INFEZIONE POLMONARE DA BLASTOSCHIZOMICES CAPITATUS

Geotrichum capitatum, now known as Blastoschizomyces capitatus, can be responsible for several opportunistic infections (systemic infection or localized at lungs, liver, kidney, encephalitis or meningitis) in an immunocompromised host, especially in those patients affected by leukaemia or under immunosuppressive therapies. A 66-year-old woman with polimyosite under steroid and immunosuppressant therapy was hospitalized in ICU for an acute respiratory distress with moderate hypoxaemia and normocapnia. Pulmonary X-ray revealed a bilateral pneumonia. Hypoxaemia became severe 48 hours later and the patient underwent mechanical ventilation and empirical antibiotic therapy. Blood cultures, urine cultures and serological tests were negative, while yeast was identified by Gram's stain of bronchoaspirate. Before identifying the yeasts Fluconazole was added to therapy. At day 5 the clinical conditions remained severe and Candida spp were excluded: so Fluconazole was switched to liposomal Amphotericin B. At day 8 B. capitatus was identified. At day 26 the patient died of refractory respiratory insufficiency. B. capitatus infection is infrequent and its prognosis is severe, with a high mortality rate (>50%). Microbiological diagnosis requires time to characterize the yeast. At present no standard therapy is available although some authors report a good susceptibility to Amphotericin B and Voriconazole (100%), according to NCCLS guidelines

Epidemiology and clonality of carbapenem-resistant <it>Acinetobacter baumannii</it> from an intensive care unit in Palermo, Italy

Abstract Background Multidrug-resistant Acinetobacter baumannii, initially considered as having a poor clinical relevance, is frequently isolated from infection cases in intensive care units. We describe the epidemiology of carbapenem resistant A. baumannii (CRAB) in a general ICU in Palermo, Italy, from October 2010 to March 2011. Findings 58 of 61 isolates exhibited MICs for meropenem or imipenem ≥16 mg/L. Forty-nine carried blaOXA-23 and two blaOXA-58 genes. Five subtype clusters were detected by rep-PCR. Clusters D and E included 10 isolates that tested negative for the carbapenem resistance genes. MLST attributed all isolates, but two, with sequence type (ST)2, whereas the two remaining isolates with ST78. The respiratory tract was the most common site of infection (26 out of 36 cases. 72.2%). A high infection related mortality rate was observed (18 out of 35 patients, 51.4%). Nineteen patients tested positive for other multidrug resistant organisms in addition to CRAB. In eight cases isolates belonging to distinct subtype clusters and/or with distinct carbapenemase profiles were identified. Conclusions Carbapenem resistance was prominently driven by the dissemination of CRAB isolates belonging to ST2, carrying the carbapenemase gene blaOXA-23. The colonization/infection of some patients by multiple strains is suggestive of an endemic circulation of CRAB.</p

One-year surveillance of methicillin-resistant Staphylococcus aureus in health-care setting, Palermo, Italy

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging cause of infections outside of health care settings. We carried out a survey to determine the prevalence and characteristics of MRSA isolates (CA-MRSA, HA-MRSA) identified among in- and outpatients by the clinical microbiology laboratories of four general hospitals in Palermo, Italy during the period February-January 2010. Methods: Participating laboratories performed isolation, confirmed methicillin-resistance by their routine method and weekly sent their strains to the coordinating laboratory at the Department of Sciences for Health Promotion “G. D’Alessandro”, University of Palermo, Italy. The isolates were test for antimicrobial susceptibility by E-test and using the disk diffusion test. Presence of the mecA gene was investigated by PCR using primers and standard conditions. Multiplex PCR was performed to determine SCCmec types I to V.9 Strains assigned to SCCmec type IVa were submitted to polymerase chain reaction (PCR) for detection of the Panton-Valentine leukocidin toxin genes lukS-PV and lukF-PV. Multiple-locus variable-number tandem-repeat analysis (MLVA) was performed. Pulsed field gel electrophoresis (PFGE) was performed as previous reported. Multilocus sequence typing (MLST) was performed on the MRSA strains following the recommended procedure at the S. aureus MLST. Results: we collected 227 isolates from 185 patients. The distribution of MRSA from different wards was: intensive-care 25%, surgery 20%, internal medicine 33%, other 15,5% unknown 6,5%. 69% of MRSA strains were resistant to ciproflox and/or levofloxacin, 40% to macrolide and 38% to gentamycin. SCCmec type IVa has been found in 42 isolates from hospitalized patients. PFGE analysis showed 81 MLVA different banding patterns. Strains of MRSA ST398 were found. Conclusions: Detect circulation of MRSA clinically relevant strains through surveillance, timely hygienic interventions and cooperation by health care personnel are crucial to minimize or control health care-associated infections. The changing epidemiology of MRSA indicates that collaborative surveillance plans integrating human and animal information should be increased