[Show abstract][Hide abstract] 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.
Antimicrobial resistance and infection control. 12/2014; 3(1):38.
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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; · 2.02 Impact Factor
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] ABSTRACT: 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.
GMS hygiene and infection control. 01/2014; 9(3):Doc20.
[Show abstract][Hide abstract] ABSTRACT: Background
Despite advances in surgery and critical care, candidemia remains a significant cause of morbidity and mortality in patients with extensive burns.
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.
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.
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.
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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.
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; · 2.79 Impact Factor
[Show abstract][Hide abstract] 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.
The bone & joint journal. 05/2013; 95-B(5):678-82.
[Show abstract][Hide abstract] 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; · 4.13 Impact Factor
[Show abstract][Hide abstract] 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; · 3.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: The purpose of our study was to evaluate and quantify the bacterial adherence on different components of total knee prosthesis with the sonication culture method.Methods: Explanted components of all patients with presumptive prosthetic or implant infection were treated by sonication separately in sterile containers to dislodge the adherent bacteria from the surfaces and cultured. The bacterial load of the different knee components (femur, tibia, PE-inlay and patella) was evaluated by counting of colony-forming units (CFU) dislodged from the components surfaces using the sonication culture method.Results: Overall, 27 patients had positive sonication cultures of explanted total knee prostheses. Microorganisms were detected from 88 of 100 explanted components. Twenty femoral components were culture positive and 7 negative, 23 tibial components as well as 23 polyethylene (PE) platforms had positive microorganism detection from the surface. Staphylococcus epidermidis adhered to the highest number of components whereas Staphylococcus aureus yielded the highest load of CFU in the sonication cultures. Although not significant, PE-inlays and tibial components were most often affected. The highest CFU count was detected in polyethylene components. Conclusion: The sonication culture method is a reliable method to detect bacteria from the components. Additionally, the results demonstrate that bacterial adherence is not affecting a single component of knee prosthesis only. Thus, in septic revision surgery partial prosthetic exchange or exchange of single polyethylene components alone may be not sufficient.
The International journal of artificial organs 10/2012; · 1.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Candida parapsilosis has become a significant cause of invasive fungal infections in seriously ill patients. Nosocomial outbreaks through direct and indirect contact have been described. The aim of this study was the molecular characterization of what appeared to be an ongoing C. parapsilosis outbreak at the cardiothoracic intensive care unit of the University Hospital of Vienna between January 2007 and December 2008. Using two different molecular typing methods-automated repetitive sequence-based PCR (DiversiLab; bioMérieux) and microsatellite genotyping-we investigated the genetic relationship of 99 C. parapsilosis isolates. Eighty-three isolates originated from the cardiothoracic intensive care unit, while 16 isolates were random control isolates from other intensive care units and a different Austrian hospital. The 99 C. parapsilosis isolates analyzed by repetitive-element PCR all showed identical genotypes, suggesting an ongoing outbreak. In contrast, microsatellite genotyping showed a total of 56 different genotypes. Two major genotypes were observed in 10 and 15 isolates, respectively, whereas another 13 genotypes were observed in 2 to 4 isolates each. Forty-one genotypes were observed only once. Closely related genotypes that differed in only a single microsatellite marker were grouped into clonal complexes. When it comes to C. parapsilosis, microsatellite genotyping is a more discriminative method than repetitive-element PCR genotyping to investigate outbreaks.
Journal of clinical microbiology 08/2012; 50(11):3422-6. · 4.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Invasive fungal infections cause significant morbidity and mortality in immunocompromised patients. Azoles, and fluconazole in particular, are very active against Candida albicans, and are used widely because of their good tolerability. However, the increasing use of azole antifungals for the treatment of mucosal and systemic Candida infections has resulted in the selection and/or emergence of resistant Candida strains. The main mechanisms of azole resistance among Candida species are the development of bypass pathways, alterations in the ERG 11 gene encoding the azole target enzyme, and the up-regulation of genes encoding efflux pumps. A better understanding of the mechanisms and clinical impact of antifungal resistance is essential to prompt and efficient treatment of patients with invasive mycoses and to improve the outcome of such infections.
[Show abstract][Hide abstract] ABSTRACT: Invasive Candida infections in seriously ill patients are rare but associated with high mortality, while Candida colonization of the mucocuteneous surfaces is common in patients admitted to intensive care units. To investigate biofilm formation as a possible virulence factor, we analyzed the biofilm formation of 128 non-invasive isolates from long-term ICU patients and that of 106 invasive bloodstream isolates. Candida biofilms were quantified by the percent transmittance (%Tbloc) method. Crystal Violet (CV) staining was used as marker of biofilm thickness, and XTT assay was used as a marker of the metabolic activity of Candida cells. The ability of biofilm formation was 99.2% in the non-invasive isolates versus 96.2% in the bloodstream isolates (%Tbloc vs.%Tbloc not significant). However, high biofilm production (%Tbloc, ≥35) was more frequent among the non-invasive isolates compared to the bloodstream isolates (78.1 vs. 72.5, p<0.001).
The International journal of artificial organs 11/2011; 34(9):818-23. · 1.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Invasive Pilzinfektionen sind seltene aber schwerste Komplikationen bei Patienten mit Intensivtherapie. Neben Patienten mit
hämatologischen Grunderkrankungen haben Patienten mit Langzeit-Aufenthalt, großen abdominellen Operationen, Kolonisation mit
Candida sp., invasiven supportiven Eingriffen sowie Immunsuppression nach Organtransplantation ein besonderes Risiko invasive
Candida-Infektionen zu erleiden. Patienten mit Lungenkrankheiten, Cortico-Steroid-Dauertherapie, Nierenversagen und Lungentransplantation
haben ein höheres Risiko an invasiver Aspergillose zu erkranken. Für eine rationale Therapie ist die Durchführung diagnostischer
Maßnahmen entscheidend, um die adäquate Therapie in ausreichender Dosis und Dauer gewährleisten zu können. Da – wie immer
in der Medizin – eine rasche Behandlung mehr Erfolg hat, soll nach der sofortigen Durchführung aller möglichen diagnostischen
Maßnahmen – unter der Prämisse der Adaptierung nach Vorliegen der Resultate – mit der antimykotischen Therapie begonnen werden.
[Show abstract][Hide abstract] ABSTRACT: Candida albicans are the most common fungi associated with biofilm-related infections. Biofilms are defined as microbial communities encased in a matrix of extracellular polymeric substances. The most important feature of biofilm growth is the high resistance to antimicrobial agents that can be up to 1000-fold greater than that of planktonic cells. This review discusses the factors affecting antifungal resistance as well as activity of mono- and combination therapy of different antifungal classes and antifungal activity in vitro and in vivo against C. albicans biofilms.
[Show abstract][Hide abstract] ABSTRACT: Invasive Candida infections are important causes of morbidity and mortality in immunocompromised and hospitalised patients. This article provides the joint recommendations of the German-speaking Mycological Society (Deutschsprachige Mykologische Gesellschaft, DMyKG) and the Paul-Ehrlich-Society for Chemotherapy (PEG) for diagnosis and treatment of invasive and superficial Candida infections. The recommendations are based on published results of clinical trials, case-series and expert opinion using the evidence criteria set forth by the Infectious Diseases Society of America (IDSA). Key recommendations are summarised here: The cornerstone of diagnosis remains the detection of the organism by culture with identification of the isolate at the species level; in vitro susceptibility testing is mandatory for invasive isolates. Options for initial therapy of candidaemia and other invasive Candida infections in non-granulocytopenic patients include fluconazole or one of the three approved echinocandin compounds; liposomal amphotericin B and voriconazole are secondary alternatives because of their less favourable pharmacological properties. In granulocytopenic patients, an echinocandin or liposomal amphotericin B is recommended as initial therapy based on the fungicidal mode of action. Indwelling central venous catheters serve as a main source of infection independent of the pathogenesis of candidaemia in the individual patients and should be removed whenever feasible. Pre-existing immunosuppressive treatment, particularly by glucocorticosteroids, ought to be discontinued, if feasible, or reduced. The duration of treatment for uncomplicated candidaemia is 14 days following the first negative blood culture and resolution of all associated symptoms and findings. Ophthalmoscopy is recommended prior to the discontinuation of antifungal chemotherapy to rule out endophthalmitis or chorioretinitis. Beyond these key recommendations, this article provides detailed recommendations for specific disease entities, for antifungal treatment in paediatric patients as well as a comprehensive discussion of epidemiology, clinical presentation and emerging diagnostic options of invasive and superficial Candida infections.