Twenty-six cases of Blastoschizomyces capitatus infection were diagnosed in 25 patients at 7 tertiary care hematology units in Spain over a 10-year period. Most patients (92%) had acute leukemia and developed infection during a period of severe and prolonged neutropenia. Two patients had esophagitis, and the rest had invasive infection. Fungemia (20 cases) was a common finding, with frequent visceral dissemination. The 30-day mortality associated with this infection was 52%, compared with 57% among patients with systemic infection. In a univariate analysis, the following 3 variables had a positive impact on 30-day survival: removal of the central venous catheter within 5 days after the onset of infection (P=.02), a good performance status (P=.003), and receipt of systemic prophylactic or empirical antifungal therapy before infection onset (P=.006). Outcome for neutropenic patients with B. capitatus infection is still poor. Rapid removal of the central venous catheter and novel antifungal therapies are recommended for treatment of this rare infection.

This multicenter, population-based study evaluated the laboratory workload produced by zygomycetes and the number of cases of zygomycosis in Spain during 2005. Less than 8% of the patients who harbored zygomycete isolates had zygomycosis. The incidence of zygomycosis (6 cases) was 0.43 cases/1,000,000 inhabitants and 0.62 cases/100,000 hospital admissions.

Seven cases of disseminated infection due toCase 2. The patient in case 2 was a 76-year-old male with a relapse of an acute myeloblastic leukemia. Severe neutropenia developed, the patient became febrile, and blood cultures were obtained. Fever persisted in spite of empirical antibiotic treatment with ceftazidime, amikacin, and vancomycin. Three days after antibacterial treatment, skin nodules appeared and a chest radiograph revealed new bilateral lung infiltrates. Conventional AMB, 1 mg/kg of body weight/day, was added to his treatment regimen. The patient remained febrile and died 5 days later. D. capitatus grew on all blood cultures.Case 3. The patient in case 3 was a 42-year-old male with a relapse of an acute myeloblastic leukemia, type M2, who had been diagnosed 5 years before. Eight days after the chemotherapy was finished, he became febrile and neutropenic. Blood cultures were taken and yielded Escherichia coli and viridans group Streptococcus that responded to treatment with meropenem plus vancomycin. Three days later his fever reappeared, and it was accompanied by tachypnea, diarrhea, and stupor. Blood cultures were drawn, chest radiography revealed new bilateral infiltrates, and conventional AMB was added to his treatment regimen. The patient died of septic shock. Blood cultures yielded D. capitatus.Case 4. The patient in case 4 was a 44-year-old female with a B prolymphocytic leukemia with disease progression in spite of fludarabine and CHOP (cyclophosphamide, hydroxydaunomycin, vincristine [oncovin], and prednisone) treatment. Pentostatin-prednisone was administered but caused severe hematological toxicity. The patient developed pancytopenia, fever, and lung consolidation, and empirical antibacterial treatment and conventional AMB, 1 mg/kg/day, were administered in combination with granulocyte-macrophage colony-stimulating factor. The patient died of septic shock. D. capitatus grew from respiratory samples and blood cultures.Case 5. The patient in case 5 was a 76-year-old female who was diagnosed with acute myeloblastic leukemia. During the administration of chemotherapy, the patient became febrile and responded to treatment with piperacillin-tazobactam plus amikacin. Leptotrichia buccalis was isolated from blood cultures. While she was receiving the antibacterial agents, she became febrile again and a lung consolidation was seen upon chest radiography. Other blood cultures were performed, vancomycin was added to her treatment regimen with no response, and the patient was asked to join a double-blind clinical trial for febrile neutropenia of suspected fungal etiology. The clinical trial compared treatments with caspofungin and liposomal AMB. The patient accepted and was included in the clinical trial. The patient seemed to improve the first 2 days but suddenly worsened, showing jaundice, tachypnea, and pleural ef-* Corresponding author. Mailing address: Unidad de Micología,

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TE or PG are widely expressed among Candida spp., although they do not seem to influence clinical outcome.

BackgroundA study to evaluate the biofilm-development ability in three different media (Middlebrook 7H9, sterile tap water and PBS-5% glucose) was performed with 19 collection strains from 15 different species on non-pigmented rapidly growing mycobacteria (NPRGM). A microtiter plate assay was developed to evaluate the percentage of covered surface of the microtiter plate wells in different days from day 1 to day 69.ResultsAll strains were able to develop biofilm in all the tested media. Middlebrook 7H9 showed the fastest growth, followed by sterile tap water and PBS-5% glucose. A sigmoid growth curve was detected in all the strains both in Middlebrook 7H9 and in sterile tap water. A difference could be detected for Mycobacterium abscessus in tap water, where it showed faster growth than all the other strains.ConclusionBiofilm development seems to be a property of all the species of NPRGM and it depends on the nutrients present in the medium. The microtiter plate assay described here is a useful tool to evaluate differences in biofilm development among the different species of rapidly growing mycobacteria.

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Abstract. Fernández-Guerrero ML, Herrero L, Bellver M, Gadea I, Roblas RF, de Górgolas M (Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain). Nosocomial enterococcal endocarditis: a serious hazard for hospitalized patients with enterococcal bacteraemia. J Intern Med 2002; 252: 510-515.Objectives. Enterococci are a major leading cause of infectious endocarditis and also a common cause of hospital-acquired bacteraemia, which is not believed to represent a serious hazard for the endocarditis. The incidence and risk factors for infectious endocarditis in patients with hospital-acquired enterococcal bacteraemia is determined. Methods. Prospective analysis of 116 patients with enterococcal bacteraemia admitted to medical or surgical wards of a tertiary-care, university affiliated hospital during a period of 5 years. Echocardiography was performed when indicated by clinical criteria. Results. Seventy-five (61.4%) episodes were hospital-acquired and 47 (38.5%) were communityacquired. Most patients had one or more underlying chronic diseases and major abdominal (58.6%) or genitourinary (38.6%) surgery. Seventeen patients (14.6%) developed enterococcal endocarditis. By univariate analysis the risk factors associated with endocarditis were community-acquired infection (P 0.012); monomicrobial bacteraemia (P 0.006); three or more positive blood cultures (P < 0.001); underlying valvulopathy (P < 0.001); presence of a prosthetic valve (P < 0.001) and age (P 0.012). Six patients (8%) developed nosocomial endocarditis. In this group of patients, three or more positive blood cultures (P < 0.01), bacteraemia as a result of Enterococcus faecalis (P 0.007); underlying valvulopathy (P < 0.001) and presence of a prosthetic valve (P < 0.001) were associated with endocarditis. By logistic regression, the presence of underlying valvulopathy and three or more positive blood cultures were associated with endocarditis (OR 21.0; CI 95% 1.65-26.9; P 0.019). Conclusions. The risk of developing infectious endocarditis in patients with hospital-acquired enterococcal bacteraemia is significant. Patients with underlying valvulopathy and three or more positive blood cultures with E. faecalis are prone to nosocomial enterococcal endocarditis.