This is a retrospective observational study of clinical and epidemiologic data from bloodstream yeast infections over 5 years (2004-2008) in a tertiary-care hospital. During this period, there were 52 such infections, at a rate of 2.4 per 1,000 hospital admissions. Non-C. albicans Candida species and other genera were responsible for 82% of infections, with C. tropicalis and C. parapsilosis being the most common. In 2008 no C. albicans infections occurred. Several uncommon fungal pathogens were observed, including Trichosporon asahii, Rhodotorula spp. and Candida zeylanoides. Of 16 isolates tested, 3 (19%) were resistant to fluconazole, including one C. zeylanoides (MIC 8 microg/ml) and one C. tropicalis (MIC 16 microg/ml) isolate, as well as intrinsically resistant C. krusei. All isolates tested were susceptible to itraconazole (n = 7) and amphotericin B (n = 8). Yeast infections were associated with severe underlying diseases, mainly hematological/solid cancers (71%), hospitalization in the ICU (41%), central venous catheters (80%), and use of antimicrobials (94%). The overall mortality rate was 50%. Our finding of a predominance of non-C. albicans Candida species infection with uncommon yeasts, and fluconazole resistance, suggests the need for continuous surveillance of fungemia and of antibiotic susceptibility trends, in order to adopt treatment strategies applicable to particular healthcare institutions.

We hereby describe the clinical and epidemiological features and, outcomes of nine patients with Elizabethkingia meningoseptica infections in two hospitals over a 2-year period. All infections caused by this pathogen were nosocomial, or healthcare associated infections, in hemodialysis settings whereas none was correlated with hospital outbreaks.

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To describe the incidence and susceptibility profile of Candida bloodstream infections in a tertiary-care hospital, we performed a retrospective observational study from 1998 to 2007. Comorbidities and risk factors were compiled from all cases. In vitro susceptibility testing to fluconazole, itraconazole, voriconazole, and amphotericin B was performed for 100 isolates, and caspofungin was tested for C. parapsilosis complex. In a ten-year evaluation of candidemias, 44 % were caused by C. albicans, and species of the C. parapsilosis complex were the second most frequent agents (37 %). Other species presented lower incidences (C. tropicalis, 13 %, C. glabrata, 5 %, and C. krusei, 1 %). Neither C. dubliniensis nor C. metapsilosis were observed in this study. C. orthopsilosis (3 %) and C. parapsilosis stricto sensu (34 %) were also found. Species distribution was independent of catheterization, mechanical ventilation, or previous use of antifungals or corticoids. Parenteral nutrition administration was strongly related to C. glabrata infection, and the highest mortality (80 %) was observed in patients infected by this species. All C. albicans isolates showed high susceptibility to all tested drugs. However, two C. parapsilosis stricto sensu isolates presented high minimum inhibitory concentration (MIC) (4 mg/L each) to fluconazole, and one exhibited voriconazole MIC of 0.25 mg/L, highlighting the cross-resistance to these azoles. All isolates of C. tropicalis and C. glabrata showed no resistance to any drug tested. No difference was noted between C. parapsilosis and C. orthopsilosis susceptibilities to caspofungin. Our results suggest that resistance to amphotericin B, fluconazole, voriconazole, itraconazole, and caspofungin in Brazilian Candida bloodstream isolates is still uncommon.

Elizabethkingia meningoseptica is an unusual, highly resistant, gram- negative bacillus. While E. meningoseptica-associated meningitis outbreaks have been well-documented in hospital neonatal wards and among immunocompromised adults, reports describing this microorganism in critically ill children are scarce. The purpose of this report was to describe a case of a 3 year-old girl who developed pneumonia caused by E. meningoseptica in the setting of previous use of broad-spectrum antibiotics and to review the pediatric literature regarding this pathogen.

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This study describes a carbapenem-resistant Klebsiella pneumoniae (CRKP) outbreak that occurred from October 2008-December 2010. Polymerase chain reaction assays were performed to detect the bla KPC gene and molecular typing was performed using pulsed-field gel electrophoresis (PFGE) The emergence of strains of multidrug-resistant Klebsiella pneumoniae has been reported with increasing frequency in several countries worldwide. Carbapenem-resistant K. pneumoniae (CRKP) can cause nosocomial infections and outbreaks with high mortality rates (Maltezou 2009). Such infections occur mainly in patients admitted to Intensive Care Units (ICU) with several underlying diseases and histories of having received prolonged courses of antibiotics (Maltezou 2009). Several resistance mechanisms have been described. Carbapenemase production (KPC), metallo-β-lactamase (MBL) and porin loss, combined with the production of extended-spectrum beta-lactamase (ESBL), are described as the most common mechanisms of carbapenem resistance (Souli et al. 2008, Peirano et al. 2009).Control measures, including contact precautions for infected or colonised patients and active surveillance in high-risk units, have been recommended as strategies to control CRKP outbreaks (Ben-David et al. 2010). In our hospital, CRKP had never been detected until October 2008. The objectives of this study were to describe the epidemiological findings in a CRKP outbreak and to verify the existence of clones that are present in other hospitals in the state of São Paulo (SP).Hospital Brigadeiro is a public, tertiary-care teaching hospital that is part of the Brazilian National Health Care System. It has the following specialised clinics: Oncology, Haematology, Bone Marrow Transplantation, Nephrology, Renal and Liver Transplant Units, ICU in The isolates evaluated in the hospital's laboratory were sent to the Adolfo Lutz Institute, a public health laboratory, to confirm our initial identification of CRKP, to assay for the production of carbapenemases and to determine the level of genetic relatedness between samples.K. pneumoniae was confirmed by classical phenotypic methods. Disk-diffusion tests were performed to determine susceptibility to antimicrobials, according to the Clinical and Laboratory Standards Institute (CLSI 2010). Isolates were screened for the ESBL phenotype by the standard double-disk synergy test and KPC was screened both by evaluating breakpoints and using modified Hodge test, again according to CLSI guidelines (2010).Minimal inhibitory concentrations (MICs) were determined by E-test (AB Biodisk, Solna, Sweden) for the following antimicrobial drugs: ceftazidime, cefotaxime, cefotaxime plus clavulanic acid, cefepime, aztreonam, ertapenem, imipenem, meropenem, piperacillin/tazobactam, gentamicin, amikacin, tigecycline tobramycin and polymyxin (CLSI 2010). Imipenem plus ethylenediamine tetraacetic acid (EDTA) strips were used to detect the presence of metallo-beta-lactamases. Tigecycline and polymyxin B were evaluated using breakpoints for Enterobacteri...