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Biomedical subjects

C Ruef

Publications and source records attributed to C Ruef.

At least 37 records · Page 2Linked to original sources
PubMed1999

Prospective evaluation of a hospital epidemiologist's activities at a European tertiary-care medical center.

OBJECTIVE: Assessment of the distribution of tasks and consultations provided by the hospital epidemiologist (HE) at University Hospital of Zurich (UHZ). DESIGN: Prospective collection of data on hospital epidemiology consultations over a 3-year period (1995-1997). Time spent per consultation and activities of infection control practitioners were not recorded. SETTING: A 1,040-bed tertiary-care university hospital in Zurich, Switzerland. RESULTS: Between January 1, 1995, and December 31, 1997, the HE received 1,660 requests for consultation. Advice or action was sought in the following areas: epidemiology (27.5% of requests); quality assurance, including antibiotic utilization and technology assessment (24.8%); infection control and practice guidelines (22.5%); disinfection and sterilization (11.6%); clinical infectious diseases (13.4%). During 1997, 35% of epidemiology consults were related to methicillin-resistant Staphylococcus aureus and 5.8% to tuberculosis. Public or private hospitals not affiliated with UHZ requested 40% of all consults. CONCLUSIONS: This study shows that HEs are involved in many different activities. Only 27.5% of hospital epidemiology consultations were directly related to issues of epidemiology. Practical knowledge of the methodologies for continuous quality improvement and assessment of various new technologies is important for HEs. The results of this study may be useful in discussions between HEs and administrators about allocation of resources or issues of reimbursement.

Epidemiology↗
PubMed1999

Septicemia caused by dysgonic fermenter 3 in a severely immunocompromised patient and isolation of the same microorganism from a stool specimen.

Dysgonic fermenter 3 (DF-3)-associated bacteremia occurred in a febrile patient with acute myelocytic leukemia during aplasia. Another DF-3 isolate, identical by ribotyping, was grown 10 weeks later from stool collected in the absence of diarrhea. This is the first case in which DF-3 was isolated from blood and stool specimens from the same patient.

Bacteremia↗
PubMed1998

Cryopreserved arterial allografts in the treatment of major vascular infection: a comparison with conventional surgical techniques.

OBJECTIVE: Recent findings with cryopreserved heart valve allografts in the treatment of infectious endocarditis suggest that the use of cryopreserved arterial allografts may improve the outcome in patients with vascular infections. METHODS: Seventy-two patients with mycotic aneurysms (n = 29) or infected vascular prostheses (n = 43) of the thoracic (n = 26) or abdominal aorta (n = 46) were treated with in situ repair and extra-anatomic reconstruction using prosthetic material (n = 38) or implantation of a cryopreserved arterial allograft (n = 34). Disease-related survival and survival free of reoperation were assessed. Morbidity, cumulative lengths of intensive care, hospitalization, antibiotic treatment, and costs were calculated per year of follow-up. RESULTS: The use of cryopreserved arterial allografts was superior to conventional surgery in terms of disease-related survival (P =.008), disease-related survival free of reoperation (P =.0001), duration of intensive care per year of follow-up (median 1 vs 11 days; range 1 to 42 vs 2 to 120 days; P =.001), hospitalization (14 vs 30 days; range 7 to 150 vs 15 to 240 days; P =.002), duration of postoperative antibiotic therapy (21 vs 40 days; range 21 to 90 vs 60 to 365 days; P =.002), incidence of complications (24% vs 63%; P =.005), and elimination of infection (91% vs 53%; P =.001). In addition, costs were 40% lower in the group treated by allografts (P =.005). CONCLUSIONS: The use of cryopreserved arterial allografts is a more effective treatment for mycotic aneurysms and infected vascular prostheses than conventional surgical techniques.

Adult↗
PubMed1997

Elevated serum macrophage inhibitory factor-related protein (MRP) 8/14 levels in advanced HIV infection and during disease exacerbation.

UNLABELLED: To assess the value of MRP 8, MRP 14, and MRP 8/14 serum concentrations as markers of disease progression in HIV infection and as markers of intercurrent infections. DESIGN: We measured MRP 8, MRP 14, and MRP 8/14 serum concentrations in 184 HIV-infected patients in various stages of disease with or without disease exacerbation and in 50 healthy control subjects. In clinically stable HIV-infection correlations of MRP levels with stage of HIV disease, CD4 counts, p24 antigen, and beta-2 microglobulin levels were studied. In patients with intercurrent illnesses, correlations of MRP levels with type of disease exacerbation and with CRP were calculated and compared with those found in stable HIV infection. RESULTS: MRP 8/14 levels were significantly elevated and MRP 8 levels slightly decreased in stable HIV infection compared with HIV-negative controls. The CD4 cell count and MRP 8/14 levels correlated significantly in patients with AIDS. Despite higher values of MRP 8/14 during advanced disease, these were not significant predictors of progression to death. In patients with acute infections, MRP 8/14 levels were significantly elevated, compared with patients with illnesses of noninfectious origin. Levels of MRP 8/14 associated with acute infections were significantly higher in patients with AIDS than in patients during earlier stages of HIV infection. CONCLUSIONS: Both stable HIV infection and advanced immunedeficiency are associated with an elevation of the MRP 8/14 complex and probably with a decline of MRP 8 serum levels. MRP 8/14 is preserved as a marker of acute infection in immunecompromised patients.

Acute Disease↗
PubMed1997

Mycobacterium smegmatis infection in a healthy woman following a facelift: case report and review of the literature.

In a 35-year-old female HIV-negative patient a facelift was followed by a Pseudomonas aeruginosa wound infection. The infection persisted despite treatment with ciprofloxacin, and an additional bacteriological wound examination revealed Mycobacterium smegmatis as the causative agent. Combination therapy with ciprofloxacin, doxycycline and amikacin led to a slow healing process without the need for further surgical intervention. A relapse 6 months after initial therapy was successfully treated with local measures. Infection with M. smegmatis might have come about by contaminated intraoperative liquids or the application of lipid creams to the open wound. However, microbiological examination of potential sources remained negative. Infection caused by M. smegmatis following plastic surgery should be considered in patients with spontaneous ulceration and violaceous discoloration of the skin adjacent to the surgical wound. Prolonged antibiotic therapy and possibly repeat surgical interventions may become necessary to treat this rare infection.

Adult↗
PubMed1996

Sternal wound infection after heart operations in pediatric patients associated with nasal carriage of Staphylococcus aureus.

A cluster of six pediatric cases of deep-seated Staphylococcus aureus infection after heart operations prompted us to perform molecular typing of the S. aureus isolates by pulsed-field gel electrophoresis. This revealed the presence of genotypically distinct isolates in four of the six patients. Isolates of two patients were genotypically identical. All patients carried S. aureus in the anterior nares. In each patient, the banding pattern of deoxyribonucleic acid in these isolates was indistinguishable from that in strains isolated from blood or wound cultures. Molecular typing with pulsed-field gel electrophoresis ruled out nosocomial transmission of S. aureus between four patients; at the same time, it provided evidence for an association between nasal colonization and postoperative wound infection. Epidemiologic investigation of potential links between two patients with identical isolates did not provide any evidence for nosocomial transmission of S. aureus between these patients. Because nasal colonization with S. aureus may be a risk factor for surgical wound infection in pediatric patients undergoing heart operations, preoperative decolonization appears to be warranted.

Anti-Bacterial Agents↗
PubMed1996

Infertility as the first symptom of male genitourinary tuberculosis.

The diagnosis of male genitourinary tuberculosis is seldom apparent until the disease is far advanced. The earliest clinical symptoms in most cases are epididymitis, dysuria, and hematuria. In the present case, evaluation of a 26-year-old male complaining about primary infertility revealed leukocytospermia and a normal sperm count. The diagnosis of genitourinary tuberculosis was based on positive morning urine culture. Infertility is an uncommon first sign of male genitourinary tuberculosis, but may be a clue to early diagnosis, as demonstrated in the present case.

Adult↗
PubMed1995

[Clinical value of a polymerase chain reaction on cytomegalovirus DNA in cerebrospinal fluid in HIV patients with neurological symptoms].

The value of the PCR for CMV in the CSF was evaluated. 23 samples from 20 patients were examined for CMV DNA, of which 11 were positive and 12 were negative for CMV. The clinical spectrum of the patients with positive samples included encephalitis, encephalitis, and polyradiculopathy, or isolated polyradiculopathy. The main symptoms were fever, confusion, lethargy, cognitive disturbance, cranial neuropathy, weakness of the legs, and incontinence. The laboratory evaluation showed a low CD4 lymphocyte count, a slightly increased blood sedimentation rate and a large variation of CSF patterns. The CMV early antigen tests were negative in all cases. In 4 cases the neuroradiological examination was compatible with CMV infection. 8 patients were treated with ganciclovir or foscarnet. Improvement of symptoms was observed in 2 cases and stabilization in 2 others. However, the CMV infection was rapidly progressive and 9 out of 10 patients died after a mean of 53 days after diagnosis.

AIDS Dementia Complex↗
PubMed1995

Endogenous TNF-alpha modulates the proliferation of rat mesangial cells and their prostaglandin E2 synthesis.

Mesangial cells (MC) are one cellular source of tumor necrosis factor alpha (TNF) within the kidney as shown by experimental stimulation with endotoxin. TNF was shown to increase MC synthesis of prostaglandins E2 (PGE2) which down regulate MC proliferation. The involvement of endogenous TNF as an autocrine factor to control MC proliferation is unknown. This role was evaluated in vitro by addition of anti-TNF immunoglobulins and soluble TNF receptor-I (sTNF-RI) on rat MC. Anti-TNF immunoglobulins and sTNF-RI induced a dose-dependent increase of cell proliferation when the cells were quiescent in 0.5% FCS P = 0.002). No effect was found when the cells were growing in 10% FCS (P = 0.113). Incubation of MC with anti-TNF immunoglobulins resulted in a dose-dependent decrease of PGE2 release. In order to investigate if the effect of TNF on MC proliferation was mediated by the decrease of PGE2 release, PGE2 was added to the culture medium at concentrations of 0.1 to 10 micrograms/ml in conjunction with anti-TNF immunoglobulins. PGE2 did not modify the proliferation induced by anti-TNF immunoglobulins. We conclude that anti-TNF immunoglobulins and sTNF-RI promoted MC DNA synthesis and influenced their PGE2 release by blocking the endogenous TNF. The mechanism of action on DNA synthesis was not mediated by PGE2. This indicates that endogenous TNF has a substantial role in the control of resting mesangial cells.

Animals↗
PubMed1995

Infection control in Switzerland.

Infection control in hospitals is not mandatory in Switzerland as in the United States. There are more than 300 acute-care hospitals in Switzerland. Hospitals are reimbursed by patient-days rather than diagnosis-related group. However, all five Swiss university hospitals have developed an infection control program. The major criteria for setting up and running these programs are reviewed; data are based on a questionnaire and personal interviewing of each institution. Most of the major criteria exist in all five institutions. Resources allocated to infection control differ markedly. The number of infection control nurses per 250 beds varies between 0.2 and 0.75 for the five hospitals; the activity of those in charge of infection control differs between hospitals. A comparison is made between the Swiss and U.S. programs with regard to some aspects of healthcare and infection control.

Cross Infection↗
PubMed1994

[Sinusitis in HIV infection].

Case notes of 722 HIV-infected patients who had died between March 1986 and August 1993 were analysed to evaluate the prevention and characteristic features of sinusitis associated with HIV infection. In 73 patients (10%) sinusitis had been diagnosed at least once on the basis of radiological or clear-cut clinical criteria. In addition, 15 patients with sinusitis were identified among those attending an HIV out-patient clinic. There were altogether 126 episodes of sinusitis in 88 patients (62 men, 26 women; mean age 33 [19-69] years). In 62 patients the CD4 lymphocyte count was under 100/microliters. The most commonly affected site was the maxillary sinuses. Patients with mirror formation had a significantly longer duration of illness than those without (P = 0.021). In 58 patients the symptoms of fever, headache and rhinitis were predominantly caused by the sinusitis, in 49 only partially so, and in 19 sinusitis was a chance diagnosis. In 10 of 49 attacks of sinusitis the concurrent disease (e.g. cerebral toxoplasmosis, malignant non-Hodgkin lymphoma) had not been recognized by the referring doctor. There were 1-5 recurrences over an observation period of 11.8 (0-72) months in 23 patients.-These findings show that sinusitis frequently occurs in HIV-infected patients, takes a protracted course and is difficult to distinguish from concomitant diseases by its clinical presentation. If symptoms persist, possible concurrent respiratory infection or CNS involvement must be looked for. Sinus needle aspiration is of decisive importance to ascertain the causative organism.

Adult↗
PubMed1994

[Encephalitis in adults].

Encephalitis is the result of focal or global inflammation of the brain caused by invasion of the brain parenchyma by viruses, bacteria, parasites or fungi. In addition, postinfectious encephalitis may result from immunological processes as a consequence of preceding viral infections such as measles. For most forms of viral encephalitis no specific therapy is available. Herpes simplex encephalitis may be diagnosed using modern laboratory techniques for detection of viral DNA without the need for brain biopsy. Herpes simplex encephalitis responds well to treatment with acyclovir, as does encephalitis caused by varicella-zoster virus, which typically occurs following cutaneous herpes zoster involving dermatomal distributions of the trigeminal nerve. In immunocompromised hosts many etiologies of encephalitis need to be considered. It is important to arrive at a precise diagnosis in order to choose appropriate therapeutic agents directed toward treatable pathogens such as Toxoplasma gondii and cytomegalovirus.

Adult↗
PubMed1994

[Meningitis in adults].

The clinical presentation of a 38-year-old female patient with acute onset of fever and decreased level of consciousness is described. The clinical reasoning concerning differential diagnosis, therapeutic options, workup of the patient and possible bacterial etiologies, which is usually part of the physician's initial encounter with the patient, is included in the case presentation. This summary of a workshop offers a concise review of clinical aspects of bacterial meningitis.

Adult↗
PubMed1993

[Disseminated tuberculosis with a multiresistant strain of Mycobacterium tuberculosis in an HIV-infected Swiss male].

Multidrug-resistant M. tuberculosis in HIV-infected people has not yet been reported in Switzerland, and there have been no nosocomial epidemics as they have recently occurred in the USA. We present the case of a 38-ear-old HIV-infected man who developed disseminated tuberculosis as AIDS-defining disease. Initially he was treated with isoniazid, pyrazinamide and rifampin. Due to the emergence of resistance to isoniazid and streptomycin, ethambutol was added for one month. Later the therapy was changed back to the initial three drugs. The patient responded well to this therapy, but five months later developed a relapse. In addition to the originally diagnosed double-drug resistance, a reduced susceptibility to rifampin appeared. Ethambutol, ciprofloxacin and amikacin were added to the original three-drug regimen. This resulted in rapid clinical improvement, although sputum cultures remained positive for M. tuberculosis two months later. This isolate was resistant to pyrazinamide. For that reason pyrazinamide was replaced by clofazimine. 14 months after diagnosis the patient died of hepatic failure. Because there was a delay in isolation of one week, 37 potentially exposed health care workers were tested by the Mantoux skin test. No conversions were observed. This case report demonstrates that tuberculosis in HIV-infected patients in Switzerland may be caused by multidrug-resistant M. tuberculosis. We propose that until the results of a susceptibility assay are known, a four-drug combination should be used initially in this patient group.

AIDS-Related Opportunistic Infections↗
PubMed1993

[Diagnosis and therapy of community-acquired pneumonia].

Whereas the diagnosis of community-acquired pneumonia usually is straightforward, in many cases the exact etiology is difficult or impossible to determine. The clinician must have a management strategy for this illness which is not dependent upon precise microbiological diagnosis in each case. Therefore, understanding of the spectrum of community-acquired pneumonias and awareness of the possible pathogens in specific clinical settings is crucial for the choice of the most appropriate antimicrobial therapy. The factors influencing prognosis of community-acquired pneumonia are important for the decision as to which patients should be hospitalized.

Anti-Bacterial Agents↗