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Cardiovascular prosthetic material infections

English title Cardiovascular prosthetic material infections
Applicant Hasse Barbara
Number 163132
Funding scheme Project funding (special)
Research institution Klinik für Infektionskrankheiten und Spitalhygiene Universitätsspital Zürich
Institution of higher education University of Zurich - ZH
Main discipline Internal Medicine
Start/End 01.02.2016 - 31.01.2019
Approved amount 506'625.00
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All Disciplines (4)

Discipline
Internal Medicine
Infectious Diseases
Clinical Cardiovascular Research
Surgery

Keywords (5)

Prosthetic vascular graft infection; Prosthetic valve endocarditis; Broad range PCR; Negative pressure wound therapy; Biofilm

Lay Summary (German)

Lead
Infektionen von kardialen Fremdkörpern
Lay summary

Gefässprothesen und künstliche Herzklappen werden im Zuge der älter werdenden Bevölkerung zunehmend implantiert. Mit unserem Forschungsprojekt wollen wir Infektionen erforschen, die im menschlichen Körper ausgehend von diesen Kunstmaterialien entstehen. Dabei setzen wir auf die enge Zusammenarbeit zwischen Infektiologen, Herz-/Gefässchirurgen, Kardiologen, Mikrobiologen, Radiologen und von Grundlagenforschern.
Basierend auf der seit März 2013 bestehende Infrastruktur zum Studium der vaskulären Gefässprothesen werden wir Langzeitergebnisse von Komplikationen nach Gefässprotheseneinbau studieren. Wir werden bestehende diagnostische Kriterien für Gefässprotheseninfektionen validieren, und die Inzidenz und die Risikofaktoren für Gefässprotheseninfektionen eruieren. Weiter sind Analysen zur Mortalität nach Gefässprotheseninfektion und zur optimalen Behandlungsmethode vorgesehen. Die Dauer der antiinfektiven Therapie wird bereits jetzt mittels PET/CT festgelegt, und die Validität dieser Methode soll wissenschaftlich untersucht werden. Weiter planen wir die Genauigkeit von PET / Angio-CT und MRT zur Diagnose von Gefässprotheseninfektionen zu vergleichen.
Mit unserem zweiten Ziel planen wir die Antibiotika-Prophylaxe in der Gefäßchirurgie und Herz-Kreislauf zu optimieren. Im Interesse der Sicherheit der Patienten, werden wir eingehende Untersuchungen im Operationssaal machen. Ein besonderer Fokus auf soll auf Wasser-übertragene Krankheitserreger gelegt werden, welche in Geräten enthalten sind, die Wasser für die Wartung (zB Heizungskühler-Einheiten) benötigen. In Folge der Hypothese der Umweltübertragung als Risiko für Implantatinfektionen werden wir prospektiv die Mikrobiologie und Histopathologie von allen Patienten mit Prothesenendokarditis und kardialen Wundinfektionen analysieren.
Mit dem dritten Ziel werden wir translationale Forschungsprojekte zu Biofilm-vermittelten Herz-Kreislauf-Infektionen durchführen.
Direct link to Lay Summary Last update: 23.12.2015

Responsible applicant and co-applicants

Employees

Publications

Publication
The role of FDG PET/CT in therapy control of aortic graft infection
Husmann Lars, Ledergerber Bruno, Anagnostopoulos Alexia, Stolzmann Paul, Sah Bert-Ram, Burger Irene A., Pop Roxana, Weber Alberto, Mayer Dieter, Rancic Zoran, Hasse Barbara (2018), The role of FDG PET/CT in therapy control of aortic graft infection, in European Journal of Nuclear Medicine and Molecular Imaging, 45(11), 1987-1997.

Collaboration

Group / person Country
Types of collaboration
Prof. Jakko van Ingen Radboud University Niemegen Netherlands (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Prof. D. Wagner, Freiburg i Breisgau Germany (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
European Congress of Radiology Talk given at a conference Comparing the diagnostic accuracy of 18F-FDG-PET/CT, contrast-enhanced CT and combined imaging in patients with suspected vascular graft infections 17.02.2019 Vienna, Austria Hasse Barbara; Husmann Lars; Ledergerber Bruno;
Club de Pathologies' of the Swiss Society of Infectious Diseases Individual talk Comparing the thoracic aortic graft infection risk based on two different types of vascular grafts: evidence from an in-vitro study 06.02.2019 Bern, Switzerland Boumasmoud Mathilde; Hasse Barbara; Zinkernagel Annelies;
Veith Symposium Talk given at a conference Paradigm shift with VAC in case of vascular graft infection (Talk together with Dr. Zoran Rancic) 18.11.2018 New York, United States of America Ledergerber Bruno; Mayer Dieter; Hasse Barbara;
Annual Meeting of the Swiss Society of Infectious Diseases Poster Postsurgical complications after graft implantation are important risk factors for subsequent vascular graft infections – prospective results from the VASGRA Cohort Study (Poster A. Anagnostopoulos) 13.09.2018 Interlaken, Switzerland Hasse Barbara; Ledergerber Bruno;
Annual Meeting of the Swiss Society of Infectious Diseases Poster Validation of the Management of Aortic Graft Infection Collaboration criteria for the diagnosis of vascular graft infection: results from the prospective Vascular graft cohort study. (Posterflash Fabienne Meyer) 13.09.2018 Interlaken, Switzerland Hasse Barbara;
Infektiologisches Curriculum Individual talk Cardiovascular infections: a multidisciplinary treatment approach 10.09.2018 Freiburg i Berisgau, Germany Hasse Barbara;
Society of Vascular Surgery Talk given at a conference Good Early Results of Negative Pressure Wound Non-Excisional Treatment for Prosthetic Graft Infection Are Durable: It Is a Game Changer (Talk Dr. Rancic Zoran) 20.06.2018 Boston, United States of America Mayer Dieter; Hasse Barbara;
Schweizerischen Gesellschaft für Chirurgie Talk given at a conference Risk factors for prosthetic vascular graft infections (Talk by Zoran Rancic) 24.05.2018 Basel, Switzerland Ledergerber Bruno; Hasse Barbara; Mayer Dieter;
ECCMID Talk given at a conference After an outbreak - Mycobacterium chimaera: under control or under water? 21.04.2018 Madrid, Spain Hasse Barbara;
Dutch Association of Clinical Microbiologists (NVMM) and the Dutch Association of Infectious Disease specialists (VIZ) and the Belgian Association of Infectious Diseases and Clinical Microbiology (BVIKM). Talk given at a conference Vascular prosthetic graft infections 17.11.2017 De Ruwenberg, Netherlands Hasse Barbara;
Infectious Diseases Society of America Poster Risk factors for prosthetic vascular graft infections (Poster Dr. Anagnostopoulos) 04.10.2017 San Diego, United States of America Hasse Barbara;
SEICAV Talk given at a conference Epidemiología, diagnóstico y tratamiento de las infecciones por Mycobacterium chimaera. 29.09.2017 Barcelona, Spain Hasse Barbara;
Joint annual meeting 2017: SSInf, SSHH, SSTMP, SSTTM Talk given at a conference 18F FDG PET/CT for therapy control in prosthetic vascular graft infection shows a longlasting effect (Talk by Dr. Anagnostopoulos 01.09.2017 Basel, Switzerland Husmann Lars; Hasse Barbara;
International Society of Cardiovascular Infectious Diseases Society (ISCVID) Talk given at a conference A global perspective on cases diagnosed and treated for M. chimaera infection associated with heater coolers 24.06.2017 Dublin, Ireland Hasse Barbara;
International Society of Cardiovascular Infectious Diseases Society (ISCVID) Talk given at a conference Vascular graft infection: a multidisciplinary treatment approach 23.06.2017 Dublin, Ireland Hasse Barbara;
ECCMID Talk given at a conference Clinical management of Mycobacterium chimaera infections 25.04.2017 Vienna, Austria Hasse Barbara;
Update on Management of Cardiovascular Infections Symposium. Talk given at a conference The multidisciplinary management of prosthetic vascular graft infections: The Zurich Experience 07.04.2017 Barcelona, Spain Hasse Barbara;
Annual ID Symposium Talk given at a conference Clinical management of Mycobacterium chimaera infections 23.03.2017 Lucerne, Switzerland Hasse Barbara;
Veith Symposium Talk given at a conference Results of negative pressure wound non-excisional treatment for prosthetic graft infection are durable. It is a game changer. Techniques and long-term results (Talk by Zoran Rancic) 18.11.2016 New York, United States of America Mayer Dieter; Hasse Barbara;
Dreiländertagung der Schweizerischen, Deutschen und Österreichischen Gesellschaften für Gefässchirurgie Talk given at a conference VAC – keine Antibiotika – Minimal invasiv: ist das Alles 05.10.2016 Bern, Switzerland Mayer Dieter;
EACTS Talk given at a conference Bacterial growth in the heater cooler unit – relevance for patients and perfusionists. 29.09.2016 Barcelona, Spain Hasse Barbara;
Joint annual meeting 2016: SSInf, SSHH, SSTMP, SSTTM Talk given at a conference Prosthetic vascular graft infections 14.09.2016 Montreux, Switzerland Hasse Barbara;
ASM Microbe Talk given at a conference Nontuberculous Mycobacterium infections among two patients with cardiopulmonary bypass surgery: outbreak or coincidence 16.06.2016 Boston, United States of America Hasse Barbara;
ECCMID Poster Management of endovascular graft infections 12.04.2016 Amsterdam, Netherlands Hasse Barbara;


Associated projects

Number Title Start Funding scheme
184918 Personalized Medicine in cardiovascular infections 01.04.2019 Project funding
144277 Vascular graft infections - epidemiology, best treatment options, imaging modalities and impact of negative pressure wound therapy 01.02.2013 Project funding

Abstract

This research project addresses prosthetic vascular graft infection and prosthetic valve endocarditis. We believe that we are privileged to continue this collaborative and interdisciplinary project at the University hospital Zurich (USZ) because of (1) the existing very close collaboration between cardiologists, vascular and cardiovascular surgeons, hospital epidemiology and infectious disease specialists with comprehensive surveillance possibilities, and established antimicrobial stewardship and infection control programs; (2) experience with patient orientated databases; (3) a dedicated team of vascular and cardiovascular surgeons with interest in septic surgery; (4) the high experience of our cardiologists in the use of the most modern echocardiographic technologies; (5) a highly experienced nuclear medicine team familiar with the use and interpretation of PET/CT scans; and (6) an established research group in experimental bacteriology to perform translational research on the microbiology and the pathogenesis of biofilm-mediated vascular graft infections and prosthetic valve endocarditis. With the first aim we will broaden our research infrastructure to study all cardiovascular foreign body infections, i.e. extend the ongoing data collection of VASGRA, and also include cardiac prosthesis material infections. We will continue our established SNF-funded prospective enrolment of all patients who receive a vascular graft at the University Hospital of Zurich (VASGRA Cohort A). Patients with a prosthetic vascular graft infection will be included in VASGRA Cohort B as outlined in the last grant application. In addition, we will newly start a systematic data collection on patients with prosthetic valve endocarditis, in close collaboration with our cardiologists and cardiovascular surgeons. We already established a biobank with the collection of tissue- and blood samples of patients with cardiac and vascular prosthetic material infections. With the second aim we will investigate different research questions on prosthetic material infections and on patient safety. We will determine risk factors and best treatment strategies for prosthetic vascular graft infections. In addition, we will validate diagnostic criteria for prosthetic vascular graft infections. We will determine the accuracy of PET/angio-CT and MRI for the diagnosis of prosthetic vascular graft infections, and the role of PET/CT versus angio-CT for the assessment of treatment response. We will determine the bacterial diversity of vascular wound infections using 16s rRNA amplification. Here, we will also study the impact of negative pressure wound therapy alone or with instillation on bacterial diversity in the treatment course of prosthetic vascular graft infections. We will optimize antibiotic prophylaxis in vascular and cardiovascular surgery. In the interest of patient safety, we will perform in-depth investigations in the operating theater with a special focus on transmission of water-borne pathogens from devices that use water for maintenance (eg heater-cooler units). In consequence of the hypothesis of environment transmission as a risk for implant infections we will prospectively assess the microbiology and histopathology of patients with prosthetic valve endocarditis and sternal wound infections undergoing redo cardiac surgery. With the third aim we will perform translational research projects on biofilm-mediated cardiovascular infections. We will assess effects of protein synthesis inhibitors on staphylococcal DNase activity, biofilm formation, and persistence on various surfaces including medical endovascular grafts currently used in clinics (polyester/ PTFE grafts). We will also assess effects of antibiotics known to interfere with biofilms such as rifampicin and daptomycin on S. aureus DNase activity and subsequently on biofilm formation and persistence. Since mycobacterial prosthetic valve endocarditis and prosthetic vascular graft infections are mostly recalcitrant to currently used antimicrobial agents we plan to assess the efficacy of different antimicrobial agents in a mycobacteria specific biofilm model.
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