Probiotics are commonly prescribed as an adjuvant in the treatment of antibiotic-associated diarrhea caused by Clostridium difficile. We report the case of an immunocompromised 73-year-old patient on chemotherapy who developed Saccharomyces cerevisiae var. boulardii fungemia in a central venous catheter during treatment of antibiotic-associated pseudomembranous colitis with the probiotic Saccharomyces cerevisiae var. boulardii. Fungemia was resolved after interruption of probiotic administration without the need to replace the central venous line.

Introduction: In Porto Alegre (South Brazil), since the first VRE isolation in 2000 until the middle of the last decade, the epidemiology of enterococcal infections presented the peculiarity that, as opposed to other regions of the country, almost all VRE were E. faecalis. The aim of this study was to investigate the microbiological and epidemiological characteristics of a VRE outbreak that occurred between August 2010 and September 2011 in Porto Alegre, South Brazil. Methodology: Twenty-nine isolates from inpatients of Mãe de Deus Hospital that were identified and characterized for their susceptibility profile, vancomycin genotype, presence of esp gene, biofilm production, and clonal relationship were collected. Patients' records were reviewed for clinical information. Results: All isolates were identified as vancomycin/ampicillin resistant E. faecium carrying the vanA gene. Almost all were susceptible to gentamicin and streptomycin. Most patients died and were associated with a hemodialysis unit stay. All but the first isolate were clustered in a main clone. Conclusions: An important change in vancomycin-resistant enterococci was observed. Studies like this are necessary to monitor the dissemination of VRE, especially of some individual clones.

Resumo: Staphylococcus aureus resistente à meticilina (MRSA), outrora isolado especificamente em ambientes hospitalares, vem sendo identificado como causador de infecções cutâneas em pacientes da comunidade. Neste artigo, é relatado um caso do sul do Brasil com furunculose por CA-MRSA. O microrganismo isolado foi submetido a exames de PCR para o gene mecA e para o gene que codifica a leucocidina de Panton-Valentine. Esses exames permitiram a identificação genotípica do CA-MRSA. Palavras-chave: Furunculose; Resistência a meticilina; Staphylococcus aureus Abstract: Methicillin-resistant Staphylococcus aureus (MRSA), particularly isolated at hospital setting, has been identified in cutaneous infections of community patients. This paper reports a case of furunculosis from the southern Brazil. Dermatologists must be attentive to this emergent etiological diagnosis. The isolated microorganism was subjected to PCR for gene mecA and to PCR for the gene that encodes the leukocidin of Panton-Valentine. These exams enabled genotypic identification of CA-MRSA.

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first steps in environmentally compatible fly control and will provide long-term discouragement of additional pest invaders. I recommend the following systematic approach: (1) prioritized leadership and hospital administrative commitment to sanitation; (2) empowering and educating food service workers in illness prevention; (3) emphasizing environmentally compatible sanitation methods coupled with strategic and specific applications of antipest agents when required; and (4) looking beyond surface cleanliness to follow food as an attractor of pests. Acknowledgments. Kurt C. Stange, MD, PhD, provided helpful guidance in writing this commentary. Financial support. No financial support was provided relevant to this article.

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