Elisabeth Presterl

Vienna General Hospital, Wien, Vienna, Austria

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Publications (116)272.94 Total impact

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    ABSTRACT: Dear Editor,Patients with thermal injury are vulnerable to local and systemic infections. Candida spp. were the second most common pathogens isolated from catheter tips in European countries (9.1 %) [1]. Although several studies were performed to evaluate the clinical relevance of Candida spp. colonization of intravascular catheters, burn patients were only rarely studied [2-5].Patients suffering from severe burns with an Abbreviated Burn Severity Index (ABSI) ≥6, a length of ICU stay ≥24 h, a survival of more than 7 days and central venous catheter (CVC) tip culture yielding ≥15 colony-forming units of Candida spp. met the general inclusion criteria for this study. Patients were categorized into two groups based on their final outcome. Group I consisted of subjects with “poor outcome” (patients with positive CVC tip cultures for Candida spp. that suffered from subsequent or catheter related candidemia); Group II consisted of subjects with “good outcome” (patients with positive CVC tip ...
    European Journal of Intensive Care Medicine 04/2015; DOI:10.1007/s00134-015-3784-3 · 5.54 Impact Factor
  • 33. Jahrestagung der deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV); 14.-17.Jänner, 2015; Leogang, Austria; 01/2015
  • 33. Jahrestagung der deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV); 14.-17.Jänner, 2015; Leogang, Austria; 01/2015
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    ABSTRACT: Current recommendations indicate that patients who are coughing and have multidrug resistant microorganisms (MDROs) in their sputum are considered to be shedders and should be cared for in single room isolation at least until symptoms resolve. Airborne spread and subsequent contamination of surfaces adjacent to patients may contribute to transmission. Hence, isolation measures for patients colonized or infected with MDRO at their respiratory tract are intended to interrupt such transmission. However, the potential for microbial shedding in patients with MDRO-positive microbiological reports from their respiratory tract and factors justifying the need for single room isolation are viewed controversially. Cough aerosol produced by patients colonized with MDROs was measured for viable counts. Descriptive analysis together with logistic regression analysis was performed to assess the impact of strength of cough on growth of MDRO on culture plates. In 18% (23/128) MDRO were transmitted. Multivariate analysis revealed that strength of cough significantly predicts the yield of MDRO on culture plates (P = 0.012). Based on these results it can be concluded that risk stratification for decision of single room isolation of patients colonized or infected with MDROs at their respiratory tract may also take the severity of cough into consideration. However, more work is required in order to assess the severity of cough objectively.
    12/2014; 3(1):38. DOI:10.1186/s13756-014-0038-z
  • Sebastian Kautzky, Thomas Staudinger, Elisabeth Presterl
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    ABSTRACT: During the past decades, a steady increase in the incidence of invasive Candida infections in patients requiring intensive care has been reported. Nevertheless, the diagnosis of invasive Candida infections in the intensive care unit setting remains still difficult and is often made late in the course of disease. Additionally, prognosis worsens rapidly with delayed initiation of antifungal therapy. Clinical scoring systems such as the Candida colonization index or the four risk factor-based Candida score could be very useful tools to select patients at high risk of developing invasive Candida infections, who would benefit from the administration of systemic antifungal therapy. The main objective was to determine the incidence of invasive Candida infection among patients of a medical intensive care unit and to investigate its association with the Candida colonization index and the Candida score. A prospective, observational, single-center study was performed from December 2010 to December 2011. All patients over the age of 18 years who were admitted for at least 7 days in a medical intensive care unit were included. Demographic characteristics, underlying diseases, reasons for intensive care unit admission and presence and duration of risk factors for Candida species colonization and infection were collected for each patient. The Candida colonization index and the Candida score were calculated weekly until discharge or death. A total of 65 patients were included. Proven invasive Candida infections were diagnosed in five patients (7.7 %), i.e. two developed candidemia, two peritonitis, and one pneumonia. All of these patients were characterized by a Candida colonization index ≥ 0.5 (incidence rate: 16.7 % [5/30]) and a Candida score ≥ 2.5 (incidence rate: 29.4 % [5/17]). Mechanical ventilation (p = 0.013) and both Candida scoring systems (p = 0.013 versus p < 0.001) were statistically and significantly associated with invasive Candida infections. The mortality rate was high (80 %). Interestingly, treatment with antifungal drugs was not statistically and significantly associated with invasive candidiasis (p = 0.077) and patients outcome (p = 0.057). Both the Candida colonization index and the Candida score with cut-off values ≥ 0.5 and ≥ 2.5 are very useful tools to select patients at high risk of developing invasive Candida infections in the medical intensive care unit setting, who would benefit from early antifungal treatment.
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    ABSTRACT: Background: The aim of this study was to characterise the epidemiology of P. aeruginosa isolated from cystic fibrosis (CF) patients at the Vienna General Hospital (VGH) by molecular genetic fingerprinting in order to understand transmission ways and to evaluate the established infection control protocols. Methods: The outpatient clinic for CF patients at the VGH cares for children and adolescents up to the age of 18 years. Among an average of 139 patients cared for at the clinic, 41 were tested positive for P. aeruginosa during the study period. Fifty P. aeruginosa isolates, obtained between August 2010 and March 2012 from routine examinations of CF patients, were subject to molecular characterization using the DiversiLab® method. Results: 42 distinguishable molecular-biological patterns were identified, 7 of which were found multiple times. 40 out of 42 genotypes were retrieved from single patients only, while two patterns were present in two patients each. Nine patients presented with two or more phenotypically diverse P. aeruginosa isolates. In five of these cases the retrieved isolates belonged to the same genotype. Conclusion: The broad genetic heterogeneity of P. aeruginosa in the studied patient population suggests that the majority of CF patients cared for at the VGH acquire P. aeruginosa from environmental sources. It may be concluded that implemented infection control guidelines have been successful in preventing nosocomial transmission of P. aeruginosa among CF patients within the VGH and patient-to-patient transmission outside the hospital. Chronic polyclonal infection/colonization was rare in the study population.
    09/2014; 9(3):Doc20. DOI:10.3205/dgkh000240
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    ABSTRACT: Despite advances in surgery and critical care, candidemia remains a significant cause of morbidity and mortality in patients with extensive burns.
    Burns: journal of the International Society for Burn Injuries 09/2014; 41(2). DOI:10.1016/j.burns.2014.07.004 · 1.84 Impact Factor
  • 45. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 19. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC), 52. Jahrestagung der Österreichischen Gesellschaft f; 09/2014
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    ABSTRACT: Clostridium difficile infection (CDI) is the major cause of hospital-acquired bacterial diarrhoea. The incidence of CDI has been increasing in Canada, the US and Europe and severe cases are becoming more common. A retrospective cohort study investigating all patients with an episode of CDI present at the Vienna University Hospital between 01 January 2012 and 31 December 2012 was conducted. All microbiologically confirmed C. difficile toxin positive cases were included, ribotyped and analysed regarding their clinical course. A total of 278 patients with CDI were recorded, with an overall CDI incidence of 5.23 per 10,000 patients-days. Around 84,5 % (235/278) of CDI cases would have been classified as severe CDI according to European Society of Clinical Microbiology and Infectious Diseases (ESCMID) if all criteria were used. According to Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America (SHEA/IDSA) guidelines only 16.5 % (46/278) could be classified as severe; with a severe CDI incidence of 4.41 and 0.86 per 10,000 patient-days, respectively. Multivariate analysis showed only a co-morbidity index of a parts per thousand yenaEuro parts per thousand 3 (p = 0.013) as independent risk factor for severe CDI. No link between ribotype 027 and severity or clustering was observed in our study population. Special attention in terms of restrictive antibiotic prescription should be given to patients having a Charlson co-morbidity a parts per thousand yenaEuro parts per thousand 3 at the time of hospital admission. SHEA/IDSA guidelines were more accurate than ESCMID criteria in predicting severe CDI in our collective, of mostly severely ill patients, in a tertiary care hospital setting.
    Wiener klinische Wochenschrift 06/2014; 126(13-14). DOI:10.1007/s00508-014-0549-x · 0.79 Impact Factor
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    ABSTRACT: The purpose of our study was to evaluate and quantify the bacterial adherence to the different components of total hip prosthesis. The bacterial load of 80 retrieved hip components from 24 patients was evaluated by counting of colony-forming units (CFU) dislodged from component surfaces using the sonication culture method. Micro-organisms were detected in 68 of 80 explanted components. The highest bacterial load was detected on the polyethylene liners, showing a significant difference in distribution of CFU between the liner and metal components (stem and cup). Staphylococcus epidermidis was identified as the pathogen causing the highest CFU count, especially from the polyethylene liner. Results of our study confirm that sonicate culture of the retrieved liners and heads, which revealed the highest bacterial loads, are reliable and sufficient for pathogen detection in the clinical diagnostic routine.
    International Orthopaedics 05/2014; 38(8). DOI:10.1007/s00264-014-2358-2 · 2.02 Impact Factor
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    ABSTRACT: Organ transplant recipients (OTR) are at higher risk of developing life-threatening infections. In this study, we tested 527 Candida isolates obtained from the oral and genital mucosa from OTR and healthy controls in order to monitor antifungal susceptibility patterns in this particular risk group. Testing was carried out in parallel for already marketed azoles and anidulafungin. Minimal inhibitory concentrations (MICs) were determined using the E-test(®) for azoles and CLSI broth microdilution for anidulafungin. Overall, there was no difference in the distribution of Candida spp. for both groups, C. albicans being the most frequently isolated Candida sp. followed by C. glabrata. Also, there were only minor differences in the susceptibility patterns to all antifungal agents. All C. albicans isolates were fully susceptible to fluconazole and voriconazole. In C. glabrata, 2.2 % (n = 1) were resistant to fluconazole, and 82.6 % (n = 38) to itraconazole, and in C. krusei, 66.7 % (n = 2) were resistant in itraconazole. All strains were susceptible to voriconazole. Only fluconazole showed a higher rate of resistant C. glabrata isolates for OTR (3.7 %), whereas the control group showed only intermediate susceptible and no resistant isolates. As there are no breakpoints established for posaconazole by CLSI, breakpoints determined by EUCAST were used. A total of 87.9 % of C. albicans, 81.3 % of C. parapsilosis and 66.7 % of C. tropicalis were considered susceptible. C. glabrata and C. krusei showed higher MIC values and thus lesser susceptibility than the other Candida species. There were no differences observed between OTR and control groups. For anidulafungin, 99.8 % of C. albicans isolates were susceptible, 0.2 % were intermediate, whereas for C. glabrata, only 95.3 % were susceptible, 0.2 % were resistant and 4.5 % were interpreted as intermediate. Interestingly, the two resistant isolates were found in the control group. Also, the controls showed a marginally higher percentage of intermediate strains compared to the transplant patients. All in all, resistant isolates were only observed for C. glabrata of the control group.
    Mycopathologia 03/2014; DOI:10.1007/s11046-014-9738-4 · 1.55 Impact Factor
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    ABSTRACT: Background Despite advances in surgery and critical care, candidemia remains a significant cause of morbidity and mortality in patients with extensive burns. Methods A retrospective single-center cohort study was performed on 174 patients admitted to the Burn Intensive Care Unit of the General Hospital of Vienna (2007–2013). An AIC based model selection procedure for logistic regression models was utilized to identify factors associated with the presence of candidemia. Results Twenty (11%) patients developed candidemia on median day 16 after ICU admission associated with an increased overall mortality (30% versus 10%). Statistical analysis identified the following factors associated with proven candidemia: younger age (years) odds ratio (OR):0.96, 95% confidence interval (95% CI):0.92–1.0, female gender (reference male) OR:5.03, 95% CI:1.25–24.9, gastrointestinal (GI) complications requiring surgery (reference no GI complication) OR:20.37, 95% CI:4.25–125.8, non-gastrointestinal thromboembolic complications (reference no thromboembolic complication) OR:17.3, 95% CI:2.57–170.4 and inhalation trauma (reference no inhalation trauma) OR:7.96, 95% CI:1.4–48.4. Conclusions Above-mentioned patient groups are at considerably high risk for candidemia and might benefit from a prophylactic antifungal therapy. Younger age as associated risk factor is likely to be the result of the fact that older patients with a great extent of burn body surface have a lower chance of survival compared to younger patients with a comparable TBSA.
  • 32. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV); 15.-18.Jänner, 2014; Arosa, Schweiz; 01/2014
  • 32. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV); 15.-18.Jänner, 2014; Arosa, Schweiz; 01/2014
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    ABSTRACT: Background and Objectives:The aim of this study was to compare direct microscopic examination with culture and PCR for the diagnosis of Mucoralesinfection in blood and tissue specimens. Material and Methods: Blood samples and tissue specimens were obtained from 28 patients (total 58 samples) with suspected invasive fungal infection and cultured on proper media. Direct smear of tissue samples was done with potassium hydroxide, hematoxylin and eosin, and methenamine silver staining. DNA extracted from blood and tissue specimens were used for semi-nested PCR targeting 18S rDNA of Mucoralesspecies. Results: Mucormycosis was documented in 7/28 (25%) of tissue specimens with positive findings by direct smear, of which PCR and culture were positive in 6 (86%) and 5 (70%) specimens, respectively. The etiologic agents were Mucorspp. and Rhizopus spp. However, culture and PCR results for all blood specimens were negative. Conclusions: As the orders of Mucoralesdo not have well growth in culture media, PCR with tissue specimens is more sensitive than tissue or blood culture methods. Unfortunately, there is no alternative method for direct smear, which is an invasive method. Molecular methods may be helpful in these cases.
    Iranian Journal of Microbiology 12/2013; 5(4):406-410.
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    ABSTRACT: Aortic valve replacement is one of the most common cardiac surgical procedures, especially in elderly patients. Whether or not there is a net life gain over a long period of time is a matter for debate. To compare survival of patients with that of the age, sex, and follow-up year-matched normal population (relative survival). Single-centre, prospectively collected data. Tertiary care centre, Vienna, Austria. We enrolled 1848 patients undergoing elective aortic valve replacement between 1997 and the end of 2008. None. Relative survival at the end of 2011 as determined by relative Cox regression analysis. Sixty-nine patients (3.7%) died within the first 30 days. Another 70 patients (3.8%) died within the first year and 429 (23.2%) died during the remaining follow-up period. The longest follow-up period was 14 years (median, 5.8; interquartile range, 3.2 to 8.9). Medical risk indicators for relative survival were diabetes mellitus [hazard ratio 1.69, 95% confidence interval, CI 1.37 to 2.07, P <0.001], pulmonary disease (hazard ratio 1.45, 95% CI 1.16 to 1.81, P = 0.001), history of atrial fibrillation (hazard ratio 1.35, 95% CI 1.10 to 1.66, P = .005) and angiotensin-converting enzyme inhibitor medication (hazard ratio 1.21, 95% CI 1.02 to 1.44, P = 0.031). Perioperative risk indicators were urgent surgery (hazard ratio 1.40, 95% CI 1.00 to 1.94, P = 0.047), resternotomy at 48 h or less (hazard ratio 1.87, 95% CI 1.29 to 2.70, P = 0.001), resternotomy at more than 48 h (hazard ratio 1.80, 95% CI 1.32 to 2.45, P <0.001), blood transfusion (hazard ratio 1.06, 95% CI 1.01 to 1.12, P = 0.018) and renal replacement therapy (hazard ratio 2.02, 95% CI 1.41 to 2.90, P <0.001). Relative survival was highest in the oldest age quartile (76 to 94 years) and lowest in the youngest (19 to 58 years) (hazard ratio 0.27, 95% CI 0.21 to 0.36; P <0.001). Patients who survived the first year after aortic valve replacement had a similar chance of survival as the matched normal population. Relative survival benefit was higher in the oldest age quartile.
    European Journal of Anaesthesiology 09/2013; 30(11). DOI:10.1097/EJA.0b013e3283657829 · 3.01 Impact Factor
  • Magda Diab-Elschahawi, Elisabeth Presterl
    Krankenhaushygiene up2date 07/2013; 08(02):101-113. DOI:10.1055/s-0033-1344235
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    ABSTRACT: The aim of this study was to evaluate whether coating titanium discs with selenium in the form of sodium selenite decreased bacterial adhesion of Staphylococcus aureus and Staph. epidermidis and impeded osteoblastic cell growth. In order to evaluate bacterial adhesion, sterile titanium discs were coated with increasing concentrations of selenium and incubated with bacterial solutions of Staph. aureus (ATCC 29213) and Staph. epidermidis (DSM 3269) and stained with Safranin-O. The effect of selenium on osteoblastic cell growth was also observed. The adherence of MG-63 cells on the coated discs was detected by staining with Safranin-O. The proportion of covered area was calculated with imaging software. The tested Staph. aureus strain showed a significantly reduced attachment on titanium discs with 0.5% (p = 0.011) and 0.2% (p = 0.02) selenium coating. Our test strain from Staph. epidermidis showed a highly significant reduction in bacterial adherence on discs coated with 0.5% (p = 0.0099) and 0.2% (p = 0.002) selenium solution. There was no inhibitory effect of the selenium coating on the osteoblastic cell growth. Selenium coating is a promising method to reduce bacterial attachment on prosthetic material. Cite this article: Bone Joint J 2013;95-B:678-82.
    05/2013; 95-B(5):678-82. DOI:10.1302/0301-620X.95B5.31216
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    ABSTRACT: AIM: Invasive Candida infections (ICI) in intensive care unit (ICU) patients are associated with high mortality. A 2-year prospective study was performed to improve clinical decision making in long-term ICU patients after cardiac surgery. METHODS: Demographic, clinical and physiological data, the incidence of ICI and Candida colonisation scores were analysed. To assess severity of illness the new simplified acute physiology score (SAPS II score), the European system for cardiac operative risk evaluation (EuroSCORE) and the sequential organ failure assessment (SOFA) score were calculated. To define independent risk factors univariate and multivariate Cox-regression analyses with time-dependent covariates were calculated. RESULTS: One hundred and sixty-nine cardiac surgery patients with ICU admittance ≥4 days out of 513 admittances were enrolled. Ten patients had proven ICI. In the multivariate analysis the SOFA score (HR = 1.29, p = 0.009) was associated with proven ICI. In 71 patients receiving empiric antifungal therapy for presumptive but unproven ICI the SOFA score (HR = 1.18, p = 0.029) and corrected Candida colonisation index (HR 11.08; p = 0.030) were significantly associated to ICI. Neither SAPS II score nor EuroScore were associated with ICI in either patient group. The mortality rate of patients receiving empiric antifungal therapy was significantly lower compared to that of patients with proven ICI (36.6% vs. 80%, respectively). CONCLUSION: Time-associated SOFA score assessing acute organ failure was the only independent risk factor for proven ICI. Cardiovascular procedures did not confer risk to develop ICI. Empiric antifungal therapy may be warranted in severely ill cardiac surgery patients.
    The Journal of infection 02/2013; 66(6). DOI:10.1016/j.jinf.2013.02.003 · 4.02 Impact Factor
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    ABSTRACT: A universal vs a targeted hepatitis C virus (HCV) screening policy for identifying pregnant women with the virus were compared. Universal screening did not yield significantly more identification of patients with HCV than targeted screening. However, 14 of 67 (21%) women with confirmed HCV would not have been detected by targeted risk-based HCV screening.
    American journal of infection control 10/2012; 41(5). DOI:10.1016/j.ajic.2012.06.003 · 2.33 Impact Factor

Publication Stats

2k Citations
272.94 Total Impact Points

Institutions

  • 1996–2014
    • Vienna General Hospital
      Wien, Vienna, Austria
  • 1992–2014
    • Medical University of Vienna
      • • Department of Medicine I
      • • Klinische Abteilung für Infektionen und Tropenmedizin
      • • Institute for Social Medicine
      Wien, Vienna, Austria
  • 2005
    • Universitätsklinikum Tübingen
      Tübingen, Baden-Württemberg, Germany
  • 1993–2003
    • University of Vienna
      • • Institute of Social Medicine
      • • Hygiene Institute
      • • Clinic for Internal Medicine I
      Vienna, Vienna, Austria
  • 2001
    • Karl-Franzens-Universität Graz
      Gratz, Styria, Austria