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Goals Of Work: The goal of this study was to describe the incidence of Clostridium difficile-associated disease (CDAD) in children with solid tumours.Patients and Methods: After documentation of a case of C. difficile-associated pseudomembranous colitis in a patient with neuroblastoma, the presence of C. difficile toxins A and B was prospectively tested in all children undergoing antineoplastic chemotherapy for solid tumours or lymphomas at the "G. Gaslini" Children Hospital in Genoa who presented abdominal pain.Main Results: From January 2005 to December 2006, nine (6%) out of 141 patients treated for solid tumours had C. difficile toxin A detected in their stools in the presence of abdominal symptoms including vomit, abdominal pain and diarrhoea. The majority of patients had a normal neutrophil count at onset of gastrointestinal disease No patient developed pseudomembranous colitis, and none died. All patients received antibiotics and/or antineoplastic drugs previously associated with CDAD.Conclusions: CDAD may be a complication of children with solid tumours. Since this disease may be life threatening and cause epidemic clusters, this possibility must be kept in mind for the differential diagnosis of abdominal diseases in children with cancer, especially in absence of neutropenia. [ABSTRACT FROM AUTHOR]

Abstract: The activity of amphotericin B, fluconazole, flucytosine, itraconazole and voriconazole was tested in vitro against 618 clinical Candida spp. isolates, using the broth microdilution or the disk diffusion method (voriconazole). Amphotericin B and voriconazole were the most potent antifungal agents assayed (100% of susceptible strains). Resistance to fluconazole and itraconazole was detected in three (0.7%) and 11 (2.7%) isolates of Candida albicans and in four (3.7%) isolates of Candida glabrata. Flucytosine intermediate, resistant strains, or both, were observed in C. albicans (0.3% and 0.7%), C. glabrata (2.8% intermediate) and C. tropicalis (15.2% and 15.2%). C. krusei was the least susceptible species to azoles. No statistically significant differences in the rates of resistant isolates depending on site of infection and age of the patient were observed, with the exception of C. albicans and itraconazole (higher percentage of resistance in children). At present, acquired antifungal resistance represents an uncommon finding in most Candida spp. circulating in Northern Italy. [Copyright &y& Elsevier]

We evaluated the rates of gastroenteritis admissions to the emergency department and of rotavirus-related hospitalisations in children ≤5 years of age in 2006 at an Italian paediatric hospital. We calculated the number of rotavirus cases avoidable through the universal vaccination of children. Epidemiological data were extracted from the Data Elaboration Centre. To calculate the hospitalisation rate due to rotavirus, the virus was sought in the faeces of children hospitalised for acute gastroenteritis by means of rapid immunochromatographic assay. Emergency department admissions due to gastroenteritis numbered 2,396 (11.58% of the total admissions). Of these, 276 children (11.52%) were examined and then sent home, 1,286 (53.67%) were kept in short observation and 776 (32.38%) were hospitalised. In 27.83% of hospitalised cases, the rotavirus test proved positive. The rotavirus hospitalisation rate was 55 per 10,000 children ≤5 years of age in Genoa in 2006. In 85.6% of hospitalised patients with community-acquired rotavirus infection, the disease was severe. The number of avoidable cases confirmed that the vaccination of children ≤1 year of age could reduce the burden of rotavirus infection, especially with regard to hospitalisation (45 per 10,000 children ≤5 years of age) and admissions to short observation (85 per 10,000), generating benefits for the Italian healthcare system. [ABSTRACT FROM AUTHOR]

Clin Microbiol Infect 2010; 16: 1197–1203 Serum galactomannan (GM) antigen detection is not recommended for defining invasive aspergillosis (IA) in children undergoing aggressive chemotherapy or allogeneic haemopoietic stem cell transplantation (HSCT). The ability of the GM test to identify IA in children was retrospectively evaluated in a cohort of children. Test performance was evaluated on samples that were collected during 195 periods at risk of IA. Proven IA was diagnosed in seven periods, all with positive GM test results (true positives, 4%), and possible IA was diagnosed in 15 periods, all with negative GM test results (false negatives, 8%). The test result was positive with negative microbiological, histological and clinical features in three periods (false positives, 1%), and in 170 periods it was negative with negative microbiological, histological and clinical features (true negatives, 87%). The sensitivity was 0.32 and the specificity was 0.98; the positive predictive value was 0.70 and the negative predictive value was 0.92. The efficiency of the test was 0.91, the positive likelihood ratio was 18.3, and the negative likelihood ratio was 1.4. The probability of missing an IA because of a negative test result was 0.03. Test performance proved to be better during at-risk periods following chemotherapy than in periods following allogeneic HSCT. The GM assay is useful for identifying periods of IA in children undergoing aggressive chemotherapy or allogeneic HSCT. [ABSTRACT FROM AUTHOR]

Invasive mycoses represent a rare but severe complication following hemopoietic SCT (HSCT) in children. Their incidence is related to the type of donor, being higher after allogeneic transplant, especially from alternative donors. Moreover, the incidence of invasive mycoses varies in the different post transplant phases. Neutropenia, lymphopenia, GvHD, high-dose steroids or other immunosuppressive drugs represent well-known risk factors. The clinical features of invasive mycoses after HSCT in children are similar to those observed in adults, and the diagnostic tools, including Aspergillus galactomannan antigen detection, are feasible also in pediatrics. Mortality due to invasive mycoses after HSCT in children is high.Bone Marrow Transplantation (2008) 41, S107–S111; doi:10.1038/bmt.2008.67 [ABSTRACT FROM AUTHOR]

We describe a case of Cryptosporidium infection occurring in a child after allogeneic SCT for acute non-lymphoblastic leukemia. This patient presented an intestinal, biliar, and pancreatic Cryptosporidium disease associated with an intestinal aGvHD. The increase in CD3+/CD4+ cells secondary to the reduction of steroid therapy associated with the improvement of aGvHD and the use of antiparasitic treatments (especially nitazoxanide) improved the infection-related symptoms and led to a complete clearance of the Cryptosporidium. [ABSTRACT FROM AUTHOR]

The ENTER-NET project is coordinated by the Istituto Superiore di Sanita (ISS) and includes Hospital and University laboratories from different areas of the country. This project has the aim to study the emergence and the spread of Salmonella spp. isolates at a national level and to evaluate their antibiotic resistance. In the period 2008-2009 the Bacteriological Laboratory of Genoa University Department of Health Sciences (DISSAL) collected and confirmed every year about 100 Salmonella specimens isolated by ARPAL (Azienda Regionale Protezione Ambiente Ligure) laboratories and coming from peripheral ligurian hospital laboratories. Over 204 cases of 2008-2009 period, the 50.98% had not a human origin, the 20.19% of which came from food and the 79.81% from surface streams. The remaining 49.02% were of human origin and the 65% was represented by the serotype S. typhimurium (mostly from hospitalized under 14 years old children) while S.enteritidis (12%) was mostly collected from adult hospitalized subjects and did not present pluri-resistance. Between non-human serotypes a strain of S. bredeney, isolated from a sample of raw lamb meat in 2009, was resistant to 8 antibiotics including Chloramphenicol (CAF), Tetracycline, Ampicillin, Trimethoprim and Sulfometoxazol while a strain of S. typhymurium (from a sample of sea water) was resistant to the same last antibiotics and to the Clavulanic Acid-Amoxicillin association. [ABSTRACT FROM AUTHOR]

The incidence of bacteremia following hemopoietic SCT (HSCT) changes over time from the procedure. The first 30 days have the highest incidence, both in autologous and allogeneic HSCT recipients. In the following periods, bacteremia is a frequent complication in allogeneic HSCT, especially from alternative donors. Gram-positive cocci represent the most frequent cause of single-agent bacteremia. Knowledge of epidemiology (incidence and etiology) of bacteremias following HSCT is pivotal for planning management strategies (prevention, diagnosis and therapy) that must be distinct in the different post-transplant period.Bone Marrow Transplantation (2008) 41, S104–S106; doi:10.1038/bmt.2008.66 [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article Persistence of high-level (1,3);-D-glucan after candidemia following autologous peripheral SCT in a pediatric patient, in the online September 22, 2014 issue of the journal Bone Marrow Transplantation.

The article presents a case study of a 16-year-old acute lymphoblastic leukemia patient diagnosed with candidaemia with hepatic lesions during neutropenia after chemotherapy. The study suggests the possibility of micafungin administration in treating invasive candidiasis patients who are unable to take other antifungals. It points out the significance of long-term antifungal drug administration in patients in need of prolonged immunosuppression.

Objectives Carbapenemases, that hydrolyse most b-lactams, have emerged and spread worldwide. Currently are not many data of CPE in CF. The accesses to different hospitals, such as transplant centres, make these patients at high risk for transmission of CPE. The study aims to quantify and describe the CPE isolated from CF patients in a year about active surveillance. Methods During 2014, 147 rectal swabs were analyzed. The swabs were inoculated on McConkey agar plate with meropenem disk. The susceptibility testing was performed with automatic method (Phoenix). Carbapenemase were tested by disk diffusion synergy test. For molecular characterization was used GeneXpert. The fingerprinting of isolates were performed by Box-PCR. Results In ten samples we not evaluated the CPE because there was no bacterial growth. Three patients were colonized by CPE identified as E. cloacae. Clonal identity among strains was founded. The strains show a reduced susceptibility to carbapenems and the resistance to other b-lactams and aminoglycosides. The strains were susceptibility to fluoroquinolones, colistin and tigecycline. The molecular assay shows the presence of bla VIM gene. Conclusion The screening using culture methods has unsuitable for some CF patients while molecular method has more effective. Moreover the genotyping suggests a spread among patients. The CPE represents a danger for CF patients: this resistance may be transmitted to the multi-resistant pathogens that support CF pulmonary infection. Then an active surveillance, with an appropriate method of screening for CF patients, is needed to decrease and prevent the transmission of CPE. [ABSTRACT FROM AUTHOR]