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Objectives Biofilm formation (BF) by fungal isolates may dramatically complicate infection. We determined the ability of Candida parapsilosis isolates from single fungaemia episodes to form biofilms and we analysed biofilm subgroups for antifungal susceptibility and pathogenic potential. We then correlated BF with clinical characteristics and outcomes of the episodes. Methods BF was measured using the crystal violet biomass assay. Antifungal susceptibility of preformed biofilms was assessed, and virulence was studied using the Galleria mellonella model. A retrospective analysis of patients' clinical records was performed. Results Of 190 patient-unique isolates, 84, 38 and 68 were identified as having high BF (HBF), moderate BF (MBF) or low BF (LBF), respectively. Among 30 randomly selected isolates, nine (eight HBF and one MBF), six (all HBF) and one (HBF) isolates had elevated sessile minimum inhibitory concentrations to fluconazole, anidulafungin or amphotericin B; all HBF and MBF isolates had elevated voriconazole sessile minimum inhibitory concentrations. G. mellonella killing rates of HBF isolates were significantly greater than MBF (or LBF) isolates (50% vs. 20%, 2 days from infection). By comparing HBF/MBF (106 patients) and LBF (84 patients) groups, we found that HBF/MBF patients had more central venous catheter-related fungaemias (62/106 (58.5%) vs. 29/84 (34.5%), p 0.001) and were more likely to die at 30 days from fungaemia onset (61/106 (57.5%) vs. 28/84 (33.3%), p 0.01). In the HBF/MBF group, azole antifungal therapy and central venous catheter removal were significantly associated with a higher and lower 30-day mortality rate, respectively. Conclusions C. parapsilosis BF influences the clinical outcome in patients with fungaemia. [ABSTRACT FROM AUTHOR]

Knowledge of carbapenem-resistant Klebsiella pneumoniae ( CR- KP) colonization is important to prevent nosocomial spread but also to start prompt adequate antibiotic therapy in patients with suspicion of infection. However, few studies have examined the incidence and risk factors for CR- KP bloodstream infection ( BSI) among rectal carriers. To identify risk factors for CR- KP BSI among carriers, we performed a multicentre prospective matched case-control study of all adult CR- KP rectal carriers hospitalized in five tertiary teaching hospitals in Italy over a 2-year period. Carriers who developed CR- KP BSI were compared with those who did not develop subsequent BSI. Overall, 143 CR- KP BSIs were compared with 572 controls without a documented infection during their hospitalization. Multivariate analysis revealed that admission to the Intensive Care Unit ( ICU) ( OR, 1.65; 95% CI, 1.05-2.59; p 0.03), abdominal invasive procedure ( OR, 1.87; 95% CI, 1.16-3.04; p 0.01), chemotherapy/radiation therapy ( OR, 3.07; 95% CI, 1.78-5.29; p <0.0001), and number of additional colonization sites ( OR, 3.37 per site; 95% CI, 2.56-4.43; p <0.0001) were independent risk factors for CR- KP BSI development among CR- KP rectal carriers. A CR- KP BSI risk score ranging from 0 to 28 was developed based on these four independent variables. At a cut-off of ≥2 the model exhibited a sensitivity, specificity, positive predictive value and negative predictive value of 93%, 42%, 29% and 93%, respectively. Colonization at multiple sites with CR- KP was the strongest predictor of BSI development in our large cohort of CR- KP rectal carriers. [ABSTRACT FROM AUTHOR]