Candida palmioleophila isolation in Italy from two cases of systemic infection, after a CHROMagar and Vitek system mis-identification as C. albicans.

A correct, fast, reliable identification method is pivotal in nosocomial environments to guide treatment strategies, whereas misidentification might lead to treatment failure. For routine identifications the Vitek system and CHROMagar are widely used but not always reliable, especially now with an increasing number of new emerging fungal pathogens that need careful identification. Here we describe two cases of candidemia, due to Candida palmioleophila previously misidentified as Candida albicans by using the Vitek2 system and CHROMagar. The first case is a 54-year-old man with an infected ulcer in the lower right limb, treated with a targeted therapy using a central venous catheter (CVC). After two months he developed a CVC-related candidemia MDR identified as C. albicans. The second case is a 2-month-old male baby that was admitted to the neonatal unit with acute respiratory failure due to a severe community-acquired bilateral pneumonia; blood cultures were all positive for C. albicans MDR. The isolated strains where re-identified with Maldi-Tof and DNA sequencing as C. palmioleophila. From the identification point of view, CHROMagar can be clearly misleading, especially because CHROMagar types currently available are not designed to discriminate new emerging species, suggesting that systems other than MALDI-TOF and marker sequencing may be inadequate even for routine identification and could contribute to producing misleading identifications and therapeutically wrong practices, leading to failures and patient death.

Breakthrough pneumonia, meningitis and bloodstream infection due to Streptococcus pneumoniae during cefixime therapy.

Streptococcus pneumoniae is the main pathogen in invasive, life-threatening diseases such as bacteremia, meningitis, and pneumonia. We describe three cases of breakthrough pneumococcal severe life-threatening infections, including two meningitis and one bloodstream infection in patients treated with cefixime for otitis, sinusitis and pneumonia, respectively. Cefixime does not seem to be fully effective in treating invasive pneumococcal diseases. Because penicillin non-susceptibility might be linked to cefixime failure, the prompt knowledge of susceptibility to penicillin in S. pneumoniae might be very useful. Furthermore, MIC of cefixime should be measured because values >0.5 mg/L might be related to failure.

KPC-producing Klebsiella pneumoniae gut decolonisation following ceftazidime/avibactam-based combination therapy: A retrospective observational study.

OBJECTIVES: KPC-producing Klebsiella pneumoniae (KPC-Kp) gut colonisation is a major risk factor for developing systemic infection. Ceftazidime/avibactam (CAZ/AVI) may have a role as decolonisation therapy in special situations. METHODS: This was a retrospective, observational, multicentre study. The KPC-Kp gut decolonisation rate of CAZ/AVI-based therapy (Group A) was compared with other antimicrobial regimens (Group B) in patients with KPC-Kp infection. RESULTS: Among 12 patients in Group A, 11 (91.7%) achieved gut decolonisation. None of the 24 patients of Group B were decolonised. CONCLUSION: CAZ/AVI-based therapy could be useful in KPC-Kp gut decolonisation in high-risk patients.

Enrichment of semen culture in the diagnosis of bacterial prostatitis.

The objective was to investigate the diagnostic accuracy of our microbiological protocol to simplify the evaluation of bacterial prostatitis in the clinical practice. Our findings show the possibility to apply our alternative enrichment semen culture method to detect prostatic bacterial infection with higher sensitivity than the gold standard M&S technique.