Organization of Patient Management and Fungal Epidemiology in Cystic Fibrosis

The achievement of a better life for cystic fibrosis (CF) patients is mainly caused by a better management and infection control over the last three decades. Herein, we want to summarize the cornerstones for an effective management of CF patients and to give an overview of the knowledge about the fungal epidemiology in this clinical context in Europe. Data from a retrospective analysis encompassing 66,616 samples from 3235 CF patients followed-up in 9 CF centers from different European countries are shown

Secular Trends in Nosocomial Bloodstream Infections: Antibiotic-Resistant Bacteria Increase the Total Burden of Infection

In this international study, we demonstrate that increasing rates of nosocomial bloodstream infections caused by antibiotic-resistant bacteria do not replace infections caused by antibiotic-susceptible bacteria, but occur in addition to these infections, thereby increasing the total burden of diseas

Five-years surveillance of invasive aspergillosis in a university hospital

<p>Abstract</p> <p>Background</p> <p>As the most common invasive fungal infection, invasive aspergillosis (IA) remains a serious complication in immunocompromised patients, leading to increased mortality. Antifungal therapy is expensive and may result in severe adverse effects.</p> <p>The aim of this study was to determine the incidence of invasive aspergillosis (IA) cases in a tertiary care university hospital using a standardized surveillance method.</p> <p>Methods</p> <p>All inpatients at our facility were screened for presence of the following parameters: positive microbiological culture, pathologist's diagnosis and antifungal treatment as reported by the hospital pharmacy. Patients fulfilling one or more of these indicators were further reviewed and, if appropriate, classified according to international consensus criteria (EORTC).</p> <p>Results</p> <p>704 patients were positive for at least one of the indicators mentioned above. Applying the EORTC criteria, 214 IA cases were detected, of which 56 were proven, 25 probable and 133 possible. 44 of the 81 (54%) proven and probable cases were considered health-care associated. 37 of the proven/probable IA cases had received solid organ transplantation, an additional 8 had undergone stem cell transplantation, and 10 patients were suffering from some type of malignancy. All the other patients in this group were also suffering from severe organic diseases, required long treatment and experienced several clinical complications. 7 of the 56 proven cases would have been missed without autopsy. After the antimycotic prophylaxis regimen was altered, we noticed a significant decrease (p = 0.0004) of IA during the investigation period (2003-2007).</p> <p>Conclusion</p> <p>Solid organ and stem cell transplantation remain important risk factors for IA, but several other types of immunosuppression should also be kept in mind. Clinical diagnosis of IA may be difficult (in this study 13% of all proven cases were diagnosed by autopsy only). Thus, we confirm the importance of IA surveillance in all high-risk patients.</p

Enzymatic Mechanisms Involved in Evasion of Fungi to the Oxidative Stress: Focus on Scedosporium apiospermum

The airways of patients with cystic fibrosis (CF) are frequently colonized by various filamentous fungi, mainly Aspergillus fumigatus and Scedosporium species. To establish within the respiratory tract and cause an infection, these opportunistic fungi express pathogenic factors allowing adherence to the host tissues, uptake of extracellular iron, or evasion to the host immune response. During the colonization process, inhaled conidia and the subsequent hyphae are exposed to reactive oxygen species (ROS) and reactive nitrogen species (RNS) released by phagocytic cells, which cause in the fungal cells an oxidative stress and a nitrosative stress, respectively. To cope with these constraints, fungal pathogens have developed various mechanisms that protect the fungus against ROS and RNS, including enzymatic antioxidant systems. In this review, we summarize the different works performed on ROS- and RNS-detoxifying enzymes in fungi commonly encountered in the airways of CF patients and highlight their role in pathogenesis of the airway colonization or respiratory infections. The potential of these enzymes as serodiagnostic tools is also emphasized. In addition, taking advantage of the recent availability of the whole genome sequence of S. apiospermum, we identified the various genes encoding ROS- and RNS-detoxifying enzymes, which pave the way for future investigations on the role of these enzymes in pathogenesis of these emerging species since they may constitute new therapeutics targets

Increasing Occurrence of Multidrug-Resistance in Acinetobacter baumannii Isolates From Four German University Hospitals, 2002–2006

Background: Acinetobacter baumannii can cause severe infections, mainly in critically ill inpatients. Treatment is complicated by multidrug-resistance (MDR). In Germany, to date, little is known on the extent of MDR in A. baumannii isolated from inpatients in German hospitals and potential factors influencing the emergence of MDR. Materials and Methods: We retrospectively analysed the data of A. baumannii isolates from the inpatients of four German university hospitals, tested for antimicrobial resistance with the broth dilution method between 2002 and 2006. We defined MDR as resistance to three or more classes of recommended drugs. After calculating the proportions of MDR in A. baumannii isolates, we investigated the association between MDR in A. baumannii and year of pathogen isolation, hospital, ward type, specimen and demographics. We performed descriptive analysis and multivariable logistic regression. Additionally, proportions of in vitro drug effectiveness against multidrug-resistant and non-multidrugresistant A. baumannii isolates were determined. Results: MDR was found in 66 of 1,190 (5.6%) A. baumannii isolates and increased from 2.1% in 2002 to 7.9% in 2006. The highest proportions of MDR were found in hospital A (8.9%), in intensive care units (7.3%), in isolates from blood (7.6%) and in male patients aged 60 years or older (6.6%). In multivariable analysis, the chance of MDR in A. baumannii isolates increased with the successive years of pathogen isolation (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.1–1.5) and there was a higher risk of MDR in A. baumannii in intensive care units (OR 1.8, 95% CI 1.1–2.9). The lowest in vitro antibiotic resistance was found in meropenem, imipenem and ampicillin/sulbactam, with 33, 37 and 39% for multidrugresistant and 0.4, 1 and 3% in non-multidrug-resistant A. baumannii isolates, respectively. Conclusions: The increase of MDR in A. baumannii isolates from 2002 to 2006 in four hospitals suggests that clinicians in Germany may expect a rising proportion of MDR in A. baumannii isolates among inpatients. The antimicrobial susceptibility testing of A. baumannii isolates against recommended drugs, combined with in-house antimicrobial resistance surveillance, is needed to ensure appropriate treatment

Automatic dynamic driving routes aligning method for location-referred riding driving requests requested by persons in transport unit, involves transmitting notification records of alignment unit to terminals of peoples with information

The method involves coupling route points of route to paths of digital maps. A destination time and/or target time is achieved by an accepted variation of a person (1) under collection account existing paths in the digital maps by another person (2). Automatically notification records (400) of an alignment unit (30) are transmitted to terminals (10, 20) of the persons with information over fetch time and/or fetching location during accessibility of joggle location, duration of deposition, destination and/or objective time. Independent claims are also included for the following: (1) a system for automatically aligning dynamic driving routes with location-referred riding along driving requests of persons in a transport unit comprising terminals (2) an alignment unit comprising data sets