A biofi lm is a complex community of surface-associated cells enclosed in a polymer matrix. They attach to solid surfaces and their formation can be affected by growth conditions and co-infection with other pathogens. The presence of biofi lm may protect the microorganisms from host defenses, as well as signifi cantly reduce their susceptibility to antifungal agents. Pathogenic microbes can form biofi lms on the inert surfaces of implanted devices such as catheters, prosthetic cardiac valves and intrauterine devices (IUDs). The present study was carried out to analyze the presence of biofi lm on the surface of intrauterine devices in patients with recurrent vulvovaginal candidiasis, and to determine the susceptibility profi le of the isolated yeasts to amphotericin B and fl ucona-zole. Candida albicans was recovered from the IUDs and it was found to be susceptible to the antifungal agents when tested under planktonic growing conditions. These fi nd-ings indicate the presence of the biofi lm on the surface of the IUD as an important risk factor for recurrent vulvovaginal candidiasis. Keywords Candida albicans , biofi lm , intrauterine device biofi lms [ 7 ]. The intrauterine devices (IUDs) are the most commonly employed method of preventing fertilization [ 2 ,8, 9, 10 ]. The present paper describes two cases of patients with signs and symptoms of recurrent vulvovaginal can-didiasis (RVVC) who used IUDs as a contraceptive method. After their removal, the IDU was analyzed for the presence of biofi lm on their surfaces, and the susceptibility pattern of the yeasts recovered from the devices was investigated. Materials and methods Patients Two patients with signs and symptoms suggestive of RVVC, defi ned by at least four symptomatic episodes in 1 year [ 11 ], were enrolled in the present study after obtaining Institutional Review Board approval. Microbiological studies were conducted at the

SUMMARYThe study involved 100 yeast isolates, obtained from urine samples provided by a Public Pediatric Hospital of São Paulo, Brazil, from 1999 to 2004. The most frequent species was Candida albicans, followed by C. tropicalis, C. glabrata and C. parapsilosis. In regard to virulence, 97% of the isolates showed index 3 for proteinase and 63% index 2 for phospholipase. The most frequent killer biotypes were 511 and 888.

Disseminated candidiasis is the most common nosocomial fungal infection, and Candida albicans has been reported to account for 50% to more than 70% of cases of invasive candidiasis. However, recent reports have also suggested the emergence of infections caused by non-albicans species. In addition, less-common pathogenic yeasts (Malassezia, Trichosporon, Rhodotorula, Debaryomyces and Pichia) have recently been reported, with increased frequency, as causes of nosocomial infections with high mortality. This article describes two cases of fungemia caused by Pichia anomala in newborns that occurred in an intensive care unit (ICU), in November 2004 at the Instituto da Criança (Pediatric Institute) of the Hospital das Clínicas of the School of Medicine, São Paulo University, Brazil. The principal factors related to virulence (proteinase and phospholipase) and the susceptibility of the isolated strains to antifungal agents were also evaluated, and the biotype of each strain was determined through the use of an epidemiological marker (killer biotype).

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