Genitourinary infections caused by non-Candida yeasts are uncommon, and especially due to Saccharomyces cerevisiae. We describe the cases of two adult females with vulvovaginal infections caused by itraconazole-resistant S. cerevisiae who made a full recovery after oral fluconazole therapy. We also provide a concise review of recently published studies on this topic.

The authors have reported the first case of vaginal infection caused by Enterococcus raffinosus. The latter is a rarely identified species, but some of the infections described in the literature should direct some attention to this, often opportunistic pathogen, and its emerging multidrug resistance. Case reportDuring the second month of hospitalization by the Department of Haematology, a 50-year-old immunocompromised patient with acute leukaemia developed severe vulvovaginal itching and burning. At speculum examination, erythema and discharge were observed. Vaginal pH was 5.2, the amine test was negative and microscopy (Gram stain) showed the presence of numerous Gram-positive cocci and leukocytes. We obtained swab specimens from the middle third of the vagina and placed them on Sabouraud dextrose agar, sheep blood agar, MacConkey agar and Mannitol salt agar (all from Biolife). The plates were incubated in air. A second blood agar plate was inoculated and incubated anaerobically, whilst a third blood agar plate and a Thayer-Martin plate were inoculated and incubated in an atmosphere of 5 % CO 2 . All cultures were kept at 37 u C and examined after 24 and 48 h. After 24 h of incubation, smooth and a-haemolytic colonies (.150 c.f.u.), about 1 mm in diameter, were observed on all blood agar plates. The organism was found to be a Gram-positive coccus that formed pairs and short chains, and non-motile at 36 u C. None of Lancefield group A, B, C, D, F and G antisera produced a positive reaction (SLIDEX Strepto Plus; bioMérieux) (Facklam & Collins, 1989) and the catalase test was negative. No other organisms of known vaginal pathogenicity were isolated. The isolate was identified as Enterococcus raffinosus by using the VITEK 2 system (card GP; bioMérieux) with 99 % certainty, and the identification was confirmed by using the API system (Rapid ID 32 Strep; bioMérieux). Antibiotic susceptibility testing was performed with brain heart infusion agar (Biolife) using the disc diffusion method and was interpreted as per Clinical and Laboratory Standards Institute guidelines (Chirurgi et al., 1991; NCCLS, 2000;Prakash et al., 2005). The organism was found to be resistant to penicillin, ampicillin, amoxicillin/clavulanate, ampicillin/sulbactam, piperacillin/tazobactam, imipenem, meropenem, ciprofloxacin, clindamycin, erythromycin, cotrimoxazole, tetracycline, amikacin, gentamicin, netilmicin and tobramicin, and susceptible only to vancomycin, teicoplanin and rifampicin. Discs were provided by Oxoid.Pending the results from cultures, the patient was treated empirically and unsuccessfully with oral amoxicillin/clavulanate (1000 mg, every 12 h). Instead, the vaginal symptoms disappeared suddenly within the second day of teicoplanin therapy that the patient had received empirically because of the outbreak of a Gram-positive cocci bacteraemia (data not shown). One week after glycopeptide treatment, vaginal examination and cultures were repeated but they did not show signs of inflammation or E. raffinosus colonies, respectively. Fur...

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Background The optimal approach to prevent preterm birth (PTB) in twins has not been fully established yet. Recent evidence suggests that placement of cervical cerclage in twin pregnancies with short cervical length at ultrasound or cervical dilatation at physical examination might be associated with a reduced risk of PTB. However, such evidence is based mainly on small studies thus questioning the robustness of these findings. The aim of this systematic review was to determine the role of cervical cerclage in preventing PTB and adverse maternal or perinatal outcomes in twin pregnancies. Methods and findings Key databases searched and date of last search: MEDLINE, Embase, and CINAHL were searched electronically on 20 April 2023. Eligibility criteria: Inclusion criteria were observational studies assessing the risk of PTB among twin pregnancies undergoing cerclage versus no cerclage and randomized trials in which twin pregnancies were allocated to cerclage for the prevention of PTB or to a control group (e.g., placebo or treatment as usual). The primary outcome was PTB <34 weeks of gestation. The secondary outcomes were PTB <37, 32, 28, 24 weeks of gestation, gestational age at birth, the interval between diagnosis and birth, preterm prelabor rupture of the membranes (pPROM), chorioamnionitis, perinatal loss, and perinatal morbidity. Subgroup analyses according to the indication for cerclage (short cervical length or cervical dilatation) were also performed. Risk of bias assessment: The risk of bias of the included randomized controlled trials (RCTs) was assessed using the Revised Cochrane risk-of-bias tool for randomized trials, while that of the observational studies using the Newcastle–Ottawa scale (NOS). Statistical analysis: Summary risk ratios (RRs) of the likelihood of detecting each categorical outcome in exposed versus unexposed women, and (b) summary mean differences (MDs) between exposed and unexposed women (for each continuous outcome), with their 95% confidence intervals (CIs) were computed using head-to-head meta-analyses. Synthesis of the results: Eighteen studies (1,465 twin pregnancies) were included. Placement of cervical cerclage in women with a twin pregnancy with a short cervix at ultrasound or cervical dilatation at physical examination was associated with a reduced risk of PTB <34 weeks of gestation (RR: 0.73, 95% CI [0.59, 0.91], p = 0.005 corresponding to a 16% difference in the absolute risk, AR), <32 (RR: 0.69, 95% CI [0.57, 0.84], p < 0.001; AR: 16.92%), <28 (RR: 0.54, 95% [CI 0.43, 0.67], 0.001; AR: 18.29%), and <24 (RR: 0.48, 95% CI [0.23, 0.97], p = 0.04; AR: 15.57%) weeks of gestation and a prolonged gestational age at birth (MD: 2.32 weeks, 95% [CI 0.99, 3.66], p < 0.001). Cerclage in twin pregnancy with short cervical length or cervical dilatation was also associated with a reduced risk of perinatal loss (RR: 0.38, 95% CI [0.25, 0.60], p < 0.001; AR: 19.62%) and composite adverse outcome (RR: 0.69, 95% CI [0.53, 0.90], p = 0.007; AR: 11.75%). Cervical cerclage was associated with a reduced risk of PTB <34 weeks both in women with cervical length <15 mm (RR: 0.74, 95% CI [0.58, 0.95], p = 0.02; AR: 29.17%) and in those with cervical dilatation (RR: 0.68, 95% CI [0.57, 0.80], p < 0.001; AR: 35.02%). The association between cerclage and prevention of PTB and adverse perinatal outcomes was exclusively due to the inclusion of observational studies. The quality of retrieved evidence at GRADE assessment was low. Conclusions Emergency cerclage for cervical dilation or short cervical length <15 mm may be potentially associated with a reduction in PTB and improved perinatal outcomes. However, these findings are mainly based upon observational studies and require confirmation in large and adequately powered RCTs.