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Highlights • In our experience chest CT had a significantly higher specificity and accuracy in detecting COVID-19 pneumonia than previously reported. • Chest CT and RT-PCR positive rates were 485/773 (62.7 %) and 462/773 (59.7 %), respectively. • CT sensitivity and specificity for COVID 19 with RT-PCR as reference were 90.7 % and 78.8 % respectively. • CT PPV, NPV and accuracy were 86.4 %, 85.1 % and 85.9 % respectively., Objectives The goal of this study was to assess chest computed tomography (CT) diagnostic accuracy in clinical practice using RT-PCR as standard of reference. Methods From March 4th to April 9th 2020, during the peak of the Italian COVID-19 epidemic, we enrolled a series of 773 patients that performed both non-contrast chest CT and RT-PCR with a time interval no longer than a week due to suspected SARS-CoV-2 infection. The diagnostic performance of CT was evaluated according to sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy, considering RT-PCR as the reference standard. An analysis on the patients with discrepant CT scan and RT-PCR result and on the patient with both negative tests was performed. Results RT-PCR testing showed an overall positive rate of 59.8 %. CT sensitivity, specificity, PPV, NPV, and accuracy for SARS-CoV-2 infection were 90.7 % [95 % IC, 87.7%–93.2%], 78.8 % [95 % IC, 73.8−83.2%], 86.4 % [95 % IC, 76.1 %–88.9 %], 85.1 % [95 % IC, 81.0 %–88.4] and 85.9 % [95 % IC 83.2−88.3%], respectively. Twenty-five/66 (37.6 %) patients with positive CT and negative RT-PCR results and 12/245 (4.9 %) patients with both negative tests were nevertheless judged as positive cases by the clinicians based on clinical and epidemiological criteria and consequently treated. Conclusions In our experience, in a context of high pre-test probability, CT scan shows good sensitivity and a consistently higher specificity for the diagnosis of COVID-19 pneumonia than what reported by previous studies, especially when clinical and epidemiological features are taken into account.

Background: The aetiology of lower respiratory tract infections is challenging to investigate. Despite the wide array of diagnostic tools, invasive techniques, such as bronchoalveolar lavage (BAL), are often required to obtain adequate specimens. PneumoniaCheckTM is a new device that collects aerosol particles from cough, allowing microbiological analyses. Up to now it has been tested only for bacteria detection, but no study has investigated its usefulness for virus identification. Methods: In this pilot study we included 12 consecutive patients with pneumonia. After testing cough adequacy via a peak flow meter, a sampling with PneumoniaCheckTM was collected and a BAL was performed in each patient. Microbiological analyses for virus identification were performed on each sample and concordance between the two techniques was tested (sensitivity, specificity and positive/negative predictive values), taking BAL results as reference. Results: BAL was considered adequate in 10 patients. Among them, a viral pathogen was identified by PneumoniaCheckTM 6 times, each on different samples, whereas BAL allowed to detect the presence of a virus on 7 patients (14 positivities). Overall, the specificity for PneumoniaCheckTM to detect a virus was 100%, whereas the sensitivity was 66%. When considering only herpes viruses, PneumoniaCheckTM showed a lower sensitivity, detecting a virus in 1/4 of infected patients (25%). Conclusions: In this pilot study PneumoniaCheckTM showed a good correlation with BAL for non-herpes virologic identification in pneumonia patients, providing excellent specificity. Further studies on larger population are needed to confirm these results and define its place in the panorama of rapid diagnostic tests for lower respiratory tract infections.

Infection is an important cause of morbidity and mortality among patients with end stage renal disease. Stenotrophomonas maltophilia is an unusual yet emerging pathogen in dialysis units. We performed a systematic PubMed/Medline and Scopus review of peer-reviewed English papers on S. maltophilia infections among patients undergoing chronic dialysis, with regard to vascular accesses, systemic infections and environment contaminations. Moreover, we suggest a treatment algorithm to preserve the patient and the permanent dialysis catheters.

The detection of Aspergillus antigen (galactomannan) is considered a reliable marker for the diagnosis of invasive aspergillosis (IA), yet the sensibility and specificity of the assays commonly employed in routine are not optimal. The aim of the present study was to investigate whether the detection of another panfungal antigen, the (1,3)-b-D-glucan could have an auxiliary role in the identification of patients with IA. The study was carried out on 63 sera belonging to patients who had been screened for galactomannan, according to the clinical suspect of IA. Our data show that the positive galactomannan results were not confirmed by positive (1,3)-b-D-glucan results in patients receiving therapy with beta-lactam antibiotics associated with tazobactam, whereas in all the other cases, with the exception of four, the results of the (1,3)-b-D-glucan test were confirmatory of the galactomannan results.

Although there has been an overall good coverage of Candida glabrata infections by the echinocandins, emergence of antifungal resistance during therapy has been reported. We investigated, by using an invertebrate host model, the fitness of sequential C. glabrata isolates with different echinocandins susceptibility patterns. The studied strains were isolated from a case of recurrent fungemia with a fatal outcome due to C. glabrata that developed cross-resistance to echinocandins during caspofungin therapy. The sequential strains isolated post-therapy showed a S663P mutation in the Fks2p hot spot 1. In vivo study in the invertebrate host Galleria mellonella did not suggest a fitness cost related to the acquired antifungal resistance, the three isolates displayed a similar rate of killing (P = 0.54). We observed a clear correlation between emergence of antifungal resistance and persistence of the causal agent, probably aided by the unchanged fitness and unresponsiveness in vivo to the adopted therapy.

Infection is a common complication in patients carrying a central venous catheter (CVC) and is associated with increased morbidity and mortality. Leclercia adecarboxylata is an unusual but emerging pathogen in healthy and immunocompromised patients. We report a case of L. adecarboxylata bacteraemia in a patient with a haemodialysis tunnelled CVC. In accordance with the susceptibility to the tested antimicrobials, a long-course treatment with intravenous gentamicin plus amoxicillin-clavulanic acid and gentamicin-lock therapy was adopted. The patient had a full recovery and the catheter was not removed. We also performed a systematic PubMed/Medline and Scopus review of peer-reviewed English papers on L. adecarboxylata infections, focusing on bacteraemia in patients with different types of CVCs. Moreover, we suggest a treatment algorithm to preserve the patient and maintain the CVC.

Summary Fungaemia is an increasing nosocomial pathology. The ‘gold standard’ for detection of fungaemia is blood culture, but it is time-consuming and its sensitivity for early detection is low. On the other hand, yeasts present different antifungal sensitivity patterns to be quickly detected to allow an effective treatment. The aim of this study was to evaluate the diagnostic performances of PNA-FISH to directly identify yeasts from blood cultures and to compare results with those obtained by culture. A total of 176 blood cultures positive for yeasts at direct Gram stain and 24 negative blood cultures as control collected from 15 Italian hospitals, included in a network coordinated by the Medical Mycology Committee, Italian Society of Clinical Microbiology (AMCLI), were examined both by culture and PNA-FISH technology. Sensitivity of the PNA-FISH technique evaluated for five Candida species was 99.3% and specificity, 100%. Distinguishing which yeast is implicated in fungaemia and whether the infection is caused by multiple species are important for the selection of antifungal therapy. The PNA-FISH technique is a very useful approach because the test discriminates between groups of Candida species with different susceptibility pattern, particularly against azoles and echinocandins, with only a 90-minute turn-around time after the Gram-stain reading.

Significant changes in the management of fungaemia have occurred in the last decade with increased use of fluconazole prophylaxis, of empirical treatment and of echinocandins as first-line agents for documented disease. The emergence of drug resistance in fungal pathogens has a profound impact on human health given limited number of antifungal drugs. Antifungal resistance in Candida may be either intrinsic or acquired and may be encountered in the antifungal drug exposed but also the antifungal drug naïve patient The variation in resistance rates between centers emphasizes that it is essential to have knowledge of the local Candida species distribution and antifungal resistance rates to guide initial therapy for Candida BSI. Moreover, all Candida isolates from blood and normally sterile sites should be identified to the species level. The Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing have developed breakpoints and epidemiological cutoff values that are now established for Candida spp. Clinical microbiology laboratories will be employed commercial susceptibility assays, rather than reference broth microdilution methods and comparative studies are particularly important. Vitek 2®, Etest® and Sensititre YeastOne® provided a high degree of essential agreement and comparable sensitivity and specificity to BMD-RPMI for identifying resistance to azole and echinocandins in Candida spp.

The emergence of drug resistance in fungal pathogens has a profound impact on human health given limited number of antifungal drugs. Antifungal resistance in Aspergillus spp. infection can be encountered in the antifungal drug-exposed patient due to selection of intrinsically resistant species or isolates with acquired resistance belonging to species that are normally susceptible. Resistance to triazoles is not common in Aspergillus spp., however, triazole resistance in A. fumigatus appears to be increasing in several European countries in recent years and can be clinically relevant. The Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing have developed breakpoints and epidemiological cutoff values that are now established for Aspergillus spp. Clinical microbiology laboratories will be employed commercial susceptibility assays, rather than reference broth microdilution methods and comparative studies are particularly important.

A recently developed microdilution method (Sensititre) YeastOne) may represent a valid alternative to the National Committee for Clinical Laboratory Standards (NCCLS) method for routine testing. The Medical Mycology Committee of the Associazione Microbiologi Clinici Italiani (AMCLI) decided to evaluate its reproducibility and reliability compared with the NCCLS M27A protocol and the E-test. Nineteen strains each of Candida albicans and Ca. parapsilosis, isolated from systemic infections, were tested against amphotericin B, flucytosine, ketoconazole, itraconazole, and fluconazole. All the participating laboratories tested the YeastOne panels, while the E-test and the NCCLS method were performed by two laboratories each. Interlaboratory reproducibility showed a good correlation (from 95% for amphotericin B to 92.5% for flucytosine). The agreement between NCCLS and YeastOne ranged from 95 (ketoconazole and itraconazole) to 100% (amphotericin B and flucytosine), whereas the agreement between E-test and YeastOne ranged from 72.5 (fluconazole) to 100% (amphotericin B and flucytosine). The Sensititre YeastOne panels appear to be an excellent alternative to both the E-test and the NCCLS protocol for antifungal susceptibility testing.

Invasive aspergillosis is a serious problem for immunocompromised patients, especially if neutropenic. The diagnosis of this infection is complicated, since clinical symptoms are often similar to those of other fungal diseases. The chance of detecting the presence of a specific antigen in the serum could confirm the suspected clinical diagnosis and, perhaps, be useful for the follow-up of the patient. The Medical Mycology Committee of the Associazione Microbiologi Clinici Italiani (AMCLI) decided to evaluate in a multicenter prospective study (from 1 November 1998 to 28 February 1999) the performance of the Platelia® Aspergillus Kit (Bio-Rad) for the detection of Aspergillus galactomannan in human serum. The enrolled patients included various groups of immunosuppressed patients (mostly neutropenic). Blood samples were drawn at the time of enrollment. This decision was based upon a clinical diagnosis of probable aspergillosis (antibiotic non-responsive fever for at least 96 hours, cough, hemophthosis and positive chest X-ray). Additional blood samples were drawn on days 3, 6, 9, 12, 15 and 21. Culture and histopathologic examinations were performed according to the individual laboratory workflow. For each patient the laboratory filled a form with all the available clinical information, to create a database on which to evaluate the results of the test. During the study, 187 patients with various kinds of immunosuppression were enrolled. A total of 256 sera were tested: for 117 patients (62.6%) only the basal sample was tested, whereas for the 70 symptomatic patients (37.4%) multiple specimens (range: 1–6) were tested. The results allowed the laboratories to exclude (68.6%) or confirm (31.5%: confirmed and/or probable) the clinical diagnosis of invasive aspergillosis; 4 cases remained undetermined. Based on the results of this study, it seems that the use of this test should be limited to those patients with clinical symptoms of aspergillosis.

The purpose of this study was to verify the standard procedures and minimum level of knowledge of Italian public laboratories involved in the management of antifungal susceptibility testing (AST). Two nationwide surveys were performed in 1999 and 2004. One hundred and two Italian hospitals located in 85 provincial capitals (82.5%) participated to these surveys. In 1999, 28 (27.5%) laboratories versus 16 (15.7%) in 2004 stated that they did not perform any susceptibility testing. Some discrepancies observed in the survey confirm that AST is difficult to be correctly managed, and that it can be performed only in very well-trained centers. The great variability of the results of MIC determination and clinical interpretation underlines the urgent need to improve knowledge about indications, method choice, and interpretative criteria for AST both for clinical microbiologists and clinicians.

Purpose We compared the risk factors, the diagnostic tools and the outcome of filamentous fungal infections (FFIs) in hematological patients (HAEs) and non-hematological patients (non-HAEs). Methods Prospective surveillance (2009–2011) of proven and probable FFIs was implemented in 23 Italian hospitals. Results Out of 232 FFIs, 113 occurred in HAEs and 119 in non-HAEs. The most frequent infection was invasive aspergillosis (76.1 % for HAEs, 56.3 % for non-HAEs), and the localization was principally pulmonary (83.2 % for HAEs, 74.8 % for non-HAEs). Neutropenia was a risk factor for 89.4 % HAEs; the main underlying condition was corticosteroid treatment (52.9 %) for non-HAEs. The distribution of proven and probable FFIs was different in the two groups: proven FFIs occurred more frequently in non-HAEs, whereas probable FFIs were correlated with the HAEs. The sensitivity of the galactomannan assay was higher for HAEs than for non-HAEs (95.3 vs. 48.1 %). The overall mortality rate was 44.2 % among the HAEs and 35.3 % among the non-HAEs. The etiology influenced the patient outcomes: mucormycosis was associated with a high mortality rate (57.1 % for HAEs, 77.8 % for non-HAEs). Conclusions The epidemiological and clinical data for FFIs were not identical in the HAEs and non-HAEs. The differences should be considered to improve the management of FFIs according to the patients’ setting.

The authors evaluated the performance of the MycArray™ Yeast ID (Myconostica Ltd, UK) assay in the identification of a total of 88 yeast isolates recovered in culture as compared to that obtained through routine methods. The turn-around time for species identification directly from cultures by the MycArray was 6 hours, much quicker than classical methods and all yeasts were correctly identified. In two cases a double identification including Saccharomyces cerevisiae was noted, but it was not confirmed by culture. The results show that MycArray Yeast ID can be a potential tool for rapid detection and identification of Candida species.

Antifungal susceptibility testing of yeasts and the development of interpretive breakpoints are nowadays very important topics both for the increasing incidence of invasive mycoses and number of available antifungal drugs and for the appearance of acquired resistance. The Subcommittee on Antifungal Susceptibility Testing (AFST) of the European Committee on Antibiotic Susceptibility Testing (EUCAST) has recently released both the operative standards to evaluate the fermenting yeasts susceptibility against antimycotic drugs and the breakpoints for infections due to some Candida species and for some of the available antifungals. Antifungal susceptibility testing is mandatory on a routine base for: 1. therapeutic failure, 2. breakthrough fungemias, 3. on yeasts isolated from patients who recently received prophylactic antifungal treatments, and 4. when the deep-seated infection is due to less common yeasts, with an unknown susceptibility pattern. The Medical Mycology Committee (CoSM) of the Italian Society of Clinical Microbiologists (AMCLI) adopted the interpretive breakpoints of both CLSI and EUCAST. The operating procedure for antifungal susceptibility testing according to EUCAST is supported by the recommendation to use, when clinically necessary, validated commercial methods (Vitek2, Sensititre, E-test). Finally, the CoSM reports the recommendations for a correct management of antifungal susceptibility testing.

Background Yeasts are a common cause of invasive fungal infections in critically ill patients. Antifungal susceptibility testing results of clinically significant fungal strains are of interest to physicians, enabling them to adopt appropriate strategies for empiric and prophylactic therapies. We investigated the antifungal susceptibility of yeasts isolated over a 2-year period from hospitalised patients with invasive yeast infections. Methods 638 yeasts were isolated from the blood, central venous catheters and sterile fluids of 578 patients on general and surgical intensive care units and surgical wards. Etest strips and Sensititre panels were used to test the susceptibility of the isolates to amphotericin B, anidulafungin, caspofungin, fluconazole, itraconazole, posaconazole and voriconazole in 13 laboratories centres (LC) and two co-ordinating centres (CC). The Clinical and Laboratory Standards Institute (CLSI) reference broth microdilution method was used at the CCs for comparison. Results Etest and Sensititre (LC/CC) MIC90 values were, respectively: amphotericin B 0.5/0.38, 1/1 mg/L; anidulafungin 2/1.5 and 1/1 mg/L; caspofungin 1/0.75 and 0.5/0.5 mg/L; fluconazole 12/8 and 16/16 mg/L; itraconazole 1/1.5, 0.5/0.5 mg/L; posaconazole 0.5 mg/L and voriconazole 0.25 mg/L for all. The overall MIC90 values were influenced by the reduced susceptibility of Candida parapsilosis isolates to echinocandins and a reduced or lack of susceptibility of Candida glabrata and Candida krusei to azoles, in particular fluconazole and itraconazole. Comparison of the LC and CC results showed good Essential Agreement (90.3% for Etest and 92.9% for Sensititre), and even higher Categorical Agreement (93.9% for Etest and 96% for Sensititre); differences were observed according to the species, method, and antifungal drug. No cross-resistance between echinocandins and triazoles was detected. Conclusions Our data confirm the different antifungal susceptibility patterns among species, and highlight the need to perform antifungal susceptibility testing of clinically relevant yeasts. With the exception of a few species (e.g. C. glabrata for azoles and C. parapsilosis for echinocandins), the findings of our study suggest that two of the most widely used commercial methods (Etest and Sensititre) provide valid and reproducible results.

Introduction: The bone and joint infections sustained by mycobacteria and mainly involving the synovium, tendons and bone stock, may be traumatic, especially in open fractures or iatrogenic post surgical procedures. Methods: The frustules, taken after cleaning the bone, were sent to the Microbiological Laboratory and processed for the presence of Gram-positive and Gram-negative bacterial populations, the mycobacteria Group M. tuberculosis complex and the mycobacteria belonging to the group of NTM (Non Tubercular Mycobacteria). Results: The decontaminated material was sown on liquid culture (MGIT 960 System BD Diagnostics) and on solid growth medium (Löwenstein-Jensen) and kept under observation at 37° C for 60 days. After 15 days on the solid medium there developed a mycobacterium strongly pigmented in orange. By the reverse hybridization method “GenoType® CM; Hain Diagnostika, Nehren, Germany; Arnika”, Mycobacterium szulgai was identified, an organism rarely isolated in our laboratory. On preliminary characterization it resulted scotochromogenic at 37° C and photochromogenic when cultured at 25° C. Conclusions: The isolation of M. szulgai, and the previous isolation of a M. intracellular (paper in press) from a similar material suggest that, in this type of infection, the role of mycobacteria can be clinically relevant and probably underestimated, both because the difficulty of isolating and identifying these organisms and because surgeons almost never request this type of investigation. It would therefore be appropriate to send routinely these materials to dedicated laboratories equipped to search for mycobacteria. Its identification could allow a more realistic picture on the role played by these bacterial infections in osteoarticular infections.

Chlamydia trachomatis infections represent the most common sexually transmitted diseases.The lack of growth of these microorganisms on common media and the roundabout research by immunofluorescence, has meant that, until now, these special-lived intracellular microorganisms have played a role probably underestimated in cases of infections affecting the sexual organs.The introduction of molecular biology has made possible their research in a much more simple, reliable and standardized methods. The study was carried out on endocervical samples, male urethral swabs and urine samples of men and women, determining the C. trachomatis DNA amplified using the BD ProbeTec ET system. This system uses technology SDA (Strand Displacement Amplification - Elongationcrowding of the blanks). The study was conducted from June 2008 to june 2009. Symptomatic and asyntptomatic patients residents in the provinces of Novara and the Verbano-Cusio-Ossola were considered. In this period 784 determinations were made in molecular biology. Chlamydia trachomatis was found in 26 cases equal to a percentage of 3.32%. While considering these preliminary data, however, we can estimate the rate of detection of C. trachomatis as a good starting point, because we have the impression that improved procedures particularly relate to the techniques for sampling and for storage and transport of the sample, can undoubtedly lead to much higher percentages.

Invasive fungal infections are an important cause of morbidity and mortality in immunocompromised patients. Improvements in the management of critical care and neoplastic diseases, and development of newer antimicrobial agents have contributed to the emergence of new fungi and the resurgence of older.The Medical Mycology Division (CoSM) of the Associazione Microbiologi Clinici Italiani (AMCLI) proposed the institution of 1. a national register (2006-2008) of all cases of infection by uncommon moulds, implicated as aethiological agents in subcutaneous and deep mycoses and 2. a fungal library, to perform in vitro epidemiological typing.The strains isolated at each Laboratory have been identified by the means of standard procedures and confirmed by sequencing a fragment encoding the ribosomal large subunit RNA and by comparing in the GenBank. 14 Italian Centers sent 87 strains. The survey confirmed Aspergillus (36/87), Fusarium (17/87), zigomycetes (15/87), dematiaceous (12/87), Histoplasma capsulatum var. capsulatum (3/87) and other jaline moulds (3/87). Sequencing can be considered a confirmatory technique only for unusual moulds difficult to identify.

Dirofilaria spp. causes a common zoonotic filarial infection found in dogs and humans in the tropical, subtropical and temperate areas. After biological development in the mosquito, dogs and humans may be infected with the infective larvae when the mosquito takes a blood meal. In humans, the worms do not reach maturity, and no microfilariae can be detected.A number of species, such as D. tenuis, D. repens, D. immitis have been identified as causative agents of subcutaneous or conjunctival nodules in humans. Diagnosis is made by identifying the worm in biopsies or extracting the worm from the lesion. Surgical removal of the worms is the only known treatment.

The purpose of this study was to verify the standard procedures and minimum level of knowledge of Italian public laboratories involved in the management of antifungal susceptibility testing (AST).Two nation-wide surveys were performed in 1999 and 2004. 102 Italian hospitals located in 85 province capitals (82.5%) participated to these surveys. In 1999, 28 (27.5%) laboratories versus 16 (15.7%) in 2004 stated that they did not perform any susceptibility testing. Some discrepancies observed in the survey confirm that AST is difficult to be correctly managed, and that it can be performed only in very well-trained centers. The great variability of the results of MIC determination and clinical interpretation underlines the urgent need to improve knowledge about indications, method choice and interpretative criteria for AST both for clinical microbiologists and clinicians.

From June 2004 to June 2005, a total of 58 mycobacterial isolates were recovered from inpatients admitted to the “Ospedale Maggiore” in Novara, Italy. Most of the above strains were from respiratory secretions. Among the 32 isolates identified as Mycobacterium tuberculosis complex (MTC), susceptibility testing to streptomycin, isoniazid, rifampin, ethambutol and pyrazinamide was subsequently performed by using the MGIT 960 system. Starting from positive cultures, the Genotype MTBDR “Arnika” test, based on target amplification and stripbased reverse hybridization was also carried out. In addition to the MTC identification, the test can investigate the resistance to both rifampin (by molecular analysis of the rpoB region) and isoniazid (by detecting mutations at the resistance domain of katG gene). The results were compared with those obtained by conventional liquid medium susceptibility testing. Full agreement with both drugs was obtained on all the tested isolates. In conclusion, the GenoType MTBDR assay was found to enable a very rapid resistance detection of the most important anti-tubercular drugs.These data are important to set up an effective therapy and consequent disease control.

Central venous catheter represents a major source of nosocomial bloodstream infection, which cause considerable excess morbidity.The diagnosis of catheter-related infections relies on the presence of clinical manifestation of infection and the evidence of colonization of the catheter tip by bacteria or fungi. The most frequent pathogens were Gram-positive organisms, mainly coagulase negative staphylococci, followed by Gram-negative and mycetes. During the years 2001-2003 we examined 2079 vascular catheters, of which 896 were positive for bacterial and fungal species. Of these, 675 (75,3%) involved Gram-positive bacterial, 145 (16,2%) Gram-negative and 76 (8,5%) mycetes.

A multicenter retrospective survey of funguria was run at 6 Italian hospitals (Bergamo,Novara,Varese, Florence, Ancona, Pescara) from January 1, 2001 to December 31, 2002. The aim of the study was to evaluate the incidence of recovery of yeasts from urine cultures, the distribution among the hospital wards, the involved species and the number of patients with concurrent fungemia and funguria. Microorganisms (either bacteria or yeasts) were isolated from the 21% of urine cultures: overall, 2% of them were positive for yeasts, whereas 19% for bacteria.Yeasts were recovered from the 8% of the positive urine cultures. Yeasts in the urine were mostly observed in Intensive Care Units (24% of positive urine cultures), and less frequently in Medical and Surgical wards. Candida albicans was the most frequently recovered species (63%), followed by C. glabrata (18%), C. tropicalis (9%), C. parapsilosis (3%); other Candida species, Trichosporon asahii and Saccharomyces cerevisiae were occasionally isolated, whereas moulds were never recovered. Overall, 5% of patients (55/1119) with funguria had concurrent fungemia and in 41 cases the same species was recovered from both urine and blood. C. albicans was the most frequently recovered species, followed by C. glabrata, C. tropicalis and C. parapsilosis.

The multiple problems associated with the recovery of yeasts from urine specimens induced the Medical Mycology Committee (CoSM) of AMCLI to run a nationwide epidemiologic survey on candiduria in order to evaluate risk factors, involved species, treatment and outcome. Ten hospitals (Bergamo, Como, Crema, Novara,Varese,Ancona, Florence, Pescara, Palermo and Taranto) participated to this study, which was run on a 15-month period (October 1, 2001-December 31, 2002). Overall, 83 Data Forms were collected, regarding patients admitted to Intensive Care Units (45), Surgical (9) and Medical (29) wards. The most common risk factors were: bladder catheter, antibiotic therapy, parenteral nutrition, kidney failure, surgery. Candiduria, mostly asymptomatic, were often associated with fever and bacterial infections. Concurrent candidaemia was detected in 13 patients. Candida albicans was the most frequently recovered species, from both urine and blood, followed by C. glabrata. Other Candida species were occasionally isolated from urine specimens. Specific antifungal treatment was administered to 58% of the patients, mostly using fluconazole. The remaining subjects did not receive antimycotic therapy. Eradication of Candida from urine specimens was observed even without a specific therapy.

We determined the in vitro activity of fluconazole against 1565 clinical Candida spp. isolates collected from different specimens of non-AIDS outpatients and inpatients in 3 different regions of Italy. Susceptibility testing was performed by agar disk diffusion using the NCCLS document M44-A guidelines. Candida albicans was the most frequently isolated yeast (68%) followed by C. glabrata (15%), C. tropicalis (5%), C. parapsilosis (5%), and C. krusei (5%). Other yeasts represented 4% of all isolates. Of the 1565 isolates tested, 1449 (92.6%) were susceptible (S) to fluconazole, 43 (2.7%) were susceptible dose-dependent (S-DD) and 73 (4.7%) were resistant (R). Almost all (98.2%) of the C. albicans isolates were classified as S or S-DD. Despite its widespread use, fluconazole displayed good activity against the isolates we tested, and the disk diffusion method was confirmed as a reliable approach to the evaluation of in vitro susceptibility of yeasts to this antimycotic agent.

In thIe latter years Enterobacter cloacae has been counted as a very important occasional pathogen, above all in causing hospital infections.The micro-organism’s interesting increases because of its high resistance in vitro to many antimicrobial agents. For this reason it would be possible to find out others resistance mutant phenotypes. The results (2000-2001 and the first six months of 2002), carried out 341 isolated samples from hospital patients, show that the percentage of these E. cloacae is little more than 1%, increasing prevalence of patients belonging to General Surgery and Intensive Care Unit. The susceptible tests suggest (without important differences during the whole year) that most of the clinical isolates have moderate or high level resistance to various antimicrobial agents (penicillins, cephalosporins, aminoglycosides, quinolones, monobactam) and almost all were susceptible to amikacin, carbapenems (imipenem) and trimethoprim/sulfmamethoxazolo. Always regarding the resistance of these pathogens, it was possible to find out some phenotypes, and one of these, among 172 isolates belonging to Intensive Care Unit, was a particular multiresistance phenotype. The VITEK ESsL detection test and the conventional double disk synergy test for detection of ESsL find out some phenotypes showing expression of stably derepressed beta-lactamase.

Two clinical cases of mycotic infections secondary to knee spacers medicated with antibiotics against bacterial infections are presented. Care must be taken between the first and second stage (when the spacer is in place), and attention must be paid to the management of the surgical wound to avoid secondary contamination.