BackgroundAlthough Candida albicans is the most common cause of fungal blood stream infections (BSIs), infections due to Candida species other than C. albicans are rising. Candida parapsilosis complex has emerged as an important fungal pathogen and became one of the main causes of fungemia in specific geographical areas. We analyzed the factors related to outcome of candidemia due to C. parapsilosis in a single tertiary referral hospital over a five-year period.MethodsA retrospective observational study of all cases of candidemia was carried out at a 980-bedded University Hospital in Italy. Data regarding demographic characteristics and clinical risk factors were collected from the patient’s medical records. Antifungal susceptibility testing was performed and MIC results were interpreted according to CLSI species-specific clinical breakpoints.ResultsOf 270 patients diagnosed with Candida BSIs during the study period, 63 (23 %) were infected with isolates of C. parapsilosis complex which represented the second most frequently isolated yeast after C. albicans. The overall incidence rate was 0.4 episodes/1000 hospital admissions. All the strains were in vitro susceptible to all antifungal agents. The overall crude mortality at 30 days was 27 % (17/63), which was significantly lower than that reported for C. albicans BSIs (42 % [61/146], p = 0.042). Being hospitalized in ICU resulted independently associated with a significant higher risk of mortality (HR 4.625 [CI95% 1.015–21.080], p = 0.048). Conversely, early CVC removal was confirmed to be significantly associated with a lower risk of mortality (HR 0.299 [CI95% 0.102–0.874], p = 0.027). Finally, the type of primary antifungal therapy did not influence the outcome of infection.ConclusionsCandidemia due to C. parapsilosis complex, the second most commonly causative agent of yeast BSIs in our center, is characterized by a non-negligible mortality at 30 days. An early CVC removal is associated with a significant reduced mortality.

In Italy, paediatric IE develops without any previous predisposing factors in a number of children, methicillin-resistant S. aureus has emerged as a common causative agent and the therapeutic approach is extremely variable.

Rothia mucilaginosa, previously known as Stomatococcus mucilaginosus, is a Gram-positive microrganism, which is a part of normal flora of the human oral cavity and upper respiratory tract [1]. R. mucilaginosa has been recognized as an emerging opportunistic pathogen, especially in immunocompromised or neutropenic patients [2].The identification of this bacterium may be difficult due to the similarity to other Gram-positive cocci. However, the role of R. mucilaginosa in a variety of opportunistic infections has been repeatedly reported over the last few years, as a consequence of better knowledge of such microbiologic aspects. We describe a case of R. mucilaginosa bacteraemia in a patient with Shwachman-Diamond syndrome (SDS).A 3-year-old boy with SDS diagnosed at the age of 5 months was referred to our unit for fever, vomiting and severe diarrhoea over the last 2 days. The child was on regular prophylactic treatment with oral amoxicillin/ clavulanate (40 mg/kg/day, for the first 3 days weekly) and intramuscular granulocyte colony stimulating factor (GCSF) (6 mcg/kg daily). At the admission, a moderatesevere dehydration was present. The routine laboratory tests were normal, with exception of a peripheral WBC count of 20,500/μl (91% neutrophils, 5% lymphocytes, 4% monocytes), platelet count of 99,000/μl, and mild increase of alanine aminotransferase 73 U/l. Intravenous hydration and broad spectrum antibiotic therapy (ampicillin/sulbactam 50 mg/kg t.i.d. and netilmicin 6 mg/kg daily) were started, and treatment with GCSF was continued. Blood culture was negative. The faecal culture was positive for Salmonella typhimurium which was sensitive to ampicilin/sulbactam. The patient gradually improved and was discharged home at hospital day 9 with regular bowel movements and normal laboratory tests. No treatment was prescribed at home.Four days later, the child was admitted again to our unit for recurrence of high fever and mild diarrhoea over the last 48 h. Physical examination was normal; the routine laboratory tests were normal except for hemoglobin concentration of 10.3 g/dl, peripheral WBC count of 9,100/μl (74% neutrophils, 20% lymphocytes, 6% monocytes), and C-reactive protein of 1.1 mg/dl. Intravenous ampicillin/ sulbactam and netilmicin therapy was empirically administered until the result of blood culture was known. Two blood cultures grew microrganisms which were identified as R. mucilaginosa on the basis of the following characteristics: Gram-positive cocci in clusters and tetrads, weakly catalase-positive colonies that adhered strongly to the agar surface, glucose fermentation, failure to grow on nutrient agar containing 5% NaCl, poor or no growth on Mueller-Hinton agar, presence of mucoid capsule, and ability to hydrolize gelatine and esculin [3]. In the API 32 Staph system (API system, bioMérieux, Marcy l'Etoile, France) typical profile was 063135200. The MICs were determined by the standard agar dilution method [4]. Mueller-Hinton agar supplemented with 5% sheep blood (Becton Dickinson Diagnostic Systems, S...

This report describes the successful management of a documented necrotizing pneumonia due to Streptococcus pneumoniae in a child with pandemic influenza A (H1N1). The importance of early recognition of bacterial superinfection in patients with influenza and the immunologic interactive mechanisms between viruses and bacteria in determining respiratory diseases are highlighted. The role of modern molecular techniques in improving diagnostic microbiology sensitivity and informing consequent clinical care is emphasized.

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