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Schwarz C, Bend J, Hebestreit H, Hogardt M, Hügel C, Illing S, Mainz JG, Rietschel E, Schmidt S, Schulte-Hubbert B, Sitter H, Wielpütz MO, Hammermann J, Baumann I, Brunsmann F, Dieninghoff D, Eber E, Ellemunter H, Eschenhagen P, Evers C, Gruber S, Koitschev A, Ley-Zaporozhan J, Düesberg U, Mentzel HJ, Nüßlein T, Ringshausen FC, Sedlacek L, Smaczny C, Sommerburg O, Sutharsan S, Vonberg RP, Weber AK, Zerlik J. [CF Lung Disease - a German S3 Guideline: Pseudomonas aeruginosa]. Pneumologie 2024. [PMID: 38423036 DOI: 10.1055/a-2278-6685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Carsten Schwarz
- Klinikum Westbrandenburg GmbH, Standort Potsdam, Deutschland
| | - Jutta Bend
- Mukoviszidose Institut gGmbH, Bonn, Deutschland
| | | | - Michael Hogardt
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Frankfurt, Deutschland
| | - Christian Hügel
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Deutschland
| | | | - Jochen G Mainz
- Klinikum Westbrandenburg, Standort Brandenburg an der Havel, Universitätsklinikum der Medizinischen Hochschule Brandenburg (MHB), Brandenburg an der Havel, Deutschland
| | - Ernst Rietschel
- Medizinische Fakultät der Universität zu Köln, Mukoviszidose-Zentrum, Klinik und Poliklinik für Kinder- und Jugendmedizin, Köln, Deutschland
| | - Sebastian Schmidt
- Ernst-Moritz-Arndt Universität Greifswald, Kinderpoliklinik, Allgemeine Pädiatrie, Greifswald, Deutschland
| | | | - Helmut Sitter
- Philipps-Universität Marburg, Institut für theoretische Medizin, Marburg, Deutschland
| | - Marc Oliver Wielpütz
- Universitätsklinikum Heidelberg, Klinik für Diagnostische und Interventionelle Radiologie, Heidelberg, Deutschland
| | - Jutta Hammermann
- Universitäts-Mukoviszidose-Zentrum "Christiane Herzog", Dresden, Deutschland
| | - Ingo Baumann
- Universität Heidelberg, Hals-Nasen-Ohrenklinik, Heidelberg, Deutschland
| | - Frank Brunsmann
- Allianz Chronischer Seltener Erkrankungen (ACHSE) e. V., Deutschland (Patient*innenvertreter)
| | | | - Ernst Eber
- Medizinische Universität Graz, Univ. Klinik für Kinder- und Jugendheilkunde, Klinische Abteilung für Pädiatrische Pulmonologie und Allergologie, Graz, Österreich
| | - Helmut Ellemunter
- Tirolkliniken GmbH, Department für Kinderheilkunde, Pädiatrie III, Innsbruck, Österreich
| | | | | | - Saskia Gruber
- Medizinische Universität Wien, Universitätsklinik für Kinder- und Jugendheilkunde, Wien, Österreich
| | - Assen Koitschev
- Klinikum Stuttgart - Standort Olgahospital, Klinik für Hals-Nasen-Ohrenkrankheiten, Stuttgart, Deutschland
| | - Julia Ley-Zaporozhan
- Klinik und Poliklinik für Radiologie, Kinderradiologie, LMU München, Deutschland
| | | | - Hans-Joachim Mentzel
- Universitätsklinikum Jena, Sektion Kinderradiologie, Institut für Diagnostische und Interventionelle Radiologie, Jena, Deutschland
| | - Thomas Nüßlein
- Gemeinschaftsklinikum Mittelrhein, Klinik für Kinder- und Jugendmedizin Koblenz und Mayen, Koblenz, Deutschland
| | - Felix C Ringshausen
- Medizinische Hochschule Hannover, Klinik für Pneumologie und Infektiologie und Deutsches Zentrum für Lungenforschung (DZL), Hannover, Deutschland
| | - Ludwig Sedlacek
- Medizinische Hochschule Hannover, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Hannover, Deutschland
| | - Christina Smaczny
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Deutschland
| | - Olaf Sommerburg
- Universitätsklinikum Heidelberg, Sektion Pädiatrische Pneumologie, Allergologie und Mukoviszidose-Zentrum, Heidelberg, Deutschland
| | | | - Ralf-Peter Vonberg
- Medizinische Hochschule Hannover, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Hannover, Deutschland
| | | | - Jovita Zerlik
- Altonaer Kinderkrankenhaus gGmbH, Abteilung Physiotherapie, Hamburg, Deutschland
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Schwarz C, Bend J, Hebestreit H, Hogardt M, Hügel C, Illing S, Mainz JG, Rietschel E, Schmidt S, Schulte-Hubbert B, Sitter H, Wielpütz MO, Hammermann J, Baumann I, Brunsmann F, Dieninghoff D, Eber E, Ellemunter H, Eschenhagen P, Evers C, Gruber S, Koitschev A, Ley-Zaporozhan J, Düesberg U, Mentzel HJ, Nüßlein T, Ringshausen FC, Sedlacek L, Smaczny C, Sommerburg O, Sutharsan S, Vonberg RP, Weber AK, Zerlik J. [CF Lung Disease - a German S3 Guideline: Pseudomonas aeruginosa]. Pneumologie 2024. [PMID: 38350639 DOI: 10.1055/a-2182-1907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Cystic Fibrosis (CF) is the most common autosomal recessive genetic multisystemic disease. In Germany, it affects at least 8000 people. The disease is caused by mutations in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene leading to dysfunction of CFTR, a transmembrane chloride channel. This defect causes insufficient hydration of the airway epithelial lining fluid which leads to reduction of the mucociliary clearance.Even if highly effective, CFTR modulator therapy has been available for some years and people with CF are getting much older than before, recurrent and chronic infections of the airways as well as pulmonary exacerbations still occur. In adult CF life, Pseudomonas aeruginosa (PA) is the most relevant pathogen in colonisation and chronic infection of the lung, leading to further loss of lung function. There are many possibilities to treat PA-infection.This is a S3-clinical guideline which implements a definition for chronic PA-infection and demonstrates evidence-based diagnostic methods and medical treatment in order to give guidance for individual treatment options.
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Affiliation(s)
- Carsten Schwarz
- Klinikum Westbrandenburg GmbH, Standort Potsdam, Deutschland
| | - Jutta Bend
- Mukoviszidose Institut gGmbH, Bonn, Deutschland
| | | | - Michael Hogardt
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Frankfurt, Deutschland
| | - Christian Hügel
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Deutschland
| | | | - Jochen G Mainz
- Klinikum Westbrandenburg, Standort Brandenburg an der Havel, Universitätsklinikum der Medizinischen Hochschule Brandenburg (MHB), Brandenburg an der Havel, Deutschland
| | - Ernst Rietschel
- Medizinische Fakultät der Universität zu Köln, Mukoviszidose-Zentrum, Klinik und Poliklinik für Kinder- und Jugendmedizin, Köln, Deutschland
| | - Sebastian Schmidt
- Ernst-Moritz-Arndt Universität Greifswald, Kinderpoliklinik, Allgemeine Pädiatrie, Greifswald, Deutschland
| | | | - Helmut Sitter
- Philipps-Universität Marburg, Institut für theoretische Medizin, Marburg, Deutschland
| | - Marc Oliver Wielpütz
- Universitätsklinikum Heidelberg, Klinik für Diagnostische und Interventionelle Radiologie, Heidelberg, Deutschland
| | - Jutta Hammermann
- Universitäts-Mukoviszidose-Zentrum "Christiane Herzog", Dresden, Deutschland
| | - Ingo Baumann
- Universität Heidelberg, Hals-Nasen-Ohrenklinik, Heidelberg, Deutschland
| | - Frank Brunsmann
- Allianz Chronischer Seltener Erkrankungen (ACHSE) e. V., Deutschland (Patient*innenvertreter)
| | | | - Ernst Eber
- Medizinische Universität Graz, Univ. Klinik für Kinder- und Jugendheilkunde, Klinische Abteilung für Pädiatrische Pulmonologie und Allergologie, Graz, Österreich
| | - Helmut Ellemunter
- Tirolkliniken GmbH, Department für Kinderheilkunde, Pädiatrie III, Innsbruck, Österreich
| | | | | | - Saskia Gruber
- Medizinische Universität Wien, Universitätsklinik für Kinder- und Jugendheilkunde, Wien, Österreich
| | - Assen Koitschev
- Klinikum Stuttgart - Standort Olgahospital, Klinik für Hals-Nasen-Ohrenkrankheiten, Stuttgart, Deutschland
| | - Julia Ley-Zaporozhan
- Klinik und Poliklinik für Radiologie, Kinderradiologie, LMU München, Deutschland
| | | | - Hans-Joachim Mentzel
- Universitätsklinikum Jena, Sektion Kinderradiologie, Institut für Diagnostische und Interventionelle Radiologie, Jena, Deutschland
| | - Thomas Nüßlein
- Gemeinschaftsklinikum Mittelrhein, Klinik für Kinder- und Jugendmedizin Koblenz und Mayen, Koblenz, Deutschland
| | - Felix C Ringshausen
- Medizinische Hochschule Hannover, Klinik für Pneumologie und Infektiologie und Deutsches Zentrum für Lungenforschung (DZL), Hannover, Deutschland
| | - Ludwig Sedlacek
- Medizinische Hochschule Hannover, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Hannover, Deutschland
| | - Christina Smaczny
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Deutschland
| | - Olaf Sommerburg
- Universitätsklinikum Heidelberg, Sektion Pädiatrische Pneumologie, Allergologie und Mukoviszidose-Zentrum, Heidelberg, Deutschland
| | | | - Ralf-Peter Vonberg
- Medizinische Hochschule Hannover, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Hannover, Deutschland
| | | | - Jovita Zerlik
- Altonaer Kinderkrankenhaus gGmbH, Abteilung Physiotherapie, Hamburg, Deutschland
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Zoqi H, Schmidt D, Sedlacek L, Rath PM, Steinmann J, Kirchhoff L. Establishment of a Novel Short Tandem Repeat Typing Method for Exophiala dermatitidis. Mycopathologia 2024; 189:5. [PMID: 38231292 PMCID: PMC10794339 DOI: 10.1007/s11046-023-00825-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/18/2023] [Indexed: 01/18/2024]
Abstract
The opportunistic black yeast-like fungus Exophiala dermatitidis frequently colonizes the respiratory tract of cystic fibroses (CF) patients. Additionally, it can cause superficial, systemic, and cerebral forms of phaeohyphomycoses. The objective of this study was to develop and apply a microsatellite or short tandem repeat (STR) genotyping scheme for E. dermatitidis. In total, 82 E. dermatitidis isolates from various geographic origins (environmental = 9, CF = 63, invasive isolates = 9, melanin-deficient mutant = 1) were included in this study. After next-generation sequencing of a reference strain and sequence filtering for microsatellites, six STR markers were selected and amplified in two multiplex PCR reactions. The included isolates were discriminated in a genetic cluster analysis using the Pearson algorithm to reveal the relatedness of the isolates. The E. dermatitidis isolates clustered on basis of both, their source and their origin. The invasive isolates from Asia were unrelated to isolates from CF. Nearly all environmental isolates were grouped separately from patients' isolates. The Simpson index was 0.94. In conclusion, we were able to establish a STR genotyping scheme for investigating population genomics of E. dermatitidis.
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Affiliation(s)
- Hamide Zoqi
- Institute of Medical Microbiology, ECMM Center of Excellence in Clinical and Laboratory Mycology and Clinical Studies (Diamond Status), University Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany
| | - Dirk Schmidt
- Institute of Medical Microbiology, ECMM Center of Excellence in Clinical and Laboratory Mycology and Clinical Studies (Diamond Status), University Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany
| | - Ludwig Sedlacek
- Institute of Medical Microbiology and Hospital Epidemiology, Medical School Hannover (MHH), Hannover, Germany
| | - Peter-Michael Rath
- Institute of Medical Microbiology, ECMM Center of Excellence in Clinical and Laboratory Mycology and Clinical Studies (Diamond Status), University Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany
| | - Joerg Steinmann
- Institute of Medical Microbiology, ECMM Center of Excellence in Clinical and Laboratory Mycology and Clinical Studies (Diamond Status), University Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany
- Institute of Clinical Microbiology, Infectious Diseases and Infection Control, Klinikum Nürnberg, Paracelsus Medical University, 90419, Nuremberg, Germany
| | - Lisa Kirchhoff
- Institute of Medical Microbiology, ECMM Center of Excellence in Clinical and Laboratory Mycology and Clinical Studies (Diamond Status), University Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany.
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Corbett C, Finger P, Heiß-Neumann M, Bohnert J, Eder IB, Eisele M, Friesen I, Kaasch AJ, Kehrmann J, Lang R, Rödel J, Roessler S, Schmidt A, Schneitler S, Schui D, Schuler F, Sedlacek L, Serr A, Sitaru AG, Steinmann J, Wagner D, Wichelhaus TA, Hofmann-Thiel S, Hoffmann H. Development of prevalence and incidence of non-tuberculous mycobacteria in German laboratories from 2016 to 2020. Emerg Microbes Infect 2023; 12:2276342. [PMID: 37883336 PMCID: PMC10769520 DOI: 10.1080/22221751.2023.2276342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/24/2023] [Indexed: 10/28/2023]
Abstract
Numbers of non-tuberculous mycobacteria (NTM) pulmonary diseases (PD) have been repeatedly reported as increasing over the last decades, particularly in Europe. Sound epidemiological data are however missing for most European regions. This study calculated prevalence and incidence of NTM recovered from patients' lungs in Germany, the largest Central European country, over a five-year period. It furthermore determined regional particularities of NTM species and results from susceptibility testing. 22 German NTM laboratories provided their mycobacteriological diagnostic data of 11,430 NTM isolates recovered from 5998 pulmonary patients representing 30% of all notified NTM-PD cases of Germany from 2016 to 2020. NTM incidence and prevalence were calculated for every study year. The presented epidemiological indicators are particularly reliant as TB surveillance data were used as a reference and TB notification reaches almost 100% in Germany. Laboratory incidence and prevalence of NTM recovered from respiratory samples ranged from 4.5-4.9 and from 5.3-5.8/100,000 for the population of Germany, respectively, and did not change over the five-year study period. Prevalence and incidence were stable also when stratifying for facultative pathogenic NTM, M. avium/intracellulare complex (MAIC), and M. abscessus/chelonae complex (MABSC). The proportion of NTM with drug susceptibility testing (DST) increased from 27.3% (2016) to 43.8% (2020). The unchanging laboratory NTM prevalence/incidence in Germany represents a "ceiling" of possible NTM-PD notification when diagnostic strategies do not change in the coming years. A notable increase in NTM-DST may indicate better notification of NTM-PD and/or awareness of new clinical guidelines but still remains below clinical needs.
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Affiliation(s)
- Caroline Corbett
- Institute of Microbiology and Laboratory Medicine, Department IML red GmbH, WHO - Supranational Tuberculosis Reference Laboratory, Munich-Gauting, Germany
| | - Philipp Finger
- Institute of Microbiology and Laboratory Medicine, Department IML red GmbH, WHO - Supranational Tuberculosis Reference Laboratory, Munich-Gauting, Germany
| | - Marion Heiß-Neumann
- Department of Pneumology & Infectious Diseases, Asklepios Lung Clinic Munich-Gauting, member of the German Centre for Lung Research; Gauting, Germany
| | - Juergen Bohnert
- Friedrich Loeffler-Institute of Medical Microbiology, Greifswald, Germany
| | - Ines B. Eder
- Institute of Medical Microbiology and Virology, University Hospital Leipzig, Leipzig, Germany
| | - Melanie Eisele
- Institut für medizinische Mikrobiologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Inna Friesen
- Labor Berlin - Charité Vivantes GmbH, Berlin, Germany
| | - Achim J. Kaasch
- Institute of Medical Microbiology and Hospital Hygiene, Medical Faculty, University Hospital Magdeburg, Otto von Guericke University, Magdeburg, Germany
| | - Jan Kehrmann
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Roland Lang
- Institut für Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jürgen Rödel
- Institute of Medical Microbiology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Susann Roessler
- Institut für Medizinische Mikrobiologie und Virologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden Germany
| | - Annika Schmidt
- Institut für medizinische Mikrobiologie und Hygiene, Tübingen, Germany
| | - Sophie Schneitler
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
- Institute of Pneumology at the University of Cologne, Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Solingen, Germany
| | - Daniela Schui
- Bioscientia Institut für Medizinische Diagnostik GmbH, Mikrobiologie, Ingelheim, Germany
| | - Franziska Schuler
- Institute of Medical Microbiology, University Hospital, Münster, Germany
| | - Ludwig Sedlacek
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Annerose Serr
- Institute of Medical Microbiology and Hygiene, University of Freiburg, Freiburg, Germany
| | | | - Joerg Steinmann
- Institute of Clinical Microbiology, Infectious Diseases and Infection Control, Paracelsus Medical University, Klinikum Nürnberg, Nürnberg, Germany
| | - Dirk Wagner
- Division of Infectious Diseases, Department of Internal Medicine II, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas A. Wichelhaus
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - the EpiNTM-Group
- Institute of Microbiology and Laboratory Medicine, Department IML red GmbH, WHO - Supranational Tuberculosis Reference Laboratory, Munich-Gauting, Germany
| | - Sabine Hofmann-Thiel
- Institute of Microbiology and Laboratory Medicine, Department IML red GmbH, WHO - Supranational Tuberculosis Reference Laboratory, Munich-Gauting, Germany
- SYNLAB Gauting, SYNLAB MVZ Dachau GmbH, Munich-Gauting, Germany
| | - Harald Hoffmann
- Institute of Microbiology and Laboratory Medicine, Department IML red GmbH, WHO - Supranational Tuberculosis Reference Laboratory, Munich-Gauting, Germany
- SYNLAB Gauting, SYNLAB MVZ Dachau GmbH, Munich-Gauting, Germany
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Plank PM, Hinze CA, Sedlacek L, Welte T, Suhling H, Gottlieb J. Pleural infection caused by Mycobacterium kansasii in a patient after lung transplantation. J Clin Tuberc Other Mycobact Dis 2023; 32:100380. [PMID: 37389012 PMCID: PMC10302558 DOI: 10.1016/j.jctube.2023.100380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Affiliation(s)
- Pia Maria Plank
- Hannover Medical School, Department of Cardiology, 30625 Hannover, Germany
| | | | - Ludwig Sedlacek
- Hannover Medical School, Institute of Medical Microbiology and Hospital Epidemiology, 30625 Hannover, Germany
| | - Tobias Welte
- Hannover Medical School, Department of Respiratory Medicine, 30625 Hannover, Germany
| | - Hendrik Suhling
- Hannover Medical School, Department of Respiratory Medicine, 30625 Hannover, Germany
| | - Jens Gottlieb
- Hannover Medical School, Department of Respiratory Medicine, 30625 Hannover, Germany
- German Center for Lung Reasarch (DZL), Germany
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Rosenboom I, Oguz S, Lüdemann IM, Ringshausen FC, Rademacher J, Sedlacek L, Tümmler B, Cramer N. Pseudomonas aeruginosa population genomics among adults with bronchiectasis across Germany. ERJ Open Res 2023; 9:00156-2023. [PMID: 37377651 PMCID: PMC10291309 DOI: 10.1183/23120541.00156-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 06/29/2023] Open
Abstract
Genome sequencing of 130 Pseudomonas aeruginosa isolates from 110 bronchiectasis patients identified a few dominant clones common in the global bacterial population and numerous rare clones infrequently seen in the environment or other human infections https://bit.ly/3lIfD2X.
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Affiliation(s)
- Ilona Rosenboom
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), Hannover, Germany
| | - Sibel Oguz
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Idalina M. Lüdemann
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), Hannover, Germany
| | - Felix C. Ringshausen
- German Center for Infection Research (DZIF), Hannover, Germany
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany
- European Reference Network for Rare and Complex Lung Diseases (ERN-LUNG), Frankfurt am Main, Germany
| | - Jessica Rademacher
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany
| | - Ludwig Sedlacek
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Burkhard Tümmler
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany
| | - Nina Cramer
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), Hannover, Germany
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Schütz K, Grewendorf S, Kontsendorn J, Fuge J, Happle C, Rudolf I, Dopfer C, Sedlacek L, Hansen G, Junge S, Dittrich AM. Comparison of Three Eradication Treatment Protocols for Pseudomonas Aeruginosa in Children and Adolescents with Cystic Fibrosis. Klin Padiatr 2023; 235:75-83. [PMID: 36758577 DOI: 10.1055/a-1996-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Pseudomonas aeruginosa (Pa) continues to affect disease progression in cystic fibrosis (CF). However, the best eradication regimen remains unclear. This work compares three different antibiotic eradication regimens in pediatric CF: an administration according to a standard-operating procedure (SOP) order vs. administration outside of this order (ooSOP). METHODS This observational study includes all CF patients<18 years who received one of three Pa eradication treatments in the past eight years at our center: 1) inhaled high-dose tobramycin (Hi-TOBI), 2) inhaled colistin+oral ciprofloxacin (COL/Cip), 3) inhaled low-dose tobramycin+4 intravenous 14-day Pa active antibiotic treatments (lo-Tobra/IV). We compared eradication rates of the three treatment regimens performed according to the SOP-based order vs. ooSOP. Logistic regression analysis was performed to identify risk factors for eradication failure. RESULTS Performed according to SOP order, Hi-TOBI showed the greatest efficacy, followed by lo-Tobra/IV and finally COL/Cip, while ooSOP lo-Tobra/IV was most successful, followed by COL/Cip and Hi-TOBI. Previous Pa-infections and Pa-therapies along with age at CF diagnosis were risk factors for eradication failure. CONCLUSION Antibiotic treatment in SOP-based pre-defined order leads to significantly better eradication rates than individual modifications of the order of administration. A short course of inhalational high-dose Tobramycin is most successful at the first attempt. Prolonged antibiotic therapy seems to improve eradication after failed initial attempts.
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Affiliation(s)
- Katharina Schütz
- Dep. of Paediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany.,Excellence Cluster RESIST - Resolving Infection Susceptibility, Hannover Medical School, Hannover, Germany
| | - Simon Grewendorf
- Dep. of Paediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Julia Kontsendorn
- Dep. of Paediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany.,German Center for Lung Research, BREATH location, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- German Center for Lung Research, BREATH location, Hannover Medical School, Hannover, Germany
| | - Christine Happle
- Dep. of Paediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany.,Excellence Cluster RESIST - Resolving Infection Susceptibility, Hannover Medical School, Hannover, Germany.,German Center for Lung Research, BREATH location, Hannover Medical School, Hannover, Germany
| | - Isa Rudolf
- Dep. of Paediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany.,German Center for Lung Research, BREATH location, Hannover Medical School, Hannover, Germany
| | - Christian Dopfer
- Dep. of Paediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Ludwig Sedlacek
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Gesine Hansen
- Dep. of Paediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany.,Excellence Cluster RESIST - Resolving Infection Susceptibility, Hannover Medical School, Hannover, Germany.,German Center for Lung Research, BREATH location, Hannover Medical School, Hannover, Germany
| | - Sibylle Junge
- Dep. of Paediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Anna-Maria Dittrich
- Dep. of Paediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany.,German Center for Lung Research, BREATH location, Hannover Medical School, Hannover, Germany
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Örgel M, Aschoff HH, Sedlacek L, Graulich T, Krettek C, Roth S, Ranker A. Twenty-four months of bacterial colonialization and infection rates in patients with transcutaneous osseointegrated prosthetic systems after lower limb amputation—A prospective analysis. Front Microbiol 2022; 13:1002211. [DOI: 10.3389/fmicb.2022.1002211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTranscutaneous osseointegrated prosthesis systems (TOPS) are alternative rehabilitation methods to socket prosthetics, after limb amputation. TOPS compromise a two-step surgery: starting with the implantation of the stem which is then followed by the creation of the transcutaneous stoma through which the exoprosthesis can be connected. Immediately after surgery, this opening is permanently exposed to pathogens. This study aimed to investigate the dynamics of bacterial colonization of the stoma to analyze whether obligate bacterial colonization leads to a risk of periprosthetic infections after TOPS treatment.MethodsThis prospective study analyzed data from 66 patients (aged 26–75 years) after TOPS treatment between 2017 and 2019. Microbiological swabs from the stoma were analyzed on the first postoperative day and 3, 6, 12, and 24 months after stoma creation. Infection rates, laboratory values (CRP, leukocyte count, hemoglobin), and body temperature were recorded at these points in time. Statistical analysis was performed using SPSS 28.ResultsThe results show the formation of a stable environment dominated by Gram-positive bacteria in the stoma of TOPS patients over 24 months. Staphylococcus aureus, Staphylococcus spp., and Streptococcus spp. were the most common species found. With regard to the cohort up to the 3 months follow-up, 7.9% (five patients) developed infections surrounding the TOPS procedure. In relation to the whole cohort with loss to follow-up of 80.3% at the 24 months follow-up the infection rates increased up to 38.3%.ConclusionThe soft tissue inside and around the transcutaneous stoma is colonialized by multiple taxa and changes over time. A stable Gram-positive dominated bacterial taxa could be a protective factor for ascending periprosthetic infections and could possibly explain the relatively low infection rate in this study as well as in literature.
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9
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Örgel M, Aschoff HH, Sedlacek L, Graulich T, Krettek C, Roth S, Ranker A. Analysis of Stomal Bacterial Colonialization After Transcutaneous Osseointegrated Prosthetic Systems Surgery. JAMA Netw Open 2022; 5:e2223383. [PMID: 35867064 PMCID: PMC9308056 DOI: 10.1001/jamanetworkopen.2022.23383] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This cohort study evaluates bacterial colonization of the stoma after transcutaneous osseointegrated prosthetic systems surgery.
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Affiliation(s)
- Marcus Örgel
- Trauma Department, Hannover Medical School, Hannover, Germany
| | | | - Ludwig Sedlacek
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Tilman Graulich
- Trauma Department, Hannover Medical School, Hannover, Germany
| | | | - Sabine Roth
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Alexander Ranker
- Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany
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10
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Hauffe F, Fauzan R, Schohe AL, Scholle D, Sedlacek L, Scherer KA, Klapp C, Ramsauer B, Henrich W, Schlembach D, Abou-Dakn M, Schaefer-Graf UM. Need for less tight glucose control in early pregnancy after embryogenesis due to high risk of maternal hypoglycaemia in women with pre-existing diabetes can be compensated by good control in late pregnancy. Diabet Med 2020; 37:1490-1498. [PMID: 32583455 DOI: 10.1111/dme.14350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 05/18/2020] [Accepted: 06/18/2020] [Indexed: 11/29/2022]
Abstract
AIM Poor glucose control is associated with adverse outcomes in pregnancies with pre-existing diabetes. However, strict glucose control increases the risk of severe hypoglycaemia, particularly in the first trimester. Therefore, we aimed to investigate whether less tight glucose control in the first trimester determines adverse outcomes or can be compensated for by good control in late pregnancy. METHODS Retrospective data were collected from 517 singleton pregnancies complicated by pre-existing diabetes delivering between 2010 and 2017. Three hundred and thirty-six pregnancies fulfilled the inclusion criteria of having available HbA1c values either pre-conception or in the first trimester (65% type 1 diabetes, 35% type 2 diabetes). RESULTS Higher HbA1c values in the first trimester were associated with increasing rates of large for gestational age (LGA) neonates, preterm delivery or neonatal intensive care unit admissions. Multiple regression analysis demonstrated third trimester HbA1c , type 1 diabetes, multiparity and excess weight gain, but not first trimester HbA1c , to be independently predictive for LGA. Pre-eclampsia and third trimester HbA1c increased the risk for preterm delivery. If HbA1c was ≤ 42 mmol/mol (6.0%) in the third trimester, rates of adverse outcomes were not significantly higher even if HbA1c targets of ≤ 48 mmol/mol (6.5%) had not been met in the first trimester. Good first trimester glucose control did not modify the rates of adverse outcomes if HbA1c was > 42 mmol/mol (6.0%) in the third trimester. CONCLUSIONS Less tight glycaemic control, for example due to high frequency of severe hypoglycaemia in the first trimester, does not lead to increased adverse neonatal events if followed by tight control in the third trimester. Besides glycaemic control, excess weight gain is a modifiable predictor of adverse outcome.
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Affiliation(s)
- F Hauffe
- Berlin Center for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St. Joseph Hospital, Berlin, Germany
| | - R Fauzan
- Berlin Center for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St. Joseph Hospital, Berlin, Germany
| | - A L Schohe
- Berlin Center for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St. Joseph Hospital, Berlin, Germany
| | - D Scholle
- Berlin Center for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St. Joseph Hospital, Berlin, Germany
| | - L Sedlacek
- Berlin Center for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St. Joseph Hospital, Berlin, Germany
| | - K A Scherer
- Department of Obstetrics, Campus Rudolf-Virchow, Charité, Humboldt-University, Berlin, Germany
| | - C Klapp
- Department of Obstetrics, Campus Rudolf-Virchow, Charité, Humboldt-University, Berlin, Germany
| | - B Ramsauer
- Clinic of Obstetrics, Clinicum Vivantes Neukoelln, Berlin, Germany
| | - W Henrich
- Department of Obstetrics, Campus Rudolf-Virchow, Charité, Humboldt-University, Berlin, Germany
| | - D Schlembach
- Clinic of Obstetrics, Clinicum Vivantes Neukoelln, Berlin, Germany
| | - M Abou-Dakn
- Berlin Center for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St. Joseph Hospital, Berlin, Germany
| | - U M Schaefer-Graf
- Berlin Center for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St. Joseph Hospital, Berlin, Germany
- Department of Obstetrics, Campus Rudolf-Virchow, Charité, Humboldt-University, Berlin, Germany
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11
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Seufert R, Sedlacek L, Kahl B, Hogardt M, Hamprecht A, Haase G, Gunzer F, Haas A, Grauling-Halama S, MacKenzie CR, Essig A, Stehling F, Sutharsan S, Dittmer S, Killengray D, Schmidt D, Eskandarian N, Steinmann E, Buer J, Hagen F, Meis JF, Rath PM, Steinmann J. Prevalence and characterization of azole-resistant Aspergillus fumigatus in patients with cystic fibrosis: a prospective multicentre study in Germany. J Antimicrob Chemother 2019; 73:2047-2053. [PMID: 29684150 DOI: 10.1093/jac/dky147] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/23/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives Aspergillus fumigatus is the most prevalent filamentous fungus in the respiratory tract of patients with cystic fibrosis (CF). The aim of this prospective multicentre study was to investigate the prevalence of azole-resistant A. fumigatus (ARAF) in respiratory secretions from CF patients across Germany and to characterize ARAF isolates by phenotypic and molecular methods. Methods Twelve tertiary care centres from Germany participated in the study. In total, 2888 A. fumigatus isolates from 961 CF patients were screened for ARAF by using azole-containing agar plates. Antifungal susceptibility testing of isolates was performed by broth microdilution according to EUCAST guidelines. Analysis of mutations mediating resistance was performed using PCR and sequencing of the cyp51A gene. Furthermore, genotyping by microsatellite PCR was performed. Results Of a total of 2888 A. fumigatus isolates, 101 isolates from 51 CF patients were found to be azole resistant (prevalence per patient 5.3%). The Essen centre had the highest prevalence (9.1%) followed by Munich (7.8%), Münster (6.0%) and Hannover (5.2%). Most ARAF isolates (n = 89) carried the TR34/L98H mutation followed by eight G54E/R, one TR46/Y121F/T289A and one F219S mutation. In two isolates no mutation was found. Genotyping results showed no major clustering. Forty-five percent of CF patients with ARAF had previously received azole therapy. Conclusions This is the first multicentre study analysing the prevalence of ARAF isolates in German CF patients. Because of a resistance rate of up to 9%, susceptibility testing of A. fumigatus isolates from CF patients receiving antifungal treatment should be part of standard diagnostic work-up.
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Affiliation(s)
- R Seufert
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Nuremberg, Germany
| | - L Sedlacek
- Institute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - B Kahl
- Institute of Medical Microbiology, University Clinics Münster, Münster, Germany
| | - M Hogardt
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - A Hamprecht
- Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany
| | - G Haase
- Clinical Laboratory and Diagnostic Services (LDZ), Rheinisch-Westfälische Technische Hochschule Aachen University Hospital, Aachen, Germany
| | - F Gunzer
- Institute of Medical Microbiology and Hygiene, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - A Haas
- Max von Pettenkofer-Institute of Hygiene and Medical Microbiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - S Grauling-Halama
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - C R MacKenzie
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - A Essig
- Institute of Medical Microbiology and Hygiene, Ulm University Hospital, Ulm, Germany
| | - F Stehling
- Department of Pediatric Pulmonology and Sleep Medicine, University of Duisburg-Essen, Children's Hospital, Essen, Germany
| | - S Sutharsan
- Department of Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - S Dittmer
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - D Killengray
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - D Schmidt
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - N Eskandarian
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - E Steinmann
- Institute for Experimental Virology, TWINCORE Centre for Experimental and Clinical Infection Research [a joint venture between the Medical School Hannover (MHH) and the Helmholtz Centre for Infection Research (HZI)], Hannover, Germany
- Department of Molecular and Medical Virology, Ruhr-University Bochum, Bochum, Germany
| | - J Buer
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - F Hagen
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Department of Medical Mycology, Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
| | - J F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Centre of Expertise in Mycology, Radboud University Medical Centre/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - P-M Rath
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - J Steinmann
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Nuremberg, Germany
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12
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Selb R, Fuchs V, Graf B, Hamprecht A, Hogardt M, Sedlacek L, Schwarz R, Idelevich EA, Becker SL, Held J, Küpper-Tetzel CP, McCormick-Smith I, Heckmann D, Gerkrath J, Han CO, Wilmes D, Rickerts V. Molecular typing and in vitro resistance of Cryptococcus neoformans clinical isolates obtained in Germany between 2011 and 2017. Int J Med Microbiol 2019; 309:151336. [PMID: 31444102 DOI: 10.1016/j.ijmm.2019.151336] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/05/2019] [Accepted: 07/31/2019] [Indexed: 02/07/2023] Open
Abstract
Cryptococcosis is a fungal infection of the central nervous system predominantly caused by Cryptococcus neoformans in immunocompromised patients. In several countries worldwide, up to 50% of isolates show in vitro resistance to clinically used antifungals including fluconazole. No prospective data on susceptibility to antifungal drugs are available for Germany. In this study, we characterised all C. neoformans isolates collected from individual patients' samples at the German reference laboratory for cryptococcosis 2011 and 2017 (n = 133) by multi-locus sequence typing and phenotypic drug susceptibility testing. We identified serotype A/genotype VNI isolates belonging to clonal complexes previously described from Europe, Africa, Asia and South America as the most prevalent agents of cryptococcosis in Germany. Overall, we observed minimal inhibitory concentrations (MICs) above the epidemiological cut-offs (ECVs) in 1.6% of isolates regarding fluconazole and 2.3% of isolates regarding 5-flucytosine. Here, two C. neoformans var. grubii isolates displayed decreased drug susceptibility to fluconazole, one of them additionally to 5-flucytosine. We also found 5-flucytosine MICs above the ECV for two C. neoformans var. neoformans isolates. We identified a novel mutation in the ERG11 gene which might be associated with the elevated fluconazole MIC in one of the isolates. The clinical importance of the detected in vitro resistance is documented by patient histories showing relapsed infection or primary fatal disease. Of note, sertraline demonstrated antifungal activity comparable to previous reports. Systematic collection of susceptibility data in combination with molecular typing of C. neoformans is important to comprehensively assess the spread of isolates and to understand their drug resistance patterns.
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Affiliation(s)
- Regina Selb
- European Public Health Microbiology Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch-Institute, Berlin, Germany
| | - Vidmante Fuchs
- Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch-Institute, Berlin, Germany
| | - Barbara Graf
- Labor Berlin - Charité Vivantes GmbH, Berlin, Germany
| | - Axel Hamprecht
- Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany
| | - Michael Hogardt
- Institute of Medical Microbiology and Infection Control, Goethe University Hospital, Frankfurt/Main, Germany
| | - Ludwig Sedlacek
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Roman Schwarz
- MVZ Dr. Stein and colleagues, Moenchengladbach, Germany
| | - Evgeny A Idelevich
- Institute of Medical Microbiology, University Hospital Muenster, Muenster, Germany
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Jürgen Held
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Claus P Küpper-Tetzel
- Medical Department II, Infectious Diseases Unit, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Ilka McCormick-Smith
- Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch-Institute, Berlin, Germany
| | - Daniela Heckmann
- Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch-Institute, Berlin, Germany
| | - Jasmin Gerkrath
- Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch-Institute, Berlin, Germany
| | - Chang-Ok Han
- Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch-Institute, Berlin, Germany
| | - Dunja Wilmes
- Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch-Institute, Berlin, Germany
| | - Volker Rickerts
- Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch-Institute, Berlin, Germany.
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13
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Cramer N, Sedlacek L, Tümmler B, Welte T. Low transmission risk of Pseudomonas aeruginosa in a bronchiectasis clinic based on the knowledge of bacterial population biology. Eur Respir J 2019; 53:13993003.02191-2018. [PMID: 30635293 DOI: 10.1183/13993003.02191-2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 12/19/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Nina Cramer
- Clinic for Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Ludwig Sedlacek
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Burkhard Tümmler
- Clinic for Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany
| | - Tobias Welte
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany.,Dept for Respiratory Medicine, Hannover Medical School, Hannover, Germany
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14
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Schwarz C, Brandt C, Melichar V, Runge C, Heuer E, Sahly H, Schebek M, Köster H, Bouchara JP, Biedermann T, Meißner P, Große-Onnebrink J, Skopnik H, Hartl D, Sedlacek L, Tintelnot K. Combined antifungal therapy is superior to monotherapy in pulmonary scedosporiosis in cystic fibrosis. J Cyst Fibros 2019; 18:227-232. [DOI: 10.1016/j.jcf.2018.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 08/06/2018] [Accepted: 08/31/2018] [Indexed: 12/13/2022]
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15
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Hauffe F, Schaefer-Graf UM, Fauzan R, Schohe AL, Scholle D, Sedlacek L, Scherer KA, Klapp C, Ramsauer B, Henrich W, Schlembach D, Abou-Dakn M. Higher rates of large-for-gestational-age newborns mediated by excess maternal weight gain in pregnancies with Type 1 diabetes and use of continuous subcutaneous insulin infusion vs multiple dose insulin injection. Diabet Med 2019; 36:158-166. [PMID: 30698863 DOI: 10.1111/dme.13861] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2018] [Indexed: 12/19/2022]
Abstract
AIMS To compare glycaemic control, maternal and neonatal outcomes in pregnancies with Type 1 diabetes, managed either by continuous subcutaneous insulin infusion, multiple daily insulin injection or switch from multiple daily insulin injection (MDI) to continuous subcutaneous insulin infusion (CSII) in early pregnancy. RESEARCH DESIGN AND METHODS Data from 339 singleton pregnancies were retrospectively reviewed. HbA1c values were measured preconception and in each trimester. In a secondary analysis, use of CSII pre-pregnancy was compared with initiation of CSII during pregnancy. RESULTS MDI was used in 140 pregnancies (41.3%) and CSII was used in 199 (58.7%), including 34 pregnancies (10.0%) during which the women switched to CSII. In pregnancies during which CSII was used duration of diabetes [median (interquartile range) 16.0 (8.0-23.0) years vs 11.0 (5.5-17.5) years; P<0.001] was longer, and the Institute of Medicine recommendations for appropriate weight gain were exceeded more often (64.8% vs. 50.8%; P=0.01). CSII use and pre-pregnancy BMI were independent predictors of excess weight gain. There was no difference in glucose control, but CSII was associated with higher birth weight [median (interquartile range) 3720 (3365-4100) g vs 3360 (3365-4100) g; P<0.001] and higher large-for-gestational-age (LGA) rate (44.7% vs. 33.6%; P=0.04) than MDI. HbA1c concentration in the third trimester and excess weight gain were predictive of LGA infants [odds ratio 2.33 (95% CI 1.54-3.51); P<0.001 and 1.89 (95% CI 1.02-3.51); P=0.04]. In pregnancies where CSII therapy was initiated in the first trimester and in those with pre-pregnancy use, similar glucose control and outcome was achieved. CONCLUSIONS There was no advantage of CSII with respect to glycaemic control and neonatal outcomes. The rate of LGA neonates was higher in the CSII group, possibly mediated by excess maternal weight gain, which was more frequent than in women treated with MDI.
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Affiliation(s)
- F Hauffe
- Berlin Centre for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St Joseph Hospital, Berlin, Germany
| | - U M Schaefer-Graf
- Berlin Centre for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St Joseph Hospital, Berlin, Germany
| | - R Fauzan
- Berlin Centre for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St Joseph Hospital, Berlin, Germany
| | - A L Schohe
- Berlin Centre for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St Joseph Hospital, Berlin, Germany
| | - D Scholle
- Berlin Centre for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St Joseph Hospital, Berlin, Germany
| | - L Sedlacek
- Berlin Centre for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St Joseph Hospital, Berlin, Germany
| | - K A Scherer
- Department of Obstetrics, Campus Rudolf-Virchow, Charité Medical Faculty, Humboldt University, Berlin, Germany
| | - C Klapp
- Department of Obstetrics, Campus Rudolf-Virchow, Charité Medical Faculty, Humboldt University, Berlin, Germany
| | - B Ramsauer
- Vivantes Neukoelln Hospital, Berlin, Germany
| | - W Henrich
- Department of Obstetrics, Campus Rudolf-Virchow, Charité Medical Faculty, Humboldt University, Berlin, Germany
| | | | - M Abou-Dakn
- Berlin Centre for Diabetes and Pregnancy, Department of Obstetrics and Gynaecology, St Joseph Hospital, Berlin, Germany
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16
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Schwarz C, Vandeputte P, Rougeron A, Giraud S, Dugé de Bernonville T, Duvaux L, Gastebois A, Alastruey-Izquierdo A, Martín-Gomez MT, Mazuelos EM, Sole A, Cano J, Pemán J, Quindos G, Botterel F, Bougnoux ME, Chen S, Delhaès L, Favennec L, Ranque S, Sedlacek L, Steinmann J, Vazquez J, Williams C, Meyer W, Le Gal S, Nevez G, Fleury M, Papon N, Symoens F, Bouchara JP. Developing collaborative works for faster progress on fungal respiratory infections in cystic fibrosis. Med Mycol 2018. [PMID: 29538733 DOI: 10.1093/mmy/myx106] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cystic fibrosis (CF) is the major genetic inherited disease in Caucasian populations. The respiratory tract of CF patients displays a sticky viscous mucus, which allows for the entrapment of airborne bacteria and fungal spores and provides a suitable environment for growth of microorganisms, including numerous yeast and filamentous fungal species. As a consequence, respiratory infections are the major cause of morbidity and mortality in this clinical context. Although bacteria remain the most common agents of these infections, fungal respiratory infections have emerged as an important cause of disease. Therefore, the International Society for Human and Animal Mycology (ISHAM) has launched a working group on Fungal respiratory infections in Cystic Fibrosis (Fri-CF) in October 2006, which was subsequently approved by the European Confederation of Medical Mycology (ECMM). Meetings of this working group, comprising both clinicians and mycologists involved in the follow-up of CF patients, as well as basic scientists interested in the fungal species involved, provided the opportunity to initiate collaborative works aimed to improve our knowledge on these infections to assist clinicians in patient management. The current review highlights the outcomes of some of these collaborative works in clinical surveillance, pathogenesis and treatment, giving special emphasis to standardization of culture procedures, improvement of species identification methods including the development of nonculture-based diagnostic methods, microbiome studies and identification of new biological markers, and the description of genotyping studies aiming to differentiate transient carriage and chronic colonization of the airways. The review also reports on the breakthrough in sequencing the genomes of the main Scedosporium species as basis for a better understanding of the pathogenic mechanisms of these fungi, and discusses treatment options of infections caused by multidrug resistant microorganisms, such as Scedosporium and Lomentospora species and members of the Rasamsonia argillacea species complex.
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Affiliation(s)
- Carsten Schwarz
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center Berlin/Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Patrick Vandeputte
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France.,Laboratoire de Parasitologie-Mycologie, CHU, Angers, France
| | - Amandine Rougeron
- Université de Bordeaux, Microbiologie Fondamentale et Pathogénicité UMR 5234, Bordeaux, France; CNRS, Microbiologie Fondamentale et Pathogénicité, UMR 5234, Bordeaux, France; Laboratoire de Parasitologie-Mycologie, CHU, Bordeaux, France
| | - Sandrine Giraud
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France
| | - Thomas Dugé de Bernonville
- Biomolécules et Biotechnologies Végétales (EA 2106), Département de Biologie et Physiologie Végétales, UFR Sciences et Techniques, Université François Rabelais, Tours
| | - Ludovic Duvaux
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France.,Institut de Recherche en Horticulture et Semences (IRHS), UMR INRA 1345, Beaucouzé, France
| | - Amandine Gastebois
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Maria Teresa Martín-Gomez
- Respiratory Bacteriology Unit & Clinical Mycology Unit, Department of Microbiology, Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Amparo Sole
- Unidad de Trasplante Pulmonar y Fibrosis Quística, Hospital Universitari la Fe, Valencia, Spain
| | - Josep Cano
- Mycology Unit, Medical School/Oenology School, Universitat Rovira i Virgili, Reus, Spain
| | - Javier Pemán
- Unidad de Micología, Servicio de Microbiología, Universitari la Fe, Valencia, Spain
| | - Guillermo Quindos
- Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Enfermería, Universidad del País Vasco, Bilbao, Spain
| | - Françoise Botterel
- Laboratoire de Parasitologie-Mycologie, CHU Henri Mondor, Créteil, France
| | | | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR - Pathology West, Westmead Hospital, Westmead, New South Wales, Australia
| | - Laurence Delhaès
- Center for Cardiothoracic Research of Bordeaux, Inserm U1045, Bordeaux, France
| | - Loïc Favennec
- Laboratoire de Parasitologie-Mycologie, EA 3800, CHU Charles Nicolle and Université de Rouen, Rouen, France
| | - Stéphane Ranque
- Laboratoire de Parasitologie-Mycologie, AP-HM Timone, Marseille, France
| | - Ludwig Sedlacek
- Institute of Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Hannover, Germany
| | - Joerg Steinmann
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jose Vazquez
- Division of Infectious Diseases, Department of Medicine, Georgia Regents University, Augusta, GA, USA
| | - Craig Williams
- University of the West of Scotland, Institute of Healthcare Associated Infection, University Hospital Crosshouse, Kilmarnock, United Kingdom
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Sydney Medical School, Westmead Clinical School, Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Westmead Hospital, Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Solène Le Gal
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Brest, France.,Laboratoire de Parasitologie-Mycologie, CHU, Brest, France
| | - Gilles Nevez
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Brest, France.,Laboratoire de Parasitologie-Mycologie, CHU, Brest, France
| | - Maxime Fleury
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France
| | - Nicolas Papon
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France
| | - Françoise Symoens
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France
| | - Jean-Philippe Bouchara
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France.,Laboratoire de Parasitologie-Mycologie, CHU, Angers, France
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17
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Schwarz C, Schulte-Hubbert B, Bend J, Abele-Horn M, Baumann I, Bremer W, Brunsmann F, Dieninghoff D, Eickmeier O, Ellemunter H, Fischer R, Grosse-Onnebrink J, Hammermann J, Hebestreit H, Hogardt M, Hügel C, Hug M, Illing S, Jung A, Kahl B, Koitschev A, Mahlberg R, Mainz JG, Mattner F, Mehl A, Möller A, Muche-Borowski C, Nüßlein T, Puderbach M, Renner S, Rietschel E, Ringshausen FC, Schmidt S, Sedlacek L, Sitter H, Smaczny C, Tümmler B, Vonberg R, Wielpütz MO, Wilkens H, Wollschläger B, Zerlik J, Düesberg U, van Koningsbruggen-Rietschel S. [CF Lung Disease - a German S3 Guideline: Module 2: Diagnostics and Treatment in Chronic Infection with Pseudomonas aeruginosa]. Pneumologie 2018; 72:347-392. [PMID: 29758578 DOI: 10.1055/s-0044-100191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Cystic Fibrosis (CF) is the most common autosomal-recessive genetic disease affecting approximately 8000 people in Germany. The disease is caused by mutations in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene leading to dysfunction of CFTR, a transmembrane chloride channel. This defect causes insufficient hydration of the epithelial lining fluid which leads to chronic inflammation of the airways. Recurrent infections of the airways as well as pulmonary exacerbations aggravate chronic inflammation, lead to pulmonary fibrosis and tissue destruction up to global respiratory insufficiency, which is responsible for the mortality in over 90 % of patients. The main aim of pulmonary treatment in CF is to reduce pulmonary inflammation and chronic infection. Pseudomonas aeruginosa (Pa) is the most relevant pathogen in the course of CF lung disease. Colonization and chronic infection are leading to additional loss of pulmonary function. There are many possibilities to treat Pa-infection. This is a S3-clinical guideline which implements a definition for chronic Pa-infection and demonstrates evidence-based diagnostic methods and medical treatment for Pa-infection in order to give guidance for individual treatment options.
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Affiliation(s)
- C Schwarz
- Charité - Universitätsmedizin Berlin, Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Christiane Herzog Zentrum, Berlin
| | - B Schulte-Hubbert
- Medizinische Klinik und Poliklinik I, Pneumologie, Universitätsklinikum Dresden
| | - J Bend
- Mukoviszidose Institut, Bonn
| | - M Abele-Horn
- Universität Würzburg, Institut für Hygiene und Mikrobiologie
| | - I Baumann
- Universität Heidelberg, Hals-Nasen-Ohrenklinik, Heidelberg
| | | | - F Brunsmann
- Charité Universitätsmedizin Berlin, Deutschland (Patientenvertreter)
| | - D Dieninghoff
- Kliniken der Stadt Köln, Lungenklinik, Lehrstuhl der Universität Witten Herdecke
| | - O Eickmeier
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Christiane Herzog CF-Zentrum, Frankfurt
| | - H Ellemunter
- Tirolkliniken GmbH, Department für Kinderheilkunde Pädiatrie III, Innsbruck, Österreich
| | - R Fischer
- Zentrum für erwachsene Mukoviszidose-Patienten München-West
| | - J Grosse-Onnebrink
- Universitätsklinikum Münster UKM; Klinik für Kinder- und Jugendmedizin; Allgemeine Pädiatrie Mukoviszidose-Ambulanz, Münster
| | - J Hammermann
- Universitäts-Mukoviszidose-Zentrum "Christiane Herzog", Dresden
| | | | - M Hogardt
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Frankfurt
| | - C Hügel
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Zentrum der Inneren Medizin, Frankfurt, Deutschland
| | - M Hug
- Universitätsklinikum Freiburg, Apotheke des Klinikums Freiburg
| | - S Illing
- Olgahospital - Kinderklinik - CF-Zentrum/Jugendliche/Erwachsene Stuttgart
| | - A Jung
- Kinderspital Zürich, Abteilung Pneumologie, Zürich, Schweiz
| | - B Kahl
- Universitätsklinikum Münster UKM, Institut für Medizinische Mikrobiologie, Münster
| | - A Koitschev
- Klinikum Stuttgart - Standort Olgahospital, Klinik für Hals-Nasen-Ohrenkrankheiten, Stuttgart
| | - R Mahlberg
- Klinikum Mutterhaus der Borromäerinnen, Abteilung Innere Medizin, Trier
| | - J G Mainz
- Universitätsklinikum Jena, Mukoviszidosezentrum/Pädiatrische Pneumologie, Jena
| | - F Mattner
- Kliniken der Stadt Köln, Institut für Hygiene, Köln
| | - A Mehl
- Charité - Universitätsmedizin Berlin, Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Christiane Herzog Zentrum, Berlin
| | - A Möller
- Pneumologie und CF Ambulanz der Universitäts-Kinderklinik Zürich, Schweiz
| | - C Muche-Borowski
- Philipps-Universität Marburg, AWMF-Institut für Medizinisches Wissensmanagement, Marburg und Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Allgemeinmedizin, Hamburg
| | - T Nüßlein
- Gemeinschaftsklinikum Mittelrhein, Klinik für Kinder- und Jugendmedizin Koblenz und Mayen
| | - M Puderbach
- Hufeland Klinikum, Abteilung für Diagnostische und Interventionelle Radiologie, Bad Langensalza
| | - S Renner
- Allgemeines Universitätskrankenhaus, Klinik für Kinder- und Jugendheilkunde, CF Ambulanz, Wien, Österreich
| | - E Rietschel
- Mukoviszidose-Zentrum Köln, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universität zu Köln
| | - F C Ringshausen
- Medizinische Hochschule Hannover, Klinik für Pneumologie und Deutsches Zentrum für Lungenforschung (DZL), Hannover
| | - S Schmidt
- Ernst-Moritz-Arndt Universität Greifswald, Zentrum für Kinder- und Jugendmedizin; Mukoviszidose Zentrum Mecklenburg/Vorpommern, Greifswald
| | - L Sedlacek
- Medizinische Hochschule Hannover, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Hannover
| | - H Sitter
- Philipps-Universität Marburg, Institut für theoretische Medizin, Marburg
| | - C Smaczny
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Zentrum der Inneren Medizin, Frankfurt, Deutschland
| | - B Tümmler
- Medizinische Hochschule Hannover, Klinische Forschergruppe OE 6710, Klinik für Pädiatrische Pneumologie und Neonatologie
| | - R Vonberg
- Medizinische Hochschule Hannover, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Hannover
| | - M O Wielpütz
- Diagnostische und Interventionelle Radiologie Universitätsklinikum Heidelberg, Heidelberg
| | - H Wilkens
- Universitätsklinikum des Saarlandes, Medizinische Klinik V, Pneumologie, Allergologie und Beatmungsmedizin, Homburg
| | - B Wollschläger
- Martin-Luther-Universität Halle, Universitätsklinik und Poliklinik für Innere Medizin I/Pneumologie, Halle
| | - J Zerlik
- Altonaer Kinderkrankenhaus gGmbH, Abteilung Physiotherapie, Hamburg
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Raab P, Sedlacek L, Buchholz S, Stolle S, Lanfermann H. Imaging Patterns of Rhino-Orbital-Cerebral Mucormycosis in Immunocompromised Patients : When to Suspect Complicated Mucormycosis. Clin Neuroradiol 2017; 27:469-475. [PMID: 29026931 DOI: 10.1007/s00062-017-0629-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to describe radiological imaging findings of a complicated sinusitis, which should raise the suspicion of rhino-orbital-cerebral mucormycosis as being the underlying cause. METHODS In this retrospective analysis, we describe the cases and imaging findings of 8 patients with proven mucormycosis. These patients presented mostly with new facial or orbital swelling and were referred for imaging to our institution. Magnetic resonance imaging and computed tomography images were classified as abnormal or normal with respect to orbital, paranasal and cerebral signal results. Special emphasis was placed on the distribution of the signal abnormalities regarding involvement of the skull base and the cavernous sinus. RESULTS Out of a pool of 43 patients with colonization or proven Mucorales infection at different sites of the body, we identified 8 patients with infiltration of the midface and skull base. Unexpectedly seven out of the eight patients with abnormal findings of the paranasal sinuses and the adjacent tissues showed no bony sinus wall destruction. Of the eight patients seven showed inflammatory changes involving the infratemporal fossa and facial/periorbital tissues, three of the eight patients suffered from fungal invasion of the cavernous sinus and the carotid artery and one of the eight patients had a local infection of the hard palate only. CONCLUSION Imaging findings of inflammatory tissue infiltration adjacent to the paranasal sinuses with possible extension into the pterygopalatine fossa, infratemporal fossa and orbit or the cavernous sinus should raise the suspicion of a mucormycosis, especially in immunocompromised patients.
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Affiliation(s)
- Peter Raab
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Ludwig Sedlacek
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stefanie Buchholz
- Praxis Dr. Buchholz, Goslarsche Str. 14, 38304, Wolfenbüttel, Germany
| | - Stefan Stolle
- Department of ENT, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - H Lanfermann
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Müsken M, Klimmek K, Sauer-Heilborn A, Donnert M, Sedlacek L, Suerbaum S, Häussler S. Towards individualized diagnostics of biofilm-associated infections: a case study. NPJ Biofilms Microbiomes 2017; 3:22. [PMID: 28970943 PMCID: PMC5620081 DOI: 10.1038/s41522-017-0030-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 12/21/2022] Open
Abstract
Organized within biofilm communities, bacteria exhibit resistance towards a broad spectrum of antibiotics. Thus, one might argue that bacteria isolated from biofilm-associated chronic infections should be subjected to resistance profiling under biofilm growth conditions. Various test systems have been developed to determine the biofilm-associated resistance; however, it is not clear to what extent the in vitro results reflect the situation in vivo, and whether the biofilm-resistance profile should guide clinicians in their treatment choice. To address this issue, we used confocal microscopy in combination with live/dead staining, and profiled biofilm-associated resistance of a large number (>130) of clinical Pseudomonas aeruginosa isolates from overall 15 cystic fibrosis patients. Our results demonstrate that in addition to a general non-responsiveness of bacteria when grown under biofilm conditions, there is an isolate-specific and antibiotic-specific biofilm-resistance profile. This individual resistance profile is independent on the structural properties of the biofilms. Furthermore, biofilm resistance is not linked to the resistance profile under planktonic growth conditions, or a mucoid, or small colony morphology of the tested isolates. Instead, it seems that individual biofilm structures evolve during biofilm-associated growth and are shaped by environment-specific cues. In conclusion, our results demonstrate that biofilm resistance profiles are isolate specific and cannot be deduced from commonly studied phenotypes. Further clinical studies will have to show the added value of biofilm-resistance profiling. Individualized diagnosis of biofilm resistance might lead to more rational recommendations for antimicrobial therapy and, thus, increased effectiveness of the treatment of chronically infected patients.
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Affiliation(s)
- Mathias Müsken
- Institute for Molecular Bacteriology, TWINCORE, Centre for Experimental and Clinical Infection Research, Hannover, Germany.,Department of Molecular Bacteriology, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Present Address: Central Facility for Microscopy, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Kathi Klimmek
- Institute for Molecular Bacteriology, TWINCORE, Centre for Experimental and Clinical Infection Research, Hannover, Germany.,Department of Molecular Bacteriology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | | | - Monique Donnert
- Institute for Molecular Bacteriology, TWINCORE, Centre for Experimental and Clinical Infection Research, Hannover, Germany.,Department of Molecular Bacteriology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Ludwig Sedlacek
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Sebastian Suerbaum
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany.,Max von Pettenkofer Institute, Medical Microbiology and Hospital Epidemiology, München, Germany
| | - Susanne Häussler
- Institute for Molecular Bacteriology, TWINCORE, Centre for Experimental and Clinical Infection Research, Hannover, Germany.,Department of Molecular Bacteriology, Helmholtz Centre for Infection Research, Braunschweig, Germany
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20
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Schwenkenbecher P, Pul R, Wurster U, Conzen J, Pars K, Hartmann H, Sühs KW, Sedlacek L, Stangel M, Trebst C, Skripuletz T. Common and uncommon neurological manifestations of neuroborreliosis leading to hospitalization. BMC Infect Dis 2017; 17:90. [PMID: 28109263 PMCID: PMC5251276 DOI: 10.1186/s12879-016-2112-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 12/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neuroborreliosis represents a relevant infectious disease and can cause a variety of neurological manifestations. Different stages and syndromes are described and atypical symptoms can result in diagnostic delay or misdiagnosis. The aim of this retrospective study was to define the pivotal neurological deficits in patients with neuroborreliosis that were the reason for admission in a hospital. METHODS We retrospectively evaluated data of patients with neuroborreliosis. Only patients who fulfilled the diagnostic criteria of an intrathecal antibody production against Borrelia burgdorferi were included in the study. RESULTS Sixty-eight patients were identified with neuroborreliosis. Cranial nerve palsy was the most frequent deficit (50%) which caused admission to a hospital followed by painful radiculitis (25%), encephalitis (12%), myelitis (7%), and meningitis/headache (6%). In patients with a combination of deficits, back pain was the first symptom, followed by headache, and finally by cranial nerve palsy. Indeed, signs of meningitis were often found in patients with neuroborreliosis, but usually did not cause admission to a hospital. Unusual cases included patients with sudden onset paresis that were initially misdiagnosed as stroke and one patient with acute delirium. Cerebrospinal fluid (CSF) analysis revealed typical changes including elevated CSF cell count in all but one patient, a blood-CSF barrier dysfunction (87%), CSF oligoclonal bands (90%), and quantitative intrathecal synthesis of immunoglobulins (IgM in 74%, IgG in 47%, and IgA in 32% patients). Importantly, 6% of patients did not show Borrelia specific antibodies in the blood. CONCLUSION In conclusion, the majority of patients presented with typical neurological deficits. However, unusual cases such as acute delirium indicate that neuroborreliosis has to be considered in a wide spectrum of neurological diseases. CSF analysis is essential for a reliable diagnosis of neuroborreliosis.
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Affiliation(s)
- Philipp Schwenkenbecher
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Refik Pul
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Ulrich Wurster
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Josef Conzen
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Kaweh Pars
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hans Hartmann
- Department of Paediatrics, Hannover Medical School, Hannover, Germany
| | - Kurt-Wolfram Sühs
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Ludwig Sedlacek
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Martin Stangel
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Corinna Trebst
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thomas Skripuletz
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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21
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Bajor A, Luhr A, Brockmann D, Suerbaum S, Framme C, Sedlacek L. Listeria monocytogenes endophthalmitis - case report and review of risk factors and treatment outcomes. BMC Infect Dis 2016; 16:332. [PMID: 27424034 PMCID: PMC4947317 DOI: 10.1186/s12879-016-1680-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 06/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background The majority of cases of endophthalmitis are caused by exogenous pathogens; only 5–10 % are of endogenous origin. One cause of these rare cases of endogenous endophthalmitis is Listeria monocytogenes. Twenty-six cases of endophthalmitis due to this pathogen have been published over the last twenty years. The aim of this review is to summarize the main risk factors and common clinical findings of endogenous endophthalmitis due to Listeria monocytogenes. Case presentation We report on a 62-year-old female presenting with a sterile hypopyon iritis with secondary glaucoma and an underlying rheumatoid disease. In microbiological analysis we identified Listeria monocytogenes. Further we searched through all published cases for typical signs, risk factors, details of medical and surgical treatment and outcome of endogenous endophthalmitis due to this rare pathogen. Ocular symptoms in almost all of these published cases included pain, redness of the eye, and decreased vision. Main clinical features included elevated intraocular pressure and fibrinous anterior chamber reaction, as well as a dark hypopyon. While the infection is typically spread endogenously, neither an exogenous nor endogenous source of infection could be identified in most cases. Immunocompromised patients are at higher risk of being infected than immunocompetent patients. The clinical course of endophthalmitis caused by Listeria monocytogenes had different visual outcomes. In some cases, the infection led to enucleation, blindness, or strong visual loss, whereas most patients showed a tendency of visual improvement during therapy. Conclusion Early diagnosis and treatment initiation are crucial factors in the outcome of endogenous endophthalmitis caused by Listeria monocytogenes. This possible differential diagnosis should be kept in mind while treating patients with presumable sterile hypopyon and anterior uveitis having a high intraocular pressure. A bacterial source should be considered with a prompt initiation of systemic antibiotic treatment, mainly in immunocompromised patients, who develop endogenous anterior uveitis. An appropriate microbiological sampling is essential to detect atypical microorganisms and to choose an effective antibiotic treatment.
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Affiliation(s)
- Anna Bajor
- University Eye Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany.
| | - Anke Luhr
- University Eye Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany
| | - Dorothee Brockmann
- University Eye Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany
| | - Sebastian Suerbaum
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Carsten Framme
- University Eye Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany
| | - Ludwig Sedlacek
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
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22
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Hussein K, Peter C, Sedlacek L, Kaisenberg CV, Kreipe HH. [Necrotizing funisitis : Histopathological indicator of occult congenital syphilis]. Pathologe 2016; 38:312-316. [PMID: 27411696 DOI: 10.1007/s00292-016-0177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Congenital syphilis is a rare disease in central Europe. Placental changes may be non-specific but a typical finding is necrotizing funisitis of the umbilical cord. In a case report we describe how the histopathological incidental finding of B lymphocyte-rich, necrotizing funisitis led to the diagnosis of a previously unknown Treponema pallidum infection in parents and their newborn child. The pathological suspicion of congenital syphilis, although rare, has implications for the clinical management (serological evaluation of parents and child as well as the social environment, evaluation of viral coinfection and treatment decision) and is a notifiable disease.
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Affiliation(s)
- K Hussein
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - C Peter
- Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - L Sedlacek
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - C von Kaisenberg
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - H H Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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23
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Ziesing S, Suerbaum S, Sedlacek L. Fungal epidemiology and diversity in cystic fibrosis patients over a 5-year period in a national reference center. Med Mycol 2016; 54:781-6. [PMID: 27364649 DOI: 10.1093/mmy/myw035] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 12/20/2022] Open
Abstract
The knowledge on prevalence rates of yeasts and moulds in patients with cystic fibrosis (CF) in Germany is scarce. The aim of this report is to give an overview of the diversity and epidemiology of fungal species in CF patients. Over a 5-year period, all fungal isolates cultured from microbiological specimen from CF patients were recorded. Beside standard bacteriological culture media two fungal media were used for cultivation. Species were identified by microscopy, biochemical profiling, MALDI-TOF analysis or DNA sequencing methods. In sum, 25,975 clinical samples from CF patients were analyzed. About 75% of CF patients were colonized by yeasts, mainly Candida albicans (38%) and Candida dubliniensis (12%). In 35% of the patients Aspergillus spp. (Aspergillus fumigatus: 29%) were detected, followed by Exophiala dermatitidis and Scedosporium/Lomentospora complex isolates (4% each). Data for other fungal species are shown. Over a 5-year period, the epidemiology of fungal species detected in CF patients was relatively constant. Clinical microbiology laboratories should carefully monitor samples from CF patients for newly occurring fungal pathogens.
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Affiliation(s)
- S Ziesing
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| | - S Suerbaum
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| | - L Sedlacek
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
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24
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Petersson LP, Albrecht UV, Sedlacek L, Gemein S, Gebel J, Vonberg RP. Portable UV light as an alternative for decontamination. Am J Infect Control 2014; 42:1334-6. [PMID: 25465267 DOI: 10.1016/j.ajic.2014.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/14/2014] [Accepted: 08/14/2014] [Indexed: 10/24/2022]
Abstract
We evaluated the capability of a commercially available hand-held device that emits ultraviolet (UV) light to disinfect plain surfaces. Eight bacterial species were tested, including Clostridium difficile ribotype 027 and 3 other spore-forming species. Even bacterial spores could be successfully inactivated within a few seconds of irradiation. UV light may provide an alternative for the decontamination of medical products, such as mobile phones or tablet computers, that cannot be treated otherwise.
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Konnerth S, Rademacher G, Suerbaum S, Ziesing S, Sedlacek L, Vonberg RP. Identification of pathogens from blood culture bottles in spiked and clinical samples using matrix-assisted laser desorption ionization time-of-flight mass-spectrometry analysis. BMC Res Notes 2014; 7:405. [PMID: 24972877 PMCID: PMC4091744 DOI: 10.1186/1756-0500-7-405] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/23/2014] [Indexed: 12/21/2022] Open
Abstract
Background Blood stream infections significantly contribute to mortality. An early most appropriate antimicrobial therapy is crucial for a favourable outcome of the patient. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) may speed up the diagnostic of causative micro organisms. Findings MALDI-TOF MS using the SARAMIS database was applied to 37 spiked blood culture samples. Identification rates of spiked samples were as follows: The species level was determined in 16 of 21 (76.2%) Gram negative bacteria and in 11 of 13 (84.6%) Gram positive bacteria. Genus level only was determined in additional 2 Gram negative and for the 2 Gram positive strains. Yeast species could not be identified. MALDI-TOF MS was also compared to cultured-based results in standard routine diagnostic. Identification rates of patient samples were as follows: The species level was determined in 41 of 47 (87.2%) Gram negative bacteria and in 63 of 123 (51.2%) Gram positive bacteria. Genus level only was determined in additional 2 Gram negative bacteria. Once again no yeasts were identified. A prolonged incubation of BC bottles for 16 hours after primary positive alert did not influence the concentration of bacteria and identification rates. Conclusions The SARAMIS database used in our experiments mainly confirms previous findings that were obtained with the MALDI-TOF MS BRUKER system by others.
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Affiliation(s)
| | | | | | | | | | - Ralf-Peter Vonberg
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Str, 1, D-30625 Hannover, Germany.
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26
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Steinmann J, Giraud S, Schmidt D, Sedlacek L, Hamprecht A, Houbraken J, Meis JF, Bouchara JP, Buer J, Rath PM. Validation of a novel real-time PCR for detecting Rasamsonia argillacea species complex in respiratory secretions from cystic fibrosis patients. New Microbes New Infect 2014; 2:72-8. [PMID: 25356347 PMCID: PMC4184661 DOI: 10.1002/nmi2.44] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/14/2014] [Accepted: 03/21/2014] [Indexed: 12/18/2022] Open
Abstract
Members of the recently introduced fungal genus Rasamsonia (formerly included in
the Geosmithia genus) have been described as emerging pathogens in immunosuppressed
hosts or patients with cystic fibrosis (CF). Rasamsonia species have often been
misidentified as Penicillium or Paecilomyces because of similar
morphological characteristics. We validated a commercially available real-time PCR assay
(Primerdesign™, UK) for accurate detection of species from the Rasamsonia
argillacea complex. First, we tested this assay with a collection of 74 reference strains
and clinical isolates and then compared the PCR with cultures of 234 respiratory samples from 152
patients with CF from two University Hospitals in Germany and France. The assay reliably detected
the three main species within the Rasamsonia argillacea species complex
(R. argillacea, R. piperina,
R. aegroticola), which are typically encountered in CF patients. The limit
of DNA detection was between 0.01 and 1 pg/μL. Analysis of the DNA extracts from
respiratory specimens of CF patients revealed that four out of the 153 patients studied
(2.6%) were colonized with R. argillacea species complex. Two species
from the R. argillacea complex grew in the parallel cultures from the same
patients. In one patient the PCR was positive 5 months before culture. The real-time PCR
assay is a sensitive and specific method for detecting the three most important species of the
R. argillacea species complex encountered in the CF
context. Detection of these emerging pathogens in respiratory secretions from CF patients by this
novel assay may increase our understanding of the occurrence and epidemiology of the R.
argillacea species complex.
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Affiliation(s)
- J Steinmann
- Institute of Medical Microbiology, University Hospital
Essen, University of Duisburg-EssenEssen, Germany
- Corresponding author: J. Steinmann, Institute of Medical
Microbiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122
Essen, Germany E-mail:
| | - S Giraud
- L'UNAM Université, Université
d′Angers, Groupe d′Etude des Interactions Hôte-PathogèneAngers, France
| | - D Schmidt
- Institute of Medical Microbiology, University Hospital
Essen, University of Duisburg-EssenEssen, Germany
| | - L Sedlacek
- Institute of Medical Microbiology and Hospital
Epidemiology, Hannover Medical SchoolHannover, Germany
| | - A Hamprecht
- Institute for Medical Microbiology, Immunology and
Hygiene, University Hospital of CologneCologne, Germany
| | - J Houbraken
- CBS-KNAW Fungal Biodiversity CentreUtrecht, The Netherlands
| | - J F Meis
- Department of Medical Microbiology and Infectious
Diseases, Canisius Wilhelmina HospitalNijmegen, The Netherlands
- Department of Medical Microbiology, Radboud University
Medical CentreNijmegen, The Netherlands
| | - J P Bouchara
- L'UNAM Université, Université
d′Angers, Groupe d′Etude des Interactions Hôte-PathogèneAngers, France
- Laboratory of Parasitology and Mycology, Angers
University HospitalAngers, France
| | - J Buer
- Institute of Medical Microbiology, University Hospital
Essen, University of Duisburg-EssenEssen, Germany
| | - P-M Rath
- Institute of Medical Microbiology, University Hospital
Essen, University of Duisburg-EssenEssen, Germany
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Stevie FA, Sedlacek L, Babor P, Jiruse J, Principe E, Klosova K. FIB-SIMS quantification using TOF-SIMS with Ar and Xe plasma sources. SURF INTERFACE ANAL 2014. [DOI: 10.1002/sia.5483] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- F. A. Stevie
- Analytical Instrumentation Facility; North Carolina State University; 2410 Campus Shore Drive Raleigh NC 27695 USA
| | - L. Sedlacek
- TESCAN; Libusina trida 623 00 Brno Czech Republic
| | - P. Babor
- Central European Institute of Technology; Technicka 3058/10 CZ-616 00 Brno Czech Republic
| | - J. Jiruse
- TESCAN; Libusina trida 623 00 Brno Czech Republic
| | | | - K. Klosova
- TESCAN; Libusina trida 623 00 Brno Czech Republic
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28
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Sedlacek L, Ramsauer B, Brazier J, Buys N, Marretta L. AML in der Schwangerschaft: Fallvorstellung. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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29
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Albrecht UV, von Jan U, Sedlacek L, Groos S, Suerbaum S, Vonberg RP. Standardized, App-based disinfection of iPads in a clinical and nonclinical setting: comparative analysis. J Med Internet Res 2013; 15:e176. [PMID: 23945468 PMCID: PMC3758047 DOI: 10.2196/jmir.2643] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 05/26/2013] [Accepted: 06/13/2013] [Indexed: 01/08/2023] Open
Abstract
Background With the use of highly mobile tools like tablet PCs in clinical settings, an effective disinfection method is a necessity. Since manufacturers do not allow cleaning methods that make use of anything but a dry fleece, other approaches have to be established to ensure patient safety and to minimize risks posed by microbiological contamination. Objective The ability of isopropanol wipes to decontaminate iPads was evaluated prospectively in a observer blinded, comparative analysis of devices used in a clinical and a nonclinical setting. Methods 10 new iPads were randomly deployed to members of the nursing staff of 10 clinical wards, to be used in a clinical setting over a period of 4 weeks. A pre-installed interactive disinfection application (deBac-app, PLRI MedAppLab, Germany) was used on a daily basis. Thereafter, the number and species of remaining microorganisms on the surface of the devices (13 locations; front and back) was evaluated using contact agar plates. Following this, the 10 iPads were disinfected and randomly deployed to medical informatics professionals who also used the devices for 4 weeks but were forbidden to use disinfecting agents. The quality of a single, standardized disinfection process was then determined by a final surface disinfection process of all devices in the infection control laboratory. No personal data were logged with the devices. The evaluation was performed observer blinded with respect to the clinical setting they were deployed in and personnel that used the devices. Results We discovered a 2.7-fold (Mann-Whitney U test, z=-3.402, P=.000670) lower bacterial load on the devices used in the clinical environment that underwent a standardized daily disinfection routine with isopropanol wipes following the instructions provided by “deBac-app”. Under controlled conditions, an average reduction of the mainly Gram-positive normal skin microbiological load of 99.4% (Mann-Whitney U test, z=-3.1798, P=.001474) for the nonclinical group and 98.1% (Mann-Whitney U test, z=3.1808, P=.001469) for the clinical group was achieved using one complete disinfecting cycle. Conclusions Normal use of tablet PCs leads to a remarkable amount of microbial surface contamination. Standardized surface disinfection with isopropanol wipes as guided by the application significantly reduces this microbial load. When performed regularly, the disinfection process helps with maintaining a low germ count during use. This should reduce the risk of subsequent nosocomial pathogen transmission. Unfortunately, applying a disinfection procedure such as the one we propose may lead to losing the manufacturer’s warranty for the devices; this remains an unsolved issue.
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Affiliation(s)
- Urs-Vito Albrecht
- PL Reichertz Institute for Medical Informatics, Hannover Medical School, Hannover, Germany.
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30
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Hartmann C, Müller C, Weißbrodt H, Suerbaum S, Tintelnot K, Stolle S, Hansen G, Sedlacek L. Successful prevention of scedosporiosis after lung transplantation in a cystic fibrosis patient by combined local and systemic triazole therapy. Med Mycol Case Rep 2013; 2:116-8. [PMID: 24432232 PMCID: PMC3885964 DOI: 10.1016/j.mmcr.2013.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 05/03/2013] [Accepted: 05/03/2013] [Indexed: 12/04/2022] Open
Abstract
A persistent colonization with Scedosporium apiospermum (S. apiospermum) often results in disseminated infection with a high mortality rate in immunosuppressed patients. We present the first case of successful prevention of scedosporiosis in an adolescent female cystic fibrosis patient post double lung transplant, with a combination of local and systemic voriconazole therapy and surgical intervention.
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Affiliation(s)
- Carolin Hartmann
- Department of Pediatrics and Adolescent Medicine, Pediatric Pulmonolgy, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Carsten Müller
- Department of Pediatrics and Adolescent Medicine, Pediatric Pulmonolgy, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Hartmut Weißbrodt
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Sebastian Suerbaum
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Kathrin Tintelnot
- National Reference Laboratory for Pseudallescheria boydii/Scedosporium spp., Robert Koch-Institut, Berlin, Germany
| | - Stefan Stolle
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Gesine Hansen
- Department of Pediatrics and Adolescent Medicine, Pediatric Pulmonolgy, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Ludwig Sedlacek
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
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31
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Schemuth H, Dittmer S, Lackner M, Sedlacek L, Hamprecht A, Steinmann E, Buer J, Rath PM, Steinmann J. In vitroactivity of colistin as single agent and in combination with antifungals against filamentous fungi occurring in patients with cystic fibrosis. Mycoses 2012; 56:297-303. [DOI: 10.1111/myc.12022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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32
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Hartmann C, Peter C, Hermann E, Ure B, Sedlacek L, Hansen G, Bohnhorst B. Successful treatment of vancomycin-resistant Enterococcus faecium ventriculitis with combined intravenous and intraventricular chloramphenicol in a newborn. J Med Microbiol 2010; 59:1371-1374. [DOI: 10.1099/jmm.0.022921-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Vancomycin-resistant Enterococcus faecium (VRE) infection is a rare event in paediatric patients and often occurs under immunosuppression or after surgical intervention. We report what we believe to be the first paediatric case of ventriculitis due to VRE (in a 2-month-old infant) to be successfully treated with combined intravenous (i.v.) and intraventricular chloramphenicol after failure of i.v. linezolid and intraventricular gentamicin.
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Affiliation(s)
- Carolin Hartmann
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Corinna Peter
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Elvis Hermann
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Benno Ure
- Department of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Ludwig Sedlacek
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Gesine Hansen
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Bettina Bohnhorst
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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33
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Vonberg RP, Sedlacek L, Chaberny IF, Suerbaum S, Gastmeier P, Linde HJ. [Multiple abscesses in immunocompetent patients caused by Panton-Valentine leukocidin positive Staphylococcus aureus]. Hautarzt 2008; 59:319-22. [PMID: 17646948 DOI: 10.1007/s00105-007-1374-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We report cases of immunocompetent patients showing multiple abscesses by a Panton-Valentine leukocidin (PVL) positive Staphylococcus aureus. PVL is considered to be an important virulence factor. The most common manifestations by this pathogen are recurrent or multiple abscesses of the skin. Seldom necrotizing pneumonia with high mortality occurs. Even methicillin-resistant PVL positive isolates have been identified in Germany. Only appropriate infection control measures in combination with antimicrobial therapy resulted in successful eradication of this pathogen. Dermatologists should be informed about this specific type of infection and about the appropriate infection control measures.
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Affiliation(s)
- R-P Vonberg
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover.
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Abstract
In this study we introduce a rapid procedure to identify Mycobacterium abscessus (types I and II) and M. chelonae using LightCycler-based analysis of the hsp65 gene. Results from 36 clinical strains were compared with hsp65 gene restriction analysis and biochemical profiles of bacilli. As all three methods yielded identical results for each isolate, this procedure offers an excellent alternative to previously established nucleic acid amplification-based techniques for the diagnosis of mycobacterial diseases.
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Affiliation(s)
- L Sedlacek
- Department of Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
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35
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Abstract
In silico genome sequence analyses suggested that mycobacteria are devoid of the highly conserved mutLS-based post-replicative mismatch repair system. Here, we present the first biological evidence for the lack of a classical mismatch repair function in mycobacteria. We found that frameshifts, but not general mutation rates are unusually high in Mycobacterium smegmatis. However, despite the absence of mismatch correction, M. smegmatis establishes a strong barrier to recombination between homeologous DNA sequences. We show that 10-12% of DNA sequence heterology restricts initiation of recombination but not extension of heteroduplex DNA intermediates. Together, the lack of mismatch correction and a high stringency of initiation of homologous recombination provide an adequate strategy for mycobacterial genome evolution, which occurs by gene duplication and divergent evolution.
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Affiliation(s)
- Burkhard Springer
- Institut für Medizinische Mikrobiologie, Universität Zürich, Gloriastrasse 30/32, CH-3028 Zürich, Switzerland
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36
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Stermann M, Sedlacek L, Maass S, Bange FC. A promoter mutation causes differential nitrate reductase activity of Mycobacterium tuberculosis and Mycobacterium bovis. J Bacteriol 2004; 186:2856-61. [PMID: 15090527 PMCID: PMC387782 DOI: 10.1128/jb.186.9.2856-2861.2004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The recent publication of the genome sequence of Mycobacterium bovis showed >99.95% identity to M. tuberculosis. No genes unique to M. bovis were found. Instead numerous single-nucleotide polymorphisms (SNPs) were identified. This has led to the hypothesis that differential gene expression due to SNPs might explain the differences between the human and bovine tubercle bacilli. One phenotypic distinction between M. tuberculosis and M. bovis is nitrate reduction, which not only is an essential diagnostic tool but also contributes to mycobacterial pathogenesis. We previously showed that narGHJI encodes a nitrate reductase in both M. tuberculosis and M. bovis and that NarGHJI-mediated nitrate reductase activity was substantially higher in the human tubercle bacillus. In the present study we used a genetic approach to demonstrate that an SNP within the promoter of the nitrate reductase gene cluster narGHJI is responsible for the different nitrate reductase activity of M. tuberculosis and M. bovis. This is the first example of an SNP that leads to differential gene expression between the human and bovine tubercle bacilli.
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Affiliation(s)
- Marion Stermann
- Department of Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625 Hanover, Germany
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Meyer A, Sedlacek L, Bange FC. Rapid testing for nitrate reductase activity of Mycobacterium tuberculosis grown in an automated culture system. Eur J Clin Microbiol Infect Dis 2003; 22:444-6. [PMID: 12827528 DOI: 10.1007/s10096-003-0932-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In order to reduce the time to detection of nitrate reductase activity, which is arguably the most widely used phenotypic trait to differentiate between Mycobacterium tuberculosis, Mycobacterium bovis and Mycobacterium bovis BCG, the following study was conducted using cultures grown in an automated system. Automated culture systems, which are typically based on liquid medium, have greatly reduced the time-to-recovery of mycobacteria. Yet subsequent testing of isolates for nitrate reductase activity may take several weeks, because culture on solid media is required. Presented here is a procedure to obtain a final result within 24 h for nitrate reductase activity of cultures grown in an automated culture system. Using this procedure, Mycobacterium tuberculosis was rapidly differentiated from Mycobacterium bovis and Mycobacterium bovis BCG.
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Affiliation(s)
- A Meyer
- Department of Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
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38
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Springer B, Sander P, Sedlacek L, Ellrott K, Böttger EC. Instability and site-specific excision of integration-proficient mycobacteriophage L5 plasmids: development of stably maintained integrative vectors. Int J Med Microbiol 2001; 290:669-75. [PMID: 11310445 DOI: 10.1016/s1438-4221(01)80004-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Integrative vectors expressing foreign genes are used as tools for the development of recombinant vaccines in mycobacteria since it is assumed that these vectors are stably maintained even without antibiotic selection. We here demonstrate that integration-proficient vectors are lost from the mycobacterial genome in high frequency. Loss of integrated vectors occurred in recA+ and in recA-strains, indicating a RecA-independent mechanism. Loss of the integrated vector was prevented when integrase gene function was carried on a separate plasmid that is unable to replicate in mycobacteria, indicating that excision is a function of integrase. By providing attP in cis and integrase function in trans, vectors integrating at the attB site are stably maintained, even when carrying genes that deleteriously affect the host.
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Affiliation(s)
- B Springer
- Institut für Medizinische Mikrobiologie, Medizinische Hochschule Hannover, Germany.
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39
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Sedlacek L. Podiatry and psychiatry. J Am Podiatry Assoc 1969; 59:265-8. [PMID: 4184207 DOI: 10.7547/87507315-59-7-265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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