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Blay JY, Penel N, Valentin T, Anract P, Duffaud F, Dufresne A, Verret B, Cordoba A, Italiano A, Brahmi M, Henon C, Amouyel T, Ray-Coquard I, Ferron G, Boudou-Rouquette P, Tlemsani C, Salas S, Rochwerger R, Faron M, Bompas E, Ducassou A, Gangloff D, Gouin F, Firmin N, Piperno-Neumann S, Rios M, Ropars M, Kurtz JE, Le Nail LR, Bertucci F, Carrere S, Llacer C, Watson S, Bonvalot S, Leroux A, Perrin C, Gantzer J, Pracht M, Narciso B, Monneur A, Lebbe C, Hervieu A, Saada-Bouzid E, Dubray-Longeras P, Fiorenza F, Chaigneau L, Nevieres ZM, Soibinet P, Bouché O, Guillemet C, Spano JP, Ruzic JC, Isambert N, Vaz G, Meeus P, Karanian M, Ngo C, Coindre JM, De Pinieux G, Le Loarer F, Ducimetiere F, Chemin C, Morelle M, Toulmonde M, Le Cesne A. Improved nationwide survival of sarcoma patients with a network of reference centers. Ann Oncol 2024; 35:351-363. [PMID: 38246351 DOI: 10.1016/j.annonc.2024.01.001] [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: 11/01/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND We investigated the impact of the implementation of a network of reference centers for sarcomas (NETSARC) on the care and survival of sarcoma patients in France since 2010. PATIENTS AND METHODS NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTBs), funded by the French National Cancer Institute (INCa) since 2010. Its aims are to improve the quality of diagnosis and care of sarcoma patients. Patients' characteristics, treatments, and outcomes are collected in a nationwide database. The objective of this analysis was to compare the survival of patients in three periods: 2010-2012 (non-exhaustive), 2013-2015, and 2016-2020. RESULTS A total of 43 975 patients with sarcomas, gastrointestinal stromal tumors (GISTs), or connective tissue tumors of intermediate malignancy were included in the NETSARC+ database since 2010 (n = 9266 before 2013, n = 12 274 between 2013 and 2015, n = 22 435 in 2016-2020). Median age was 56 years, 50.5% were women, and 13.2% had metastasis at diagnosis. Overall survival was significantly superior in the period 2016-2020 versus 2013-2015 versus 2010-2012 for the entire population, for patients >18 years of age, and for both metastatic and non-metastatic patients in univariate and multivariate analyses (P < 0.0001). Over the three periods, we observed a significantly improved compliance to clinical practice guidelines (CPGs) nationwide: the proportion of patients biopsied before surgery increased from 62.9% to 72.6%; the percentage of patients presented to NETSARC MDTBs before first surgery increased from 31.7% to 44.4% (P < 0.0001). The proportion of patients with R0 resection on first surgery increased (from 36.1% to 46.6%), while R2 resection rate decreased (from 10.9% to 7.9%), with a better compliance and improvement in NETSARC centers. CONCLUSIONS The implementation of the national reference network for sarcoma was associated with an improvement of overall survival and compliance to guidelines nationwide in sarcoma patients. Referral to expert networks for sarcoma patients should be encouraged, though a better compliance to CPGs can still be achieved.
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Affiliation(s)
- J Y Blay
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon.
| | - N Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - T Valentin
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - P Anract
- Department of Orthopedics, Hôpital Cochin Saint Vincent de Paul, Paris
| | - F Duffaud
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - A Dufresne
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - B Verret
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - A Cordoba
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - A Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - M Brahmi
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Henon
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - T Amouyel
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - I Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - G Ferron
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | | | - C Tlemsani
- Department of Orthopedics, Hôpital Cochin Saint Vincent de Paul, Paris
| | - S Salas
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - R Rochwerger
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - M Faron
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - E Bompas
- Department of Medical Oncology, Cochin Hospital, Paris; Department of Medical Oncology, Centre René Gauducheau, Nantes St. Herblain
| | - A Ducassou
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - D Gangloff
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - F Gouin
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Service Orthopedie, CHU Nantes, Nantes
| | - N Firmin
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - S Piperno-Neumann
- INSERM U1194, IRCM, Univ Montpellier, Montpellier; Department of Medical Oncology, Institut Curie, Paris; Department of Surgical Oncology, Institut Curie, Paris
| | - M Rios
- Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - M Ropars
- Department of Orthopedics, CHU Rennes, Rennes
| | | | | | - F Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille
| | - S Carrere
- Service Orthopedie, CHU Nantes, Nantes
| | - C Llacer
- Service Orthopedie, CHU Nantes, Nantes
| | - S Watson
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - S Bonvalot
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - A Leroux
- INSERM U1194, IRCM, Univ Montpellier, Montpellier
| | - C Perrin
- Department of Medical Oncology, Eugene Marquis Comprehensive Cancer Center, Rennes
| | - J Gantzer
- Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - M Pracht
- Department of Medical Oncology, Eugene Marquis Comprehensive Cancer Center, Rennes
| | - B Narciso
- Department of Orthopedic Surgery, Tours
| | - A Monneur
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille
| | - C Lebbe
- Department of Dermatology, INSERM U976 University Paris Diderot Saint Louis Hospital, Paris; Department of CIC, INSERM U976 University Paris Diderot Saint Louis Hospital, Paris
| | - A Hervieu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon
| | - E Saada-Bouzid
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice
| | - P Dubray-Longeras
- Department of Medical Oncology, Centre Jean Perrin, Clermont-Ferrand
| | - F Fiorenza
- Department of Orthopedic Surgery, CHU Limoges, Limoges
| | - L Chaigneau
- Department of Medicine, CHU Besancon, Besancon
| | | | - P Soibinet
- Department of Medicine, Centre Francois Baclesse, Caen
| | - O Bouché
- Department of Gastroenterology, CHU Reims, Reims
| | - C Guillemet
- Department of Medical Oncology, Centre J Godinot Reims, Reims
| | - J P Spano
- Department of Oncology, Hôpital Pitié-Salpétriere, Paris
| | - J C Ruzic
- Departement d'oncologie, CHU, La Reunion
| | - N Isambert
- Service d'oncologie, CHU Poitiers, Poitiers, France
| | - G Vaz
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - P Meeus
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Karanian
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Ngo
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - J M Coindre
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | | | - F Le Loarer
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - F Ducimetiere
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Chemin
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Morelle
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - A Le Cesne
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
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2
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Boyer J, Kriegl L, Valentin T, Krause R. Re: 'ESCMID guidelines on diagnosis and treatment of brain abscess in children and adults' by Bodilsen et al. Clin Microbiol Infect 2024; 30:147-148. [PMID: 37805033 DOI: 10.1016/j.cmi.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 09/27/2023] [Accepted: 09/30/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Johannes Boyer
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
| | - Lisa Kriegl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Valentin
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Robert Krause
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Blay JY, Tlemsani C, Toulmonde M, Italiano A, Rios M, Bompas E, Valentin T, Duffaud F, Le Nail LR, Watson S, Firmin N, Dubray-Longeras P, Ropars M, Perrin C, Hervieu A, Lebbe C, Saada-Bouzid E, Soibinet P, Fiorenza F, Bertucci F, Boudou P, Vaz G, Bonvalot S, Honoré C, Marec-Berard P, Minard V, Cleirec M, Biau D, Meeus P, Babinet A, Dumaine V, Carriere S, Fau M, Decanter G, Gouin F, Ngo C, Le Loarer F, Karanian M, Meurgey A, Dufresne A, Brahmi M, Chemin-Airiau C, Ducimetiere F, Penel N, Le Cesne A. Sclerosing Epithelioid Fibrosarcoma (SEF) versus Low Grade Fibromyxoid Sarcoma (LGFMS): Presentation and outcome in the nationwide NETSARC+ series of 330 patients over 13 years. Eur J Cancer 2024; 196:113454. [PMID: 38008029 DOI: 10.1016/j.ejca.2023.113454] [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: 09/27/2023] [Accepted: 11/08/2023] [Indexed: 11/28/2023]
Abstract
Sclerosing Epithelioid Fibrosarcoma (SEF) and Low Grade Fibromyxoid Sarcoma (LGFMS) are ultrarare sarcomas sharing common translocations whose natural history are not well known. We report on the nationwide exhaustive series of 330 patients with SEF or LGFMS in NETSARC+ since 2010. PATIENTS AND METHODS NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTB). Since 2010, (i) pathological review has been mandatory for sarcoma,and (ii) tumour/patients' characteristics have been collected in the NETSARC+ nationwide database. The characteristics of patients with SEF and LGFMS and their outcome are compared. RESULTS 35/73 (48%) and 125/257(49%) of patients with SEF and LGFMS were female. More visceral, bone and trunk primary sites were observed in SEF (p < 0.001). 30% of SEF vs 4% of LGFMS patients had metastasis at diagnosis (p < 0.0001). Median size of the primary tumor was 51 mm (range 10-90) for LGFMS vs 80 (20-320) for SEF (p < 0.001). Median age for LGFMS patients was 12 years younger than that of SEF patients (43 [range 4-98] vs 55 [range 10-91], p < 0.001). Neoadjuvant treatment was more often given to SEF (16% vs 9%, p = 0.05). More patients with LGFMS were operated first in reference centers (51% vs 26%, p < 0.001). The R0 rate on the operative specimen was 41% in LGFMS vs 16% in SEF (p < 0.001). Median event-free survival (EFS) of patients with SEF and LGFMS were 32 vs 136 months (p < 0.0001). The median overall survival (OS) was not reached. Fifty-months OS was 93% vs 81% for LGFMS vs SEF (p = 0.05). Median OS was 77 months after first relapse, similar for SEF and LGFMS. In multivariate analysis, age, tumor size, metastasis at diagnosis were independent prognostic factors for OS in LGFMS. CONCLUSIONS Although sharing close molecular alterations, SEF and LGFMS have a different natural history, clinical presentation and outcome, with a higher risk of metastatic relapse in SEF. Survival after relapse is longer than with other sarcomas, and similar for SEF and LGFMS.
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Affiliation(s)
- J Y Blay
- Centre Léon Bérard & Université Claude Bernard, Lyon, France.
| | | | - M Toulmonde
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - A Italiano
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - M Rios
- Institut Cancerologie Lorraine, Centre Alexis Vautrin, Nancy, France
| | - E Bompas
- Department of Medical Oncology, Institut de Cancerologie Ouest Nantes, France
| | - T Valentin
- Institut Claudius Regaud & Institut Universitaire de Cancerologie, Oncopole, Toulouse, France
| | - F Duffaud
- La Timone University Hospital, Marseille, France
| | | | - S Watson
- Dept of Medical Oncology, Institut Curie & INSERM U830, Institut Curie Research Center, Paris, France
| | - N Firmin
- Institut de Cancérologie de Montpellier, Montpellier, France
| | | | - M Ropars
- Eugene Marquis Comprehensive Cancer Center, France
| | | | - A Hervieu
- Centre George Francois Leclerc, Dijon, France
| | - C Lebbe
- Centre Georges François Leclerc, Dijon, France
| | - E Saada-Bouzid
- Dermato-Oncology Unit, Saint Louis Hospital, Paris, France
| | | | | | - F Bertucci
- Institut Paoli-Calmettes, Marseille, France
| | | | - G Vaz
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | | | - C Honoré
- Gustave Roussy Cancer Campus, Villejuif, France
| | - P Marec-Berard
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - V Minard
- Gustave Roussy Cancer Campus, Villejuif, France
| | | | - D Biau
- Hopital Cochin, Paris, France
| | - P Meeus
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | | | | | - S Carriere
- Institut de Cancérologie de Montpellier, Montpellier, France
| | - M Fau
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - G Decanter
- Univ. Lille, CHU Lille, ULR 2694 - Metrics: Evaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - F Gouin
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - C Ngo
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | | | - M Karanian
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - A Meurgey
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - A Dufresne
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - M Brahmi
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - C Chemin-Airiau
- Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - F Ducimetiere
- Centre Léon Bérard & Université Claude Bernard, Lyon, France.
| | - N Penel
- Univ. Lille, CHU Lille, ULR 2694 - Metrics: Evaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; Department of Medical Oncology, Centre Oscar Lambret, Lille, France
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4
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Blay JY, Piperno-Neumann S, Watson S, Dufresne A, Valentin T, Duffaud F, Toulmonde M, Italiano A, Bertucci F, Tlemsani C, Firmin N, Bompas E, Perrin C, Ropars M, Saada-Bouzid E, Dubray-Longeras P, Hervieu A, Lebbe C, Gantzer J, Chaigneau L, Fiorenza F, Rios M, Isambert N, Soibinet P, Boudou-Roquette P, Verret B, Ferron G, Ryckewaert T, Lebellec L, Brahmi M, Gouin F, Meeus P, Vaz G, Le Loarer F, Karanian M, De Pinieux G, Ducimetiere F, Chemin C, Morelle M, Le Cesne A, Penel N. Epithelioid hemangio-endothelioma (EHE) in NETSARC: The nationwide series of 267 patients over 12 years. Eur J Cancer 2023; 192:113262. [PMID: 37625241 DOI: 10.1016/j.ejca.2023.113262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/06/2023] [Revised: 07/07/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023]
Abstract
EPITHELIOID HEMANGIOENDOTHELIOMA A NATIONWIDE STUDY: Epithelioid hemangioendothelioma (EHE) is an ultrarare sarcoma whose natural history and treatment is not well defined. We report on the presentation and outcome of 267 patients with EHE in the NETSARC+ network since 2010 in France. PATIENTS AND METHODS NETSARC (netsarc.org) is a network of 26 reference sarcoma centres with specialised multidisciplinary tumour boards (MDTB), funded by the French National Cancer Institute (NCI), Institut National du Cancer (INCA). Since 2010, presentation to an MDTB and second pathological review are mandatory for sarcoma patients. Patients' characteristics are collected in a nationwide database regularly monitored with stable incidence since 2013. The characteristics of patients with EHE at diagnosis are presented as well as progression-free survival (PFS), overall survival (OS), and outcome under treatment. RESULTS Two hundred and sixty-seven patients with EHE were included in the NETSARC+ database since 2010. Median age in the series was 51 (range 10-90) years, 58% were women. Median tumour size was 37 mm (4-220). Forty-eight percent, 42%, and 10% were visceral, soft parts, or bone primaries. The most frequent sites were liver (28%), lung (13%). 40% were reported to have systemic (i.e. multifocal or metastatic disease) at diagnosis. With a median follow-up of 20 months, OS and PFS rates at 24 months were 82% and 67%, with 10-year projected OS and PFS of 62% and 21% respectively. Male and M+ patients at diagnosis had a significantly worse OS, but not PFS. Local treatment was associated with a favourable survival in localised but not in patients with advanced stage at diagnosis. For 23 patients receiving medical treatment, PFS and OS were 50.2% and 33.2% at 60 months were respectively. CONCLUSIONS EHE is a frequently metastatic sarcoma at diagnosis with a unique natural history. This study shows in a nationwide series over 12 years that most patients progressed but are still alive at 10 years, both in localised and metastatic stages.
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Affiliation(s)
- J Y Blay
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France.
| | - S Piperno-Neumann
- Department of Medical Oncology, Institut Curie and INSERM U830, Institut Curie Research Center, Paris, France
| | - S Watson
- Department of Medical Oncology, Institut Curie and INSERM U830, Institut Curie Research Center, Paris, France
| | - A Dufresne
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - T Valentin
- Department of Medical oncology, Institut Claudius Regaud and Institut Universitaire de Cancerologie, Oncopole, Toulouse, France
| | - F Duffaud
- Department of Medical oncology, La Timone University Hospital, Marseille, France
| | - M Toulmonde
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - A Italiano
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - F Bertucci
- Department of Medical oncology, Institut Paoli-Calmettes, Marseille, France
| | - C Tlemsani
- Department of Medical oncology, Hôpital Cochin-Saint-Vincent de Paul, Paris, France
| | - N Firmin
- Department of Medical oncology, Institut de Cancérologie de Montpellier, Montpellier, France
| | - E Bompas
- Department of Medical Oncology, Institut de Cancerologie Ouest, Nantes, France
| | - C Perrin
- Department of Medical oncology, Eugene Marquis Comprehensive Cancer Center and CHU, Rennes, France
| | - M Ropars
- Department of Medical oncology, Eugene Marquis Comprehensive Cancer Center and CHU, Rennes, France
| | - E Saada-Bouzid
- Department of Medical oncology, Centre Antoine-Lacassagne, Nice, France
| | - P Dubray-Longeras
- Department of Medical oncology, Centre Georges François Leclerc, Dijon, France
| | - A Hervieu
- Department of Medical oncology, Centre Jean Perrin/ERTICa EA 4677, Clermont-Ferrand, France
| | - C Lebbe
- Department of Medical oncology, Oncology Unit, Saint Louis Hospital, Paris, France
| | - J Gantzer
- Department of Medicine, ICANS, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - L Chaigneau
- Department of Medical oncology, CHU Besancon, Besançon, France
| | - F Fiorenza
- Department of Medical oncology, CHU Limoges, Limoges, France
| | - M Rios
- Department of Medical oncology, Institut Cancerologie Lorraine, Centre Alexis Vautrin, Nancy, France
| | - N Isambert
- Department of Medical oncology, CHU, Poitiers, France
| | - P Soibinet
- Department of Medical oncology, Institut J Godinot Reims, Reims, France
| | - P Boudou-Roquette
- Department of Medical oncology, Hôpital Cochin-Saint-Vincent de Paul, Paris, France
| | - B Verret
- Department of Medical oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - G Ferron
- Department of Medical oncology, Institut Claudius Regaud and Institut Universitaire de Cancerologie, Oncopole, Toulouse, France
| | - T Ryckewaert
- Department of Medical oncology, Centre Oscar Lambret, and Université de Lille ULR 2694, Lille, France
| | - L Lebellec
- Department of Medical oncology, Centre Oscar Lambret, and Université de Lille ULR 2694, Lille, France
| | - M Brahmi
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - F Gouin
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - P Meeus
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - G Vaz
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - F Le Loarer
- Departement of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - M Karanian
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - G De Pinieux
- Department of Medical oncology, CHU Tours, Tours, France
| | - F Ducimetiere
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - C Chemin
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - M Morelle
- Department of Medical oncology, Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - A Le Cesne
- Department of Medical oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - N Penel
- Department of Medical oncology, Centre Oscar Lambret, and Université de Lille ULR 2694, Lille, France
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5
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König E, Iser J, Zechner-Sammer T, Friedl H, Krause R, Valentin T, Leitner E, Steinmetz I, Zollner-Schwetz I. Establishing breakpoints for amoxicillin/clavulanate and ampicillin/sulbactam for rapid antimicrobial susceptibility testing directly from positive blood culture bottles. J Med Microbiol 2023; 72. [PMID: 36951904 DOI: 10.1099/jmm.0.001672] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
Introduction. In 2018, EUCAST released guidelines on rapid antimicrobial susceptibility testing (RAST) directly from positive blood culture bottles for selected bacterial species and antimicrobial agents, but not for the commonly used agents amoxicillin/clavulanate (AMC) and ampicillin/sulbactam (SAM).Hypothesis/Gap statement. This work addresses the Enterobacterales RAST capability gap for betalactam/betalactamase inhibitor combinations.Aim. We aimed to determine RAST breakpoints for AMC and SAM for Escherichia coli and Klebsiella pneumoniae after 4 and 6 h of incubation directly from positive blood cultures.Methodology. Blood culture bottles were spiked with clinical isolates of E. coli (n=89) and K. pneumoniae (n=81). RAST was performed according to EUCAST guidelines and zones were read after 4 and 6 h. Breakpoints were defined to avoid very major errors.Results. The proportion of readable zone diameters after 4 h of incubation were 90.8 % in E. coli and 85.8 % in K. pneumoniae isolates. After 6 h of incubation all zone diameters could be read. The proposed breakpoints for E. coli after 6 h of incubation were ≥16 mm S (susceptible), 14-15 mm ATU (area of technical uncertainty) and <14 mm R (resistant) for AMC; ≥15 mm S, 12-14 mm ATU and <12 mm R for SAM; for K. pneumoniae these were ≥16 mm S, 14-15 mm ATU and <14 mm R for AMC; ≥13 mm S, 12 mm ATU, <12 mm R for SAM. Applying our newly set breakpoints, major errors were infrequent (2.6 %).Conclusion. We propose novel AMC and SAM breakpoints for RAST directly from positive blood cultures for reading after 4 and 6 h of incubation.
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Affiliation(s)
- Elisabeth König
- Diagnostic & Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Juliane Iser
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Tanja Zechner-Sammer
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Herwig Friedl
- Institute of Statistics, Graz University of Technology, Kopernikusgasse 24, 8010 Graz, Austria
| | - Robert Krause
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Thomas Valentin
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Eva Leitner
- Diagnostic & Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
| | - Ivo Steinmetz
- Diagnostic & Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
| | - Ines Zollner-Schwetz
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
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6
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Vielgut I, Putzl L, Thomüller I, Igrec J, Brcic I, Valentin T, Wittig U, Zettl R, Sadoghi P, Leithner A, Fischerauer S, Scheipl S. Musculoskeletal tuberculosis revisited: bone and joint tuberculosis in Austria. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04615-x. [PMID: 36149487 PMCID: PMC9510170 DOI: 10.1007/s00402-022-04615-x] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND To prevent further spread of the disease and secondary deformity, musculoskeletal tuberculosis (TB) remains a challenge in terms of early diagnosis and treatment. This study gives an overview on TB trends in Austria (pulmonary and extrapulmonary TB) (A) and analyses a retrospective series of musculoskeletal TB cases diagnosed and treated at an Austrian tertiary centre (B). METHODS (A) We analysed data obtained from the Austrian national TB registry to provide information on TB patients´ demographics and manifestation sites between 1995 and 2019. (B) Furthermore, we performed an observational study of all patients with a confirmed diagnosis of musculoskeletal TB who were admitted to the Department of Orthopaedics and Trauma, Medical University of Graz (2005-2019). Demographic, diagnostic, clinical and follow-up data were retrieved from the medical records. RESULTS (A) From 1995 to 2019, a significant linear reduction in overall Austrian tuberculosis incidence rates occurred (p < 0.001). In the period investigated, Austria recorded a total of 307 patients with musculoskeletal TB. (B) Our retrospective case-series included 17 individuals (9 males, 8 females; average follow-up 48.4 months; range 0-116). There was a biphasic age distribution with a peak in elderly native Austrians (median 69, range 63-92), and a second peak in younger patients with a migration background (median 29, range 18-39). Sites of manifestation were the spine (n = 10), peripheral joints (n = 5), and the soft tissues (n = 2). Diagnosis was based on histology (n = 13), PCR (n = 14), and culture (n = 12). Eleven patients underwent surgery (64.7%). Secondary deformities were frequent (n = 9), and more often observed in patients with spinal TB (n = 6). CONCLUSION Musculoskeletal TB should be considered if untypical joint infections or nonspecific bone lesions occur in younger patients with a migration background or in patients with specific risk factors.
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Affiliation(s)
- Ines Vielgut
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Lisa Putzl
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | | | - Jasminka Igrec
- grid.11598.340000 0000 8988 2476Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036 Graz, Austria
| | - Iva Brcic
- grid.11598.340000 0000 8988 2476Diagnostic and Research Institute of Pathology, Diagnostic and Research Center for Molecular BioMedicine, Medical University of Graz, Neue Stiftingtalstraße 10, 8010 Graz, Austria
| | - Thomas Valentin
- grid.11598.340000 0000 8988 2476Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Ulrike Wittig
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Richard Zettl
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Patrick Sadoghi
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Andreas Leithner
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Stefan Fischerauer
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Susanne Scheipl
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
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7
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Dufresne A, Huillard O, Dalban C, Geier M, Wassermann J, Zanetta S, Cabourg M, Catargi B, El Kouri C, Hrab I, Laramas M, Moreira A, Saada E, Tournigand C, Valentin T, Vauleon E, Mayet R, Perol D, Blay JY. 465P Larotracking: Real-life study of locally advanced/metastatic solid tumor treated with larotrectinib in French expanded access program. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.594] [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: 11/01/2022] Open
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8
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Cousin S, Bellera C, J-P. Guegan, Valentin T, Bahleda R, Metges JP, Cassier P, Cantarel C, Spalato Ceruso M, Kind M, Soubeyran I, Palussiere J, Bessede A, Italiano A. 1494P Regomune - a phase II study of regorafenib + avelumab in solid tumors: Results of the soft tissue sarcoma (STS) cohort. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1597] [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: 11/01/2022] Open
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9
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Schulz E, Grumaz S, Hatzl S, Gornicec M, Valentin T, Huber-Kraßnitzer B, Kriegl L, Uhl B, Deutsch A, Greinix H, Krause R, Neumeister P. Pathogen detection by metagenomic next generation sequencing during neutropenic fever in patients with hematological malignancies. Open Forum Infect Dis 2022; 9:ofac393. [PMID: 36004313 PMCID: PMC9394763 DOI: 10.1093/ofid/ofac393] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/29/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Febrile neutropenia (FN) following chemotherapy is a major cause of morbidity during cancer treatment. The performance of metagenomic next-generation sequencing (mNGS) of circulating cell-free DNA from plasma may be superior to blood culture (BC) diagnostics for identification of causative pathogens. The aim of this study was to validate mNGS (DISQVER test) for the detection of pathogens in hematologic patients with FN.
Methods
We collected paired whole blood specimens from central venous catheter and peripheral vein during FN for BC and mNGS testing. We repeated paired sampling at the earliest after 3 days of fever, which was defined as one FN episode. All clinical data were retrospectively reviewed by an infectious disease expert panel. We calculated percent positive agreement (PPA), percent negative agreement (PNA), percent overall agreement (POA), and sensitivity and specificity.
Results
We analyzed a total of 98 unselected FN episodes in 61 patients who developed predominantly FN after conditioning therapy for allogeneic (n = 22) or autologous (n = 21) hematopoietic stem cell transplantation. Success rate of mNGS was 99% (97/98). Positivity rate of mNGS was 43% (42/97) overall and 32% (31/97) excluding viruses compared to 14% (14/98) in BC. PPA, PNA and POA between mNGS and BC were 84.6% (95% CI, 54.6% to 98.1%), 63.1% (51.9% to 73.4%) and 66% (55.7% to 75.3%), respectively. Sensitivity for bacteria or fungi was 40% (28.0% to 52.9%) and 18.5% (9.9% to 30.0%), respectively.
Conclusion
Pathogen detection by mNGS (DISQVER) during unselected FN episodes shows twofold higher sensitivity and a broader pathogen spectrum than BC.
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Affiliation(s)
- Eduard Schulz
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
- Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda, Maryland , USA
| | | | - Stefan Hatzl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Maximilian Gornicec
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Thomas Valentin
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Bianca Huber-Kraßnitzer
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Lisa Kriegl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Barbara Uhl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Alexander Deutsch
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Hildegard Greinix
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Robert Krause
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
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10
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Amerstorfer F, Igrec J, Valentin T, Leithner A, Leitner L, Glehr M, Friesenbichler J, Brcic I, Bergovec M. Cat at home? Cat scratch disease with atypical presentations and aggressive radiological findings mimicking sarcoma, a potential diagnostic pitfall. Acta Orthop 2021; 92:753-759. [PMID: 34165046 PMCID: PMC8635669 DOI: 10.1080/17453674.2021.1941624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Cat scratch disease (CSD) is a self-limiting disease caused by Bartonella (B.) henselae. It is characterized by granulomatous infection, most frequently involving lymph nodes. However, it can present with atypical symptoms including musculoskeletal manifestations, posing a diagnostic challenge. We describe the prevalence and demographics of CSD cases referred to a sarcoma center, and describe the radiological, histological, and molecular findings.Patients and methods - Our cohort comprised 10 patients, median age 27 years (12-74) with clinical and radiological findings suspicious of sarcoma.Results - 7 cases involved the upper extremities, and 1 case each involved the axilla, groin, and knee. B. henselae was found in 6 cases tested using polymerase chain reaction and serology in 5 cases. 9 cases were soft tissue lesions and 1 lesion involved the bone. 1 patient had concomitant CSD with melanoma metastasis in enlarged axillary lymph nodes. On MRI, 5 soft tissue lesions were categorized as probably inflammatory. In 3 cases, with still detectable lymph node structure and absent or initial liquefaction, the differential diagnosis included lymph node metastasis. A sarcoma diagnosis was suggested in 4 cases. The MRI imaging features of the bone lesion were suspicious of a bone tumor or osteomyelitis.Interpretation - Atypical imaging findings cause a diagnostic challenge and the differential diagnosis includes malignant neoplasms (such as sarcoma or carcinoma metastasis) and other infections. The distinction between these possibilities is crucial for treatment and prognosis.
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Affiliation(s)
| | - Jasminka Igrec
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz
| | - Andreas Leithner
- Department of Orthopedics and Trauma, Medical University of Graz, Graz
| | - Lukas Leitner
- Department of Orthopedics and Trauma, Medical University of Graz, Graz
| | - Mathias Glehr
- Department of Orthopedics and Trauma, Medical University of Graz, Graz
| | | | - Iva Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Graz, Austria
| | - Marko Bergovec
- Department of Orthopedics and Trauma, Medical University of Graz, Graz
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11
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Trummer C, Theiler-Schwetz V, Steinberger E, Reisinger AC, Hassler E, Valentin T, Reinisch S, Pilz S. Acute suppurative thyroiditis due to Streptococcus anginosus leading to sepsis and acute respiratory distress syndrome: a case report. Arch Endocrinol Metab 2021; 65:846-851. [PMID: 34762790 PMCID: PMC10065398 DOI: 10.20945/2359-3997000000420] [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: 11/23/2022]
Abstract
Acute suppurative thyroiditis (AST) is a rare but potentially life-threatening thyroid disease with a high mortality if left untreated. Thus, differentiation from other thyroid disorders is highly important in clinical practice. A 22-year-old male patient was admitted to a tertiary care hospital with cervical pain, palpitations, thyrotoxicosis, and an inhomogeneously enlarged right thyroid lobe. In view of the clinical findings, subacute thyroiditis (SAT) was suspected and treatment with glucocorticoids was started. After initial amelioration, the patient developed cervical erythema, fever, and recurrent pain. A CT scan showed extensive phlegmonous inflammation and abscess formation, suggestive of AST. We started immediate empiric antibiotic therapy and performed surgical drainage of the abscess formations. Subsequently, the patient developed hypoxic respiratory failure, leading to ICU admission and intermittent need for non-invasive ventilation. Blood and abscess cultures were positive for Streptococcus anginosus. If left untreated, AST represents a potentially life-threatening disease. Thus, in clinically doubtful cases, liberal further assessment by means of cervical CT scans or fine needle aspiration biopsy are strongly advised.
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Affiliation(s)
- Christian Trummer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria,
| | - Verena Theiler-Schwetz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Eva Steinberger
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander C Reisinger
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Eva Hassler
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Sabine Reinisch
- Division of General Otorhinolaryngology, Head and Neck Surgery, Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria
| | - Stefan Pilz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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12
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Asgeirsson DO, Christiansen MG, Valentin T, Somm L, Mirkhani N, Nami AH, Hosseini V, Schuerle S. 3D magnetically controlled spatiotemporal probing and actuation of collagen networks from a single cell perspective. Lab Chip 2021; 21:3850-3862. [PMID: 34505607 PMCID: PMC8507888 DOI: 10.1039/d1lc00657f] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/28/2021] [Indexed: 05/15/2023]
Abstract
Cells continuously sense and react to mechanical cues from their surrounding matrix, which consists of a fibrous network of biopolymers that influences their fate and behavior. Several powerful methods employing magnetic control have been developed to assess the micromechanical properties within extracellular matrix (ECM) models hosting cells. However, many of these are limited to in-plane sensing and actuation, which does not allow the matrix to be probed within its full 3D context. Moreover, little attention has been given to factors specific to the model ECM systems that can profoundly influence the cells contained there. Here we present methods to spatiotemporally probe and manipulate extracellular matrix networks at the scale relevant to cells using magnetic microprobes (μRods). Our techniques leverage 3D magnetic field generation, physical modeling, and image analysis to examine and apply mechanical stimuli to fibrous collagen matrices. We determined shear moduli ranging between hundreds of Pa to tens of kPa and modeled the effects of proximity to rigid surfaces and local fiber densification. We analyzed the spatial extent and dynamics of matrix deformation produced in response to magnetic torques on the order of 10 pNm, deflecting fibers over an area spanning tens of micrometers. Finally, we demonstrate 3D actuation and pose extraction of fluorescently labelled μRods.
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Affiliation(s)
- Daphne O Asgeirsson
- Responsive Biomedical Systems Laboratory, Department of Health Science and Technology, ETH Zurich, 8093 Zurich, Switzerland.
| | - Michael G Christiansen
- Responsive Biomedical Systems Laboratory, Department of Health Science and Technology, ETH Zurich, 8093 Zurich, Switzerland.
| | - Thomas Valentin
- Responsive Biomedical Systems Laboratory, Department of Health Science and Technology, ETH Zurich, 8093 Zurich, Switzerland.
| | - Luca Somm
- Responsive Biomedical Systems Laboratory, Department of Health Science and Technology, ETH Zurich, 8093 Zurich, Switzerland.
| | - Nima Mirkhani
- Responsive Biomedical Systems Laboratory, Department of Health Science and Technology, ETH Zurich, 8093 Zurich, Switzerland.
| | - Amin Hosseini Nami
- Department of Biotechnology, College of Science, University of Tehran, Tehran 1417614411, Iran
| | - Vahid Hosseini
- Department of Bioengineering, University of California, Los Angeles, CA 90095, USA
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA 90024, USA
| | - Simone Schuerle
- Responsive Biomedical Systems Laboratory, Department of Health Science and Technology, ETH Zurich, 8093 Zurich, Switzerland.
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13
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Hatzl S, Reisinger AC, Posch F, Prattes J, Stradner M, Pilz S, Eller P, Schoerghuber M, Toller W, Gorkiewicz G, Metnitz P, Rief M, Prüller F, Rosenkranz AR, Valentin T, Krause R, Hoenigl M, Schilcher G. Antifungal prophylaxis for prevention of COVID-19-associated pulmonary aspergillosis in critically ill patients: an observational study. Crit Care 2021; 25:335. [PMID: 34526087 PMCID: PMC8441945 DOI: 10.1186/s13054-021-03753-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/31/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coronavirus disease 19 (COVID-19)-associated pulmonary aspergillosis (CAPA) emerged as important fungal complications in patients with COVID-19-associated severe acute respiratory failure (ARF). Whether mould active antifungal prophylaxis (MAFP) can prevent CAPA remains elusive so far. METHODS In this observational study, we included all consecutive patients admitted to intensive care units with COVID-19-associated ARF between September 1, 2020, and May 1, 2021. We compared patients with versus without antifungal prophylaxis with respect to CAPA incidence (primary outcome) and mortality (secondary outcome). Propensity score adjustment was performed to account for any imbalances in baseline characteristics. CAPA cases were classified according to European Confederation of Medical Mycology (ECMM)/International Society of Human and Animal Mycoses (ISHAM) consensus criteria. RESULTS We included 132 patients, of whom 75 (57%) received antifungal prophylaxis (98% posaconazole). Ten CAPA cases were diagnosed, after a median of 6 days following ICU admission. Of those, 9 CAPA cases were recorded in the non-prophylaxis group and one in the prophylaxis group, respectively. However, no difference in 30-day ICU mortality could be observed. Thirty-day CAPA incidence estimates were 1.4% (95% CI 0.2-9.7) in the MAFP group and 17.5% (95% CI 9.6-31.4) in the group without MAFP (p = 0.002). The respective subdistributional hazard ratio (sHR) for CAPA incidence comparing the MAFP versus no MAFP group was of 0.08 (95% CI 0.01-0.63; p = 0.017). CONCLUSION In ICU patients with COVID-19 ARF, antifungal prophylaxis was associated with significantly reduced CAPA incidence, but this did not translate into improved survival. Randomized controlled trials are warranted to evaluate the efficacy and safety of MAFP with respect to CAPA incidence and clinical outcomes.
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Affiliation(s)
- Stefan Hatzl
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Division of Haematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander C Reisinger
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florian Posch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Juergen Prattes
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Martin Stradner
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Stefan Pilz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Philipp Eller
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Michael Schoerghuber
- Department of Anaesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria
| | - Wolfgang Toller
- Department of Anaesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria
| | | | - Philipp Metnitz
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Martin Rief
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Florian Prüller
- Clinical Institute for Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Alexander R Rosenkranz
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Valentin
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Robert Krause
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
| | - Martin Hoenigl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Division of Infectious Diseases, University of California San Diego, San Diego, USA
| | - Gernot Schilcher
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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14
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Chen TW, Chang RJ, Le Cesne A, Hsieh YC, Italiano A, Yang YW, Penel N, Lee WC, Bompas E, Valentin T, Anract P, Firmin N, Duffaud F, Chan K, Blay JY. 1544P Soft tissue sarcoma (STS) incidences and clinical characteristics are significantly different between different geographic and ethnic populations. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.874] [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: 11/24/2022] Open
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15
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Amerstorfer F, Schober M, Valentin T, Klim S, Leithner A, Fischerauer S, Glehr M. Risk of reinfection after two- or multiple-stage knee revision surgery using superficial vancomycin coating and conventional spacers. J Orthop Res 2021; 39:1700-1709. [PMID: 33118642 PMCID: PMC8451795 DOI: 10.1002/jor.24892] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/06/2020] [Accepted: 10/21/2020] [Indexed: 02/04/2023]
Abstract
This study investigates the effect of superficial vancomycin coating (SVC) in two- or more-stage exchange procedures of prosthetic knee joint infections. We hypothesized that spacer treatment with SVC result in lower reinfection rates than conventional spacers after prosthetic reimplantation. Our secondary aim was to determine the demographic and treatment factors associated with reinfection rates. This retrospective cohort study compromised 96 cases with prosthetic knee infections. Twenty-four cases were treated with a temporary SVC spacer and 72 cases with conventional spacers. Prosthetic reinfection occurred after a median observation period of 1.7 ± 4.0 years in 24 cases (25%). The prevalence of having a reinfection was not significantly different between the two treatment groups (13% [3 cases] in the SVC group vs. 29% [21 cases] in the conventional spacer group [p = .104]). In seven cases (7.3%), two in the SVC group (8.3%) and five (6.9%) in the conventional spacer group (p ≥ .999), histological, respectively microbiological evaluations from the intraoperative specimens revealed persistent infection at the second stage. Nevertheless, in all seven cases no significant higher risk of periprosthetic reinfection was observed during follow-up (p = .750). Our secondary investigation of cofactors revealed that spacers additionally stabilized by nails were significantly associated with a 3.9-fold higher hazard ratio of sustaining a reinfection of revision prosthesis (p = .005).
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Affiliation(s)
| | - Martina Schober
- Department of Orthopedics and TraumaHospital St. Josef BraunauBraunau am InnAustria
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Sebastian Klim
- Department of Orthopedics and TraumaMedical University of GrazGrazAustria
| | - Andreas Leithner
- Department of Orthopedics and TraumaMedical University of GrazGrazAustria
| | - Stefan Fischerauer
- Department of Orthopedics and TraumaMedical University of GrazGrazAustria
| | - Mathias Glehr
- Department of Orthopedics and TraumaMedical University of GrazGrazAustria
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16
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Valentin T, Koenig E, Prattes J, Wunsch S, Loizenbaur T, Krause R, Zollner-Schwetz I. Implementation of rapid antimicrobial susceptibility testing combined with routine infectious disease bedside consultation in clinical practice (RAST-ID): a prospective single-centre study. J Antimicrob Chemother 2021; 76:233-238. [PMID: 33305799 DOI: 10.1093/jac/dkaa380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/10/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Recently, EUCAST released guidelines for rapid antimicrobial susceptibility testing (RAST) directly from positive blood culture bottles. The aim of our prospective single-centre clinical study was to assess the proportion of readable results and errors compared with routine antimicrobial susceptibility testing and the clinical consequences drawn by infectious disease (ID) physicians from RAST results during same-day bedside consultation. METHODS All positive blood cultures suitable for RAST from January to December 2019 were included and RAST results at 4 and 6 h compared with standard disc diffusion. The real-life impact of RAST on clinical decisions was assessed during same-day ID bedside consultation. RESULTS The proportion of readable RAST results was significantly higher after 6 h of incubation compared with after 4 h (881/930 versus 642/847; P < 0.0001). Major and very major errors were rare (17/642 after 4 h and 12/881 after 6 h; P = 0.087). ID consultation was performed in 134 patients after the RAST result. Antimicrobial treatment was changed in 73 patients and 84 additional measures (i.e. imaging studies, surgery, additional resistance testing) were ordered in 62 patients. CONCLUSIONS RAST according to EUCAST methods was easy to implement with a low number of major and very major errors after 6 h of incubation. ID physicians performing bedside consultations frequently used this information to change antimicrobial treatment and recommended additional measures.
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Affiliation(s)
- Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria
| | - Elisabeth Koenig
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria.,Diagnostic & Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstraße 6, A-8010 Graz, Austria
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria
| | - Stefanie Wunsch
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria
| | - Tobias Loizenbaur
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria
| | - Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria
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17
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Wunsch S, Zurl C, Strohmaier H, Meinitzer A, Rabensteiner J, Posch W, Lass-Flörl C, Cornely O, Pregartner G, König E, Feierl G, Hoenigl M, Prattes J, Zollner-Schwetz I, Valentin T, Krause R. Longitudinal Evaluation of Plasma Cytokine Levels in Patients with Invasive Candidiasis. J Fungi (Basel) 2021; 7:jof7020101. [PMID: 33535593 PMCID: PMC7912850 DOI: 10.3390/jof7020101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/17/2020] [Revised: 01/13/2021] [Accepted: 01/28/2021] [Indexed: 12/14/2022] Open
Abstract
Interleukin (IL) 17A plays a decisive role in anti-Candida host defense. Previous data demonstrated significantly increased IL-17A values in candidemic patients. We evaluated levels and time courses of IL-17A, and other cytokines suggested to be involved in Candida-specific immunity (IL-6, IL-8, IL-10, IL-17F, IL-22, IL-23, interferon-γ, tumor necrosis factor-α, Pentraxin-related protein 3, transforming growth factor-β) in patients with invasive candidiasis (IC) compared to bacteremic patients (Staphylococcus aureus, Escherichia coli) and healthy controls (from previous 4 days up to day 14 relative to the index culture (-4; 14)). IL-17A levels were significantly elevated in all groups compared to healthy controls. In IC, the highest IL-17A values were measured around the date of index sampling (-1; 2), compared to significantly lower levels prior and after sampling the index culture. Candidemic patients showed significantly higher IL-17A values compared to IC other than candidemia at time interval (-1; 2) and (3; 7). No significant differences in IL-17A levels could be observed for IC compared to bacteremic patients. Candidemic patients had higher IL-8, IL-10, IL-22, IFN-γ, PTX3 and TNF-α values compared to non-candidemic. Based on the limited discriminating competence between candidemia and bacteremia, IL-17A has to be considered a biomarker for blood stream infection rather than invasive Candida infection.
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Affiliation(s)
- Stefanie Wunsch
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (C.Z.); (E.K.); (M.H.); (J.P.); (I.Z.-S.); (T.V.)
- BioTechMed-Graz, 8010 Graz, Austria
- Correspondence: (S.W.); (R.K.); Tel.: +43-316-385-81319 (S.W.); +43-316-385-81796 (R.K.)
| | - Christoph Zurl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (C.Z.); (E.K.); (M.H.); (J.P.); (I.Z.-S.); (T.V.)
- BioTechMed-Graz, 8010 Graz, Austria
- Department of Paediatrics and Adolescent Medicine, Division of General Paediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Heimo Strohmaier
- Center for Medical Research, Medical University of Graz, 8010 Graz, Austria;
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, 8036 Graz, Austria; (A.M.); (J.R.)
| | - Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, 8036 Graz, Austria; (A.M.); (J.R.)
| | - Wilfried Posch
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (W.P.); (C.L.-F.)
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (W.P.); (C.L.-F.)
| | - Oliver Cornely
- Excellence Center for Medical Mycology (ECMM), Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
- Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria;
| | - Elisabeth König
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (C.Z.); (E.K.); (M.H.); (J.P.); (I.Z.-S.); (T.V.)
- Diagnostic & Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, 8010 Graz, Austria;
| | - Gebhard Feierl
- Diagnostic & Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, 8010 Graz, Austria;
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (C.Z.); (E.K.); (M.H.); (J.P.); (I.Z.-S.); (T.V.)
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA 92093, USA
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (C.Z.); (E.K.); (M.H.); (J.P.); (I.Z.-S.); (T.V.)
- BioTechMed-Graz, 8010 Graz, Austria
| | - Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (C.Z.); (E.K.); (M.H.); (J.P.); (I.Z.-S.); (T.V.)
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (C.Z.); (E.K.); (M.H.); (J.P.); (I.Z.-S.); (T.V.)
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (C.Z.); (E.K.); (M.H.); (J.P.); (I.Z.-S.); (T.V.)
- BioTechMed-Graz, 8010 Graz, Austria
- Correspondence: (S.W.); (R.K.); Tel.: +43-316-385-81319 (S.W.); +43-316-385-81796 (R.K.)
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18
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Brahmi M, Lesluyes T, Dufresne A, Toulmonde M, Italiano A, Mir O, Le Cesne A, Valentin T, Chevreau C, Bonvalot S, Penel N, Coindre JM, Le Guellec S, Le Loarer F, Karanian M, Blay JY, Chibon F. Expression and prognostic significance of PDGF ligands and receptors across soft tissue sarcomas. ESMO Open 2021; 6:100037. [PMID: 33524869 PMCID: PMC7848659 DOI: 10.1016/j.esmoop.2020.100037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 09/22/2020] [Revised: 12/06/2020] [Accepted: 12/13/2020] [Indexed: 11/28/2022] Open
Abstract
Background While the anti-PDGFRA antibody olaratumab failed to confirm an impact on survival in unselected advanced soft tissue sarcoma (STS) patients, the level of expression and the prognosis of platelet-derived growth factor (PDGF) receptors and ligands in STS remain unclear. Patients and methods We analyzed PDGF ligands and receptors' expression levels in a series of 255 patients with different histologies of STS [gastrointestinal stromal tumor (GIST), myxoid liposarcoma (MLPS), sarcoma with complex genomics, synovial sarcoma (SyS)] with Agilent single-color micro-arrays. We explored expression levels as prognostic values in univariate and multivariate analysis using R software (version 3.4.2). Results Complex patterns of correlation of expression between ligands and receptors were observed for each histotype. PDGFA levels were highest in SyS and lowest in MLPS (P < 4 × 10−9), PDGFB and C levels were lower in GIST (P < 2 × 10−15 and P < 3 × 10−9) while PDGFD expression was similar across histological subtypes. PDGF receptor (PDGFR) A expression was lowest in MLPS (P < 0.002), whereas PDGFRB and L expressions were lowest in GIST and SyS (P < 0.0004). Interestingly, high PDGFA expression levels were associated with higher risk of metastasis (P = 0.006), whereas PDGFD levels above average were associated with a reduced risk of metastasis (P = 0.01) in univariate and multivariate analysis. Conclusions The expression of PDGF ligands and receptors varies across sarcoma histological subtypes. PDGFA and D expression levels independently and inversely correlate with the risk of metastatic relapse. The expression of PDGF ligands and receptors substantially varies across sarcoma histological subtypes. PDGFA and D expression levels independently and inversely correlate with the risk of metastatic relapse. The differential expression of ligands might be used as biomarker of efficacy for PDGFRα antibodies in STS.
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Affiliation(s)
- M Brahmi
- Centre Léon Bérard, Lyon, France.
| | - T Lesluyes
- University of Bordeaux, Bordeaux, France; Inserm U1218, Institut Bergonié, Bordeaux, France; Inserm UMR1037, Cancer Research Center of Toulouse, Toulouse, France; Institut Claudius Regaud, Toulouse, France
| | | | - M Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - A Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - O Mir
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - A Le Cesne
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - T Valentin
- Institut Claudius Regaud, Toulouse, France
| | - C Chevreau
- Institut Claudius Regaud, Toulouse, France
| | - S Bonvalot
- Department of Medical Oncology, Institut Curie, Paris, France
| | - N Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | | | | | - F Le Loarer
- Inserm U1218, Institut Bergonié, Bordeaux, France
| | | | - J-Y Blay
- Centre Léon Bérard, Lyon, France; Université Claude Bernard, Lyon, France
| | - F Chibon
- Inserm UMR1037, Cancer Research Center of Toulouse, Toulouse, France; Institut Claudius Regaud, Toulouse, France
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19
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Zurl C, Prattes J, Zollner-Schwetz I, Valentin T, Rabensteiner J, Wunsch S, Hoenigl M, Krause R. T2Candida magnetic resonance in patients with invasive candidiasis: Strengths and limitations. Med Mycol 2021; 58:632-638. [PMID: 31613367 DOI: 10.1093/mmy/myz101] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 07/01/2019] [Accepted: 10/02/2019] [Indexed: 12/12/2022] Open
Abstract
T2Candida enables detection of five Candida species in whole blood within approximately 5 hours. Routinely drawn EDTA blood samples were prospectively stored and tested with T2Candida in patients with invasive candidiasis identified by routine index blood or sterile site cultures. T2Candida was compared to diagnostic blood and sterile site cultures and also performed with samples obtained prior and after collection of index cultures. T2Candida was evaluated with 133 samples of 32 patients with candidemia and 22 patients with deep-seated invasive candidiasis. In the candidemic group 28/32 (87.5%) patients had at least one positive T2Candida result at any time point. A total of 17/25 (68%) candidemic patients had a positive T2Candida sample that was drawn concurrently to the index blood culture. In the per patient analysis 17/18 (94.4%) candidemic patients with matched T2Candida samples and peripheral blood cultures at any timepoint had a positive T2Candida test. T2Candida revealed discordant Candida species identification in two candidemic patients. Six of 22 (27.3%) deep-seated IC patients had a positive T2Candida result. Despite advanced time-to-results the clinical value of T2Candida in diagnosing candidemia seems to be limited by missing blood culture positive cases. Positivity rates of T2Candida increased when serial T2Candida samples were tested. In patients with suspected deep-seated invasive candidiasis T2Candida might act as a blood based adjunct to sterile site cultures.
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Affiliation(s)
- Christoph Zurl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Division of General Paediatrics, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,BioTechMed-Graz, Graz, Austria
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,BioTechMed-Graz, Graz, Austria
| | - Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
| | - Stefanie Wunsch
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,BioTechMed-Graz, Graz, Austria
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Division of Infectious Diseases, Department of Medicine, University of California San Diego, San Diego, California, United States
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,BioTechMed-Graz, Graz, Austria
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20
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Dufresne A, Lesluyes T, Ménétrier-Caux C, Brahmi M, Darbo E, Toulmonde M, Italiano A, Mir O, Le Cesne A, Le Guellec S, Valentin T, Chevreau C, Bonvalot S, Robin YM, Coindre JM, Caux C, Blay JY, Chibon F. Specific immune landscapes and immune checkpoint expressions in histotypes and molecular subtypes of sarcoma. Oncoimmunology 2020; 9:1792036. [PMID: 32923153 PMCID: PMC7458655 DOI: 10.1080/2162402x.2020.1792036] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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] [Indexed: 10/28/2022] Open
Abstract
Soft tissue sarcomas are a group of rare and aggressive connective tissue neoplasms for which curative therapeutic opportunities are limited in advanced phase. Clinical trials assessing immunotherapy in these tumors have so far reported limited efficacy. The objective of this study is to provide a description of the immunologic landscape of sarcomas to guide the next clinical trials of immunotherapy in these diseases. The gene expression profile of 93 immune checkpoint (ICP) and membrane markers (MM) of immune cells was analyzed in a series of 253 soft tissue sarcoma (synovial sarcoma, myxoid liposarcoma, sarcoma with complex genomic and GIST) using Agilent Whole Human Genome Microarrays. The unsupervised hierarchical clustering of gene expression level was found able to properly group patients according to the histological subgroup of sarcoma, indicating that each sarcoma subgroup is associated with a specific immune signature defined by its gene expression pattern. Using the prognostic impact of CIBERSORT signature on metastatic-free survival in each subgroup, specific target could be proposed for each of the four groups: Treg through ICOS and GITR in GIST, M0 macrophages in all four sarcoma subtypes, OX40 in SS, CD40 in GIST and SS. The immune landscape of sarcoma was found to be as heterogeneous as the histotypes and molecular subtypes, but strongly correlated to the histotype. Histotype adapted immunotherapeutic approaches in each sarcoma subtypes must be considered in view of these results, consistently with the already reported specific response of histotypes of ICPs.
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Affiliation(s)
- A Dufresne
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - T Lesluyes
- University of Bordeaux, Bordeaux, France.,Inserm U1218, Institut Bergonié, Bordeaux, France.,Inserm UMR1037, Cancer Research Center of Toulouse, Toulouse, France.,Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
| | - C Ménétrier-Caux
- Inserm U1052, CNRS 5286, Cancer Research Center of Lyon, Université Claude Bernard Lyon 1, Bordeaux, France
| | - M Brahmi
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - E Darbo
- University of Bordeaux, Bordeaux, France.,Inserm U1218, Institut Bergonié, Bordeaux, France.,Bordeaux Bioinformatics Center (BCIB), Bordeaux, France
| | - M Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - A Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - O Mir
- Department of Ambulatory Care, Institut Gustave Roussy, Villejuif, France
| | - A Le Cesne
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France
| | - S Le Guellec
- Inserm UMR1037, Cancer Research Center of Toulouse, Toulouse, France.,Department of Pathology, Institut Claudius Regaud, Toulouse, France
| | - T Valentin
- Inserm UMR1037, Cancer Research Center of Toulouse, Toulouse, France.,Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
| | - C Chevreau
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
| | - S Bonvalot
- Department of Surgery, Institut Curie, Bordeaux, France
| | - Y M Robin
- Department of Pathology, Centre Oscar Lambret, Lille, France
| | - J-M Coindre
- University of Bordeaux, Bordeaux, France.,Department of Pathology, Institut Bergonié, Bordeaux, France
| | - C Caux
- Inserm U1052, CNRS 5286, Cancer Research Center of Lyon, Université Claude Bernard Lyon 1, Bordeaux, France
| | - J Y Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France.,Inserm U1052, CNRS 5286, Cancer Research Center of Lyon, Université Claude Bernard Lyon 1, Bordeaux, France
| | - F Chibon
- Inserm UMR1037, Cancer Research Center of Toulouse, Toulouse, France.,Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
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21
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Zurl C, Waller M, Schwameis F, Muhr T, Bauer N, Zollner-Schwetz I, Valentin T, Meinitzer A, Ullrich E, Wunsch S, Hoenigl M, Grinschgl Y, Prattes J, Oulhaj A, Krause R. Isavuconazole Treatment in a Mixed Patient Cohort with Invasive Fungal Infections: Outcome, Tolerability and Clinical Implications of Isavuconazole Plasma Concentrations. J Fungi (Basel) 2020; 6:jof6020090. [PMID: 32580296 PMCID: PMC7344482 DOI: 10.3390/jof6020090] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 05/13/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 12/18/2022] Open
Abstract
Isavuconazole (ISA) is a triazole antifungal agent recommended for treatment of invasive aspergillosis or mucormycosis. The objective of this study was to evaluate ISA levels in a real world setting in a mixed patient cohort including patients with non-malignant diseases and extracorporeal treatments, and to correlate findings with efficacy and safety outcomes. We investigated 33 ISA treatment courses in 32 adult patients with hematological and other underlying diseases and assessed the clinical response, side effects and ISA trough plasma concentrations. ISA treatment led to complete and partial response in 87% of patients and was well tolerated. The median ISA plasma concentration was 3.05 µg/mL (range 1.38–9.1, IQR 1.93–4.35) in patients without renal replacement therapy (RRT) or extracorporeal membrane oxygenation (ECMO) and significantly lower in patients with RRT including cases with additional ECMO or Cytosorb® adsorber therapy (0.88 µg/mL, range 0.57–2.44, IQR 0.71–1.21). After exclusion of values obtained from four patients with ECMO or Cytosorb® adsorber the median concentration was 0.91 µg/mL (range 0.75–2.44, IQR 0.90–1.36) in the RRT group. In addition to previous recommendations we propose to monitor ISA trough plasma concentrations in certain circumstances including RRT, other extracorporeal treatments and obesity.
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Affiliation(s)
- Christoph Zurl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (C.Z.); (M.W.); (I.Z.-S.); (T.V.); (E.U.); (S.W.); (M.H.); (J.P.)
- Division of General Paediatrics, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria
- BioTechMed-Graz, 8010 Graz, Austria
| | - Maximilian Waller
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (C.Z.); (M.W.); (I.Z.-S.); (T.V.); (E.U.); (S.W.); (M.H.); (J.P.)
| | - Franz Schwameis
- Department for Anaesthesiology and Intensive Care Medicine, Landesklinikum Baden, 2500 Baden, Austria;
| | - Tina Muhr
- Department of Internal Medicine, Landeskrankenhaus Graz 2, 8020 Graz, Austria;
| | - Norbert Bauer
- Department of Internal Medicine, Landeskrankenhaus Hartberg, 8230 Hartberg, Austria;
| | - Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (C.Z.); (M.W.); (I.Z.-S.); (T.V.); (E.U.); (S.W.); (M.H.); (J.P.)
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (C.Z.); (M.W.); (I.Z.-S.); (T.V.); (E.U.); (S.W.); (M.H.); (J.P.)
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, 8036 Graz, Austria;
| | - Elisabeth Ullrich
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (C.Z.); (M.W.); (I.Z.-S.); (T.V.); (E.U.); (S.W.); (M.H.); (J.P.)
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Stefanie Wunsch
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (C.Z.); (M.W.); (I.Z.-S.); (T.V.); (E.U.); (S.W.); (M.H.); (J.P.)
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (C.Z.); (M.W.); (I.Z.-S.); (T.V.); (E.U.); (S.W.); (M.H.); (J.P.)
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA 92093, USA
| | - Yvonne Grinschgl
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (C.Z.); (M.W.); (I.Z.-S.); (T.V.); (E.U.); (S.W.); (M.H.); (J.P.)
- BioTechMed-Graz, 8010 Graz, Austria
| | - Abderrahim Oulhaj
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, UAE;
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (C.Z.); (M.W.); (I.Z.-S.); (T.V.); (E.U.); (S.W.); (M.H.); (J.P.)
- BioTechMed-Graz, 8010 Graz, Austria
- Correspondence: ; Tel.: +43-316-385-81796
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Prattes J, Valentin T, Hoenigl M, Talakic E, Reisinger AC, Eller P. Invasive pulmonary aspergillosis complicating COVID-19 in the ICU - A case report. Med Mycol Case Rep 2020; 31:2-5. [PMID: 32395423 PMCID: PMC7211620 DOI: 10.1016/j.mmcr.2020.05.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [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: 04/21/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 01/15/2023] Open
Abstract
It is not yet known, if critically ill COVID-19 patients are prone to fungal infections. We report a 69-year-old patient without typical risk factors for invasive pulmonary aspergillosis (IPA), who developed IPA two weeks after onset of symptoms. Our report shows that IPA may occur in critically ill COVID-19 patients. Invasive pulmonary aspergillosis may complicate severe Covid-19. Physicians should be aware for aspergillosis in critically ill Covid-19 patients. Screening for aspergillosis may be indicated in these patients.
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Affiliation(s)
- Juergen Prattes
- Department of Internal Medicine, Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Valentin
- Department of Internal Medicine, Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Martin Hoenigl
- Department of Internal Medicine, Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.,Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, USA
| | - Emina Talakic
- Department of Radiology, Division of General Radiology, Medical University of Graz, Graz, Austria
| | - Alexander C Reisinger
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Graz, Austria
| | - Philipp Eller
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Graz, Austria
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23
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Valentin T, Lesluyes T, Le Guellec S, Chibon F. Chemotherapy in localized soft tissue sarcoma: will we soon have to treat grade 1 tumors? Update on CINSARC performances. Ann Oncol 2019; 30:153-155. [PMID: 30335133 DOI: 10.1093/annonc/mdy465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Valentin
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse; INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse.
| | - T Lesluyes
- INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse; INSERM U1218, Institut Bergonié, Bordeaux; University of Bordeaux, Bordeaux
| | - S Le Guellec
- INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse; Department of Pathology, Institut Claudius Regaud, Toulouse, France
| | - F Chibon
- INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse; Department of Pathology, Institut Claudius Regaud, Toulouse, France
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24
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Pedrono M, Mir O, Chaltiel L, Brahmi M, Italiano A, Decanter G, Rouquette PB, Ropars M, Bompas E, Firmin N, Isambert N, Valentin T, Duffaud F, Gantzer J, Thyss A, Guillemet C, Blay JY, Cesne AL, Chevreau C, Perrin C. Outcome of 98 patients with epithelioid sarcoma treated in curative intent: A retrospective study from the French Sarcoma Group (GSF-GETO). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz283.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Wunsch S, Krause R, Valentin T, Prattes J, Janata O, Lenger A, Bellmann-Weiler R, Weiss G, Zollner-Schwetz I. Multicenter clinical experience of real life Dalbavancin use in gram-positive infections. Int J Infect Dis 2019; 81:210-214. [PMID: 30794940 DOI: 10.1016/j.ijid.2019.02.013] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [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: 01/14/2019] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 11/28/2022] Open
Abstract
Dalbavancin, a lipoglycopeptide with prolonged half-life approved for the treatment of acute bacterial skin and soft tissue infections, can be used for the treatment of infections caused by gram-positive bacteria requiring long term treatment such as endocarditis, prosthetic joint infections (PJI) or osteomyelitis. Clinical data are limited in these settings. OBJECTIVES To evaluate indications, safety, tolerability and long-term outcomes of dalbavancin-treated patients. Patients and methods Our multicenter, retrospective study includes patients who received dalbavancin in Austria from September 2016 to March 2018. 90-day outcomes and tolerability were determined. RESULTS A total of 101 patients were included in 3 centers (57% male, median age 65 years). The treated infections were PJI (31%), osteomyelitis (29%), endocarditis (25%) and acute bacterial skin and soft tissue infections (12%). Concomitant use of other antimicrobial substances was common (63%). The mean total cumulative dose of dalbavancin was 3,357mg (±2,283mg). Clinical success rate was 89%. Side effects occurred in 3/101 patients. CONCLUSION In this real-life study dalbavancin was primarily used in off-label indications for treatment of PJI, osteomyelitis and endocarditis. Success rate was high (89%), tolerability and safety were excellent in this setting. Dalbavancin may therefore be used in these off-label indications as alternative treatment approach.
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Affiliation(s)
- S Wunsch
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria
| | - R Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria
| | - T Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria
| | - J Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria
| | - O Janata
- Department of Hygiene and Infection Control, Danube Hospital, Vienna, Austria
| | - A Lenger
- Department of Hygiene and Infection Control, Danube Hospital, Vienna, Austria
| | - R Bellmann-Weiler
- Department of Internal Medicine II (Infectious Disease, Immunology, Rheumatology, Pneumology), Medical University of Innsbruck, Austria
| | - G Weiss
- Department of Internal Medicine II (Infectious Disease, Immunology, Rheumatology, Pneumology), Medical University of Innsbruck, Austria
| | - I Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria.
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26
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Schilcher G, Eisner F, Hackl G, Eller P, Valentin T, Zollner-Schwetz I, Krause R, Brcic L. Candida infection of membrane oxygenator during ECMO therapy. J Infect 2019; 78:75-86. [DOI: 10.1016/j.jinf.2018.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/14/2018] [Accepted: 08/18/2018] [Indexed: 10/28/2022]
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27
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Szyszkowitz A, Zurl C, Herzeg A, Berger A, Gemes G, Mitteregger M, Prüller F, Prattes J, Zollner-Schwetz I, Valentin T, Hoenigl M, Krause R. Serum 1,3-Beta-D-Glucan Values During and After Laparoscopic and Open Intestinal Surgery. Open Forum Infect Dis 2018; 5:ofy296. [PMID: 30568978 PMCID: PMC6290064 DOI: 10.1093/ofid/ofy296] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 10/08/2018] [Accepted: 11/03/2018] [Indexed: 01/10/2023] Open
Abstract
Background 1,3-beta-D Glucan (BDG) assay has good accuracy for distinguishing patients with invasive fungal infections from patients without. Some procedures and medications affect BDG levels, resulting in false-positive BDG results. The extent of intestinal surgery on BDG kinetics is unknown. We evaluated the influence of laparoscopic and open intestinal surgery on peri- and postsurgical serum BDG values. Methods BDG was determined in 346 samples from 50 patients undergoing laparoscopic (24) or open (26) intestinal surgery at the following time points: after insertion of arterial but before skin incision, after skin incision but before dissection of the intestinal mucosa, after completion of anastomosis, after completion of skin sutures, in the evening after surgery, day 2 after surgery, 4–5 days after surgery. Results BDG was positive (ie, concentration ≥80 pg/mL) in 54% to 61% of patients during laparoscopic and open surgery (highest rates after completion of skin sutures). BDG was still positive in 12% (open) to 17% (laparoscopic) of patients without any suspected or proven fungal infection or anastomotic leakage 4–5 days after surgery. After completion of gut anastomosis, the BDG increase was higher in open compared with laparoscopic intestinal surgery. Conclusions The value of positive BDG tests in the perioperative setting up to 5 days postsurgery seems to be limited due to BDG elevations from intestinal surgical procedures.
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Affiliation(s)
| | - Christoph Zurl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Anna Herzeg
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Anton Berger
- Hospital of St. John of God, Marschallgasse, Graz, Austria
| | - Geza Gemes
- Hospital of St. John of God, Marschallgasse, Graz, Austria
| | | | - Florian Prüller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Division of Infectious Diseases, Department of Medicine, University of California San Diego, San Diego, California
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,BioTechMed-Graz, Graz, Austria
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28
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Mourey L, Ravaud A, Digue L, Cabarrou B, Gomez-Roca C, Valentin T, Olivier P, Fabre A, Mounier M, Balardy L, Filleron T. VOTRAGE study pazopanib in a population of “frail” elderly patients after geriatric assessment: A phase I study with geriatric criteria. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy283.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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29
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Le Guellec S, Lesluyes T, Sarot E, Valle C, Filleron T, Rochaix P, Valentin T, Pérot G, Coindre JM, Chibon F. Validation of the Complexity INdex in SARComas prognostic signature on formalin-fixed, paraffin-embedded, soft-tissue sarcomas. Ann Oncol 2018; 29:1828-1835. [DOI: 10.1093/annonc/mdy194] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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30
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Prattes J, Hoenigl M, Krause R, Buzina W, Valentin T, Reischies F, Koidl C, Zollner-Schwetz I. Invasive aspergillosis in patients with underlying liver cirrhosis: a prospective cohort study. Med Mycol 2018; 55:803-812. [PMID: 28431001 DOI: 10.1093/mmy/myx011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 09/29/2016] [Accepted: 02/06/2017] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to determine the prevalence of invasive aspergillosis (IA) in patients with liver cirrhosis and the performance of serum galactomannan (GM) screening. Patients with decompensated liver cirrhosis and patients with compensated liver cirrhosis presenting with fever and/or respiratory symptoms were prospectively enrolled. All patients were screened by serum GM twice weekly irrespective of clinical signs and symptoms. Positive serum GM triggered work-up consisting of chest computed tomography and in case of pathological findings bronchoscopy. 150 patients were included in the study. Two (1.3%) had probable, one (0.7%) had possible, and 147 (98%) had no evidence of IA. Both patients with probable IA had compensated liver cirrhosis. Sensitivity for serum GM screening for probable versus no IA was 0.5 (95% CI, 0.09-0.91), specificity 0.97 (95% CI: 0.92-0.99), negative predictive value 0.99 (95% CI, 0.96-0.99) and positive predictive value (PPV) 0.17 (95% CI, 0.01-0.64). PPV was 0.5 (95% CI, 0.03-0.98) in patients with clinical suspicion of IA. In conclusion, prevalence of IA in patients with liver cirrhosis seems to be low. Targeted GM testing in case of clinical suspicion of IA may be associated with markedly higher PPVs when compared to universal GM screening in patients with liver cirrhosis.
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Affiliation(s)
- Juergen Prattes
- Medical University of Graz, Section of Infectious Diseases and Tropical Medicine, Auenbruggerplatz 15, 8036 Graz, Austria.,CBmed - Center for biomarker research in medicine, Stiftingtalstrasse 5, 8010 Graz, Austria
| | - Martin Hoenigl
- Medical University of Graz, Section of Infectious Diseases and Tropical Medicine, Auenbruggerplatz 15, 8036 Graz, Austria.,CBmed - Center for biomarker research in medicine, Stiftingtalstrasse 5, 8010 Graz, Austria.,University of California, San Diego, Division of Infectious Diseases, Dickinson Street 220, 92103, San Diego, United States
| | - Robert Krause
- Medical University of Graz, Section of Infectious Diseases and Tropical Medicine, Auenbruggerplatz 15, 8036 Graz, Austria.,CBmed - Center for biomarker research in medicine, Stiftingtalstrasse 5, 8010 Graz, Austria
| | - Walter Buzina
- Medical University of Graz, Institute of Hygiene, Microbiology and Environmental Medicine, Universitätsplatz 4, 8010 Graz, Austria
| | - Thomas Valentin
- Medical University of Graz, Section of Infectious Diseases and Tropical Medicine, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Frederike Reischies
- Medical University of Graz, Section of Infectious Diseases and Tropical Medicine, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Christoph Koidl
- Medical University of Graz, Institute of Hygiene, Microbiology and Environmental Medicine, Universitätsplatz 4, 8010 Graz, Austria
| | - Ines Zollner-Schwetz
- Medical University of Graz, Section of Infectious Diseases and Tropical Medicine, Auenbruggerplatz 15, 8036 Graz, Austria.,CBmed - Center for biomarker research in medicine, Stiftingtalstrasse 5, 8010 Graz, Austria
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31
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Valentin T, Feierl G, Masoud-Landgraf L, Kohek P, Luxner J, Zarfel G. Proteus mirabilis harboring carbapenemase NDM-5 and ESBL VEB-6 detected in Austria. Diagn Microbiol Infect Dis 2018; 91:284-286. [PMID: 29571841 DOI: 10.1016/j.diagmicrobio.2018.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 08/29/2017] [Revised: 02/08/2018] [Accepted: 02/12/2018] [Indexed: 11/27/2022]
Abstract
We describe a case of carbapenemase-harboring Proteus mirabilis together with detection of NDM-5 in Austria accompanied by other bacterial strains with a wide range of beta-lactamases including OXA-181 and VEB-6. Isolates were obtained from a subphrenic abscess from one patient who was previously treated with broad-spectrum antibiotics in Bangladesh.
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Affiliation(s)
- Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria
| | - Gebhard Feierl
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Austria
| | - Lilian Masoud-Landgraf
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Austria
| | - Peter Kohek
- Department of Surgery, Medical University of Graz, Austria
| | - Josefa Luxner
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Austria
| | - Gernot Zarfel
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Austria.
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32
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Fabian E, Schneeweiss B, Valentin T, Flick H, Aigelsreiter A, Hofmann-Wellenhof R, Cerroni L, Goritschan AM, Brezinsek HP, Zitta S, Rosenkranz A, Graninger W, Krejs GJ. Clinical-Pathological Conference Series from the Medical University of Graz : Case No 162: A 30-year-old woman from Nigeria with fever 3 months postpartum. Wien Klin Wochenschr 2017; 129:145-152. [PMID: 28120106 PMCID: PMC5318465 DOI: 10.1007/s00508-016-1164-9] [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] [Received: 12/15/2016] [Accepted: 12/19/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Elisabeth Fabian
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Bruno Schneeweiss
- Department of Internal Medicine, Hospital Kirchdorf on the Krems, Kirchdorf on the Krems, Austria
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Holger Flick
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | | | - Lorenzo Cerroni
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
| | - Anna Maria Goritschan
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Hans-Peter Brezinsek
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Sabine Zitta
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander Rosenkranz
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Winfried Graninger
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Guenter J Krejs
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
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33
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Jud P, Valentin T, Regauer S, Gary T, Hackl G, Rief P, Brodmann M, Hafner F. Invasive Candida krusei infection and Candida vasculitis of a leg ulcer in an immunocompetent patient: A case report. Int J Infect Dis 2017; 55:96-98. [PMID: 28104503 DOI: 10.1016/j.ijid.2017.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 06/22/2016] [Revised: 12/27/2016] [Accepted: 01/09/2017] [Indexed: 11/19/2022] Open
Abstract
A 71year old female Caucasian farmer without any known immunosuppression presented with a painful ulcer of her right lower leg after a trauma caused by a wood billet. There was no response to empirical antibacterial treatment. An ulcer biopsy showed an invasive Candida infection of the soft tissue and leucocytoclastic vasculitis. Voriconazole treatment was followed by wound healing. Invasive Candida infection and localized Candida vasculitis represent a rare cause of persisting leg ulcers. The similar clinical picture of chronic venous leg ulcers might blur the true cause and refractory cases should therefore promptly be processed by histopathological diagnostics.
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Affiliation(s)
- Philipp Jud
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Sigrid Regauer
- Institute of Pathology, Medical University Graz, Graz, Austria
| | - Thomas Gary
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gerald Hackl
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Rief
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Franz Hafner
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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34
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Krause R, Moissl-Eichinger C, Halwachs B, Gorkiewicz G, Berg G, Valentin T, Prattes J, Högenauer C, Zollner-Schwetz I. Mycobiome in the Lower Respiratory Tract - A Clinical Perspective. Front Microbiol 2017; 7:2169. [PMID: 28119685 PMCID: PMC5222816 DOI: 10.3389/fmicb.2016.02169] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 12/23/2016] [Indexed: 01/01/2023] Open
Abstract
Recently the paradigm that the healthy lung is sterile was challenged and it is now believed that the lungs harbor a diverse microbiota also contributing to the pathogenesis of various diseases. Most of the research studies targeting the respiratory microbiome have focused on bacteria and their impact on lung health and lung diseases. Recently, also the mycobiome has gained attention. Lower respiratory tract (LRT) diseases (e.g., cystic fibrosis) and other diseases or conditions (e.g., HIV infection, lung transplantation, and treatment at intensive care units) have been investigated with regard to possible involvement of mycobiome in development or progression of diseases. It has been shown that diversities of mycobiome in the LRT vary in different populations and conditions. It has been proposed that the mycobiome diversity associated with LRT can vary with different stages of diseases. Overall, Candida was the dominant fungal genus in LRT samples. In this review, we summarize the recent findings regarding the human LRT mycobiome from a clinical perspective focussing on characterization of investigated patient groups and healthy controls as well as sampling techniques. From these data, clinical implications for further studies or routine practice are drawn. To obtain clinically relevant answers efforts should be enhanced to collect well characterized and described patient groups as well as healthy individuals for comparative data analysis and to apply thorough sampling techniques. We need to proceed with elucidation of the role of mycobiota in healthy LRT and LRT diseases to hopefully improve patient care.
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Affiliation(s)
- Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz Graz, Austria
| | - Christine Moissl-Eichinger
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of GrazGraz, Austria; BioTechMed, Medical University of GrazGraz, Austria
| | - Bettina Halwachs
- Institute of Pathology, Medical University of Graz Graz, Austria
| | - Gregor Gorkiewicz
- BioTechMed, Medical University of GrazGraz, Austria; Institute of Pathology, Medical University of GrazGraz, Austria
| | - Gabriele Berg
- Institute of Environmental Biotechnology, Graz University of Technology Graz, Austria
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz Graz, Austria
| | - Jürgen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz Graz, Austria
| | - Christoph Högenauer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz Graz, Austria
| | - Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz Graz, Austria
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35
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Rabensteiner J, Prüller F, Prattes J, Valentin T, Zollner-Schwetz I, Krause R, Hoenigl M. suPAR remains uninfluenced by surgery in septic patients with bloodstream infection. GMS Infect Dis 2016; 4:Doc04. [PMID: 30671318 PMCID: PMC6301737 DOI: 10.3205/id000022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Surgical trauma induces activation of the immune system and may cause an increase of inflammatory biomarkers tested postoperatively in septic patients treated for bloodstream infection. The aim of this study was to determine the impact of surgical interventions on the novel sepsis biomarker soluble urokinase plasminogen activator receptor (suPAR) and to compare results with those of routine laboratory parameters CRP, PCT, and IL-6 in patients with culture-proven bloodstream infection. Forty-six adult patients with positive blood culture undergoing minor or major surgical intervention were investigated, 12 blood culture positive patients served as control group. Blood was collected 24 hours before and after surgical intervention for determination of the sepsis biomarkers suPAR, CRP, PCT, and IL-6. Within the surgical study cohort, a non-significant increase of suPAR, CRP, and PCT was observed postoperatively (p 0.642; p 0.773; p 0.087). In contrast, a slight decrease of IL-6 (p 0.599) was observed. A significant correlation was calculated for the pre- and postoperative difference of CRP (p 0.028) and PCT (p 0.008) and type of surgical intervention received: after minor surgical intervention only PCT decreased significantly (p<0.001), while after major surgical interventions no significant differences were observed for all biomarkers evaluated. In the control group, a significant decrease of CRP (p 0.005) and PCT (p 0.005) was observed. In patients treated adequately for bloodstream infections, postoperative suPAR levels remained uninfluenced of the surgical trauma and might therefore be a reliable parameter for postoperative infectious monitoring. After minor surgical intervention, PCT seems to be the most reliable parameter.
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Affiliation(s)
- Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
| | - Florian Prüller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
| | - Jürgen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria
| | - Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria.,Division of Infectious Diseases, Department of Medicine, University of California, San Diego, CA, USA
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Krause R, Halwachs B, Thallinger GG, Klymiuk I, Gorkiewicz G, Hoenigl M, Prattes J, Valentin T, Heidrich K, Buzina W, Salzer HJF, Rabensteiner J, Prüller F, Raggam RB, Meinitzer A, Moissl-Eichinger C, Högenauer C, Quehenberger F, Kashofer K, Zollner-Schwetz I. Characterisation of Candida within the Mycobiome/Microbiome of the Lower Respiratory Tract of ICU Patients. PLoS One 2016; 11:e0155033. [PMID: 27206014 PMCID: PMC4874575 DOI: 10.1371/journal.pone.0155033] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 04/22/2016] [Indexed: 02/06/2023] Open
Abstract
Whether the presence of Candida spp. in lower respiratory tract (LRT) secretions is a marker of underlying disease, intensive care unit (ICU) treatment and antibiotic therapy or contributes to poor clinical outcome is unclear. We investigated healthy controls, patients with proposed risk factors for Candida growth in LRT (antibiotic therapy, ICU treatment with and without antibiotic therapy), ICU patients with pneumonia and antibiotic therapy and candidemic patients (for comparison of truly invasive and colonizing Candida spp.). Fungal patterns were determined by conventional culture based microbiology combined with molecular approaches (next generation sequencing, multilocus sequence typing) for description of fungal and concommitant bacterial microbiota in LRT, and host and fungal biomarkes were investigated. Admission to and treatment on ICUs shifted LRT fungal microbiota to Candida spp. dominated fungal profiles but antibiotic therapy did not. Compared to controls, Candida was part of fungal microbiota in LRT of ICU patients without pneumonia with and without antibiotic therapy (63% and 50% of total fungal genera) and of ICU patients with pneumonia with antibiotic therapy (73%) (p<0.05). No case of invasive candidiasis originating from Candida in the LRT was detected. There was no common bacterial microbiota profile associated or dissociated with Candida spp. in LRT. Colonizing and invasive Candida strains (from candidemic patients) did not match to certain clades withdrawing the presence of a particular pathogenic and invasive clade. The presence of Candida spp. in the LRT rather reflected rapidly occurring LRT dysbiosis driven by ICU related factors than was associated with invasive candidiasis.
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Affiliation(s)
- Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Bettina Halwachs
- Bioinformatics, Institute for Knowledge Discovery, University of Technology, Graz, Austria and OMICS Center Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | | | - Ingeborg Klymiuk
- Center for Medical Research, Medical University of Graz, Graz, Austria
| | | | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jürgen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Katharina Heidrich
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
- Department of Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Walter Buzina
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Helmut J. F. Salzer
- Division of Clinical Infectious Diseases, Research Center Borstel, Leibnitz Center for Medicine and Biosciences, Borstel, Germany
| | - Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Florian Prüller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Reinhard B. Raggam
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Christine Moissl-Eichinger
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christoph Högenauer
- Theodor Escherich Laboratory for Microbiome Research, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Franz Quehenberger
- Institute for Medical Informatics, Statistics, and Documentation, Medical University of Graz, Graz, Austria
| | - Karl Kashofer
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Pfeiffer C, Mathieu-Dupas E, Logghe P, Lissalde-Lavigne G, Balicchi J, Caliskan U, Valentin T, Laune D, Molina F, Schved JF, Giansily-Blaizot M. Isotypic analysis of antibodies against activated Factor VII in patients with Factor VII deficiency using the x-MAP technology. Thromb Res 2016; 141:22-7. [DOI: 10.1016/j.thromres.2016.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 02/18/2016] [Accepted: 02/19/2016] [Indexed: 11/16/2022]
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Ducassou A, Valentin T, Filleron T, Delannes M, Ferron G, Le Guellec S, Rochaix P, Boulet B, Chevreau C. EP-1408: Adjuvant concurrent chemoradiotherapy in soft tissue sarcomas of the limbs: an effective strategy. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32658-5] [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: 10/21/2022]
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Valentin T, Le Cesne A, Ray-Coquard I, Italiano A, Decanter G, Bompas E, Isambert N, Thariat J, Linassier C, Bertucci F, Bay JO, Bellesoeur A, Penel N, Le Guellec S, Filleron T, Chevreau C. Management and prognosis of malignant peripheral nerve sheath tumors: The experience of the French Sarcoma Group (GSF-GETO). Eur J Cancer 2016; 56:77-84. [PMID: 26824706 DOI: 10.1016/j.ejca.2015.12.015] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [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: 12/03/2015] [Accepted: 12/12/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Malignant peripheral nerve sheath tumors (MPNST) are a rare subtype of soft tissue sarcoma. They can arise in irradiated fields, in patients with type 1 neurofibromatosis (NF1), or sporadically. MPNST exhibit an aggressive behaviour, and their optimal management remains controversial. An unsolved issue is whether NF1-related and sporadic forms of MPNST have a different prognosis, and should be managed differently. MATERIAL AND METHODS Adult and paediatric patients with histologically confirmed MPNST treated between 1990 and 2013 in French cancer centres of the GSF/GETO network, were included in this retrospective study. RESULTS A total of 353 patients (37% with NF1 and 59% with sporadic tumours) were analysed. Median age at diagnosis was 42 years (range 1-94). The majority of tumours developed in the limbs, were deep-seated and of high grade. Two hundreds and ninety four patients underwent a curative intent surgery. Among them, 60 patients (21%) had neoadjuvant treatment (mainly chemotherapy), and 173 (59%) had adjuvant treatment (mainly radiotherapy). For operated patients, median progression free and overall survival (OS) were 26.3 months and 95.8 months, respectively. In multivariate analysis, poor-prognosis factors for OS were high grade, deep location, locally advanced stage at diagnosis, and macroscopically incomplete resection (R2). NF1 status was not negatively prognostic, except in the recurrence or metastatic setting, where NF1-related MPNST patients treated with palliative chemotherapy showed worse survival than patients with sporadic forms. CONCLUSION To our knowledge, our series is the largest study of patients with MPNST reported to date. For operated patients, we showed a worse prognosis for NF1-related MPNST, due to different clinical features at diagnosis, more than NF1 status itself. The French sarcoma group is now conducting correlative analyses on these patients, using the latest molecular tools.
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Affiliation(s)
- T Valentin
- Department of Medical Oncology, IUCT-Oncopole, Toulouse, France.
| | - A Le Cesne
- Department of Medical Oncology, Gustave Roussy Institute, Villejuif, France
| | - I Ray-Coquard
- Department of Medical Oncology, Léon Bérard Center, Lyon, France
| | - A Italiano
- Department of Medical Oncology, Bergonié Institute, Bordeaux, France
| | - G Decanter
- Department of Surgery, Oscar Lambret Center, Lille, France
| | - E Bompas
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes, France
| | - N Isambert
- Department of Medical Oncology, Georges-François Leclerc Center, Dijon, France
| | - J Thariat
- Department of Radiotherapy, Antoine Lacassagne Center, Nice, France
| | - C Linassier
- Department of Medical Oncology, University Hospital, Tours, France
| | - F Bertucci
- Department of Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - J O Bay
- Department of Medical Oncology, University Hospital, Clermont-Ferrand, France
| | - A Bellesoeur
- Department of Medical Oncology, Gustave Roussy Institute, Villejuif, France
| | - N Penel
- Department of Surgery, Oscar Lambret Center, Lille, France
| | - S Le Guellec
- Department of Pathology, IUCT-Oncopole, Toulouse, France
| | - T Filleron
- Department of Statistics, IUCT-Oncopole, Toulouse, France
| | - C Chevreau
- Department of Medical Oncology, IUCT-Oncopole, Toulouse, France
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Rolland M, Sibaud V, Boulinguez S, Valentin T, Ofaiche J, Paul C, Meyer N. Régression objective de localisations leptoméningées de mélanome après traitement par un inhibiteur de PD-1. Ann Dermatol Venereol 2015. [DOI: 10.1016/j.annder.2015.10.498] [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: 11/26/2022]
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Reischies FMJ, Prattes J, Prüller F, Eigl S, List A, Wölfler A, Buzina W, Zollner-Schwetz I, Valentin T, Rabensteiner J, Flick H, Krause R, Raggam RB, Hoenigl M. Prognostic potential of 1,3-beta-d-glucan levels in bronchoalveolar lavage fluid samples. J Infect 2015; 72:29-35. [PMID: 26416472 DOI: 10.1016/j.jinf.2015.09.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 08/17/2015] [Accepted: 09/20/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The objective of this study was to investigate the prognostic potential of 1,3-beta-d-glucan (BDG) testing in bronchoalveolar lavage fluid (BALF) samples. METHODS A total of 300 BALF samples from 252 patients were investigated for BDG (Fungitell(®) assay). Prognostic potential of BALF BDG was evaluated by using: i.) Kaplan-Meier analysis, and ii.) multivariable Cox hazard regression analyses. RESULTS BALF BDG levels were found to be significantly higher in samples with Candida spp. colonization (p < 0.001). A total of 61/252 patients (24.2%) died within 90-days of BALF sampling (18.1% of patients with BALF BDG <200 pg/mL, 32.4% with BALF BDG ≥200 pg/mL). Kaplan-Meier analysis revealed that overall cumulative 90-day mortality was significantly higher in those with BALF BDG levels ≥200 pg/mL when compared to those with levels <200 pg/mL (log-rank p = 0.006, Breslow p = 0.005 and Tarone-Ware p = 0.005). The multivariable Cox regression analysis showed that BALF BDG levels were a strong predictor of 90-day overall mortality, with a hazard ratio of 1.048 (per 100 pg/mL increase of BALF BDG). CONCLUSION False positive BALF BDG results in the presence of Candida spp. colonization of the lower respiratory tract may explain the limited diagnostic potential of BALF BDG testing. In contrast, prognostic potential of BALF BDG may be promising.
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Affiliation(s)
- Frederike M J Reischies
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florian Prüller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Susanne Eigl
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Agnes List
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Albert Wölfler
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Walter Buzina
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Holger Flick
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Reinhard B Raggam
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria; Division of Infectious Diseases, Department of Medicine, University of California, San Diego, USA.
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Rabensteiner J, Theiler G, Duettmann W, Zollner-Schwetz I, Hoenigl M, Valentin T, Leitner E, Luxner J, Grisold A, Valentin A, Neumeister P, Krause R. Detection of central venous catheter-related bloodstream infections in haematooncological patients. Eur J Clin Invest 2015; 45:824-32. [PMID: 26058473 DOI: 10.1111/eci.12477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 06/03/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Catheter-related bloodstream infections (CRBSIs) are currently detected in patients with clinically suspicion. The aim of our study was to evaluate whether CRBSIs could be anticipated and detected in a subclinical stage by peptide nucleic acid fluorescence in situ hybridization (PNA FISH) using universal hybridization probes or acridine orange leucocyte cytospin (AOLC) tests in haematooncological patients with central venous catheters (CVCs) in situ. MATERIALS AND METHODS Peptide nucleic acid fluorescence in situ hybridization and AOLC tests using blood samples from one CVC lumen/port chamber in haematooncological patients were continuously performed. These results were compared to those obtained from routinely performed CRBSI diagnostic tests. RESULTS One hundred and eighty-two patients with 342 catheter periods were investigated. Seventeen CRBSI cases were detected in 6466 CVC days by routine measures resulting in a CRBSI rate of 2.6/1000 catheter days. Two of 17 showed positive PNA FISH tests, and five positive AOLC test results before the diagnosis were established with routine measures. The screening revealed further seven patients with positive universal PNA FISH tests and 10 positive AOLC tests without symptoms indicative for infection and were therefore considered not to have CRBSI. CONCLUSIONS Sampling of only one CVC lumen/port chamber screening for CRBSI in haematooncological patients seems not to be a useful tool for anticipative diagnosis of CRBSI. Reasons for false-negative results might include origin of CRBSIs from the other CVC lumina not sampled for screening, and false-positive results might origin from catheter colonization without subsequent spread of micro-organisms into the peripheral bloodstream.
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Affiliation(s)
- Jasmin Rabensteiner
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Georg Theiler
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Wiebke Duettmann
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Eva Leitner
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Josefa Luxner
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Andrea Grisold
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Angelika Valentin
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Krause R, Zollner-Schwetz I, Salzer HJF, Valentin T, Rabensteiner J, Prüller F, Raggam R, Meinitzer A, Prattes J, Rinner B, Strohmaier H, Quehenberger F, Strunk D, Heidrich K, Buzina W, Hoenigl M. Elevated levels of interleukin 17A and kynurenine in candidemic patients, compared with levels in noncandidemic patients in the intensive care unit and those in healthy controls. J Infect Dis 2015; 211:445-51. [PMID: 25149761 DOI: 10.1093/infdis/jiu468] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The interplay between Candida species and pattern recognition receptors, interleukins, kynurenine, and T cells has been studied in murine and ex vivo human studies, but data are lacking from patients with invasive fungal infections. Interleukin 17A (IL-17A) is considered an important component in host defense against Candida infections and is modulated by Candida-induced impairment of tryptophan-kynurenine metabolism. METHODS Dectin-1, Toll-like receptor 2, and Toll-like receptor 4 expression; regulatory T cell (Treg) percentages; and interleukin 6, interleukin 10, IL-17A, interleukin 22, interleukin 23, interferon γ, kynurenine, and tryptophan levels were determined in candidemic patients and compared to levels in noncandidemic patients who are in the intensive care unit (ICU) and receiving antibiotic therapy and those in healthy controls, both with and without Candida colonization. RESULTS Candidemic patients had significantly higher IL-17A and kynurenine levels, compared with noncandidemic patients, including Candida-colonized ICU patients and healthy controls. Within candidemic patients, time-dependent elevation of IL-17A and kynurenine levels was detected. IL-17A areas under the curve for differentiation between patients with early candidemia and those without candidemia (ICU patients, including Candida-colonized patients, and healthy controls) were between 0.94 (95% confidence interval [CI], .89-.99) and 0.99 (95% CI, .99-1). CONCLUSIONS Candidemic patients had significantly higher IL-17A and kynurenine levels, compared with noncandidemic patients. The statistically significant association between IL-17A and kynurenine levels and candidemia suggests their potential as biomarkers for anticipation of invasive candidiasis. CLINICAL TRIALS REGISTRATION NCT00786903.
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Affiliation(s)
- Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine
| | - Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine
| | - Helmut J F Salzer
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine Center for Internal Medicine, University Hospital Hamburg Eppendorf, Germany
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine
| | - Jasmin Rabensteiner
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine
| | - Florian Prüller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics
| | - Reinhard Raggam
- Clinical Institute of Medical and Chemical Laboratory Diagnostics
| | | | - Jürgen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine
| | | | | | | | - Dirk Strunk
- Experimental and Clinical Cell Therapy Institute, Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
| | - Katharina Heidrich
- Institute of Hygiene, Microbiology, and Environmental Medicine, Medical University of Graz
| | - Walter Buzina
- Institute of Hygiene, Microbiology, and Environmental Medicine, Medical University of Graz
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine
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Raggam RB, Wagner J, Prüller F, Grisold A, Leitner E, Zollner-Schwetz I, Valentin T, Krause R, Hoenigl M. Soluble urokinase plasminogen activator receptor predicts mortality in patients with systemic inflammatory response syndrome. J Intern Med 2014; 276:651-8. [PMID: 24645798 DOI: 10.1111/joim.12238] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The soluble urokinase plasminogen activator receptor (suPAR) reflects inflammation. However, the prognostic value of suPAR measurements, particularly at the very early onset of systemic inflammatory response syndrome (SIRS), is less well defined. METHODS The prognostic potential of suPAR levels in patients with SIRS was evaluated. From November 2010 until April 2013, 902 adult patients presenting with SIRS were investigated. Blood samples for laboratory testing of inflammation markers were collected simultaneously with initial blood cultures. suPAR testing was performed using suPARnostic(©) assay. RESULTS Analyses of receiver operating characteristics curves revealed areas under the curve (AUCs) of 0.818 for predicting overall mortality within 48 h (36/902 patients died), 0.739 for 30-day mortality (117/902 died) and 0.706 for predicting 90-day mortality (151/902 died). AUCs for procalcitonin (0.777, 0.671 and 0.638), interleukin-6 (0.709, 0.593 and 0.569) and C-reactive protein (0.66, 0.594 and 0.586) as well as renal function and age were markedly lower. Using multivariable regression analyses, suPAR levels (P < 0.001) remained significant predictors of 48-h mortality, whereas suPAR levels (P < 0.001) and bacteraemia (P = 0.002 and P = 0.001, respectively) remained significant predictors of 30- and 90-day mortality. Using Kaplan-Meier survival plots, patients with suPAR <9.15 ng mL(-1) at SIRS onset had a clear benefit. CONCLUSION suPAR plasma level determined at early SIRS is predictive for mortality.
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Affiliation(s)
- R B Raggam
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
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Hoenigl M, Raggam RB, Wagner J, Prueller F, Grisold AJ, Leitner E, Seeber K, Prattes J, Valentin T, Zollner-Schwetz I, Schilcher G, Krause R. Procalcitonin fails to predict bacteremia in SIRS patients: a cohort study. Int J Clin Pract 2014; 68:1278-81. [PMID: 24898888 DOI: 10.1111/ijcp.12474] [Citation(s) in RCA: 26] [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] [Received: 12/23/2013] [Accepted: 05/06/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Procalcitonin (PCT) has previously been proposed as useful marker to rule out bloodstream-infection (BSI). The objective of this study was to evaluate the sensitivity of different PCT cut-offs for prediction of BSI in patients with community (CA)- and hospital-acquired (HA)-BSI. METHODS A total of 898 patients fulfilling systemic-inflammatory-response-syndrome (SIRS) criteria were enrolled in this prospective cohort study at the Medical University of Graz, Austria. Of those 666 patients had positive blood cultures (282 CA-BSI, 384 HA-BSI, enrolled between January 2011 and December 2012) and 232 negative blood cultures (enrolled between January 2011 and July 2011 at the emergency department). Blood samples for determination of laboratory infection markers (e.g. PCT) were collected simultaneously with blood cultures. RESULTS Procalcitonin was significantly (p < 0.001) higher in SIRS patients with bacteremia/fungemia than in those without. Receiver operating characteristic curve analysis revealed an area under the curve (AUC) value of 0.675 for PCT (95% CI 0.636-0.714) for differentiating patients with BSI from those without. AUC for IL-6 was 0.558 (95% CI 0.515-0.600). However, even at the lowest cut-off evaluated (i.e. 0.1 ng/ml) PCT failed to predict BSI in 7% (n = 46) of patients. In the group of patients with SIRS and negative blood culture 79% (n = 185) had PCT levels > 0.1. CONCLUSION Procalcitonin was significantly higher in patients with BSI than in those without and superior to IL-6 and CRP. The clinical importance of this is questionable, because a suitable PCT threshold for excluding BSI was not established. An approach where blood cultures are guided by PCT only can therefore not be recommended.
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Affiliation(s)
- M Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Le Cesne A, Blay J, Ryckewaert T, Chevreau C, Bertucci F, Delcambre C, Saada E, Piperno-Neumann S, Bay J, Mir O, Domont J, Ray-Coquard I, Valentin T, Tresch E, Clisant S, Isambert N, Italiano A, Clisant S, Badri N, Penel N. Benefit of Maintenance Therapy with Trabectedin (T) Beyond the 6 First Cycles: Results of a Prospective Randomized Phase Ii Trial Comparing Interruption Vs. Continuation of T in Patients (Pts) with Advanced Soft Tissue Sarcoma (Asts): an Update. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu354.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Krause R, Valentin T, Hönigl M, Zollner-Schwetz I. Differential time to positivity is not predictive for central line-related Staphylococcus aureus bloodstream infection in routine clinical care. J Infect 2014; 69:293-4. [DOI: 10.1016/j.jinf.2014.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/19/2014] [Indexed: 11/30/2022]
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Hoenigl M, Wagner J, Raggam RB, Prueller F, Prattes J, Eigl S, Leitner E, Hönigl K, Valentin T, Zollner-Schwetz I, Grisold AJ, Krause R. Characteristics of hospital-acquired and community-onset blood stream infections, South-East Austria. PLoS One 2014; 9:e104702. [PMID: 25105287 PMCID: PMC4126753 DOI: 10.1371/journal.pone.0104702] [Citation(s) in RCA: 26] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 07/16/2014] [Indexed: 01/21/2023] Open
Abstract
Purpose The objective of this study was to compare epidemiology, causative pathogens, outcome, and levels of laboratory markers of inflammation of community-onset (i.e. community-acquired and healthcare-associated) and hospital-acquired bloodstream infection (BSI) in South-East Austria. Methods In this prospective cohort study, 672 patients fulfilling criteria of systemic inflammatory response syndrome with positive peripheral blood cultures (277 community-onset [192 community-acquired, 85 healthcare-associated BSI], 395 hospital-acquired) were enrolled at the Medical University of Graz, Austria from 2011 throughout 2012. Clinical, microbiological, demographic as well as outcome and laboratory data was collected. Results Escherichia coli followed by Staphylococcus aureus were the most frequently isolated pathogens. While Streptococcus spp. and Escherichia coli were isolated more frequently in patients with community-onset BSI, Enterococcus spp., Candida spp., Pseudomonas spp., Enterobacter spp., and coagulase-negative staphylococci were isolated more frequently among those with hospital-acquired BSI. With regard to the outcome, 30-day (82/395 vs. 31/277; p = 0.001) and 90-day mortality (106/395 vs. 35/277; p<0.001) was significantly higher among patients with hospital-acquired BSI even though these patients were significantly younger. Also, hospital-acquired BSI remained a significant predictor of mortality in multivariable analysis. At the time the blood cultures were drawn, patients with community-onset BSI had significantly higher leukocyte counts, neutrophil-leucocyte ratios as well as C-reactive protein, procalcitonin, interleukin-6 and serum creatinine levels when compared to those with hospital-acquired BSI. Patients with healthcare-associated BSI presented with significantly higher PCT and creatinine levels than those with community-acquired BSI. Conclusions Hospital-acquired BSI was associated with significantly higher 30- and 90-day mortality rates. Hospital-acquired BSI therefore poses an important target for the most aggressive strategies for prevention and infection control.
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Affiliation(s)
- Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
- Division of Pulmonology, Medical University of Graz, Graz, Austria
- Division of Infectious Diseases, University of California San Diego, San Diego, California, United States of America
- * E-mail: (RK); (MH)
| | - Jasmin Wagner
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Reinhard B. Raggam
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Florian Prueller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Susanne Eigl
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Eva Leitner
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Katharina Hönigl
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Andrea J. Grisold
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
- * E-mail: (RK); (MH)
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Prattes J, Hoenigl M, Rabensteiner J, Raggam RB, Prueller F, Zollner-Schwetz I, Valentin T, Hönigl K, Fruhwald S, Krause R. Serum 1,3-beta-d-glucan for antifungal treatment stratification at the intensive care unit and the influence of surgery. Mycoses 2014; 57:679-86. [PMID: 25040144 DOI: 10.1111/myc.12221] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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: 05/01/2014] [Revised: 06/18/2014] [Accepted: 06/26/2014] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate a preemptive approach with serum 1,3-beta-d-glucan (BDG) as a marker for treatment stratification of systemic antifungal (AF) therapy in patients with clinical suspected invasive fungal infections (IFI) at intensive care units (ICU), and the impact of surgical procedures. A total of 66 ICU patients with clinical suspected IFI were included in this retrospective analysis. Serum BDG testing was performed prior to initiation of AF treatment and in addition to routine diagnostic measures. Based on the BDG results the initial clinical decision whether or not to start systemic AF therapy was re-evaluated. Impact of surgical procedures on clinical utility of serum BDG was evaluated in a sub-group of 25 patients who had undergone surgical procedures prior to BDG evaluation. BDG test results led to discontinuation of AF therapy in 13 patients, and initiation of AF therapy in seven patients. In 46 patients the clinical decision was confirmed by BDG. The majority of suspected, probable and proven IFI cases (10/13, 77%) was predicted by the test. BDG testing turned out positive in 9/25 (36%) of patients that had undergone recent surgery and levels correlated with clinical findings. Serum BDG evaluation seems to be a promising tool to guide AF therapy in ICU patients even after recent surgical procedures.
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Affiliation(s)
- Jürgen Prattes
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
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Amrein K, Zajic P, Schnedl C, Waltensdorfer A, Fruhwald S, Holl A, Purkart T, Wünsch G, Valentin T, Grisold A, Stojakovic T, Amrein S, Pieber TR, Dobnig H. Vitamin D status and its association with season, hospital and sepsis mortality in critical illness. Crit Care 2014; 18:R47. [PMID: 24661739 PMCID: PMC4057427 DOI: 10.1186/cc13790] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 03/05/2014] [Indexed: 12/15/2022]
Abstract
Introduction Vitamin D plays a key role in immune function. Deficiency may aggravate the incidence and outcome of infectious complications in critically ill patients. We aimed to evaluate the prevalence of vitamin D deficiency and the correlation between serum 25-hydroxyvitamin D (25(OH) D) and hospital mortality, sepsis mortality and blood culture positivity. Methods In a single-center retrospective observational study at a tertiary care center in Graz, Austria, 655 surgical and nonsurgical critically ill patients with available 25(OH) D levels hospitalized between September 2008 and May 2010 were included. Cox regression analysis adjusted for age, gender, severity of illness, renal function and inflammatory status was performed. Vitamin D levels were categorized by month-specific tertiles (high, intermediate, low) to reflect seasonal variation of serum 25(OH) D levels. Results Overall, the majority of patients were vitamin D deficient (<20 ng/ml; 60.2%) or insufficient (≥20 and <30 ng/dl; 26.3%), with normal 25(OH) D levels (>30 ng/ml) present in only 13.6%. The prevalence of vitamin D deficiency and mean 25(OH) D levels was significantly different in winter compared to summer months (P <0.001). Hospital mortality was 20.6% (135 of 655 patients). Adjusted hospital mortality was significantly higher in patients in the low (hazard ratio (HR) 2.05, 95% confidence interval (CI) 1.31 to 3.22) and intermediate (HR 1.92, 95% CI 1.21 to 3.06) compared to the high tertile. Sepsis was identified as cause of death in 20 of 135 deceased patients (14.8%). There was no significant association between 25(OH) D and C-reactive protein (CRP), leukocyte count or procalcitonin levels. In a subgroup analysis (n = 244), blood culture positivity rates did not differ between tertiles (23.1% versus 28.2% versus 17.1%, P = 0.361). Conclusions Low 25(OH) D status is significantly associated with mortality in the critically ill. Intervention studies are needed to investigate the effect of vitamin D substitution on mortality and sepsis rates in this population.
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