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Biomedical subjects

R Krause

Publications and source records attributed to R Krause.

At least 19 recordsLinked to original sources
PubMed2006

A holistic approach to MRSA eradication in critically ill patients with MRSA pneumonia.

BACKGROUND: The number of Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia cases is increasing in many European countries. In this observational study in one medical and three surgical ICUs multiple interventions for the treatment and eradication of nosocomial MRSA-pneumonia were used. PATIENTS AND METHODS: Twenty-one critically ill patients (age: 59 +/- 14 years, 15 males/6 females, 18 ventilator-associated, 3 nosocomial, clinical pulmonary infection score > 6 in all patients, APACHE II 18 +/- 5) were enrolled. The patients were treated with a 7-day course of iv linezolid (600 mg bid) plus rifampicin (600 mg bid), endotracheal vancomycin 100 mg qid, thrice daily mouth and throat washing with chlorhexidine 1% fluid and nasal mupirocin ointment, twice daily skin and hair washings with chlorhexidine gluconate 4% and tracheostomy (n = 8) wound care with povidone-iodine spray. Control samples (endotracheal secretions, nose, wound, and pharyngeal swabs) were taken 2, 3, 4, 7 days and 2 months thereafter. Multilobular pneumonia was seen in 16, pleural effusion in 12, and MRSA bacteremia in 4 patients. RESULTS: One patient died during the follow-up period due to cerebral bleeding. In the remaining 20 patients, pneumonia was clinically cured in all patients and all patients were free of MRSA after eradication. Six patients died due to myocardial infarction (n = 3), gram-negative septic shock (n = 2), herpes encephalitis (n = 1) > 7 days after eradication. No MRSA reinfection occurred during the control period. CONCLUSION: We conclude that in patients with MRSA pneumonia an approach using a 7-day course of intravenous linezolid plus rifampicin, intratracheal vancomycin, nasal mupirocin, cutaneous and oropharyngeal chlorhexidin plus povidone-iodine cures pneumonia and is effective for MRSA eradication.

Acetamides↗
PubMed2006

Moxifloxacin versus standard therapy in patients with pneumonia hospitalized after failure of preclinical anti-infective treatment.

The failure rate of primary empirical anti-infective treatment of community-acquired pneumonia is reported to range between 2 and 7%. These patients are subject to a greater risk of intensive medical treatment and a higher mortality rate than patients who respond to primary treatment. We investigated 63 patients in a "real life scenario" who were admitted to the hospital after failure of primary outpatient therapy for community-acquired pneumonia. Thirty-three patients received intravenous standard therapy (betalactam 14, macrolide 3, levofloxacin 6, doxycycline 1, combinations 9 patients) while 30 patients were treated with intravenous moxifloxacin. The oral antibiotic pretreatment that failed most frequently was clarithromycin (n = 25), followed by amoxicillin/clavulanic acid (n = 16), cefixime (n = 10), cefuroxime/axetil (n = 5), doxycycline (3), cefpodoxime, and ciprofloxacin (2 each). There were no differences between the two groups in respect of age, gender, numbers of patients in nursing homes, numbers of patients with different underlying diseases (chronic bronchitis, coronary heart disease, diabetes mellitus, smoking, etc.), severity of pneumonia at the time of admission, numbers of patients requiring intensive care, and lethality. The group that underwent standard therapy experienced failure of the empirical intra-hospital antibiotic therapy more often during therapy [10 (30%) patients vs 2 (6%) in the moxifloxacin group, p = 0.009] and clinical failure of treatment on day 28 after initiation of therapy [7 (21%) patients vs 2 (6%) in the moxifloxacin group, p = 0.003]. In cases of failure of empirical preclinical antibiotic treatment for community-acquired pneumonia, subsequent intrahospital treatment with moxifloxacin is more successful than standard therapy in our study reflecting a "real life scenario".

Adult↗
PubMed2006

Somatostatin receptor scintigraphy in patients with cat-scratch disease.

AIM: Somatostatin receptor scintigraphy images various neoplastic, granulomatous, and auto-immune diseases. Cat-scratch disease in an infectious granulomatous disease usually affecting the lymphnodes. It is not known whether cat-scratch disease provides positive somatostatin receptor scintigrams. PATIENTS, METHODS: Twelve patients with lymphadenitis and suspected cat-scratch disease were investigated by immunofluorescence antibody testing and somatostatin receptor scintigraphy. Suppurated lymphnodes were extracted or drained and Bartonella henselae specific PCR was then performed. RESULTS: Eleven of 12 patients showed IgG antibodies against B. henselae. SRS showed positive scintigraphic results in 6 of 11 patients with CSD. B. henselae DNA was detected in tissue of lymphnodes from 4 of 5 patients with lymphnode extraction or lymphnode drainage. SRS demonstrated positive scintigrams in all patients with a positive PCR. In one patient with suspected CSD SRS was negative as well as antibody testing. CONCLUSION: Somatostatin receptor scintigraphy correlated with positive Bartonella henselae specific PCR tests and positive Bartonella henselae specific antibody tests in patients with CSD.

Animals↗
PubMed2005

Kinetics of charge translocation in the passive downhill uptake mode of the Na+/H+ antiporter NhaA of Escherichia coli.

The Na+/H+ antiporter NhaA is the main Na+ extrusion system in E. coli. Using direct current measurements combined with a solid supported membrane (SSM), we obtained electrical data of the function of NhaA purified and reconstituted in liposomes. These measurements demonstrate NhaA's electrogenicity, its specificity for Li+ and Na+ and its pronounced pH dependence in the range pH 6.5-8.5. The mutant G338S, in contrast, presents a pH independent profile, as reported previously. A complete right-side-out orientation of the NhaA antiporter within the proteoliposomal membrane was determined using a NhaA-specific antibody based ELISA assay. This allowed for the first time the investigation of NhaA in the passive downhill uptake mode corresponding to the transport of Na+ from the periplasmic to the cytoplasmic side of the membrane. In this mode, the transporter has kinetic properties differing significantly from those of the previously investigated efflux mode. The apparent Km values were 11 mM for Na+ and 7.3 mM for Li+ at basic pH and 180 mM for Na+ and 50 mM for Li+ at neutral pH. The data demonstrate that in the passive downhill uptake mode pH regulation of the carrier affects both apparent Km as well as turnover (Vmax).

Antibodies, Monoclonal↗
PubMed2005

Evaluation of potential risk factors for early infectious complications after autologous peripheral blood stem cell transplantation in patients with lymphoproliferative diseases.

A number of risk factors for the occurrence of neutropaenic fever after haematopoietic stem cell transplantation (HSCT) have been proposed. We were interested in whether these factors remain valid for several early infection-related outcomes when applied to a homogeneous group of patients in uni- and multivariate analyses. Therefore, we analysed 144 consecutive patients with lymphoproliferative disorders receiving autologous peripheral blood HSCT. Variables tested as potential risk factors for the occurrence of fever, documented infection (DI), microbiologically documented infection (MDI) or failure of first-line antimicrobial therapy were sex, conditioning regimen, prolonged neutropaenia, low number of CD34+ cells transplanted, purging, lack of selective gut decontamination, higher age and increased body mass index. In uni- and multivariate analyses, conditioning including total body irradiation was the only risk factor for the occurrence of fever, and neutropaenia >or=10 days was the only factor associated with failure of first-line antimicrobial therapy. None of the variables tested was associated with an increased risk for DI or MDI. This analysis suggests that a number of previously proposed risk factors actually are of minor clinical relevance for early infections in the majority of patients receiving autologous HSCT.

Adolescent↗
PubMed2005

Candida and antibiotic-associated diarrhoea.

The role of Candida in antibiotic-associated diarrhoea (AAD) has been controversial for many years. Since Candida exists physiologically in the gastrointestinal tract, the presence of small numbers of Candida organisms in stool has therefore been considered normal, and thus non-pathogenic. Increased Candida counts have been linked to the development of diarrhoea in antibiotic-treated patients. However, recent findings have not confirmed this. To date, there is no convincing evidence that Candida may cause AAD in adults.

Adult↗
PubMed2005

A human case of travel-related rabies in Austria, September 2004.

A young male Austrian tourist, aged 23 years and unvaccinated against rabies, was bitten by a dog in Morocco in July 2004. One month later he was hospitalised in Ceuta with symptoms compatible with rabies. He died on 23 September in an Austrian hospital after a diagnosis of rabies was confirmed by FAT, IHC and RT-PCR (including sequencing) of the neck skin and the RT-PCR (including sequencing) of the pharyngeal swab. This Austrian case of laboratory confirmed rabies highlights the urgent need for reinforcement of the international recommendations for travel vaccinations.

Adult↗
PubMed2004

N-Terminal pyrazinones: a new class of peptide-bound advanced glycation end-products.

The reaction of peptide Gly-Ala-Phe with the alpha-dicarbonyl compounds glyoxal and methylglyoxal was studied under physiological conditions (pH=7.4, 37 degrees C). Using HPLC with UV and fluorescence detection, a rapid derivatization of the peptide and the concomitant formation of well-defined products were observed. The products, which showed characteristic UV absorbance (lambda(max)=320 to 340 nm) and fluorescence (lambda(ex)=330 to 340 nm, lambda(em)=395 to 405 nm), were identified by ESI-MS and NMR spectroscopic analysis as the N-terminally pyrazinone-modified peptides I (N-[2-(2-oxo-2H-pyrazin-1-yl)-propyl]-phenylalanine) and II (N-[2-(5-methyl-2-oxo-2H-pyrazin-1-yl)-propionyl]-phenylalanine). Model experiments revealed that the reactivity of the N-termini of peptides towards a derivatization by glyoxal is in the same order of magnitude as that of arginine, which generally is attributed as main target for alpha-dicarbonyl compounds in proteins. Incubation of insulin with glyoxal proved the protein-bound formation of pyrazinones, with the N-terminus of the B-chain as the main target. According to these results, we conclude that N-terminal pyrazinones represent a new type of advanced glycation end-products (AGEs) with significance for biological systems and foods.

Animals↗
PubMed2004

Pulmonary infiltrates in patients with haematologic malignancies: transbronchial lung biopsy increases the diagnostic yield with respect to neoplastic infiltrates and toxic pneumonitis.

We retrospectively evaluated 107 fiberoptic bronchoscopies with and without transbronchial lung biopsy (TBLB) in 98 consecutive patients with haematologic malignancies and pulmonary infiltrates. Bronchoalveolar lavage (BAL) was performed in 45 and BAL plus TBLB in 62 procedures. There was no procedure-related severe haemorrhage, pneumothorax or death. Infectious aetiology was identified in 26 of 107 (24%), toxic pneumonitis in 17 of 107 (16%) and neoplastic infiltration in 9 of 107 (8.5%) episodes. Combined BAL and TBLB was significantly superior to BAL alone with respect to the diagnosis of neoplastic infiltrates (p=0.008) and toxic pneumonitis (p<0.001) and should therefore be included in the diagnostic work-up of this patient cohort.

Adult↗
PubMed2004

[Transrectal ultrasound-assisted gun-biopsy in the diagnostic of presacral recurrent rectal carcinoma].

Suspected extraluminal recurrence of rectal carcinoma after surgical treatment represents a frequent diagnostic challenge. Clinical history and examination as well as tomographic imaging often do not equivocally settle this tissue. Glucose-PET is an expensive, not universally available test. Early diagnosis is required for both successful operative reintervention aiming at cure and indication to palliative therapy. We performed gun-biopsy of presacral space-occupying lesions in three patients, choosing the ultrasound-guided transrectal approach in three of them. Extraluminal recurrence was proven in one patient. In another patient, anastomotic recurrence was proven by endoscopic biopsy and presacral recurrence ruled out before reoperation. In the third patient, no tumour tissue was found in the samples, as confirmed by his clinical course and by another biopsy after one year. By providing a sufficient amount of tissue for histological examination, ultrasound-guided gun-biopsy allows definite diagnosis in presacral space-occupying lesions and hence represents an important expansion of the diagnostic repertoire in the follow-up of rectal cancer.

Adenocarcinoma↗
PubMed2004

Isolation of Bordetella trematum from a diabetic leg ulcer.

BACKGROUND: The species Bordetella trematum (a Gram-negative, opportunistic bacterium) was established in 1996. To date, 10 cases of human infection/colonization with the pathogen have been described. CASE REPORT: The first case of isolation of B. trematum from a diabetic ulcer is reported. Since there are no commercially available kits for identification of the organism, species diagnosis was based on 16S rDNA sequencing. B. trematum disappeared from the ulcer without antimicrobial therapy. CONCLUSION: In the present case, there was no evidence for a causative role of the organism in the diabetic foot infection, which is in agreement with previously published data. However, B. trematum has to be considered when otherwise unclassified Gram-negative rods are isolated from infected diabetic ulcers.

Aged↗
PubMed2004

Detection of catheter-related bloodstream infections by the differential-time-to-positivity method and gram stain-acridine orange leukocyte cytospin test in neutropenic patients after hematopoietic stem cell transplantation.

For febrile neutropenic patients who received hematopoietic stem cell transplantation, the Gram stain-acridine orange leukocyte cytospin (AOLC) test and the differential-time-to-positivity method (DTP) were performed. As a diagnostic tool for catheter-related bloodstream infections in these patients, the Gram stain-AOLC test has a lower sensitivity than does the DTP method but acceptable positive and negative predictive values.

Acridine Orange↗
PubMed2004

Long-term comparison of a calcium-free phosphate binder and calcium carbonate--phosphorus metabolism and cardiovascular calcification.

BACKGROUND: Calcium carbonate used as a phosphate binder may contribute to cardiovascular calcification. Long-term comparisons of sevelamer, a non-calcium polymeric phosphate binder, and calcium carbonate (CC) are lacking. METHODS: 114 adult hemodialysis patients were randomly assigned to open label sevelamer or CC for 52 weeks. Study efficacy endpoints included changes in serum phosphorus, calcium, calcium-phosphorus product, and lipids. In addition, initial and sequential electron beam computerized tomography scans were performed to assess cardiovascular calcification status and change during follow-up. Safety endpoints were serum biochemistry, blood cell counts and adverse events. RESULTS: Patients receiving sevelamer had a similar reduction in serum phosphorus as patients receiving CC (sevelamer -0.58 +/- 0.68 mmol/l, CC -0.52 +/- 0.50 mmol/l; p = 0.62). Reductions in calcium-phosphorus product were not significantly different (sevelamer -1.4 +/- 1.7 mmol2/l2, CC -0.9 +/- 1.2 mmol2/l2; p = 0.12). CC produced significantly more hypercalcemia (> 2.8 mmol/l in 0% sevelamer and 19% CC patients, p < 0.01) and suppressed intact parathyroid hormone below 150 pg/ml in the majority of patients. Sevelamer patients experienced significant (p < 0.01) reductions in total (-1.2 +/- 0.9 mmol/l, -24%) and LDL cholesterol (-1.2 +/- 0.9 mmol/l, -30%). CC patients had significant increases in coronary artery (median +34%, p < 0.01) and aortic calcification (median +32%, p < 0.01) that were not observed in sevelamer-treated patients. Patients on sevelamer required more grams of binder (sevelamer 5.9 g vs. CC 3.9 g) and experienced more dyspepsia than patients on calcium carbonate. CONCLUSIONS: Sevelamer is an effective phosphate binder that unlike calcium carbonate is not associated with progressive cardiovascular calcification in hemodialysis patients.

Adult↗
PubMed2004

Nephrologists' view on exercise training in chronic kidney disease (results of the questionnaire at the WCN 2003).

During the WCN 2003 in Berlin a questionnaire on the opinion of nephrologists about physical activity was provided. A total of 47 participants completed the questionnaire (Germany 6, other European countries 15, non-European countries 15, unknown country 12). 37% of the individuals stated that they exercise on a regular basis, whereas 41% exercise infrequently. 95% agreed on the fact that the sedentary lifestyle is an important risk factor in CKD patients; 78% thought that it is the responsibility of the nephrologist to advice the patients about physical activity. 33% offer in-centre training programs. 15% of the patients participate in out-centre groups. This occurs most frequently in Germany where the health care system provides the largest financial support. 74% were in need of written material about exercising. Thus, it is an important goal to include instructions concerning training instruction and infrastructure into the routine treatment regimen of CKD patients, dialysis patients and kidney transplant recipients.

Attitude of Health Personnel↗
PubMed2004

Principles of exercising in patients with chronic kidney disease, on dialysis and for kidney transplant recipients.

Independent of the course of kidney disease, physical fitness decreases continuously with the progression of CRF. The reduced physical fitness of patients with CKD is characterized by the following: reduced flexibility, coordination disturbances, decreased muscular strength and endurance. Often CKD patients suffer from depression and loss of self-confidence. Thus, the goals are to improve the principal components of motor fitness, conditioning gymnastics, different forms of endurance training, breathing and relaxation exercises, and body experience. The training starts with an initial phase followed by a build-up phase and a maintenance phase. Each phase consists of a warm-up, the main phase, and a cool-down phase. The Borg's RPE-scale is recommended for controlling the training. Because of their specific treatment modalities, hemodialysis and peritoneal dialysis patients as well as transplantation patients should seek individual prescriptions. Large experience exists in out-center training programs in dialysis and transplantation patients. The importance of physical fitness to the somatic and psychosocial well-being is well-documented. It is therefore recommended to exercise continuously on an individual basis in order to counteract the reduction of physical fitness due to CKD. Each patient should feel encouraged to participate in an exercise training adjusted to the individual capacity.

Humans↗