Highlights

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Highlights 2007

Optimal diagnostic and therapeutic procedures and use of correct antibiotic application and duration

Three years ago our division started an antibiotic stewardship program. A first study was published which analyzed the empirical and adjusted antibiotic use in the emergency room. Inadequate antibiotics were given in 22% of empirical and in 27% of adjusted therapy. As a consequence interventions should focus on both initial empirical therapy and streamlining and adjustment of therapy once microbiological results become available. A further study is ongoing, investigating the switch of an i.v. to an oral antibiotic therapy to shorten hospital stay and to reduce costs. In a more specific study we investigated the antibiotic treatment in over 300 hospital episodes of drug addicted patients and showed that 80% of these patients could be treated according to international guidelines or recommendations by infectious disease specialists.

Article on PubMed

 

S. aureus infection and pathogens relevant for infectious diseases epidemiology

In several studies we described aspects of clinically and epidemiologically relevant pathogens such as S. aureus and Mycobacterium tuberculosis. Pathophysiologic and molecular aspects of S. aureus were investigated comparing the expression of PIA and ica specific transcripts in vitro and in an animal model. The clinical description of S. aureus infection is very important, due to its high pathogenicity and frequency. Analyzing 308 episodes of S. aureus bacteraemia showed that the overall hospital-associated mortality was still 20%. Hence, it may be important to reliably detect carriers of S. aureus as carrier state may be associated with a higher risk for latter infections. By screening close to 3000 individuals for S. aureus-carriage we showed that screening of throat swaps significantly increases the sensitivity of detection for S. aureus carriage by 25.7%. Regarding tuberculosis (Tb), we showed that new immigrants suffering from active infection are often quite asymptomatic.  For this study we investigated 111 of 42’601 new immigrants with chest radiographs suspicious for Tb and compared the symptoms and course to foreign born residents and native residents with Tb.

Biofilm Formation, icaADBC Transcription, and Polysaccharide Intercellular Adhesin Synthesis by Staphylococci in a Device-Related Infection Model

Course and outcome of Staphylococcus aureus bacteraemia: a retrospective analysis of 308 episodes in a Swiss tertiary-care centre

Throat Swabs Are Necessary to Reliably Detect Carriers of Staphylococcus aureus

TB in a Low-Incidence Country: Differences Between New Immigrants, Foreign-Born Residents and Native Residents

 

Transplant infectious diseases (viral and fungal diseases)

The last years were very much dedicated to have a stringent scientific setup for transplantation infectious diseases. A long standing interest of our group is the research on the pathogenesis of polyoma viruses, in particular the BK and JC-virus. In a recent study, investigating the dynamics of polyoma type BK virus in renal transplant recipients, a collaborative study with the Division of Kidney Diseases, we demonstrated that high-level BK-virus replication is a major pathogenetic factor that may have implications for genome rearrangements, immune invasion and antiviral resistance. This was followed up by study on the characterization of highly frequent epitope-specific T-cells as well as a detailed analysis on polyoma BK-specific cellular immune response to VP1 and large T-antigen in kidney transplant recipients.
In hematological stem cell patients diagnostic procedures are investigated for fungal and viral diseases such as aspergillosis or RSV infection. E.g. the value of galactomannan for the diagnosis of invasive aspergillosis was investigated. The structured collaboration with the Division of haematology has and will allow a more comprehensive view on infectious diseases encountered by stem cell transplanted patients.

Rapid Dynamics of Polyomavirus Type BK in Renal Transplant Recipients

BKV Replication and Cellular Immune Responses in Renal Transplant Recipients

Galactomannan Does Not Precede Major Signs on a Pulmonary Computerized Tomographic
Scan Suggestive of Invasive Aspergillosis in Patients with Hematological Malignancies

 

HIV/AIDS - treatment response and immune reconstitution

In the past years HIV research concentrated on aspects of potent antiretroviral therapies dramatically improving prognosis, in particular immune response and specific immune reconstitution. The Swiss HIV-Cohort Study following up more than 14’000 patient so far allows to specifically target patient groups of interest and to reliably compare them to control patients. In one case control study, led by Christoph Hess of the Immunology Group, we demonstrated that irrespective of absolute CD4 T-cell counts, HIV-positive patients, who subsequently developed primary CNS lymphoma lacked EBV-specific CD4 T-cell function. Further studies within this research period investigated optimal therapies regarding functional and absolute increases of CD4 T-cells.

Immunological recovery and antiretroviral therapy in HIV-1 infection

Characteristics, Determinants, and Clinical Relevance of CD4 T Cell Recovery to !500 Cells/mL in HIV Type 1–Infected Individuals Receiving Potent Antiretroviral Therapy

Cost-Effectiveness of Genotypic Antiretroviral Resistance Testing in HIV-Infected Patients with Treatment Failure

HIV Patients Developing Primary CNS Lymphoma Lack EBV-Specific CD4þ T Cell Function
Irrespective of Absolute CD4þ T Cell Counts

 

Prosthesis associated infections and osteomyelitis

Hip or knee replacements and osteosynthesis may improve quality of life. Rarely, these procedures are associated with prosthetic-joint infection. Novel methods for the detection of bacteria were analyzed such as microcalorimetry or sonication of the prothesis. The latter method showed more sensitive than conventional periprothetic-tissue culture. The microcalorimetry measures heat from replicating microorganisms and is a promising novel method to detect bacteria.

Microcalorimetry: a novel method for detection of microbial contamination in platelet products

Sonication of Removed Hip and Knee Prostheses for Diagnosis of Infection