Fungal osteomyelitis is uncommon after cardiac surgery. A case of Candida albicans and S. epiderm... more Fungal osteomyelitis is uncommon after cardiac surgery. A case of Candida albicans and S. epidermidis osteomyelitis with device infection after implantation of a left ventricular assist device in a male patient is presented. After confirmation with microbiological and radiological examinations, debridement was performed. Surgical specimens grew C. albicans and S. epidermidis. Fluconazole, daptomycin and negative pressure wound therapy failed to achieve healing. Total sternectomy and pectoralis muscle flap reconstruction were performed. There was no recurrent infection for C. albicans on a prolonged antifungal regime. The combination of antifungal therapy and aggressive surgical debridement may be useful to control fungal osteomyelitis.
Background:Infective endocarditis is a major threat after prosthetic pulmonary valve replacement.... more Background:Infective endocarditis is a major threat after prosthetic pulmonary valve replacement. Early diagnosis may improve outcomes.Methods:A structured patient education programme for prevention and early diagnosis of infective endocarditis was developed at our institution since 2016. Time delay between onset of symptoms of prosthetic pulmonary valve endocarditis and its diagnosis (defined as initiation of appropriate high-dose intravenous antibiotic treatment) was compared for patients presenting before (cohort 1) and after (cohort 2) initiation of the patient education programme.Results:Between 2008–2019, 26 patients (median age 24.9, range: 16.8–62.0 years, 73% male) were diagnosed with prosthetic pulmonary valve endocarditis, 13 patients (cohort 1) before (1.7 cases/year) and 13 patients (cohort 2) after June 2016 (3.7 cases/year). There were no differences in baseline characteristics or clinical presentation between the study cohorts. Overall, the median delay between onset...
ZusammenfassungGefäß(endo)protheseninfektionen (GEPI) nach offener Chirurgie oder nach interventi... more ZusammenfassungGefäß(endo)protheseninfektionen (GEPI) nach offener Chirurgie oder nach interventioneller Behandlung sind gefürchtete Komplikationen mit weitreichenden Konsequenzen für die betroffenen Patienten. Die Morbiditäts- und Mortalitätsraten des heute immer noch weitgehend gültigen Goldstandards, nämlich die radikale Prothesenentfernung mit in-situ oder extraanatomischer Rekonstruktion, teilweise kombiniert mit plastisch-chirurgischer Deckung, sind generell hoch. 2013 initiierten wir am Universitätsspital Zürich (USZ) deshalb die prospektive Vascular-Graft-(VASGRA)-Kohortenstudie mit dem Ziel, generell vorhandene Unsicherheiten und Unklarheiten bezüglich GEPI zu erforschen und einen allgemeingültigen Managementpfad für GEPI Szilagyi Grad 3 bzw. Samson Grad 3–5 zu entwickeln. Der neue Ansatz bestand darin, extra- und intrakavitäre GEPI mit einem möglichst minimal-invasiven, die Prothese erhaltenden oder teilerhaltenden Konzept unter lokaler NPWT multidisziplinär zu behandeln u...
OBJECTIVES In multiple countries, endovascular/disseminated Mycobacterium chimaera infections hav... more OBJECTIVES In multiple countries, endovascular/disseminated Mycobacterium chimaera infections have occurred in post-cardiac surgery patients in association with contaminated, widely-distributed cardiac bypass heater-cooler devices. To contribute to long-term characterization of this recently recognized infection, we describe the clinical course of 28 patients with 3-7 years of follow-up for survivors. METHODS Identified at five hospitals in the United States 2010-2016, post-cardiac surgery patients in the cohort had growth of Mycobacterium avium complex (MAC)/M. chimaera from a sterile site or surgical wound, or a clinically compatible febrile illness with granulomatous inflammation on biopsy. Case follow-up was conducted in May 2019. RESULTS Of 28 patients, infection appeared to be localized to the sternum in four patients. Among 18 with endovascular/disseminated infection who received combination anti-mycobacterial treatment and had sufficient follow-up, 39% appeared to have controlled infection (>12 months), 56% died, and one patient is alive with relapsed bacteremia. While the number of patients is small and interpretation is limited, four (67%) of six patients who had cardiac prosthesis removal/replacement appeared to have controlled infection compared to three (25%) of 12 with retained cardiac prosthesis (p >0.14; Fisher's exact test). CONCLUSIONS Given poor response to treatment and potential for delayed relapses, post-cardiac surgery M. chimaera infection warrants aggressive treatment and long-term monitoring.
Prosthetic vascular graft infections of the thoracic aorta are rare but can be fatal. Our compari... more Prosthetic vascular graft infections of the thoracic aorta are rare but can be fatal. Our comparison of collagen-and gelatin-coated grafts showed that collagen-coated grafts were associated with increased biofilm formation and bacterial adherence in vitro and with higher rates of perioperative vascular graft infections in vivo.
Background Hazardous alcohol consumption and HIV infection increase the risk of neurocognitive im... more Background Hazardous alcohol consumption and HIV infection increase the risk of neurocognitive impairment (NCI). We examined the association between alcohol consumption and specific neurocognitive domain function in people with HIV (PWH) taking modern antiretroviral therapy. Methods The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study is a prospective, longitudinal, multicentre and multilingual (French, German and Italian) study of patients aged ≥45 years old enrolled in the Swiss HIV Cohort Study (SHCS). Baseline data from 981 study participants were examined. Five neurocognitive domains were evaluated: motor skills, speed of information processing, attention/working memory, executive function and verbal episodic memory. NCI was examined as binary (presence/absence) and continuous (mean z-score) outcomes against Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) scores using logistic and linear regression models, respectively. Results Most...
European Journal of Vascular and Endovascular Surgery, 2021
OBJECTIVE The timely management of vascular graft/endograft infection (VGEI) is crucial to a favo... more OBJECTIVE The timely management of vascular graft/endograft infection (VGEI) is crucial to a favourable outcome, yet can be challenging as there is no validated gold standard diagnostic test. Recently, a new case definition has been proposed by the Management of Aortic Graft Infection Collaboration (MAGIC) to close the diagnostic gap. The aim of this study was to validate the MAGIC criteria as a suggested diagnostic standard for the diagnosis of suspected VGEI in the prospective Vascular Graft Cohort study (VASGRA). METHODS VASGRA is an open, prospective, observational cohort study. Prospective participants in VASGRA between 2013 and 2019 were included (257 patients; 137 with VGEI). The accuracy of the MAGIC criteria for a diagnosis of VGEI was evaluated retrospectively by calculating the sensitivity and specificity vs. the consensually adjudicated VASGRA infection status. RESULTS The VASGRA cohort categorised 137 (53.3%) patients as "diseased" and 120 patients as "not diseased"; using the MAGIC criteria, 183/257 (71.2%) patients were considered to be "diseased". Thus, for the MAGIC criteria, a sensitivity of 99% (95% confidence interval [CI] 96-100) and a specificity of 61% (95% CI 52-70) were calculated. Considering suspected VGEI according to the MAGIC criteria as "not diseased" achieved congruent assessments of the VASGRA team and the MAGIC criteria, with a sensitivity of 93% and a specificity of 93%. The accuracy of the MAGIC criteria for the different graft locations were also compared. If the suspected VGEIs were assigned to the "not diseased" group, VGEIs of the thoracic aorta seemed to have a poorer sensitivity (86%; 95% CI 73-95) than the other graft locations. CONCLUSION The current MAGIC criteria offer good sensitivity and specificity in the context of true infections but a reduced specificity for a possible VGEI.
Background: Late 2019, a new highly contagious coronavirus SARS-CoV-2 has emerged in Wuhan, China... more Background: Late 2019, a new highly contagious coronavirus SARS-CoV-2 has emerged in Wuhan, China, causing within 2 months a pandemic with the highest disease burden in elderly and people with pre-existing medical conditions. The pandemic has highlighted that new and more flexible clinical trial approaches, such as trial platforms, are needed to assess the efficacy and safety of interventions in a timely manner. The two existing Swiss cohorts of immunocompromised patients (i.e., Swiss HIV Cohort Study (SHCS) and Swiss Transplant Cohort Study (STCS)) are an ideal foundation to setup a trial platform in Switzerland leveraging routinely collected data. Within a newly founded trial platform, we plan to assess the efficacy of the first two mRNA SARS-CoV-2 vaccines that reached market authorization in Switzerland in the frame of a pilot randomized controlled trial (RCT) while at the same time assessing the functionality of the trial platform.
The aim of the study was to determine the role of 18 F-fluorodeoxyglucose (FDG) positron emission... more The aim of the study was to determine the role of 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) at the end of benzimidazole therapy in alveolar echinococcosis. Methods: A total of 22 patients undergoing PET/CT at the end of benzimidazole therapy were retrospectively registered. Maximum standardized uptake values (SUV max) were measured in remaining echinococcus manifestations and compared to normal liver tissue. Long-term clinical follow-up was performed, and recorded data included laboratory parameters, clinical information and imaging. Results: All patients had no detectable levels of Em-18 antibodies and all echinococcus manifestations were negative on PET/CT, i.e. without focally increased FDG uptake or uptake higher than normal/non-infected liver tissue. All manifestations displayed significantly less FDG-uptake than normal liver tissue, i.e. SUVmax 1.8 (interquartile range (IQR) 1.5-3.5) vs. 3.0 (IQR 2.6-5.7), (p < 0.001). Patients were clinically followed for a median of 9.5 years (IQR 6.5-32.0 years) after their initial diagnosis and for 4.5 years (IQR 3.0-14.0 years) after discontinuation of benzimidazole therapy. No patient showed signs of recurrent infection at the last clinical visit. The 10-year and 20-year freedom from all-cause mortality was 95.0% (95% confidence interval 69.5%-99.3%), for both. Two events occurred in 292 patient years of follow-up; i.e. two patients (9%) died, one because of pancreatic cancer, the other one because of unknown reasons with no detectable antibody levels. Conclusions: Negative FDG-PET/CT results combined with no detectable levels of Em-18 antibodies may allow for the safe discontinuation of benzimidazole therapy in patients with alveolar echinococcosis.
Objective: Vascular graft infections (VGIs) lead to increased morbidity and mortality, and elderl... more Objective: Vascular graft infections (VGIs) lead to increased morbidity and mortality, and elderly and comorbid patients are often affected. Negative pressure wound therapy (NPWT) is increasingly used for VGI, and some authors even advocate that a better surgical treatment option is NPWT, débridement, and graft preservation compared with more aggressive approaches in case of VGI with intact anastomosis (Samson III infection). We aimed to assess the effect of NWPT in a large cohort of patients with VGI. Methods: Participants of the prospective Vascular Graft Infection Cohort Study (VASGRA) with vascular surgery between March 2013 and March 2017 were included. Observation time was calculated from the end of surgical treatment after diagnosis of VGI to the end of antimicrobial therapy (cure of infection) or last follow-up, whichever occurred first. Patient-and procedure-related variables were assessed by NPWT status (yes/no), location of VGI (aortoiliac, thoracic, or infrainguinal), or surgical procedure (débridement and retention of graft; partial or total explantation of graft) using nonparametric tests. We performed Kaplan-Meier curves and univariable and multivariable Cox proportional hazards regression models. Results: A total of 175, predominantly male (77%) patients with a median age of 67 years contributed to the analysis. Thereof, only 15 patients (8.3%) died of VGI after a follow-up time of 2.2 years. A surgical procedure was performed in 145 of 175 (83%) patients. The graft could be retained and débrided in 78 of 145 (54%) patients, whereas 67 (46%) patients had a partial (n ¼ 12) or complete graft excision (n ¼ 55). NPTW therapy showed an association with cure of infection (Fig) in patients with infrainguinal NPWT treatment (adjusted hazard ratio [aHR], 3.42; 95% confidence interval [CI], 1.37-8.60]; P ¼ .009) and female sex (aHR, 1.74; 95% CI, 1.02-2.97; P ¼ .042). There was no association of cure with NPWT for thoracic (aHR, 0.49; 95% CI, 0.13-1.85; P ¼ .296) or abdominal VGI (aHR, 1.38; 95% CI, 0.57-3.34; P ¼ .471). Conclusions: Multistaged NPWT treatment for downgrading of the infections was associated with a much lower VGI mortality than before.
Primary and hospital care: médecine interne générale, 2020
Plusieurs décennies d'expérience et de nouvelles études randomisées montrent qu'une cystite non c... more Plusieurs décennies d'expérience et de nouvelles études randomisées montrent qu'une cystite non compliquée peut en principe être traitée avec succès sans recourir à des antibiotiques chez les femmes en bonne santé, et qui ne sont pas enceintes. Le diagnostic, la communication avec la patiente, un traitement efficace des symptômes ainsi qu'un suivi rapproché pour détecter une éventuelle complication sont essentiels et permettront de détecter les rares (5%) femmes qui, sans antibiotiques, pourraient développer une pyélonéphrite.
Background: Since the advent of combination antiretroviral therapy (cART), non-AIDS defining mali... more Background: Since the advent of combination antiretroviral therapy (cART), non-AIDS defining malignancies (NADM) have become increasingly important. We examined risk factors for NADM, including immunological, virological and socio-behavioral characteristics. Methods: We linked the Swiss HIV Cohort Study (SHCS) with cancer registries to identify incident cancers between 1996 and 2012. We analyzed four common NADM: anal, lung, prostate, and liver cancer. We calculated standardized incidence ratios (SIRs) and assessed the effect of time-updated CD4 and CD8 count, CD4/CD8 ratio, and HIV viral load (copies/ml) in Cox regression models. We lagged time-dependent variables for 12, 24, and 36 months and captured cumulative exposures using simple moving averages (SMA). In multivariable models, we also considered HIV transmission group, smoking, and chronic hepatitis B or C infection as potential predictors of NADM incidence. Results. Between 1996 and 2012, 563 HIV-infected individuals develo...
Novelty and impact: Our study compares invasive cervical cancer (ICC) rates among women living wi... more Novelty and impact: Our study compares invasive cervical cancer (ICC) rates among women living with HIV who initiated antiretroviral therapy (ART) across different geographic regions. It shows that ICC incidence rates are particularly high in women living with HIV in South Africa or Latin America. ICC prevention through early ART initiation, equitable access to effective cervical cancer screening, and promotion of human papillomavirus vaccination should be key elements of global efforts to reduce cancer-related health inequities.
Fungal osteomyelitis is uncommon after cardiac surgery. A case of Candida albicans and S. epiderm... more Fungal osteomyelitis is uncommon after cardiac surgery. A case of Candida albicans and S. epidermidis osteomyelitis with device infection after implantation of a left ventricular assist device in a male patient is presented. After confirmation with microbiological and radiological examinations, debridement was performed. Surgical specimens grew C. albicans and S. epidermidis. Fluconazole, daptomycin and negative pressure wound therapy failed to achieve healing. Total sternectomy and pectoralis muscle flap reconstruction were performed. There was no recurrent infection for C. albicans on a prolonged antifungal regime. The combination of antifungal therapy and aggressive surgical debridement may be useful to control fungal osteomyelitis.
Background:Infective endocarditis is a major threat after prosthetic pulmonary valve replacement.... more Background:Infective endocarditis is a major threat after prosthetic pulmonary valve replacement. Early diagnosis may improve outcomes.Methods:A structured patient education programme for prevention and early diagnosis of infective endocarditis was developed at our institution since 2016. Time delay between onset of symptoms of prosthetic pulmonary valve endocarditis and its diagnosis (defined as initiation of appropriate high-dose intravenous antibiotic treatment) was compared for patients presenting before (cohort 1) and after (cohort 2) initiation of the patient education programme.Results:Between 2008–2019, 26 patients (median age 24.9, range: 16.8–62.0 years, 73% male) were diagnosed with prosthetic pulmonary valve endocarditis, 13 patients (cohort 1) before (1.7 cases/year) and 13 patients (cohort 2) after June 2016 (3.7 cases/year). There were no differences in baseline characteristics or clinical presentation between the study cohorts. Overall, the median delay between onset...
ZusammenfassungGefäß(endo)protheseninfektionen (GEPI) nach offener Chirurgie oder nach interventi... more ZusammenfassungGefäß(endo)protheseninfektionen (GEPI) nach offener Chirurgie oder nach interventioneller Behandlung sind gefürchtete Komplikationen mit weitreichenden Konsequenzen für die betroffenen Patienten. Die Morbiditäts- und Mortalitätsraten des heute immer noch weitgehend gültigen Goldstandards, nämlich die radikale Prothesenentfernung mit in-situ oder extraanatomischer Rekonstruktion, teilweise kombiniert mit plastisch-chirurgischer Deckung, sind generell hoch. 2013 initiierten wir am Universitätsspital Zürich (USZ) deshalb die prospektive Vascular-Graft-(VASGRA)-Kohortenstudie mit dem Ziel, generell vorhandene Unsicherheiten und Unklarheiten bezüglich GEPI zu erforschen und einen allgemeingültigen Managementpfad für GEPI Szilagyi Grad 3 bzw. Samson Grad 3–5 zu entwickeln. Der neue Ansatz bestand darin, extra- und intrakavitäre GEPI mit einem möglichst minimal-invasiven, die Prothese erhaltenden oder teilerhaltenden Konzept unter lokaler NPWT multidisziplinär zu behandeln u...
OBJECTIVES In multiple countries, endovascular/disseminated Mycobacterium chimaera infections hav... more OBJECTIVES In multiple countries, endovascular/disseminated Mycobacterium chimaera infections have occurred in post-cardiac surgery patients in association with contaminated, widely-distributed cardiac bypass heater-cooler devices. To contribute to long-term characterization of this recently recognized infection, we describe the clinical course of 28 patients with 3-7 years of follow-up for survivors. METHODS Identified at five hospitals in the United States 2010-2016, post-cardiac surgery patients in the cohort had growth of Mycobacterium avium complex (MAC)/M. chimaera from a sterile site or surgical wound, or a clinically compatible febrile illness with granulomatous inflammation on biopsy. Case follow-up was conducted in May 2019. RESULTS Of 28 patients, infection appeared to be localized to the sternum in four patients. Among 18 with endovascular/disseminated infection who received combination anti-mycobacterial treatment and had sufficient follow-up, 39% appeared to have controlled infection (>12 months), 56% died, and one patient is alive with relapsed bacteremia. While the number of patients is small and interpretation is limited, four (67%) of six patients who had cardiac prosthesis removal/replacement appeared to have controlled infection compared to three (25%) of 12 with retained cardiac prosthesis (p >0.14; Fisher's exact test). CONCLUSIONS Given poor response to treatment and potential for delayed relapses, post-cardiac surgery M. chimaera infection warrants aggressive treatment and long-term monitoring.
Prosthetic vascular graft infections of the thoracic aorta are rare but can be fatal. Our compari... more Prosthetic vascular graft infections of the thoracic aorta are rare but can be fatal. Our comparison of collagen-and gelatin-coated grafts showed that collagen-coated grafts were associated with increased biofilm formation and bacterial adherence in vitro and with higher rates of perioperative vascular graft infections in vivo.
Background Hazardous alcohol consumption and HIV infection increase the risk of neurocognitive im... more Background Hazardous alcohol consumption and HIV infection increase the risk of neurocognitive impairment (NCI). We examined the association between alcohol consumption and specific neurocognitive domain function in people with HIV (PWH) taking modern antiretroviral therapy. Methods The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study is a prospective, longitudinal, multicentre and multilingual (French, German and Italian) study of patients aged ≥45 years old enrolled in the Swiss HIV Cohort Study (SHCS). Baseline data from 981 study participants were examined. Five neurocognitive domains were evaluated: motor skills, speed of information processing, attention/working memory, executive function and verbal episodic memory. NCI was examined as binary (presence/absence) and continuous (mean z-score) outcomes against Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) scores using logistic and linear regression models, respectively. Results Most...
European Journal of Vascular and Endovascular Surgery, 2021
OBJECTIVE The timely management of vascular graft/endograft infection (VGEI) is crucial to a favo... more OBJECTIVE The timely management of vascular graft/endograft infection (VGEI) is crucial to a favourable outcome, yet can be challenging as there is no validated gold standard diagnostic test. Recently, a new case definition has been proposed by the Management of Aortic Graft Infection Collaboration (MAGIC) to close the diagnostic gap. The aim of this study was to validate the MAGIC criteria as a suggested diagnostic standard for the diagnosis of suspected VGEI in the prospective Vascular Graft Cohort study (VASGRA). METHODS VASGRA is an open, prospective, observational cohort study. Prospective participants in VASGRA between 2013 and 2019 were included (257 patients; 137 with VGEI). The accuracy of the MAGIC criteria for a diagnosis of VGEI was evaluated retrospectively by calculating the sensitivity and specificity vs. the consensually adjudicated VASGRA infection status. RESULTS The VASGRA cohort categorised 137 (53.3%) patients as "diseased" and 120 patients as "not diseased"; using the MAGIC criteria, 183/257 (71.2%) patients were considered to be "diseased". Thus, for the MAGIC criteria, a sensitivity of 99% (95% confidence interval [CI] 96-100) and a specificity of 61% (95% CI 52-70) were calculated. Considering suspected VGEI according to the MAGIC criteria as "not diseased" achieved congruent assessments of the VASGRA team and the MAGIC criteria, with a sensitivity of 93% and a specificity of 93%. The accuracy of the MAGIC criteria for the different graft locations were also compared. If the suspected VGEIs were assigned to the "not diseased" group, VGEIs of the thoracic aorta seemed to have a poorer sensitivity (86%; 95% CI 73-95) than the other graft locations. CONCLUSION The current MAGIC criteria offer good sensitivity and specificity in the context of true infections but a reduced specificity for a possible VGEI.
Background: Late 2019, a new highly contagious coronavirus SARS-CoV-2 has emerged in Wuhan, China... more Background: Late 2019, a new highly contagious coronavirus SARS-CoV-2 has emerged in Wuhan, China, causing within 2 months a pandemic with the highest disease burden in elderly and people with pre-existing medical conditions. The pandemic has highlighted that new and more flexible clinical trial approaches, such as trial platforms, are needed to assess the efficacy and safety of interventions in a timely manner. The two existing Swiss cohorts of immunocompromised patients (i.e., Swiss HIV Cohort Study (SHCS) and Swiss Transplant Cohort Study (STCS)) are an ideal foundation to setup a trial platform in Switzerland leveraging routinely collected data. Within a newly founded trial platform, we plan to assess the efficacy of the first two mRNA SARS-CoV-2 vaccines that reached market authorization in Switzerland in the frame of a pilot randomized controlled trial (RCT) while at the same time assessing the functionality of the trial platform.
The aim of the study was to determine the role of 18 F-fluorodeoxyglucose (FDG) positron emission... more The aim of the study was to determine the role of 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) at the end of benzimidazole therapy in alveolar echinococcosis. Methods: A total of 22 patients undergoing PET/CT at the end of benzimidazole therapy were retrospectively registered. Maximum standardized uptake values (SUV max) were measured in remaining echinococcus manifestations and compared to normal liver tissue. Long-term clinical follow-up was performed, and recorded data included laboratory parameters, clinical information and imaging. Results: All patients had no detectable levels of Em-18 antibodies and all echinococcus manifestations were negative on PET/CT, i.e. without focally increased FDG uptake or uptake higher than normal/non-infected liver tissue. All manifestations displayed significantly less FDG-uptake than normal liver tissue, i.e. SUVmax 1.8 (interquartile range (IQR) 1.5-3.5) vs. 3.0 (IQR 2.6-5.7), (p < 0.001). Patients were clinically followed for a median of 9.5 years (IQR 6.5-32.0 years) after their initial diagnosis and for 4.5 years (IQR 3.0-14.0 years) after discontinuation of benzimidazole therapy. No patient showed signs of recurrent infection at the last clinical visit. The 10-year and 20-year freedom from all-cause mortality was 95.0% (95% confidence interval 69.5%-99.3%), for both. Two events occurred in 292 patient years of follow-up; i.e. two patients (9%) died, one because of pancreatic cancer, the other one because of unknown reasons with no detectable antibody levels. Conclusions: Negative FDG-PET/CT results combined with no detectable levels of Em-18 antibodies may allow for the safe discontinuation of benzimidazole therapy in patients with alveolar echinococcosis.
Objective: Vascular graft infections (VGIs) lead to increased morbidity and mortality, and elderl... more Objective: Vascular graft infections (VGIs) lead to increased morbidity and mortality, and elderly and comorbid patients are often affected. Negative pressure wound therapy (NPWT) is increasingly used for VGI, and some authors even advocate that a better surgical treatment option is NPWT, débridement, and graft preservation compared with more aggressive approaches in case of VGI with intact anastomosis (Samson III infection). We aimed to assess the effect of NWPT in a large cohort of patients with VGI. Methods: Participants of the prospective Vascular Graft Infection Cohort Study (VASGRA) with vascular surgery between March 2013 and March 2017 were included. Observation time was calculated from the end of surgical treatment after diagnosis of VGI to the end of antimicrobial therapy (cure of infection) or last follow-up, whichever occurred first. Patient-and procedure-related variables were assessed by NPWT status (yes/no), location of VGI (aortoiliac, thoracic, or infrainguinal), or surgical procedure (débridement and retention of graft; partial or total explantation of graft) using nonparametric tests. We performed Kaplan-Meier curves and univariable and multivariable Cox proportional hazards regression models. Results: A total of 175, predominantly male (77%) patients with a median age of 67 years contributed to the analysis. Thereof, only 15 patients (8.3%) died of VGI after a follow-up time of 2.2 years. A surgical procedure was performed in 145 of 175 (83%) patients. The graft could be retained and débrided in 78 of 145 (54%) patients, whereas 67 (46%) patients had a partial (n ¼ 12) or complete graft excision (n ¼ 55). NPTW therapy showed an association with cure of infection (Fig) in patients with infrainguinal NPWT treatment (adjusted hazard ratio [aHR], 3.42; 95% confidence interval [CI], 1.37-8.60]; P ¼ .009) and female sex (aHR, 1.74; 95% CI, 1.02-2.97; P ¼ .042). There was no association of cure with NPWT for thoracic (aHR, 0.49; 95% CI, 0.13-1.85; P ¼ .296) or abdominal VGI (aHR, 1.38; 95% CI, 0.57-3.34; P ¼ .471). Conclusions: Multistaged NPWT treatment for downgrading of the infections was associated with a much lower VGI mortality than before.
Primary and hospital care: médecine interne générale, 2020
Plusieurs décennies d'expérience et de nouvelles études randomisées montrent qu'une cystite non c... more Plusieurs décennies d'expérience et de nouvelles études randomisées montrent qu'une cystite non compliquée peut en principe être traitée avec succès sans recourir à des antibiotiques chez les femmes en bonne santé, et qui ne sont pas enceintes. Le diagnostic, la communication avec la patiente, un traitement efficace des symptômes ainsi qu'un suivi rapproché pour détecter une éventuelle complication sont essentiels et permettront de détecter les rares (5%) femmes qui, sans antibiotiques, pourraient développer une pyélonéphrite.
Background: Since the advent of combination antiretroviral therapy (cART), non-AIDS defining mali... more Background: Since the advent of combination antiretroviral therapy (cART), non-AIDS defining malignancies (NADM) have become increasingly important. We examined risk factors for NADM, including immunological, virological and socio-behavioral characteristics. Methods: We linked the Swiss HIV Cohort Study (SHCS) with cancer registries to identify incident cancers between 1996 and 2012. We analyzed four common NADM: anal, lung, prostate, and liver cancer. We calculated standardized incidence ratios (SIRs) and assessed the effect of time-updated CD4 and CD8 count, CD4/CD8 ratio, and HIV viral load (copies/ml) in Cox regression models. We lagged time-dependent variables for 12, 24, and 36 months and captured cumulative exposures using simple moving averages (SMA). In multivariable models, we also considered HIV transmission group, smoking, and chronic hepatitis B or C infection as potential predictors of NADM incidence. Results. Between 1996 and 2012, 563 HIV-infected individuals develo...
Novelty and impact: Our study compares invasive cervical cancer (ICC) rates among women living wi... more Novelty and impact: Our study compares invasive cervical cancer (ICC) rates among women living with HIV who initiated antiretroviral therapy (ART) across different geographic regions. It shows that ICC incidence rates are particularly high in women living with HIV in South Africa or Latin America. ICC prevention through early ART initiation, equitable access to effective cervical cancer screening, and promotion of human papillomavirus vaccination should be key elements of global efforts to reduce cancer-related health inequities.
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Papers by Barbara Hasse