be considered in neutropenic patients with fever of unknown origin who are hemodynamically stable since presentation and afebrile for at least 48 h, irrespective of neutrophil count and expected duration of neutropenia. This strategy aims to minimize the collateral damage associated with antibiotic overuse, and the further selection of resistance.
- Published
- 2013
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- View/download PDF
47. Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011).
- Author
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Averbuch D, Cordonnier C, Livermore DM, Mikulska M, Orasch C, Viscoli C, Gyssens IC, Kern WV, Klyasova G, Marchetti O, Engelhard D, and Akova M
- Subjects
- Drug Resistance, Multiple, Bacterial physiology, Europe epidemiology, Gram-Negative Bacterial Infections drug therapy, Gram-Negative Bacterial Infections microbiology, Gram-Positive Bacterial Infections drug therapy, Gram-Positive Bacterial Infections microbiology, Humans, Leukemia epidemiology, Leukemia microbiology, Anti-Bacterial Agents administration & dosage, Drug Delivery Systems methods, Drug Resistance, Multiple, Bacterial drug effects, Hematopoietic Stem Cell Transplantation adverse effects, Leukemia drug therapy, Practice Guidelines as Topic standards
- Abstract
The detection of multi-resistant bacterial pathogens, particularly those to carbapenemases, in leukemic and stem cell transplant patients forces the use of old or non-conventional agents as the only remaining treatment options. These include colistin/polymyxin B, tigecycline, fosfomycin and various anti-gram-positive agents. Data on the use of these agents in leukemic patients are scanty, with only linezolid subjected to formal trials. The Expert Group of the 4(th) European Conference on Infections in Leukemia has developed guidelines for their use in these patient populations. Targeted therapy should be based on (i) in vitro susceptibility data, (ii) knowledge of the best treatment option against the particular species or phenotype of bacteria, (iii) pharmacokinetic/pharmacodynamic data, and (iv) careful assessment of the risk-benefit balance. For infections due to resistant Gram-negative bacteria, these agents should be preferably used in combination with other agents that remain active in vitro, because of suboptimal efficacy (e.g., tigecycline) and the risk of emergent resistance (e.g., fosfomycin). The paucity of new antibacterial drugs in the near future should lead us to limit the use of these drugs to situations where no alternative exists.
- Published
- 2013
- Full Text
- View/download PDF
48. β-glucan antigenemia anticipates diagnosis of blood culture-negative intraabdominal candidiasis.
- Author
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Tissot F, Lamoth F, Hauser PM, Orasch C, Flückiger U, Siegemund M, Zimmerli S, Calandra T, Bille J, Eggimann P, and Marchetti O
- Subjects
- Adult, Aged, Aged, 80 and over, Candidiasis complications, Candidiasis immunology, Cohort Studies, Colony Count, Microbial, Female, Humans, Intensive Care Units, Intestinal Perforation complications, Intraabdominal Infections complications, Intraabdominal Infections diagnosis, Male, Middle Aged, Pancreatitis, Acute Necrotizing complications, Prospective Studies, Recurrence, Sensitivity and Specificity, Young Adult, Candidiasis diagnosis, Intraabdominal Infections blood, beta-Glucans immunology
- Abstract
Rationale: Life-threatening intraabdominal candidiasis (IAC) occurs in 30 to 40% of high-risk surgical intensive care unit (ICU) patients. Although early IAC diagnosis is crucial, blood cultures are negative, and the role of Candida score/colonization indexes is not established., Objectives: The aim of this prospective Fungal Infection Network of Switzerland (FUNGINOS) cohort study was to assess accuracy of 1,3-β-d-glucan (BG) antigenemia for diagnosis of IAC., Methods: Four hundred thirty-four consecutive adults with abdominal surgery or acute pancreatitis and ICU stay 72 hours or longer were screened: 89 (20.5%) at high risk for IAC were studied (68 recurrent gastrointestinal tract perforation, 21 acute necrotizing pancreatitis). Diagnostic accuracy of serum BG (Fungitell), Candida score, and colonization indexes was compared., Measurements and Main Results: Fifty-eight of 89 (65%) patients were colonized by Candida; 29 of 89 (33%) presented IAC (27 of 29 with negative blood cultures). Nine hundred twenty-one sera were analyzed (9/patient): median BG was 253 pg/ml (46-9,557) in IAC versus 99 pg/ml (8-440) in colonization (P < 0.01). Sensitivity and specificity of two consecutive BG measurements greater than or equal to 80 pg/ml were 65 and 78%, respectively. In recurrent gastrointestinal tract perforation it was 75 and 77% versus 90 and 38% (Candida score ≥ 3), 79 and 34% (colonization index ≥ 0.5), and 54 and 63% (corrected colonization index ≥ 0.4), respectively. BG positivity anticipated IAC diagnosis (5 d) and antifungal therapy (6 d). Severe sepsis/septic shock and death occurred in 10 of 11 (91%) and 4 of 11 (36%) patients with BG 400 pg/ml or more versus 5 of 18 (28%, P = 0.002) and 1 of 18 (6%, P = 0.05) with BG measurement less than 400 pg/ml. β-Glucan decreased in IAC responding to therapy and increased in nonresponse., Conclusions: BG antigenemia is superior to Candida score and colonization indexes and anticipates diagnosis of blood culture-negative IAC. This proof-of-concept observation in strictly selected high-risk surgical ICU patients deserves investigation of BG-driven preemptive therapy.
- Published
- 2013
- Full Text
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49. Activity of antifungal combinations against Aspergillus species evaluated by isothermal microcalorimetry.
- Author
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Furustrand Tafin U, Orasch C, and Trampuz A
- Subjects
- Aspergillus growth & development, Hot Temperature, Microbial Sensitivity Tests methods, Antifungal Agents pharmacology, Aspergillus drug effects, Calorimetry methods, Drug Interactions
- Abstract
We evaluated the activity of antifungals alone or in combination against Aspergillus fumigatus and Aspergillus terreus by real-time measurement of fungal growth-related heat production. Amphotericin B, voriconazole, caspofungin, and anidulafungin were tested alone or in combination. Heat production was measured in Sabouraud dextrose broth containing 10(5)Aspergillus conidia/mL for 48 h at 37 °C. Antifungal activity was evaluated by measuring the heat detection time relative to the growth control. Against A. fumigatus, the voriconazole-echinocandin combination demonstrated longer heat detection time than each antifungal alone. Against A. terreus, the combination amphotericin B-echinocandin prolonged the heat detection time, compared to each antifungal alone. In contrast, the echinocandin-voriconazole combination did not increase the heat detection time, compared to voriconazole alone. None of the antifungal combinations decreased the heat detection time compared to the antifungals alone (e.g. antagonism was not observed). Microcalorimetry has the potential for real-time evaluation of antifungal combinations against Aspergillus spp., (© 2013.)
- Published
- 2013
- Full Text
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50. Severe primary cytomegalovirus infection in the immunocompetent adult patient: a case series.
- Author
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Orasch C and Conen A
- Subjects
- Adult, Aged, Antiviral Agents administration & dosage, Female, Humans, Infectious Mononucleosis pathology, Male, Cytomegalovirus isolation & purification, Cytomegalovirus Infections diagnosis, Cytomegalovirus Infections pathology
- Abstract
Primary cytomegalovirus (CMV) infection is rare in immunocompetent adults, even rarer in elderly patients. Little is known about the severity of symptoms and the clinical course in this patient group. In children and younger adults, CMV mostly presents as an asymptomatic disease or a self-limiting mild mononucleosis-like syndrome. We describe the clinical course of an unusually severe primary CMV infection in a 69-y-old otherwise healthy man, as well as 6 other severe cases in immunocompetent adults at our institution, and compare them to adult cases from the literature. CMV primary infection and antiviral treatment should be considered in immunocompetent elderly persons presenting with a severe mononucleosis-like syndrome.
- Published
- 2012
- Full Text
- View/download PDF
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