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.
Introduzione.Escherichia coli è il più frequente patogeno responsabile di infezioni del tratto urinario (urinary tract infections, UTI).Le UTI ricorrenti sono spesso riscontrate nel paziente di sesso femminile che nel 25% dei casi è colpito da una reinfezione entro sei mesi dal primo evento infettivo.I fluorochinoloni rappresentano una delle opzioni terapeutiche più utilizzate per il trattamento delle UTI.Metodi.Sono stati studiati retrospettivamente i campioni urinari pervenuti al nostro laboratorio nel corso del 2004.L'identificazione e l'antibiogramma degli isolati clinici sono stati effettuati con il sistema Phoenix (Becton Dickinson, Diagnostic Systems, Sparks, MD).Per l'analisi epidemiologica sono stati utilizzati i sistemi EpiCenter (Becton Dickinson) e PowerLab (Unitech, Milano).E' stata classificata come "reinfezione" una nuova UTI insorta dopo almeno 2 settimane dal primo episodio infettivo.Risultati.Sono stati valutati 3706 pazienti affetti da UTI causata da E. coli; di questi, 495 (13.4%) hanno presentato una reinfezione.I soggetti interessati erano prevalentemente di sesso femminile (85.0%) e di provenienza ambulatoriale (91.5%).Mediamente sono state osservate 2.5 UTI/anno per paziente.Il maggior numero di soggetti presentava 2 o 3 episodi/anno (71.5% e 16.5%, rispettivamente).Le fasce di età più colpite sono risultate comprese fra 70 e 80 anni (23.0%) e fra 60 e 70 anni (19.1%).La fascia di età meno colpita era quella compresa fra 10 e 20 anni (0.9%).I test di sensibilità effettuati sui microrganismi isolati nel corso della prima UTI mostravano che 116/495 (23.4%) isolati erano resistenti ai fluorochinoloni.Negli isolati responsabili di UTI dopo reinfezione la percentuale di resistenza ai fluorochinoloni saliva al 29.4%.Conclusioni.Il paziente anziano ambulatoriale è frequentemente colpito da UTI ricorrenti causate da E. coli che possono complicarsi in infezioni più serie, come la sepsi.L'alta incidenza di ceppi resistenti ai fluorochinoloni sottolinea l'inefficacia di impostare una terapia empirica con questi farmaci.Pertanto, nel caso di UTI ricorrenti del paziente anziano, è opportuno impostare la terapia più adeguata sulla base di una corretta diagnosi eziologia e dei test di sensibilità antibiotica.
ABSTRACT A Citrobacter amalonaticus and a Morganella morganii producing the CTX-M-1 extended-spectrum β-lactamase (ESBL) were isolated from an area where this enzyme is now widespread in Escherichia coli . This is the first report of CTX-M-1 in the former species. In both cases the ESBL determinant was possibly acquired by these unusual hosts in vivo, after coinfection with E. coli strains carrying conjugative plasmids encoding CTX-M-1.
Background: The emergence of the plasmid-mediated colistin resistance mechanism in Escherichia coli has raised concern among public health experts as colistin is a last-line antimicrobial resort. The primary aim of the study was to investigate the prevalence of this resistance trait in E . coli isolates circulating in the Lombardy region, Northern Italy. The presence of mcr -type genes and their genetic relationship were also studied. Materials and methods: A prospective study was performed during a 4-month period (May to August, 2016) in six acute care Hospitals. Consecutive nonduplicate clinical isolates of E . coli from any type of clinical specimen, with the exception of rectal swabs, were included in the study. Isolates that exhibited MIC values for colistin >2 mg/L were further investigated. Bacterial identification was obtained by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Amplification of mcr -type genes (−1 to −5 variants) and microarray analysis were accomplished. Repetitive sequence-based PCR (Rep-PCR) and multilocus sequence typing (MLST) analysis were used for genotyping. Results: Overall, 3,902 consecutive E . coli isolates (2,342 from outpatients, 1,560 from inpatients) were evaluated during the study period. Of them, 18/3,902 (0.5%), collected from 4/6 centers, showed resistance to colistin. These isolates were mostly obtained from urine of both outpatients (n=12) and inpatients (n=6). Colistin MIC values ranged from 4 to 8 mg/L. The mcr-1 gene was detected in 10/18 isolates (7 from outpatients, 3 from inpatients). Rep-PCR and MLST analysis revealed the presence of nine different clusters. Further mcr -type genes were not detected. Conclusion: Resistance to colistin in E . coli clinical isolates appears low in our geographic area. With regard to mcr-1 -positive isolates, they accounted for approximately 50% of colistin-resistant E . coli isolates, thus representing a relevant resistance mechanism in this context. Although overall limited, the presence of mcr-1 determinant in our region should not be ignored and great concern should be given to the continuous surveillance. Keywords: MCR-1, colistin, Escherichia coli , prevalence, surveillance, epidemiology
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.
The aim of this work was to evaluate the performance of the new chromogenic medium BrillianceTM CREAgar (Thermo Fisher Scientific) for determining the limit of detection of carbapenem-resistant enterobacteria (CRE). A total of 70 clinical isolates were studied. Of these, 30 were well-characterized CRE, including Klebsiella pneumoniae strains producing KPC-, VIM-, and OXA-type enzymes, VIM-positive Enterobacter cloacae and Escherichia coli, NDM-positive E. coli, and enterobacterial isolates characterized by porin loss associated with ESBL production or AmpC hyperproduction. Ten carbapenem-resistant non-fermentative isolates were also included as well as 30 carbapenem-susceptible isolates. Carbapenem-resistant strains were inoculated at three different concentrations onto Brilliance CRE Agar (from 1.5x101 CFU/ml up to 1.5x104 CFU/ml) whereas carbapenem-susceptible isolates were inoculated at a concentration of 1.5x102 CFU/ml. The medium sustained the growth of carbapenem-resistant isolates, showing detection limits from 1.5x101 CFU/ml (in 31/40 cases) to 1.5x104 CFU/ml. No growth was observed with carbapenem-sensitive control strains. Our results indicate that the Brilliance CRE Agar allows the growth of carbapenem-resistant isolates with low detection limits and could represent a useful screening medium for both enterobacteria and non-fermentative Gram-negative strains resistant to carbapenems.
Strongyloides stercoralis is a nematode causing strongyloidiasis, more frequent in immigrants and in travelers coming from tropical and subtropical areas. Infection is usually asymptomatic, frequently associated with eosinophilia. Immunocompromised patients are at high risk of developing hyperinfection syndrome (HI) or dissemination (SD), life threatening complications. Diagnosis of strongyloidiasis is firstly based on larvae isolation in stool samples; specific therapy involves the use of ivermectin as first choice and albendazole as second choice. We describe two cases of strongyloidiasis. The first one is a disseminated strongyloidiasis occurred in an Ecuadorian male on corticosteroid therapy for nephrotic syndrome due to focal segmental glomerulosclerosis, successfully treated with ivermectin; the second one involves another Ecuadorian male affected by acute kidney failure and nephrotic syndrome in IgA nephropathy with a diagnosis of chronic strongyloidiasis performed before starting the immunosuppressive treatment. The timing of treatment with ivermectin has allowed the complete eradication of the parasite before starting steroid and mycophenolate mofetil therapy, preventing the occurrence of a disseminated infection. Epidemiological data show us how strongyloidiasis is rising at our latitude because of increased number of migrants and travelers coming from endemic areas. So we must always exclude asymptomatic strongyloidiasis before prescribing a steroid or immunosuppressive therapy, in order to avoid developement of disseminated and often fatal disease.
