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Microbial identification from blood cultures is essential to institute optimal antibiotic therapy and improve survival possibilities. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has been successfully applied to identify bacteria and yeasts from positive blood cultures broths. The aim of this multicentre study was to evaluate the reliability of the lysis-filtration technique associated with MALDI-TOF MS to directly identify microorganisms from 765 positive blood cultures collected in six Italian hospitals. Overall, 675/765 (78.1%) blood isolates were correctly identified at the species level, with significant differences between Gram-negative and Gram-positive bacteria (92.6%, and 69.8%, respectively). Some difficulties arise in identifying Streptococcus pneumoniae, Staphylococcus aureus, yeasts and anaerobes. The lysis-filtration protocol is a suitable procedure in terms of performance in identifying microorganisms, but it is quite expensive and technically time-consuming since the time of filtration is not regular for all the samples. The application of the MALDI-TOF MS technique to the direct microbial identification from positive blood cultures is a very promising approach, even if more experience must be gained to minimize errors and costs.

Viridans Group Streptococci (VGS) species-level identification is fundamental for patients management. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has been used for VGS identification but discrimination within the Mitis group resulted difficult. In this study, VGS identifications with two MALDI-TOF instruments, the Biotyper (Bruker) and the VITEK MS (bioMérieux) have been compared to those derived from tuf, soda and rpoB genes sequencing. VGS isolates were clustered and a dendrogram constructed using the Biotyper 3.0 software (Bruker). RpoB gene sequencing resulted the most sensitive and specific molecular method for S. pneumonia identification and was used as reference method. The sensitivity and the specificity of the VITEK MS in S. pneumonia identification were 100%, while the Biotyper resulted less specific (92.4%). In non pneumococcal VGS strains, the group-level correlation between rpoB and the Biotyper was 100%, while the species-level correlation was 61% after database upgrading (than 37% before upgrading). The group-level correlation between rpoB and the VITEK MS was 100%, while the species-level correlation was 36% and increases at 69% if isolates identified as S. mitis/S. oralis are included. The less accurate performance of the VITEK MS in VGS identification within the Mitis group was due to the inability to discriminate between S. mitis and S. oralis. Conversely, the Biotyper, after the release of the upgraded database, was able to discriminate between the two species. In the dendrogram, VGS strains from the same group were grouped into the same cluster and had a good correspondence with the gene-based clustering reported by other authors, thus confirming the validity of the upgraded version of the database. Data from this study demonstrated that MALDI-TOF technique can represent a rapid and cost saving method for VGS identification even within the Mitis group but improvements of spectra database are still recommended.

Amelogenesis imperfecta (AI) is a hereditary disorder caused by mutations of genes primarily involved in the enamel formation. Several different types of AI have been identified, based on the phenotype and on the mode of inheritance. Regardless of the type, the dental treatment tends to be the same, favoring the complete removal of the compromised enamel late in the patient's life. With the new dentistry guidelines that orient clinicians towards minimal invasiveness, it should be mandatory to intercept patients affected by AI earlier, not only to protect the dentition from further degradation but also to help patients improve their self-esteem. This article examines the restorative dentistry performed on a 24-year-old Caucasian female suffering from the hypoplastic type of AI, using only adhesive procedures. Due to the complex needs of the patient, an interdisciplinary approach was followed, involving orthodontics, periodontics, and restorative dentistry. A full-mouth adhesive rehabilitation was achieved by means of direct composite restorations, veneer/onlays and facial/palatal veneers. No elective endodontic therapy was necessary for restorative purposes. The esthetics, mechanics, and biological success were achieved and maintained. The bond to the enamel did not show signs of degradation (eg, discoloration or infiltration) even after 5 years of function. This is encouraging as it shows that adhesive techniques may be a reliable approach even in the presence of a compromised enamel layer.

Unlabelled: In case of severe dental erosion, the maxillary anterior teeth are often particularly affected. Restoring such teeth conventionally (ie, crowns) would frequently involve elective endodontic therapy and major additional loss of tooth structure. A novel, minimally invasive approach to restore eroded teeth has been developed and is currently being tested in the form of a prospective clinical trial, termed The Geneva Erosion Study. To avoid crowns, two separate veneers with different paths of insertion have been used to restore the affected anterior maxillary teeth, regardless of clinical crown length and amount of remaining enamel. This treatment is called The Sandwich Approach., Objectives: The purpose of this case series study was to analyze the mid-term clinical outcome of maxillary anterior teeth affected by severe dental erosion that were restored following the Sandwich Approach., Materials and Methods: Twelve consecutively consulting patients (mean age: 39.4 years) suffering from advanced dental erosion have been enrolled in the study and were subsequently treated. Due to the late interception of the disease, all patients needed a full-mouth rehabilitation, which was performed without any conventional crowns. At the level of the maxillary anterior teeth, a total of 70 palatal indirect composite restorations and 64 facial feldspathic ceramic veneers were delivered. Both types of veneers were adhesively luted with a hybrid composite. Clinical reevaluations were performed 6 months after insertion of the veneers, and then annually, using modified United States Public Health Service (USPHS) criteria. Marginal adaptation, marginal integrity (seal, absence of infiltration), status of pulp vitality, postoperative sensitivity, esthetics, and restoration success/failure, were the principal clinical parameters analyzed., Results: After an up to 6-year observation time (mean observation time 50.3 months for the palatal veneers and 49.6 months for the facial veneers), no complete or major failure of the restorations was encountered. On the basis of the criteria used, most of the veneers rated Alpha for marginal adaptation and marginal seal. Secondary caries or endodontic complications were not detected. Using visual analogue scale analysis, the patient-centered satisfaction revealed a high esthetic and functional acceptance of 94.6%., Conclusions: Compared to conventional crown preparation, restoring compromised maxillary anterior teeth by means of 2 veneers prevents excessive tooth structure removal and loss of tooth vitality. Questions on the longevity of this new treatment arise, due to the nonfavorable initial status of the teeth to be restored (eg, lack of enamel, sclerotic dentin substrate and short clinical crowns). The clinical performance of the teeth treated following the Sandwich Approach seems promising, since none of the treated teeth lost their vitality, no failure of any of the restorations was detected, and the patients' overall satisfaction was high. Even though further investigation is needed to determine the clinical long-term performance of the described treatment modality, the encouraging mid-term results (biological, esthetic, and mechanical success) clearly question if conventional crowns in the anterior maxillary segments can still continue to be considered the best and only option to treat this particular population of patients.

In gymnastics, monitoring of the training load and assessment of the psychophysiological status of elite athletes is important for training planning and to avoid overtraining, consequently reducing the risk of injures. The aim of this study was to examine whether heart rate variability (HRV) is a valuable tool to determine training load and psychophysiological status in young elite gymnasts. Six young male elite gymnasts took part in a 10-week observational study. During this period, beat-to-beat heart rate intervals were measured every training day in weeks 1, 3, 5, 7, and 9. Balance, agility, upper limb maximal strength, lower limb explosive, and elastic power were monitored during weeks 2, 4, 6, 8, and 10. Training load of each training session of all 10 weeks was assessed by session rating of perceived exertion (RPE) and psychophysiological status by Foster's index. Morning supine HRV (HF% and LF%/HF%) correlated with the training load of the previous day (r = 0.232, r = -0.279, p < 0.05 ). Morning supine to sitting HRV difference (mean R wave to R wave interval (RR), mean heart rate, HF%, SD1) correlated with session RPE of the previous day (r = -0.320, r = 0.301, p < 0.01; r = 0.265, r = -0.270, p < 0.05) but not with Foster's index. Training day/reference day HRV difference (mean RR, SD1) showed the best correlations with session RPE of the previous day (r = -0.384, r = -0.332, p < 0.01) and Foster's index (r = -0.227, r = -0.260, p < 0.05). In conclusion, HRV, and in particular training day/reference day mean RR difference or SD1 difference, could be useful in monitoring training load and psychophysiological status in young male elite gymnasts.

A full-mouth adhesive rehabilitation in case of severe dental erosion may present a challenge for both the clinician and the laboratory technician, not only for the multiple teeth to be restored, but also for their time schedule, difficult to be included in a busy agenda of a private practice. Thanks to the simplicity of the 3-step technique, full-mouth rehabilitations become easier to handle. In this article the treatment of a very compromised case of dental erosion (ACE class V) is illustrated, implementing only adhesive techniques. The very pleasing clinical outcome was the result of the esthetic, mechanic and most of all biological success achieved, confirming that minimally invasive dentistry should always be the driving motor of any rehabilitation, especially in patients who have already suffered from conspicuous tooth destruction.

Background: Long Term Care Facilities (LTCFs) play a key role in guaranteeing care to patients in developed countries. Many patients, mostly elderly, access LTCFs at some time in their lives, and their healthcare pathways often require them to move back and forth between hospital and outpatient settings. These patterns bring about new challenges regarding infection control, especially healthcare associated infections., Methods: A point prevalence study was conducted in 23 Italian LTCFs, to identify colonization in patients with urinary catheter (>24 hours). Species identification, susceptibility tests and extended spectrum beta lactamase (ESBL) production screenings were performed using Vitek 2 System. Enterobacteria identified by Vitek 2 System as ESBL-producers or suspected AmpC hyperproducers on the basis of cephamycin resistance, were sent to a research laboratory where they underwent a double-disk synergy test. Finally, ESBL-producers were screened for bla resistance genes by PCR assay., Results: 211 patients with catheter were screened, 185 out of 211 patients showed positive samples for the presence of Enterobacteriaceae, 114 of these 185 patients were colonized by extended spectrum cephalosporins resistant microorganisms. We identified a total of 257 Gram negative pathogens, of which 51.8% (133/257) were extended spectrum cephalosporins resistant. 7 out of 133 cephamycin not susceptible strains proved to be AmpC-type beta-lactamases and 125/133 ESBL-producers; 1 was not further characterized. 43 out of 257 (16.7%) E. coli, 37/257 (14.4%) P. mirabilis, 20/257 (7.8%), P. stuartii, 14/257 (5.4%) M. morganii, 7/257 (2.7%), K. pneumoniae, 4/257 (1.6%) C. koseri proved to be overall ESBL-producers by double-disk synergy test. Third and fourth generation cephalosporin resistant P. mirabilis, P. stuartii and M. morganii strains mainly harboured a blaTEM gene (95.9%), while 89.1% of E. coli were positive for the blaCTX-M determinant by PCR and sequencing. Patients with decubitus had a higher risk of colonization by at least one resistant isolate (p < 0.01). Samples of patients undergoing antibiotic therapy and patients with decubitus showed a higher risk (p < 0.05) of colonization by beta-lactam resistant microorganisms., Conclusions: These data confirm the presence of high percentages of ESBL-positive Enterobacteria in Italian LTCFs and the predominance of CTX-M type ESBL in E. coli. The alarming presence of ESBL-producing Enterobacteriaceae in Italian LTCFs can seriously compromise the effectiveness of antibiotic therapy.acilities (LTCFs), Antimicrobial resistance.

Dental erosion is increasing, and only recently are clinicians starting to acknowledge the problem. A prospective clinical trial investigating which therapeutic approach must be undertaken to treat erosion and when is under way at the University of Geneva (Geneva Erosion Study). All patients affected by dental erosion who present with signs of dentin exposure are immediately treated using only adhesive techniques. In this article, the full-mouth adhesive rehabilitation of one of these patients affected by severe dental erosion (ACE class IV) is illustrated. By the end of the therapy, a very pleasing esthetic outcome had been achieved (esthetic success), all of the patient's teeth maintained their vitality, and the amount of tooth structure sacrificed to complete the adhesive full-mouth rehabilitation was negligible (biological success).

Minimally invasive principles should be the driving force behind rehabilitating young individuals affected by severe dental erosion. The maxillary anterior teeth of a patient, class ACE IV, has been treated following the most conservatory approach, the Sandwich Approach. These teeth, if restored by conventional dentistry (eg, crowns) would have required elective endodontic therapy and crown lengthening. To preserve the pulp vitality, six palatal resin composite veneers and four facial ceramic veneers were delivered instead with minimal, if any, removal of tooth structure. In this article, the details about the treatment are described.

Background: There is no clear relationship between in vitro bactericidal activity tests and clinical outcome. We studied bactericidal activity of oxacillin, vancomycin and teicoplanin against Staphylococcus aureus isolates in patients with endocarditis and then we sought to determine if there was a relationship between in vitro bactericidal activity and clinical outcome., Methods: Minimal bacteriostatic and minimal bactericidal concentrations were determined for Staphylococcus aureus strains isolated from patients with endocarditis following standardized methods. Medical records were reviewed retrospectively to collect data on antimicrobial susceptibility at admission, antimicrobial therapy, need for surgery, embolic events and outcome., Results and Discussion: Sixty-two Staphylococcus aureus strains were studied in 62 patients with endocarditis. Overall, 91.9% definite, 21% methicillin resistant and 72.6% cured. Surgery was performed in 32.3% and embolic events were documented in 64.5%. Tolerance to oxacillin and teicoplanin was more common than vancomycin tolerance among methicillin susceptible Staphylococcus aureus. Among methicillin resistant Staphylococcus aureus teicoplanin was shown to have a higher rate of tolerance than vancomycin. No statistically significant differences on clinical outcome between oxacillin tolerant and oxacillin non tolerant Staphylococcus aureus infections were observed. Tolerance to oxacillin did not adversely affect clinical outcomes of patients with methicillin susceptible Staphylococcus aureus endocarditis treated with a combination of antimicrobials including oxacillin. The cure rate was significantly lower among patients with methicillin resistant Staphylococcus aureus endocarditis., Conclusions: In vitro bactericidal test results were not valid predictors of clinical outcome. Physicians need to use additional parameters when treating patients with staphylococcal endocarditis., (© 2011 Pasticci et al; licensee BioMed Central Ltd.)

Erosive tooth wear is a serious problem with very costly consequences. Intercepting patients at the initial stages of the disease is critical to avoid significant irreversible damages to their dentition and to benefit from still favorable conditions when it comes to clinical performance of the restorative measures proposed. In this article, a new classification is proposed to quantify the severity of the dental destruction and to guide clinicians and patients in the therapeutic decision-making process. The classification is based on several parameters relevant for both the selection of treatment and the assessment of the prognosis, such as dentin exposure in the palatal tooth contact areas, alterations at the level of the incisal edges, and ultimately, loss of pulp vitality.

Statement of Problem: Traditional testing of ceramic crowns creates a stress state and damage modes that differ greatly from those seen clinically. There is a need to develop and communicate an in vitro testing protocol that is clinically valid., Purpose: The purpose of this study was to develop an in vitro failure test for ceramic single-unit prostheses that duplicates the failure mechanism and stress state observed in clinically failed prostheses. This article first compares characteristics of traditional load-to-failure tests of ceramic crowns with the growing body of evidence regarding failure origins and stress states at failure from the examination of clinically failed crowns, finite element analysis (FEA), and data from clinical studies. Based on this analysis, an experimental technique was systematically developed and test materials were identified to recreate key aspects of clinical failure in vitro., Material and Methods: One potential dentin analog material (an epoxy filled with woven glass fibers; NEMA grade G10) was evaluated for elastic modulus in blunt contact and for bond strength to resin cement as compared to hydrated dentin. Two bases with different elastic moduli (nickel chrome and resin-based composite) were tested for influence on failure loads. The influence of water during storage and loading (both monotonic and cyclic) was examined. Loading piston materials (G10, aluminum, stainless steel) and piston designs were varied to eliminate Hertzian cracking and to improve performance. Testing was extended from a monolayer ceramic (leucite-filled glass) to a bilayer ceramic system (glass-infiltrated alumina). The influence of cyclic rate on mean failure loads was examined (2 Hz, 10 Hz, 20 Hz) with the extremes compared statistically (t test; α=.05)., Results: Failure loads were highly influenced by base elastic modulus (t test; P<.001). Cyclic loading while in water significantly decreased mean failure loads (1-way ANOVA; P=.003) versus wet storage/dry cycling (350 N vs. 1270 N). G10 was not significantly different from hydrated dentin in terms of blunt contact elastic behavior or resin cement bond strength. Testing was successful with the bilayered ceramic, and the cycling rate altered mean failure loads only slightly (approximately 5%)., Conclusions: Test methods and materials were developed to validly simulate many aspects of clinical failure., (Copyright © 2010 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Background: To validate the concept of early implant placement for use in the esthetically sensitive anterior maxilla, clinical trials should ideally include objective esthetic criteria when assessing outcome parameters., Methods: In this cross-sectional, retrospective 2- to 4-year study involving 45 patients treated with maxillary anterior single-tooth implants according to the concept of early implant placement, a novel comprehensive index, comprising pink esthetic score and white esthetic score (PES/WES; the highest possible combined score is 20), was applied for the objective esthetic outcome assessment of anterior single-tooth implants., Results: All 45 anterior maxillary single-tooth implants fulfilled strict success criteria for dental implants with regard to osseointegration, including the absence of peri-implant radiolucency, implant mobility, suppuration, and pain. The mean total PES/WES was 14.7 +/- 1.18 (range: 11 to 18). The mean total PES of 7.8 +/- 0.88 (range: 6 to 9) documents favorable overall peri-implant soft tissue conditions. The two PES variables facial mucosa curvature (1.9 +/- 0.29) and facial mucosa level (1.8 +/- 0.42) had the highest mean values, whereas the combination variable root convexity/soft tissue color and texture (1.2 +/- 0.53) proved to be the most difficult to fully satisfy. Mean scores were 1.6 +/- 0.5 for the mesial papilla and 1.3 +/- 0.5 for the distal papilla. A mean value of 6.9 +/- 1.47 (range: 4 to 10) was calculated for WES., Conclusions: This study demonstrated that anterior maxillary single-tooth replacement, according to the concept of early implant placement, is a successful and predictable treatment modality, in general, and from an esthetic point of view, in particular. The suitability of the PES/WES index for the objective outcome assessment of the esthetic dimension of anterior single-tooth implants was confirmed. However, prospective clinical trials are needed to further validate and refine this index.

Dental erosion is a frequently underestimated pathology that nowadays affects an increasing number of younger individuals. Often the advanced tooth destruction is the result of not only a difficult initial diagnosis (e.g. multifactorial etiology of tooth wear), but also a lack of timely intervention. A clinical trial testing a fully adhesive approach for patients affected by severe dental erosion is underway at the School of Dental Medicine of the University of Geneva. All the patients are systematically and exclusively treated with adhesive techniques, using onlays in the posterior region and a combination of facially bonded porcelain restorations and indirect palatal resin composite restorations in the anterior maxillary region. To achieve maximum preservation of tooth structure and predict the most esthetic and functional outcome, an innovative concept has been developed: the three-step technique. Three laboratory steps are alternated with three clinical steps, allowing the clinician and the dental technician to constantly interact during the planning and execution of a full-mouth adhesive rehabilitation. In this article, the third and last step of the three-step technique has been described in detail.

Traditionally, a full-mouth rehabilitation based on full-crown coverage has been recommended treatment for patients affected by severe dental erosion. Nowadays, thanks to improved adhesive techniques, the indications for crowns have decreased and a more conservative approach may be proposed. Even though adhesive treatments simplify both the clinical and laboratory procedures, restoring such patients still remains a challenge due to the great amount of tooth destruction. To facilitate the clinician's task during the planning and execution of a full-mouth adhesive rehabilitation, an innovative concept has been developed: the three-step technique. Three laboratory steps are alternated with three clinical steps, allowing the clinician and the laboratory technician to constantly interact to achieve the most predictable esthetic and functional outcome. During the first step, an esthetic evaluation is performed to establish the position of the plane of occlusion. In the second step, the patient's posterior quadrants are restored at an increased vertical dimension. Finally, the third step reestablishes the anterior guidance. Using the three-step technique, the clinician can transform a full-mouth rehabilitation into a rehabilitation for individual quadrants. The present article focuses on the second step, explaining all the laboratory and clinical steps necessary to restore the posterior quadrants with a defined occlusal scheme at an increased vertical dimension. A brief summary of the first step is also included.

Traditionally, a full-mouth rehabilitation based on full-crown coverage has been the recommended treatment for patients affected by severe dental erosion. Nowadays, thanks to improved adhesive techniques, the indications for crowns have decreased and a more conservative approach may be proposed. Even though adhesive treatments simplify both the clinical and laboratory procedures, restoring such patients still remains a challenge due to the great amount of tooth destruction. To facilitate the clinician's task during the planning and execution of a full-mouth adhesive rehabilitation, an innovative concept has been developed: the three-step technique. Three laboratory steps are alternated with three clinical steps, allowing the clinician and the laboratory technician to constantly interact to achieve the most predictable esthetic and functional outcome. During the first step, an esthetic evaluation is performed to establish the position of the plane of occlusion. In the second step, the patient's posterior quadrants are restored at an increased vertical dimension. Finally, the third step reestablishes the anterior guidance. Using the three-step technique, the clinician can transform a full-mouth rehabilitation into a rehabilitation for individual quadrants. This article illustrates only the first step in detail, explaining all the clinical parameters that should be analyzed before initiating treatment.

The restoration of the missing maxillary incisors is a complex and delicate treatment challenge. When implant therapy is used, proper treatment planning is critical, as selecting the proper number, location, and dimension of the implants is a difficult task. Thus, this article discusses the issues that must be addressed during diagnosis and treatment planning to achieve a predictable esthetic outcome when using implants to replace the maxillary incisors. The advantages and disadvantages of several implant-supported treatment options-using a combination of regular- and narrow-neck implants-are presented. Ultimately, the use of narrow-neck implants at the lateral incisor sites is presented as the best option for ensuring excellent esthetic outcomes, and the corresponding indications and contraindications are discussed. Further, all treatment options are ranked based on the predictability of their esthetic outcomes.

In this two-part treatment planning series, the case of a 63-year-old woman with severe attachment loss at the maxillary incisors is presented. In Part 1, pretreatment strategies, occlusal and periodontal status, and the advantages and disadvantages of six treatment options using both conventional and implant therapy were presented. In this follow-up article, the treatment selected for the case is revealed, and the rationale--including indications and contraindications for the different treatment options--is discussed. The treatment sequence is then outlined, and the final outcome is presented.

In this two-part treatment planning series, the case of a 54-year-old woman with a failing four-unit fixed partial denture (FPD) is presented. Part 1 presented pretreatment strategies, occlusal and periodontal status, and the advantages and disadvantages of three treatment options: removable partial denture, tooth-supported FPD, and implant-supported FPD. In this follow-up article, the treatment selected for the case is revealed, and the rationale--including indications and contraindications for the different treatment options--is discussed. The treatment sequence is then outlined, and the final outcome is presented.

In this two-part treatment planning series, the case of a 63-year-old woman with severe attachment loss at the maxillary incisors is presented. In part 1, pretreatment strategies, eg, use of intra- and extraoral photographs, analysis of periapical radiographs, and examination of occlusal and periodontal status, are discussed. The advantages and disadvantages of six treatment options using both conventional and implant therapy are presented. In part 2, the treatment selected will be revealed and the rationale governing the decision will be discussed.

In this two-part treatment planning series, the case of a 54-year-old woman with a failing four-unit fixed partial denture (FPD) is presented. In Part 1, pretreatment strategies, e.g., use of intra- and extraoral photographs, analysis of periapical radiographs, and examination of occlusal and periodontal status, are discussed. The advantages and disadvantages of three treatment options--removable partial denture, tooth-supported FPD, and implant-supported FPD-are presented. In Part 2, to be published in the next issue, the treatment selected will be revealed and the rationale governing the decision will be discussed.

We report multifocal detection (four different cities in northern Italy) of Proteus mirabilis isolates resistant to both oxyimino- and 7-alpha-methoxy-cephalosporins and producing a novel acquired AmpC-like beta-lactamase. The enzyme, named CMY-16, is a variant of the CMY/LAT lineage, which differs from the closest homologues, CMY-4 and CMY-12, by a single amino acid substitution (A171S or N363S, respectively) and from CMY-2 by two substitutions (A171S and W221R). Expression of the cloned bla(CMY-16) gene in Escherichia coli decreased susceptibility to penicillins, cephalosporins, and aztreonam. Tazobactam was more effective than clavulanate at antagonizing the enzyme activity. Genotyping, by random amplification of polymorphic DNA and pulsed-field gel electrophoresis of genomic DNA digested with SfiI, showed that isolates were clonally related to each other, although not identical. The bla(CMY-16) gene was not transferable to E. coli by conjugation or transformation. In all isolates, it was chromosomally located and inserted in a conserved genetic environment. PCR mapping experiments revealed that the bla(CMY-16) was flanked by ISEcp1 and the blc gene, similar to other genes of this lineage from plasmids of Salmonella enterica, Klebsiella spp., and E. coli. Overall, these results revealed multifocal spreading of a CMY-16-producing P. mirabilis clone in northern Italy. This finding represents the first report of an acquired AmpC-like beta-lactamase in Proteus mirabilis from Italy and underscores the emergence of similar resistance determinants in the European setting.

Cryptococcus neoformans is the cause of the most common life-threatening fungal infection in patients with AIDS. Thirty strains of C. neoformans were collected from inpatients and typied evaluating activity, morphotyping, serotyping, chemosensitivity and adhesivity. Cryptococcus neoformans strains showed different aspectotype profile, the sole presence of serotypes A and D, good susceptibility to azoles and Amphotericin B. Phenotypic epidemiologic markers can be used: characterization of clinical strains excludes a common source.

Streptococcus pneumoniae is one of most common causes of community-acquired pneumonia. We evaluated a newly available rapid immunochromatographic test to detect S. pneumoniae in urine samples verifying its importance in the diagnosis of pneumococcal pneumonia. Our data, obtained from 104 patients with community-acquired pneumonia, show that Now S. pneumoniae Urinary Test is characterized by a sensitivity value of 77.7%, a specifity of 98.8%: positive and negative predictive values are 93.3% and 95.5%, respectively. In conclusion, Now S. pneumoniae Urinary Test should be a useful test to establish the etiology of community-acquired pneumonia.

The authors analysed 10 years of experience of fungaemia at a Regional Italian Hospital, the Azienda Ospedaliera (A.O.) 'Ospedali Riuniti di Bergamo', Bergamo, Italy, from 1988 to 1997. One hundred and sixty-eight cases were observed, with a global incidence corresponding to 3.43/10,000 in-patients. Median age was 38.5 years and mean age was 38.9 years (range: 0-94 years). Female:male ratio was 1:1.75. Fungaemia occurred 25.7 days (mean value) after admission to the hospital. Aetiology was: 134 Candida spp. (70%), 11 Cryptococcus neoformans (6.5%), seven Torulopsis inconspicua (4.1%), three Trichosporon beigelii (1.8%), one Hansenula anomala (0.6%); three Fusarium verticillioides (1.8%), three Geotrichum candidum (1.8%) and one Histoplasma capsulatum (0.6%). Total mortality was 50.6%, and particularly related to Candida kefyr and Candida krusei, to Cr. neoformans and Fusarium spp.

OBJECTIVE: To review two recent cases in HIV-negative subjects in the light of literature reports (52 patients without HIV infection till 1994). METHODS: Epidemiology (animal contacts, risk factors, year, country), clinical presentation, diagnostic methods (X-ray, tomography, microbiological techniques), therapeutic approach (antibiotics, surgery) and outcome were evaluated on the basis of clinical literature reports. RESULTS: Tumors constituted an important predisposing factor and less frequently hepatobiliary pathology, rheumatologic diseases, iatrogenic causes, psychiatric pathology and trauma. Exposure to animals was reported by 55% of the patients. Pneumonia and pleurisy, without preferential localization, were detected in 50% of the patients. Etiologic diagnosis was usually obtained after an invasive collection. Combined medical therapy and surgery were required by 27.8% of the patients, and 16.7% of the patients died. CONCLUSIONS: In recent years the number of Rhodococcus equi cases has been rising also in HIV-negative patients. The infection is ubiquitous. Accurate diagnosis and the prompt selection of the most appropriate therapy depend on close cooperation between clinicians and microbiologists.