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researchprojecten FINE / CRIME

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Prevention of Fungal Infections in Neutropenic Haematologic Patients Erasmus MC (FINE)

Fungal infections (mainly by Aspergillus species) are a significant cause of morbidity and mortality in patients with chemotherapy induced prolonged neutropenia. Inhalation of aspergillus conidia is the first step in the pathogenesis of invasive pulmonary aspergillosis. In a very recent study we demonstrated that inhalation of liposomal amphotericin-B (L-AmB) prevents invasive pulmonary aspergillosis without the toxicity of intravenous amphotericin-B  (AmB). But further studies are needed.

The ‘Fungal Research group’ of the Erasmus MC, is internationally recognized for its outstanding research into prevention and treatment of fungal infections in immunocompromised patient populations. Especially, the potential to translate results from in vitro and in vivo studies from the laboratory into prevention and treatment options for patients, is widely acclaimed.

research includes:

  • basic and molecular microbiologic studies (animal models, in vivo)
  • multi-center clinical trials for the prevention and treatment of fungal infections in immunocompromised patient populations

 

current projects:

  • outcome and medical costs of invasive aspergillosis in a large cohort of patients with AML or MDS (financial support by Schering-Plough, The Netherlands)
  • efficacy and cost-effectiveness of nebulised liposomal amphotericin-B for the prevention of invasive aspergillosis in patients with acute leukemia (financial support by Gilead Sciences, UK)

 

 

Catheter Related Infections Management Erasmus MC (CRIME)

Notwithstanding the progress in our understanding of the pathogenesis of foreign body infection, catheter related infections continues to be part of the daily life at the Intensive Care or the department of Oncology or Hematology. The consequential longer duration of hospital stay brings about considerable medical costs. However, several interventions can reduce the incidence of catheter related infections. A catheter impregnated with chlorhexidine and silver sulfadiazine on the outer surface is available in Europe and has been shown to halve the incidence of catheter related infections. Two recent clinical studies showed that an improved version of this catheter (with silver sulfadiazine on the inner and outer surface) reduces catheter colonization with 45-72%. Evidence is accumulating on the use of preventive antiseptic agents in catheter lock solutions as a substitute for antibiotic locks. However, the evidence is still based on in vitro data only or on comparison with historical controls. Randomized clinical trials are needed.

research includes:

  • basic and molecular microbiologic studies (in vitro and in vivo) into new approaches of  prevention of catheter-related infections
  • clinical trials with alcohol and antibiotic ‘lock’ (amongst others) techniques to prevent and treat catheter-related infections in neutropenic haematologic patients as well as ICU patients

current projects:

  • a prospective randomized placebo controlled trial on the prevention of catheter-related bloodstream infection with ethanol locks ((financial support from Stichting Nuts Ohra, The Netherlands)