Fluorescence in situ hybridization; Infective endocarditis; Cardiovascular surgery; Broad range PCR; PET/CT; Vascular graft infection; Biofilm
Schweizer Tiziano A, Shambat Srikanth Mairpady, Haunreiter Vanina Dengler, Mestres Carlos A, Weber Alberto, Maisano Francesco, Zinkernagel Annelies S, Hasse Barbara (2020), Polyester Vascular Graft Material and Risk for Intracavitary Thoracic Vascular Graft Infection., in Emerging infectious diseases
, 26(10), 2448-2452.
Husmann Lars, Huellner Martin W., Ledergerber Bruno, Eberhard Nadia, Kaelin Marisa B., Anagnostopoulos Alexia, Kudura Ken, Burger Irene A., Mestres Carlos-A., Rancic Zoran, Hasse Barbara, Anagnostopoulos A., Hasse (PI) B., Eberhard N., Hoffmann M., Husmann L., Kopp R., Ledergerber B., Rancic Z., Mestres C.A., Zbinden R., Zinkernagel A. (2020), Diagnostic Accuracy of PET/CT and Contrast Enhanced CT in Patients With Suspected Infected Aortic Aneurysms, in European Journal of Vascular and Endovascular Surgery
, 59(6), 972-981.
Cardiovascular infections are an onging clinical problem despite the wide array of antibiotics currently available. Bacteria isolated from these infections may be in a biofilm-forming or non-growing state, thus tolerating antibiotic challenges. In-depth characterization of both the patient as well as the pathogenic bacteria will ultimately lead to personalized medicine. With this research project, we aim to establish a multidimensional assessment of patients with vascular graft infections (VGI), infective endocarditis (IE) and cardiovascular implantable electronic devices infections (CIEDI). This collaborative and interdisciplinary project at the University Hospital Zurich (USZ) relies on: (1) The existing, very close collaboration between infectious disease specialists, microbiologists, cardiovascular surgeons, cardiologists and imaging specialists (2) Two prospective, ongoing patient cohorts on patients with cardiovascular infections. (3) A dedicated team of cardiovascular surgeons with a strong interest in septic surgery. (4) A highly experienced nuclear medicine team familiar with the use and interpretation of 18F-FDG PET/CT (PET/CT). (5) The close collaboration with the Institute of Medical Microbiology (UZH) equipped with state-of-the-art microbiology techniques; and (6) an established research group in experimental bacteriology performing translational research on chronic and recurrent bacterial infections. With the first aim, we will carefully characterize patients with cardiovascular infections and establish a link to bacterial pathophysiology. We will continue our established SNF-funded cohort of patients with VGI (VASGRA) and the prospective IE/CIEDI cohort (ENVALVE). For in-depth pathophysiological investigations of these infections, we will continue our established biobank of blood, tissue and bacterial isolates. With the second aim, we will assess nested research questions. Based on the above-mentioned infrastructure, we will assess these patients based on their own perspectives, the host biology (including the microbiome, and inflammatory markers) and different environmental factors. Additionally, we will determine the impact of the interdisciplinary endocarditis board on patient's outcomes. Current treatment strategies (e.g. use of rifampin in staphylococcocal infections) and outcomes will be assessed and further optimized based on patient characteristics, biomarker kinetics, quality of life assesssments and imaging. We will also assess the role of parametric whole body dynamic PET/CT for VGI diagnosis.. Moreover, we will assess the clinical significance of incidental findings in PET/CT and probe the application of PET/CT for mycotic aneurysms and IE. We will also assess the need for device extraction/surgery among patients with early or late, hematogenous (symptoms <3 weeks) cardiovascular implantable electronic devices infections.With the third aim, we will probe the application of enhanced bacterial characterization ultimately resulting in enhanced bacterial diagnostics and treatment of biofilm-mediated cardiovascular infections. We will use different bacterial tools (e.g. Fluorescence in situ hybridization (FISH), 16s rRNA amplification, whole genome sequencing (WGS), RNAseq, 16s rRNA amplification) for enhanced diagnostics. The study on the microbiome of patients undergoing endovascular surgery with inguinal access will help understanding the pathogenesis of endovascular infections and thus improve prevention measures. We will assess whether the growth and structural characteristics of bacteria in biofilms can be linked to clinical outcome. This would provide an additional readout for determining treatment duration and the question which patients warrant prolonged anti-biofilm treatment or may profit from a shorter treatment and thus reduced stay in hospital.