We report an outbreak of Saccharomyces cerevisiae subtype boulardii fungemia among three intensive care unit roommates of patients receiving lyophilized preparations of this fungus. The fungemia was probably due to central venous catheter contamination and resolved after fluconazole treatment. The need for stringent application of proper hygiene when using a probiotic preparation of this organism is emphasized. CASE REPORTSOutbreak cases. (i) Case 1. Case 1 involved a 34-year-old man hospitalized for hypoxia after head and thoracic trauma. He was placed on enteral nutrition, with insertion of a central venous catheter (CVC), and broad-spectrum antibiotic therapy was administered. On day 42 after admission (5 November 2000), he developed a fever, which was unsuccessfully treated with teicoplanin and imipenem. Multiple blood cultures yielded Saccharomyces cerevisiae. The fever and fungemia subsided under treatment with fluconazole at 400 mg/day. The CVC was removed 3 weeks after initiation of fluconazole treatment. The infectious episode resolved, but no catheter culture was performed.(ii) Case 2. Case 2 involved a 48-year-old man hospitalized for rupture of a cerebral aneurysm and fever. He was given enteral nutrition, and a CVC was inserted. Teicoplanin alone and then teicoplanin and meropenem were administered. On day 14 (10 November 2000), one blood culture yielded S. cerevisiae. On day 19, the CVC was removed and fluconazole therapy (400 mg/day) was immediately started. No catheter culture was performed. The fever subsided within 48 h of the initiation of fluconazole treatment.(iii) Case 3. Case 3 involved a 75-year-old woman admitted for acute myocardial infarction. She was given enteral nutrition, and a CVC was inserted. She was treated with various antibiotic regimens for several febrile episodes. On day 56 (10 April 2001), a blood culture yielded S. cerevisiae. The CVC was removed, leading to immediate defervescence. The CVC tip was positive for S. cerevisiae. Fluconazole therapy (400 mg/day) was started 2 days later and administered for 2 weeks.None of the three patients described above received any probiotic treatment. Case 4 (incomplete report).A 35-year-old woman with multiple traumas who had been hospitalized in the intensive care unit (ICU) at the same time as patients 1 and 2 had blood cultures positive for S. cerevisiae. Unfortunately, her medical record was sequestered for forensic purposes and whether she had received probiotic treatment or not could not be determined. This patient improved and was transferred to the orthopedic division, from which she was discharged 2 months later.The outbreak setting was an eight-bed ICU in a 400-bed secondary-care hospital in Rome, Italy. During the year preceding the outbreak, about 20% of the ICU patients were hospitalized for emergency surgery, 12% were hospitalized for elective surgery, 18% were hospitalized for trauma, and 50% were hospitalized for medical diseases. The mean (Ϯ standard deviation) age of patients was 66 Ϯ 16 years, the mean ICU hospitali...

Background Myocardial involvement in the course of coronavirus disease 2019 (COVID-19) pneumonia has been reported, though not fully characterized yet. The aim of the present study is to undertake a joint evaluation of hs-Troponin and natriuretic peptides (NP) in patients hospitalized for COVID-19 pneumonia. Methods In this multicenter observational study, we analyzed data from n = 111 patients. Cardiac biomarkers subgroups were identified according to values beyond reference range. Results Increased hs-Troponin and NP were found in 38 and 56% of the cases, respectively. As compared to those with normal cardiac biomarkers, these patients were older, had higher prevalence of cardiovascular diseases (CVD) and had more severe COVID-19 pneumonia by higher CRP and d-dimer and lower PaO2/FIO2. Two-dimensional echocardiography performed in a subset of patients (n = 24) showed significantly reduced left ventricular ejection fraction in patients with elevated NP (p = 0.02), whereas right ventricular systolic function (tricuspid annular plane systolic excursion) was significantly reduced both in patients with high hs-Troponin and NP (p = 0.022 and p = 0.03, respectively). Both hs-Troponin and NP were higher in patients with in-hospital mortality (p = 0.001 and p = 0.002, respectively). On multivariable analysis, independent associations were found of hs-Troponin with age, PaO2/FIO2 and d-dimer (B = 0.419, p = 0.001; B = − 0.212, p = 0.013; and B = 0.179, p = 0.037, respectively) and of NP with age and previous CVD (B = 0.480, p < 0.001; and B = 0.253, p = 0.001, respectively). Conclusions Myocardial involvement at admission is common in COVID-19 pneumonia. Independent associations of hs-Troponin with markers of disease severity and of NP with underlying CVD might point toward existing different mechanisms leading to their elevation in this setting.

In the nosocomial setting, antimicrobial-resistant Enterobacteriaceae are a growing challenge, and alarming trends in resistance are currently reported all over the world. Isolates of Enterobacteriaceae producing ampC β-lactamases and extended spectrum β-lactamases are endemic in many hospitals, and are frequently resistant also to other classes of antibiotics, such as fluoroquinolones and aminoglycosides. The risk of infections due to multi-drug resistant strains should be considered also for outpatients who have had recent contact with the health system. Both nosocomial and health-care associated infections should be treated with a combination of antibiotics active against multi-drug resistant Gram negative and methicillin-resistant Staphylococcus aureus. In the absence of effective antimicrobial stewardship programs, this aggressive therapeutic approach might lead to abuse of broad-spectrum antibiotics, with consequent increase in resistances. To contain the possible antibiotic overuse, several decisional strategies, often based on risk-score systems supporting the clinical decisions, have been proposed. In this context of high antibiotic selection pressure, carbapenem-resistant pathogens recently began to spread in many hospitals. Carbapenem-resistant Klebsiella pneumoniae, as well as carbapenem-resistant Acinetobacter baumannii and P. aeruginosa, represent the new major challenges to patient safety. Against these organisms the initial empiric treatment is generally ineffective. The poor clinical outcome associated with carbapenem- resistant K. pneumoniae infections is probably due to the delete in the beginning of an appropriate antibiotic treatment, rather than to the increased virulence of pathogens. Only few therapeutic options are available, including colistin, tigecycline, aminoglycosides and carbapenems in selected cases. Several combinations of these antibiotics have been used, but no ideal regimen has been currently established.

Background: from December 2019 and the spreading of syndemics, a lot of medical centers reg-istered data about their patients. In Italy, the most relevant quantity of patients was hospitalized in internal medicine wards. Methods: In this observational, retrospective cross-sectional study, all data of the COVID-19 patients, admitted Latio hospitals, from March 01 to December 31, 2020, were collected and their Epidemiological data, demographics, signs and symptoms on admission, comorbidities, laboratory findings, chest radiography and CT findings, treatment received and mortality rate were analyzed by gender to find any differences of gravity of disease. Clinician details were registered on database (one for every hospital). Cost analysis was performed by length of stay and antiviral drugs use, using point of view of Italian Healthcare System. Results: 2256 patients with mean age of 71.01 ± 28.02 years were included. For men, frequency of hyper-tension, COPD, use of oxygen therapy, Tocilizumab were significantly higher and epidemiolog-ical link was related to rehabilitation ward and community. The gender difference about hospi-talization was one day more for man. No strong significant difference by gender in the death rate was observed. Considering antiviral drugs and hospitalization, a man costs €1000 more than woman. Conclusions: In male patients, hypertension and COPD were observed more frequently and the epidemiological link was related to rehabilitation ward and community. In female sub-jects, the epidemiological link was related to Hospital and we observed significantly higher atypical chest-X ray. Tocilizumab, oxygen therapy and antiviral drugs were prescribed more in male subjects. No differences by gender we report in other treatments and outcomes. Future studies should be analyzed to get a more comprehensive understanding of COVID-19 by gender.

A unique case of community acquired methicillin resistant Staphylococcus aureus (MRSA) sepsis, with endocardial and cerebral metastatic seeding, caused by a strain representative of the Italian clone, is described. The patient was a 47-y-old man without apparent risk factors for endocarditis and for MRSA infection who developed coma with multiple cerebritis lesions under vancomycin plus amikacin therapy. He was eventually cured with the addition of linezolid to the initial antimicrobial regimen. This observation seems to confirm previous reports of the efficacy of linezolid for the treatment of central nervous system infections caused by multidrug resistant Gram-positive bacteria. To our knowledge, this is the first report of MRSA disseminated cerebritis, a nearly always fatal disease, cured with this oxazolidinone drug. The increase in community acquired MRSA may have some impact on empirical treatment of serious infections caused by this organism.

No abstract

Pneumonia severity index (PSI) and urea, respiratory rate, blood pressure, age ≥65) are used to estimate the severity and prognosis of patients with pneumonia. NT-proBNP is a marker of myocardial stress and of sepsis-induced myocardial depression and might be used to predict short and long-term survival in patients with pneumonia. Twenty-three patients [age 79±15 standard deviation (SD); M/F 8/15, CURB-65 2.2±0.9 SD, PSI 118±38 SD, procalcitonin 3.9±5 SD] with pneumonia hospitalized in our Internal Medicine Unit were retrospectively evaluated. NT-proBNP was measured in the first 72 h of hospitalization. CURB-65 and PSI were calculated and correlation with biomarkers investigated. NT-proBNP showed a moderate statistically significant correlation with both PSI and CURB-65 (NT-proBNP vs PSI, r=0.42, P<0.05, NT-proBNP vs CURB-65, r=0.46, P<0.05). These correlations were confirmed also when patients with a diagnosis of heart failure where excluded from the analysis, even if the correlation did not reach the statistical significance. NT-proBNP seems to well correlate with the illness scores PSI and CURB-65 and might be a reliable predictor of severity and survival in patients with pneumonia.

No abstract