Emerging echinocandin-resistant Candida albicans and glabrata in Switzerland.

Echinocandins represent the first-line therapy of candidemia. Echinocandin resistance among Candida spp. is mainly due to acquired FKS mutations. In this study, we report the emergence of FKS-mutant Candida albicans/glabrata in Switzerland and provide the microbiological and clinical characteristics of 9 candidemic episodes. All patients were previously exposed to echinocandins (median 26 days; range 15-77). Five patients received initial echinocandin therapy with persistent candidemia in 4 of them. Overall mortality was 33%.

[Rapid tests during respiratory infection: an aid to non-prescription of antibiotics? ]. / Tests rapides lors d'infection respiratoire: une aide à la non-prescription d'antibiotiques?

Due to overuse, we are about to reach the end of the antibiotic era. Each of us is responsible to limit their usage to a minimum. Respiratory infections are the first cause of antibiotic prescriptions. The use of new simple tests available at the bedside can be very useful in this context. The development of sophisticated molecular diagnostic tools, such as "multiorganism" panels, may revolutionize our approach to respiratory infections. The key will be to interpret the results correctly, with due consideration of the statement, "Treat patients, not lab results".

[ESBL and carbapenemases in Enterobacteriaceae]. / Bêtalactamases à spectre étendu et carbapénémases chez les Enterobacteriaceae.

Carbapenemase-producing enterobacteria (CPE) spread all over the world during the last years, causing serious infections with increasing frequency. Very few new drugs active against CPE are expected to be clinically available. Studies summarized in this review show that there is yet room to improve our therapeutic approaches, in the treatment of infections due to CPE.

[Which benefits for the clinician to implement MALDI-TOF/MS in the bacteriology laboratory?]. / Quels bénéfices pour les cliniciens de la mise en place du MALDI-TOF/MS dans te taboratoire de bactériologie?

Mass spectrometry (MALDI-TOF/MS) is a recent technology especially adapted to identify microbial pathogens. It has rapidly established itself as a must for most medical bacteriology laboratories. Its ease of use and speed of execution typically permit providing pathogen identification one day earlier to the clinicians. MALDI-TOF/MS facilitates identification of filamentous fungi and mycobacteria that require particular lab expertise when using conventional methods. This paper highlights the multiple advantages that MALDI-TOF/MS can bring to the physicians in their practice.

Phialemoniopsis limonesiae sp. nov. causing cutaneous phaeohyphomycosis in an immunosuppressed woman.

Rare or opportunistic fungal infections are mostly described in immunosuppressed patients. We present a case of a cutaneous phaeohyphomycosis that developed on the dorsal foot in an immunosuppressed woman suffering from AIDS, caused by a novel Phialemoniopsis species. It clinically presented as an indurated violaceous plaque, surmounted by nodules exuding a sero-purulent discharge. A filamentous fungus was isolated from pus and cutaneous biopsy. ITS and LSU sequences phylogenetically resolved the fungus as an unknown species of Phialemoniopsis, which is an unresolved family within Sordariomycetes. In this study we describe the new species as Phialemoniopsis limonesiae, which clusters on a single branch clearly separated from its closest phylogenetic neighbours. This new strain showed low MIC to itraconazole, voriconazole and posaconazole.

A new mutation in the SQLE gene of Trichophyton mentagrophytes associated to terbinafine resistance in a couple with disseminated tinea corporis.

Trichophyton is the most common dermatophyte genus responsible for tinea corporis and topical treatment with terbinafine is effective for limited disease but extensive disease required systemic therapy. Failure of terbinafine therapy in patients infected with T. rubrum or T. mentagrophytes is associated with mutations in the gene encoding squalene epoxidase, the terbinafine target. We report two cases of tinea corporis resistant to systemic terbinafine in a 60-year-old man and his wife, a 51 year-old-woman. Both patients had multiple diffuse erythematous annular scaly plaques and T. mentagrophytes was isolated in culture. Systemic treatment with terbinafine in combination with topical terbinafine and then topical ketoconazole failed to improve the disease after 8 weeks. The broth microdilution tests performed to evaluate the antifungal sensitivity of the T. mentagrophytes isolate revealed a high MIC for terbinafine but a low MIC for posaconazole and itraconazole. An A1223T point mutation leading to a Q408L substitution was identified by DNA sequencing the SQLE gene of the isolate. Itraconazole 200mg daily was then introduced but stopped because of elevated liver transaminases in the man. Finally, complete healing was achieved only six months later for both patients and required a 3 and 2-week regimen of itraconazole with topical eberconazole in the man and woman respectively. We believe that a close monitoring and antifungal susceptibility tests should now be done more systematically in dermatophytic infections that do not respond to conventional treatment as terbinafine resistant strains are likely to spread worlwide.