Aims:We investigated the spectrum of yeasts isolated, and compared the epidemiological and laboratory characteristics of women carrying vulvovaginal Candida albicans with those carrying yeasts other than C albicans. Method: Between April and June 2001, 5802 consecutively received genital swabs from women were plated onto Candida ID chromogenic media (BioMerieux). Blue colonies were reported as C albicans; all other colonies (white and pink) were identified to species level using the Vitek YBC card (BioMerieux). In vitro susceptibility to amphotericin (AMB), fluconazole (FLU), itraconazole (ITZ), and voriconazole (VOR) was determined for approximately 40% of non-C albicans yeasts using a standardised microdilution method. Results: Yeast was isolated from 1221 women (21%). Of these, C albicans only was isolated from 1087 (89%) and yeasts other than C albicans from 129 (11%) women. C glabrata comprised 89 (69%) of the latter. Women in whom other yeasts were recovered were older than those with C albicans (mean 43, versus 33 years, p <0.001). All isolates tested (n=53) were susceptible to AMB and VOR. Seven (24%) C glabrata strains were susceptible to FLU with 21 (72%) testing susceptible-dose dependent. Conclusion: Yeasts other than C albicans are common vaginal isolates even in a primary care population. The species isolated are less susceptible to FLU than most C albicans. V ulvovaginal candidiasis is a common problem. The majority of infections are caused by Candida albicans, but there is increased awareness of the role of yeasts other than C albicans. It is important to identify these other yeasts because they tend to be less susceptible to the commonly used topical and oral azole antifungals 1 2 and are associated more frequently with recurrent infection than C albicans.3 Previous studies have been performed in tertiary care settings and included women with recurrent symptoms. Our study investigated the epidemiological and microbiological features of women carrying yeasts other than C albicans by examining genital specimens collected in the primary care setting, including those taken for antenatal or sexual health screening purposes. In addition, in vitro susceptibility testing was performed on 40% of yeasts other than C albicans.

To determine the potential aetiological factors of small bowel perforation in the premature neonate, we performed a retrospective chart review of those neonates with spontaneous intestinal perforation (SIP) of the small bowel seen in our tertiary paediatric hospital between January 1980 and December 2000. Data were collected on gestational feto-maternal health, medical interventions prior to perforation and the subsequent operative and laboratory findings. There were 23 patients with SIP of the small bowel over the 21-year review; 65% were male. There were 7 twin pregnancies but no cases linked to maternal drug abuse. The median gestational age was 27 weeks, the median birth weight 973 g, 19 neonates required ventilation, 15 steroids and 13 indomethacin. The median age at diagnosis was 7 days, heralded by rapid development of abdominal distension in 22 patients. Surgical intervention in addition to insertion of a peritoneal drain was required in 19 patients. Positive microbiological cultures of blood or peritoneal fluid at operation were documented in 8 patients; 5 grew Staphylococcus epidermidis and 4 Candida species. Perforations were located in the ileum in 20 and the jejunum in 1. Deficiency of the muscularis propria was found in 6 patients. Of the 6 deaths, 2 neonates had significant co-morbidity in addition to extreme prematurity. Small bowel SIP occurs in the premature neonate after the first week of life and usually presents with abdominal distension. Putative risk factors identified included twin gestation, neonatal ventilation, use of steroids and indomethacin, infection with Staphylococcus epidermidis and Candida species and deficiency of enteric smooth muscle.

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