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Biomedical subjects

U Flückiger

Publications and source records attributed to U Flückiger.

At least 19 recordsLinked to original sources
PubMed2006

[Atypical erythema induratum Bazin with tuberculous osteomyelitis].

Diagnosis of all types of cutaneous tuberculosis is challenging because the clinical picture of these diseases is highly variable. We describe the case of a 79-year old woman with an atypical presentation of Erythema induratum Bazin (EIB) on the chest and left arm in association with a tuberculous osteomyelitis of the left olecranon. Surprisingly, M. tuberculosis grew also from biopsies of the EIB-lesions. This contradicts the conventional view that considers EIB (a tuberculid) to be caused by a hypersensitivity reaction to mycobacteria. The presented case supports the hypothesis that EIB may also be caused by hematogenous or lymphatic spread of viable M. tuberculosis.

Aged↗
PubMed2006

[Nosocomial urinary tract infection in adults].

Urinary tract infection (UTI) is the most common infection in hospitalized adults. Nosocomial UTIs are mainly associated with the use of urinary catheters. Thus, the decision for catheterization should be made carefully and catheters removed in time. In order to prevent unnecessary antibiotic use in patients with urinary catheters correct diagnosis is crucial. Chinolones, broad-spectrum penicillins and third-generation cephalosporins are the mainstay of therapy. Comorbidities should be considered and potential obstructions of urinary flow removed. Economically important are the normally higher prices of i.v. antibiotics compared to oral use.

Adult↗
PubMed2006

[Dangerous fever].

Fever is a frequent symptom which can arise as a consequence of bacterial, viral and parasitic infections. Additionally, fever is a frequent symptom in non-infectious diseases, e.g. autoimmune diseases or lymphomas. The term dangerous fever describes febrile conditions which are associated with high mortality and, in most cases, mandate hospitalization, and even monitoring in an intensive care unit. As a rule, infections (bacterial infections in particular) may begin harmlessly; however, they can instantaneously change into life-threatening conditions even a few days later. In the following report we focus on some critical syndromes which must be recognized quickly, such as severe sepsis, septic shock, fever in neutropenia, and fever in the immunocompromised patient.

AIDS-Related Opportunistic Infections↗
PubMed2005

[The value of clinical infectology].

Infectious diseases specialists are involved in patient care mostly regarding patients with severe infections in complex situations. Morbidity and mortality of severe infections such as sepsis has been significantly reduced during past years and decades. Prognosis of severe infections is dependent upon timely and correct diagnosis and appropriate therapy. The diagnostic and therapeutic approach is often invasive and interdisciplinary. Importantly, thoughtful use of antibiotics may increase its effectiveness, reduce antibiotic use and occurrence of bacterial resistance and increase cost effectiveness. Hence, antibiotic management and stewardship has become more and more the focus of work. This article highlights the clinical work of infectious diseases specialists in an interdisciplinary setting and describes there value to patients and hospitals.

Anti-Bacterial Agents↗
PubMed2004

[Classification and microbiology of osteomyelitis].

The clinical presentation of osteomyelitis is multifarious. Therefore, patients are diagnosed and treated by various specialists with many different concepts of optimal management. Originally, only the acute and the chronic presentations were differentiated. The classification of Waldvogel, which is based on pathogenetic mechanisms, is more sophisticated. Diabetic foot is classified according to Wagner, who takes into account the continuous progression from sore to ulcer to osteomyelitis to gangrene. The staging according to Cierny-Mader is the most useful for the therapeutic management by surgeons. The spectrum of microorganisms is variable according to the type of osteomyelitis, epidemiology, age of the patient, co-morbidity, microbiological technique (culture, PCR), and duration of the infection. S. aureus is the leading pathogen in each type of osteomyelitis. Over the past 20 years, antimicrobial resistance has become an increasing problem. In case of osteomyelitis, standard susceptibility testing can be inaccurate. In case of device-related infection or in any type of chronic osteomyelitis, antimicrobial agents must be efficacious on stationary-phase and adhering microorganisms. Microbiologic culture and susceptibility testing should always be performed, in order to optimize the antimicrobial therapy.

Anti-Bacterial Agents↗
PubMed2004

[Diagnosis and follow-up management of postoperative bacterial osteitis].

Osteomyelitis is a term used to describe bone infection. As a complication, it can occur after open bone fracture and is associated with the implantation of foreign material. Acute disease after surgery starts after about 7 days to 4 weeks, and is characterized by a suppurative infection. Chronic infection sometimes manifests even years after surgery with a purulent sinus tract. Diagnosis is based on clinical signs, microbiological culture, histological evidence of the presence of granulocytes, and on radiological signs of osteomyelitis. However, it is sometimes difficult to distinguish between merely soft tissue involvement and osteomyelitis, especially in the presence of implanted material. Management includes a thoroughly surgical débridement and antibiotic treatment. Though frequently used, bacterial cultures of swabs of superficial wounds or fistulas are often misleading, whereas needle biopsy or surgical sampling with at least three tissue samples provides more reliable information. Because of the prolonged antibiotic treatment, it is mandatory for a successful outcome to culture the microorganism in order to determine antibiotic susceptibility. In addition to conventional radiological approaches, magnetic resonance imaging has become useful for the diagnosis of osteomyelitis. Despite significant progress in antibiotic therapy and orthopedic surgery, osteomyelitis remains difficult to treat and often relapses, even after years.

Anti-Bacterial Agents↗
PubMed2003

[Therapy of severe fungal infections].

Severe fungal infections increase in numbers in the Western world. This is due to more intensive therapies against cancers leading to severe and prolonged immunosuppression. For many years treatment of severe fungal infections had to be done solely with amphothericin B desoxycholate and 5-fluorocytosine. With the advent of triazoles such as fluconazole, lipid formulations of amphotericin B and the development of echinocandines such as caspofungin also severe candidiasis and invasive aspergillosis has become treatable. In particular, caspofungin for invasive candidiasis and voriconazole for invasive aspergillosis seem at least equivalent to amphotericin B. A clear advantage is the advent of lipid formulations of amphotericin B. This regards especially side effects which are reduced with these newer formulations, i.e. nephrotoxicity. Due to the fact that prospective trials are difficult to conduct because patient populations may vary considerably (especially the underlying disease) many comparisons were not yet performed. Nevertheless, promising results indicate that certain combinations of antifungals may enhance prognosis of refractory fungal infections with a so far very serious prognosis.

Antifungal Agents↗
PubMed2001

[Pneumonia in the immune compromised host].

The term "immunocompromised host" is generally applied to a variety of patients with different host defense defects. Pulmonary disease in the immunocompromised host remains a major cause of morbidity and has a high mortality. During the initial evaluation of the patient, it is helpful to define which of the three arms of the host defense system is most likely to be affected. Impaired granulocyte function, as seen after chemotherapy, predisposes to bacterial and fungal infections. Deficiencies in the humoral immune system predisposes to infection with encapsulated organisms, such as Streptococcus pneumoniae and Haemophilus influenzae. Impairment of the cellular immunity is a special problem of the transplant patient. Besides bacteria, a number of unusual microorganisms, such as viruses (cytomegalovirus, varicella-zoster virus, herpes simplex virus), protozoa (Toxoplasma gondii) and fungi (Pneumocystis carinii, Aspergillus, Cryptococcus neoformans) have to be considered in this group of patients. The work-up usually requires an invasive technique, such as a bronchoalveolar lavage or lung biopsy to establish the diagnosis. The initial therapy of a patient with a pulmonary infiltrate often involves an empiric broad-spectrum antibiotic therapy. Whether an additional treatment against atypical bacterial pathogens, fungi or viruses should be started, depends on the clinical presentation, the underlying type and duration of immunosuppression and the radiographic evolution of the infiltrate.

Anti-Bacterial Agents↗
PubMed2000

[Appropriateness of antibiotic prescription in ENT surgery].

INTRODUCTION: Although extensive studies on the use of antibiotics during and after surgery exist, antibiotics are still used too liberally. PURPOSE: To analyse the appropriateness of antibiotic use in ENT surgery. PATIENTS AND METHODS: Retrospective study of all surgical procedures performed at the Department of Otolaryngology, Head and Neck Surgery of the University of Basel between April and June 1999. Of the 174 procedures 30 were classified clean, 50 clean-contaminated (group A), 69 clean-contaminated (group B), 14 contaminated, and 11 dirty. RESULTS: 9% of all patients received inappropriate antibiotic prophylaxis and 4% inappropriate primary antibiotic treatment. 22% of antibiotic prophylaxis, 39% of primary antibiotic treatments and 29% of secondary antibiotic treatments were considered inappropriate. DISCUSSION: The too liberal use of antibiotics during and after surgery is largely due to the surgeon's fear of infectious complications. Only a peer-review process of all antibiotic prescriptions can reduce the inappropriate use of antibiotics.

Antibiotic Prophylaxis↗
PubMed1999

Duke criteria-negative endocarditis caused by Bartonella quintana.

Bartonella spp. were recently recognized as causative agents of culture-negative endocarditis. Molecular techniques, such as broad-range PCR, are now available to detect fastidious or slow-growing microorganisms, or those which cannot be cultured. Such microorganisms may be responsible for culture-negative endocarditis. Alcoholism and homelessness are known risk factors for Bartonella quintana endocarditis, even in patients without previous valvular disease. We report a case of B. quintana endocarditis diagnosed by PCR amplification on the excised heart valve, in a young non-alcoholic and immunocompetent patient with few clinical signs of infection who did not fulfill the Duke criteria.

Adult↗
PubMed1991

Integration of pharmacokinetics and pharmacodynamics of imipenem in a human-adapted mouse model.

The relationship between the pharmacokinetics and bactericidal activity of imipenem against Pseudomonas aeruginosa and Escherichia coli was investigated in a neutropenic mouse thigh infection model. To circumvent the problem of short elimination time in small animals, imipenem was administered in fractionized, decreasing doses such that the pharmacokinetic profiles as observed in humans after intravenous and intramuscular injections were approximated in mice. The human-simulated kinetic profile corresponding to an intramuscular injection of 500 mg at 12-h intervals proved to be as effective as the human-simulated profile of the same dose injected intravenously every 6 h. In contrast, the human-simulated profile corresponding to only one intravenous injection every 12 h resulted in bacterial breakthrough growth between 8 and 12 h after the onset of treatment. The results of our investigations confirm the hypothesis that the bactericidal effect of imipenem against P. aeruginosa and E. coli in vivo depends mainly on the time during which drug levels remain above the MIC rather than on the plasma peak/MIC ratio.

Animals↗
PubMed1991

[Antibiotic prevention of bacterial endocarditis].

Infective endocarditis is a serious disease and should be, if possible, prevented. Two risk groups are classified in relation to the patient's underlying cardiac lesions. At high risk are patients with prosthetic valves or with a previous infective endocarditis. Patients with congenital and acquired heart disease, mitral valve prolapse with regurgitation and hypertrophic obstructive cardiomyopathy are at moderate risk. Patients of these two groups should receive antibiotic prophylaxis before dental or surgical procedures that cause bacteremia. For patients at moderate risk a single dose of an orally administered antibiotic should be given one hour before the procedure (e.g. amoxicillin 3 g for procedures of the oropharyngeal, gastrointestinal or genitourinary tract, where the causitive agents of endocarditis are Viridans streptococci or enterococci). Multiple doses are recommended for patients at high risk. The combination of amoxicillin and gentamicin (vancomycin and gentamicin in penicillin-allergic patients) offers the widest margin of safety in high-risk patients.

Anti-Bacterial Agents↗