Matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) fingerprinting has recently become an effective instrument for rapid microbiological diagnostics and in particular for identification of micro-organisms directly in a positive blood culture. The aim of the study was to evaluate a collection of 82 stored yeast isolates from bloodstream infection, by MALDI-TOF MS; 21 isolates were identified also directly from positive blood cultures and in the presence of other co-infecting micro-organisms. Of the 82 isolates grown on plates, 64 (76%) were correctly identified by the Vitek II system and 82 (100%) by MALDI-TOF MS; when the two methods gave different results, the isolate was identified by PCR. MALDI-TOF MS was unreliable in identifying two isolates (Candida glabrata and Candida parapsilosis) directly from blood culture; however, direct analysis from positive blood culture samples was fast and effective for the identification of yeast, which is of great importance for early and adequate treatment.

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Neutropenic enterocolitis (NEC) is an abdominal infection reported primarily in patients with acute myeloid leukemia (AML) following chemotherapy, especially cytarabine, a notable efficacious cytotoxic agent for AML remission. Specific data regarding the impact of different cytarabine schedules and/or antibacterial regimens for NEC are sparse. The aim of the study was to identify the predictors of outcome within 30 days of NEC onset. NEC episodes were retrospectively pinpointed among 440 patients with newly diagnosed AML hospitalized in our Institution, over a 10‐year period, for receiving chemotherapy protocols with 100–6000 mg/m2 daily of cytarabine. Two subgroups, survivors versus nonsurvivors, were compared by using logistic regression analysis. NEC was documented in 100 of 420 (23.8%) analyzed patients: 42.5% had received high‐dose cytarabine, whereas 19% and 15% intermediate‐dose and standard‐dose cytarabine, respectively (P < 0.001). The 30‐day NEC attributable mortality rate was 23%. In univariate analysis, antileukemic protocols containing robust dosages of cytarabine were significantly associated with high mortality (P < 0.001); whereas, standard‐dose cytarabine and prompt initiation (at the ultrasonographic appearance of intestinal mural thickening) of NEC therapy with antibiotic combinations including tigecycline were significantly associated with low mortality. In multivariate analysis, high‐dose cytarabine‐containing chemotherapy was the independent predictor of poor outcome (odds ratio [OR]: 0.109; 95% confidence interval [CI]: 0.032–0.364; P < 0.001), whereas ultrasonography‐driven NEC therapy with antibiotic regimens including tigecycline was associated with a favorable outcome (OR: 13.161; 95% CI: 1.587–109.17; P = 0.017). Chemotherapy schedules with robust dosages of cytarabine for AML remission are associated with a high rate of NEC incidence and attributable. Vigorous antibacterial therapy, triggered off pathologic ultrasonographic findings, with drug combinations which have broad antimicrobial coverage and good gut penetration, specifically those also including tigecycline, may be effective in improving 30‐day survival rate after NEC onset.

Strains of Klebsiella pneumoniae producing KPC-carbapenemase have emerged as one of the most important multidrug-resistant Gram-negative nosocomial pathogens. Here, we report the first isolation and subsequent dissemination of a K. pneumoniae ST512 producing KPC-3 carbapenemase in a hospital in southern Italy. Isolates were obtained from blood, throat swabs, sputum, catheters, and urine of patients admitted to different hospital wards. Antimicrobial MICs were determined for all isolates by automated systems and confirmed by Etest. Carbapenemase production was confirmed by the modified Hodge test and by a disc synergy test, and carbapenemase genes were investigated by PCR. All isolates were characterized by pulse-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) analysis. Most isolates were multidrug resistant with exception of some isolates intermediately susceptible to gentamicin, tigecycline, and trimethoprim-sulfamethoxazole. PCR analysis showed that isolates harbored the bla(KPC-3) gene associated with bla(TEM) and bla(SVH). PFGE and MLST showed that all isolates belonged to the same ST512 clone recently described in Israel.

Background Neutropenic enterocolitis (NEC) is an abdominal infection reported in patients with acute myeloid leukemia (AML) following chemotherapy, especially cytarabine. Specific data regarding the impact of different cytarabine schedules and antibacterial regimens for NEC are sparse. Aims The aim of this study was to provide an update on therapeutic interventions of NEC. Predictors of mortality and determinants of favorable outcome at 30 days after NEC onset were considered, and finally we focused on the optimal antibiotic strategy for the preemptive therapy of NEC Methods NEC episodes were retrospectively pinpointed among 440 patients with newly diagnosed AML hospitalized in our institution, from 1 January 2002 to 31 December 2012, for receiving chemotherapy protocols with cytarabine. Two subgroups, survivors versus non-survivors, were compared to identify the predictors of outcome within 30-days of NEC onset. Finally, an optimal antibiotic strategy for front-line NEC treatment was suggested. Patients with severe neutropenia and clinical signs suggestive of NEC, i.e. fever (axillary temperature ³38¡C), diarrhea (>1 stool daily) and/or abdominal pain, were under strict ultrasonographic monitoring. Patients positive at US examination for pathologic bowel wall thickening (>4 mm in transversal scans for at least 30 mm length) were diagnosed with NEC, according to standardized criteria. The following variables were selected for the statistical analysis: antileukemic protocols [containing standard-dose (100 mg/m2 daily for at least 7 days), intermediate-dose (200 mg/m2 daily for at least 7 days), and high-dose (2000 to 6000 mg/m2 daily for at least 4 days) cytarabine], ultrasonographic features, microbiological findings, antibacterial therapy (front-line antibiotic treatments of febrile neutropenia that spared tigecycline, and the number and type of antibiotics definitively used after NEC diagnosis), adjunct therapeutic modalities (systemic antifungal therapy, G-CSF, bowel rest and total parenteral nutrition), and severe neutropenia resolution. Results NEC was documented in 100 (23.8%) of analyzed patients: 42.5% had received high-dose cytarabine while 19% and 15% intermediate-dose and standard-dose cytarabine, respectively (P<0.001). The 30-day NEC attributable mortality was 23%. In univariate analysis, patients in the non-survivor subgroup were more likely to have received induction chemotherapy courses based on high-dose cytarabine (P< 0.001) and NEC treatment with tigecycline-sparing ²2-antibiotic regimens. In fact, the 23 patients who died included 13 of the 37 patients (35.1%) whose antibacterial regimens consisted of 2-antibiotic combinations and 10 of the 63 patients (15.8%) who were on 3-antibiotic combination regimens (P= 0.027). The only multidrug regimen that was significantly more common in the survivor subgroup (P= 0.036) was the combination of tigecycline, meropenem and daptomycin. In multivariate analysis, high-dose cytarabine-containing chemotherapy was the independent predictor of poor outcome (OR: 0.089; 95%CI: 0.024-0.329; P<0.001), whereas NEC therapy with a combination of three specific antibiotics (tigecycline, meropenem and daptomycin) was associated with a favorable outcome (OR: 5.096; 95%CI: 1.516-17.131; P=0.008). Conclusion Chemotherapy schedules with vigorous dosages of cytarabine for AML remission are associated with a high rate of NEC incidence and attributable mortality. Prompt initiation of combined therapy with regimens of different antibiotic classes which have synergistic activity against complicated intra-abdominal infections, specifically those including tigecycline, may be particularly effective in improving 30-day survival rate after NEC onset. Figure 1 Subgroup analyses of overall survival for several variables associated with death among the entire patient population with neutropenic enterocolitis. Rates and absolute differences in the risk of mortality are given. Figure 1. Subgroup analyses of overall survival for several variables associated with death among the entire patient population with neutropenic enterocolitis. Rates and absolute differences in the risk of mortality are given. Disclosures No relevant conflicts of interest to declare.

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