Supplementum 163 - Swiss Medical Weekly

21 S SWISS MED WKLY 2008;138(Suppl 163) · www.smw.ch
Poster Session 1 – SSP / SGP
P111
Respiratory research funded by the Swiss Respiratory
Society: is it worth the money?
J-D. Aubert, C. Barazzone-Argiroffo, K. Bloch, U. Lagler, L.P. Nicod,
T. Rochat, J. Savoy, M. Tamm, R. Thurnheer.
Swiss Respiratory Society (Berne, CH)
Through an unrestricted grant from the Swiss Lung League, the Swiss
Respiratory Society (SRS) is able to offer annual funding for one to
three research projects in our country. The research committee of the
SRS is responsible for the selection process of the grant proposals.
The purpose of this study was to evaluate the scientific impact in
term of publications of the funded projects.
Data were extracted from SRS archives and publications related to
the selected projects and applicants were searched on PubMed. Only
original articles, but not reviews nor book chapters were considered.
Impact factor for each article was found on ISI Web of Knowledge.
From 2000 to 2006, 18 projects get funding from the SRS. Research
topics include pulmonary cell biology (n = 4), lung transplantation (4),
sleep medicine (3), asthma or COPD (2), and others (5). The total
allocated sum was CHF 681’400 with a mean (SD) of CHF 37’860
(23’340) per project. Fourteen published articles were found clearly
related to the selected projects. All but one were published in
international respiratory journals. The projects without any
publications yet were submitted from 2004 and thereafter. The
median impact factor of the 14 articles was 5.167 (range 1.005–
9.091). The mean time between funding and publication was 1.8 year.
We conclude that despite the relatively modest amount of money
allocated to each project, the overall quality of the research, based on
bibliometric data is excellent. It is assumed that for the searcher this
funding is a valuable adjunct to national grant agencies.
P112
Phylogeographical lineages of Mycobacterium tuberculosis
isolated in Switzerland between 2002 and 2006 as defined by
spoligotyping
K. Bögli-Stuber1 , L. Fenner2 , B. Léchenne1 , R. Frei2 , T. Bodmer1 .
1 University of Berne (Berne, CH); 2 University Hospital Basel
(Basel, CH)
Background: Recent evidence suggests that the human pathogen
Mycobacterium tuberculosis (Mtb) has a clonal genetic population
structure that is geographically constrained and that genetic
variability of Mtb may translate into phenotypic differences, such as
differences in virulence and immunogenicity. This study used spacer
oligonucleotide typing (spoligotyping) to analyse the relative
distribution of the major phylogeographical lineages among Mtb
isolates cultured in Switzerland between 2002 and 2006.
Methods: Mtb patient isolates that were deposited in the strain
repositories of the Universities of Basle and Berne in the years 2002
to 2006 were included in the study. DNA was extracted from cultures,
and spoligotyping was performed using a spoligotyping kit (Isogen
Life Science, Ijsselstein, NL). Spoligo-International-Type (SIT)
numbers were assigned using data published in SpolDB4. Data were
compiled in Microsoft Access and analysed with the Mycobacteria
MIRU-VNTRplus online analysis tool (http://www.miru-vntrplus.org).
Results: A total of 534 Mtb-complex isolates (Mtb, n = 518 (97%);
M. bovis, n = 13 (2%); and M. africanum, n = 3 (1%)) were deposited
during the study period. Of these, the spoligotyping patterns of 162
Mtb isolates were available for further analysis. The relative
distribution of the four main phyleogeographical lineages (L1-L4) was:
L1, 3.1% (n = 5); L2 (“Beijing”), 8.6% (n = 14); L3, 6.8% (n = 11); L4,
64.2% (n = 104). Overall, 21 (13%) Mtb isolates had orphan
spoligotyping patterns; in addition, 2 (1.2%) and 5 (3.1%) isolates
were of SpolDB4 lineages S and U, respectively.
Discussion: Most (64.2%) of the Mtb isolates so far studied were
attributable to L4. In addition, 13% of the spoligotype patterns were
orphan and could not yet be attributed to one of the four major
phylogeographic lineages. The relative contribution of L2, i.e.
“Beijing” strains, was 8.6%. Since in Switzerland two out of three
tuberculosis (TB) cases occur in foreign-born persons, the combining
of spoligotyping data with country of origin and socio-demographic
patient information as well as drug susceptibility testing (DST) results
will be necessary to delineate the existence of “autochthonous”
spoligotypes and to study the impact of foreign strains on the
epidemiology of TB in Switzerland. This will require the combination
of spoligotyping with additional typing methods, such as
mycobacterial interspersed repetitive unit-variable-number tandem
repeat analysis (MIRU-VNTR).
P113
Use of interferon-gamma release assays (IGRA) vs. tuberculin
skin testing for detecting latent tuberculosis (TB) in chronic
haemodialysis patients
J-P. Janssens, P. Roux-Lombard, P-A. Triverio, P. Saudan,
M. Metzger, T. Rochat.
Hôpitaux Cantonaux Universitaires de Genève (Genève, CH)
Background: IGRA have been shown to be more sensitive and more
specific than tuberculin skin testing(TST) for the detection of latent
tuberculosis infection in immuno-competent individuals and in HIV
infected subjects. Their efficacy in other immuno-suppressed patients
such as those under chronic hemodialysis (CH) is not yet well
documented.
Methods: Prospective inclusion of patients under CH, with
simultaneous sampling of 2 IGRA (T-SPOT.TB, Oxford Immunotec, UK
and QuantiFERON-Gold in tube: QFT, Cellestis, Australia),
measurement of TST, questionnaire, incidence in country of origin,
history of prior exposure or treatment for TB, BCG status, and review
of chest X-rays for signs of prior TB infection.
Results: 62 patients (16F, 46M, aged 65 ± 15 years, 50% foreignborn,
10% originating from high incidence countries, 5 with previous
TB) were included; TST was >5 mm in 12 (19%), >10 mm in 9 (14%);
T-SPOT.TB was positive in 18 subjects (29%, 6 indeterminate); QFT
was positive in 14 cases (22%; 3 indeterminate). Agreement between
IGRA was 73% (kappa value: 0.58; 95% CI: 0.34–0.82). Agreement
between TST (>10 mm) and both IGRA was low (kappa: 0.23; 95%
CI: 0.0–0.48 for T-SPOT.TB and 0.20; 95%CI: 0.0–0.48 for QFT).
Multivariate logistic regression showed that increasing age was
associated with a decrease in probability of having a TST >10 mm.
A history of prior contact with TB was predictive of a positive QFT (OR:
10.3; 95% CI: 1.5–69.3; p = 0.016), and a TST >10 mm (OR: 32.7;
95% CI: 1.9–564; p = 0.016); the trend was not significant for T-SPOT-
TB (OR: 14.7; 95% CI: 0.8–277; p = 0.07). None of the other variables
analysed were predictive of results of either IGRA or TST.
Among 5 patients with a history of prior TB, TST and T-SPOT.TB were
positive in 1, and QFT, in 2/5.
Conclusion: Both IGRA identified more CH patients with probable
LTBI or prior TB than the TST, suggesting that they may be more
sensitive than the TST. Agreement between IGRA was good, but
agreement between both IGRA and TST was low. The fact that most
patients with prior TB were not identified by either test illustrates
however the limits of available tools for reliably detecting prior TB
infection in CH patients.
P114
Tolerance to rifampicine (RIF) 4 months vs. isoniazid (INH)
6 months for latent tuberculosis infection (LTBI):
a case-control study
I. Fresard1 , E. Lankensjold2 , P-O. Bridevaux1 , T. Rochat1 ,
J-P. Janssens1 .
1 Hôpital Cantonal Universitaire (Genève, CH);
2 CHUV (Lausanne, CH)
Background: Recent international guidelines have recommended
INH for 9 months as first-line treatment for LTBI. RIF for 4 months is
an interesting alternative, because of a shorter duration of therapy,
and potentially a lesser hepato-toxicity. In our centre, RIF has
become the default treatment for LTBI as of 2004. We aimed to
compare the frequency of increase of ASAT and/or ALAT 3 x and 5 x
above maximal normal level, completion rate of treatment for LTBI,
and rates of interruption of treatment because of side effects,
between subjects treated by INH for 6 months (ad 2003) and subjects
treated with RIF 4 months (as of 2004)
Methods: Case-control study based on a retrospective analysis of all
patients treated for LTBI by INH (1993–2002) or RIF (2004-7);
database including age, gender, history of pre-existing liver disease
or alcohol consumption, completion rates, time and causes of
interruption, as well as monthly analysis of ASAT, ALAT and
compliance (urinary INH).
Results: 636 subjects were included (48% F, 52% M, aged: 33.2 ±
11.4 years), 429 treated by INH, and 207 by RIF. Age, gender and
history of prior liver disease (1.6 vs 1.9%) did not differ between
groups. Reported alcohol consumption (5.0% vs 1.4%, chi2; p =
0.01) was slightly higher in the RIF group. Treatment interruption
(17.6%) was related to non-compliance for 10.7% and side effects for
6.9% of all patients.
When controlling for age, gender, history of prior liver disease and
alcohol consumption, occurrence of increase of ASAT and/or ALAT 3x
or 5x above upper limit of normal did not differ between groups
(logistic regression; 4.4% with RIF vs 5.8% with INH; p = 0.437).
Clinical hepatitis occurred in 3 patients with INH and 1 with RIF.
Probability of interrupting treatment (logistic regression, with age,
gender, history of prior liver disease and alcohol consumption as