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Highlights 2008

CD4+ T cell count recovery in HIV type 1-infected patients is independent of class of antiretroviral therapy

Khanna et al. investigated in a study involving 3'293 patients CD4-T-cell recovery according to combination antiretroviral therapy. CD4-T-cell recovery was similar in patients receiving nonboosted protease inhibitor-, non nucleosid reverse transcriptase inhibitor-, and boosted protease inhibitor-based combination antiretroviral therapy.

Article on PubMed

 

Update of Clostridium difficile infection due to PCR ribotype 027 in Europe, 2008

In a collaborative effort Clostridium difficile infections (type 027) were investigated throughout Europe. Different countries were identified with outbreaks, after with diagnosis in single patients who acquired the infection abroad. This study concludes that ongoing epidemiological surveillance of cases with periodic characterization of the strains involved is required.

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Round-table multidisciplinary counseling of couples with HIV prior to assisted reproduction

Tschudin S. et al. investigated assisted reproduction in HIV-infected patients including discordant couples. In this study the multidisciplinary counseling of different clinical units, in particular of the women's hospital, the microbiology and the infectious diseases unit is shown. 14 pregnancies were achieved leading to birth of 8 children. The study concluded that the round-table multidisciplinary meeting approaches a feasible option for HIV-affected couples with infertility.

Article on PubMed

 

Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies

Our center within the Swiss HIV Cohort Study participated in the large analysis of the Antiretroviral Cohort Collaboration on the life expectancy in HIV-infected patients treated with antiretroviral therapy. This study investigating 18'587, 13'914, and 10'854 patients initiating combination antiretroviral therapy in 1996-1999, 2000-2002, and 2003-2005, demonstrated that mortality rates decrease over the investigated time periods. The average number of years remaining to be lived at age 20 years was about 2/3 of that in the general population in these countries.

Article on PubMed

 

Characteristics and treatment outcome of cerebrospinal fluid shunt-associated infections in adults: a retrospective analysis over an 11-year period

This study is a comprehensive retrospective analysis over an 11-year period. Most infections were associated with ventriculoperitoneal shunt (65 episodes), followed by ventriculoatrial shunt (7 episodes). Two third of infections (62%) manifested within one month after shunt surgery. Other characteristics of this complication are described in detail and are helpful for clinicians to solve associated problems.

Article on PubMed

 

Delayed diagnosis of HIV infection and late initiation of antiretroviral therapy in the Swiss HIV Cohort Study

This study within the frame of the Swiss HIV Cohort Study investigates 1'915 patients with HIV diagnosis from 1998 to 2007 and within 3 months of cohort registration. The study indicates that late presentation is still prevalent with 31% and 10% of patients arriving at our Swiss clinics with CD4-T-cell counts below 250 cells/µL, respectively. Risk factors for low CD4 count were age and non-White race. Importantly, once in a clinical setting, antiretroviral therapy was started promptly and very rarely delayed.

Article on PubMed

 

Appropriateness of antibiotic treatment in intravenous drug users, a retrospective analysis

Infectious diseases often the reason for intravenous drug users being seen in a clinical setting. This comprehensive study on 344 hospital episodes among 216 intravenous drug users demonstrates that skin and soft tissue infections are most prevalent, followed by pneumonia and endocarditis. Interestingly, we found that appropriate antibiotic therapy according to standard guidelines in hospitalized intravenous drug users is generally practicable and successful. In a minority alternative treatments may be indicated, although associated with a higher risk of relapse.

Article on PubMed

 

Less than 28 Days of Intravenous Antibiotic Treatment Is Sufficient for Suppurative Thrombophlebitis in Injection Drug Users

Among 36 episodes of proven suppurative thrombophlebitis (septic thrombosis) no relapse is occurred when treatment was given for more than 7 days intravenously and followed by oral therapy. A less than 4 week course of intravenous antibiotics may be sufficient. Noteworthy, this is the largest case series so far described for suppurative thrombophlebitis.

Article on PubMed

 

Highly effective regimen for decolonization of methicillin-resistant Staphylococcus aureus carriers

To evaluate the efficacy of a standardized regimen for decolonization of methicillin-resistant Staphylococcus aureus (MRSA) carriers and to identify factors influencing decolonization treatment failure 62 patients randomized for decolonization treatment protocol were investigated. Standardized decolonization treatment consisted of mupirocin nasal ointment, chlorhexidine mouth rinse, and full-body wash with chlorhexidine soap for 5 days. Other details for the decolonization procedures are described in the publication. Decolonization was successful in 54 (87%) of the patients in the intent-to-treat analysis and in 51 (98%) of 52 patients in the on-treatment analysis. This standardized regimen for MRSA decolonization was highly effective in patients who completed the full decolonization treatment course.

Article on PubMed

 

Respiratory syncytial virus infection in patients with hematological diseases: single-center study and review of the literature

Respiratory syncytial virus (RSV) causes significant mortality in patients with hematological diseases, but diagnosis and treatment are uncertain. 34 patients were retrospectively identified with RSV-infection. This study shows that RSV-attributed mortality was significant with 18%. The duration of RSV shedding correlated with the duration of symptoms in patients with severe immunodeficiency. Also this study shows that PCR for RSV may optimize diagnosis and monitoring. Oral ribavirin therapy in 7 patients seemed to be safe.

Article on PubMed

 

Emergence of SCCmec Type IV as the Most Common Type of Methicillin-Resistant Staphylococcus aureus in a University Hospital

In this analysis sporadic MRSA-strains isolated in our low MRSA incidence university hospital were investigated. The SCCmec Type IV/IV A is present in both community acquired MRSA and hospital acquired MRSA limiting its use as a marker for community acquired MRSA.

Article on PubMed

 

Polyomavirus BK replication dynamics

In this study Funk et al investigated the dynamics in vivo and in silico to predict cytopathology and viral clearance in kidney transplants of polyomavirus BK. Viral expansion was best explained by models where BK virus replication started in the kidney followed by urothelial amplification and tubular epithelial cell cross-feeding reaching a dynamic equilibrium after approximately 10 weeks. Interestingly, this model was clinically validated in prospectively monitored kidney transplant patients.

Article on PubMed

 

CD4+ T cell count recovery in HIV type 1-infected patients is independent of class of antiretroviral therapy

This study within the frame of the Swiss HIV cohort study investigated all patients in the Swiss HIV cohort study receiving first combination antiretroviral therapy during January 1996 through May 2007. CD4+ T cell recovery was similar in patients receiving non boosted protease inhibitors, non-nucleoside-reverse-transcriptase-inhibitors and boosted protease inhibitors-based combination antiretroviral therapy.

Article on PubMed

 

Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies

Within the frame of the antiretroviral therapy cohort collaboration with participation of our division, in particular HIV-clinic, life tables were constructed to estimate life expectancies for individuals on combination antiretroviral therapy in 1996 - 1999 (18'587 patients), 2000 - 2002 (13'914 patients) and 2003 - 2005 (1'854 patients). The study demonstrates the dramatic improvement of prognosis for HIV-infected patients increased by combination antiretroviral therapy. The average number of years remaining to be lived at age 20 years was about two-thirds of that in the general population of these countries. The antiretroviral therapy cohort collaboration is a multinational collaboration of HIV cohort studies in Europe and North America which includes also the data of the Swiss HIV cohort study.

Article on PubMed

 

Epidemiology of Clostridium difficile-associated disease at University Hospital Basel including molecular characterisation of the isolates 2006-2007

Fenner et al prospectively studied the epidemiology of clostridium difficile-associated disease at the University Hospital of Basel. 78 cases were identified. 16 patients (20.5 %) were infected with clindamycin-resistant strains of PCR-ribotype 027 during an outbreak at the geriatric hospital. PCR-ribotype 027 was associated with older age and longer duration of hospitalisation before onset of disease. The study concludes that laboratory-based and epidemiological surveillance of systems are required to monitor clostridium difficile-associated cases and emergence of new epidemic strains.

Article on PubMed