Primer caso de fungemia asociada a catéter por Candida nivariensis en la Península Ibérica / First case report of catheter-related fungemia by Candida nivariensis in the Iberian Peninsula

Antecedentes. En los últimos años estamos asistiendo a un aumento en la incidencia de la candidemia causada por especies de Candida no Candida albicans. Dentro del complejo Candida glabrata se han descrito 2 especies crípticas, Candida nivariensis y Candida bracarensis, que pueden presentar problemas en la identificación de los aislamientos en el laboratorio y una mayor resistencia a fluconazol. Objetivos. Se describe el primer aislamiento en la Península Ibérica de C. nivariensis en un paciente con fungemia asociada a catéter. Caso clínico. Varón de 81 años que ingresó en nuestro hospital con una fístula intestinal y en estado de malnutrición. En los hemocultivos y en la punta del catéter venoso central se aisló una levadura que crecía formando colonias blancas en medio BD CHROMagar Candida® y que no pudo ser identificada por la metodología convencional. A pesar del tratamiento intravenoso con fluconazol, los hemocultivos persistían positivos después de 5 días de tratamiento. Las CMI obtenidas fueron: 1μg/ml para anfotericina B, 0,015μg/ml para anidulafungina, 0,125μg/ml para caspofungina, 0,015μg/ml para micafungina, 4μg/ml para fluconazol, 0,25μg/ml para itraconazol, 0,25μg/ml para posaconazol, y 0,03μg/ml para voriconazol. Se sustituyó el fluconazol por caspofungina, que se mantuvo durante 2 semanas. El paciente fue intervenido y dado de alta tras un postoperatorio sin complicaciones. Finalmente, el aislamiento fue identificado como C. nivariensis mediante secuenciación de las regiones ITS del rARN. Conclusiones. C. nivariensis es una levadura emergente cuya identificación debe basarse en pruebas de biología molecular. En el caso clínico que presentamos el tratamiento con caspofungina fue eficaz(AU)

Background. In recent years the incidence of candidemia caused by non-albicans Candida species has been increasing. Two cryptic species have been described within the Candida glabrata complex, Candida nivariensis and Candida bracarensis, which may be troublesome in laboratory identification and have lower susceptibility to fluconazole. Aims. To describe the first isolation of C. nivariensis in the Iberian Peninsula from a patient suffering from a catheter-related fungemia. Case report. An 81-year-old man was hospitalized for surgical treatment of an intestinal fistula that was associated to a severe malnutrition. Cultures of the patient's central venous catheter tip and blood yielded white colonies in BD CHROMagar Candida® medium, which could not be identified by conventional microbiological methods. Although intravenous fluconazole was administered, blood cultures continued being positive 5 days later. The MIC values of the isolate were as follows: 1μg/ml for amphotericin B, 0.015μg/ml for anidulafungin, 0.125μg/ml for caspofungin, 0.015μg/ml for micafungin, 4μg/ml for fluconazole, 0.25μg/ml for itraconazole, 0.25μg/ml for posaconazole, and 0.03μg/ml for voriconazole. Antifungal treatment was changed to intravenous caspofungin for 2 weeks. The intestinal fistula was surgically treated. There was no evidence of relapse during the following month, and the patient was discharged. The isolate was identified as C. nivariensis based on DNA sequencing of the ITS regions of rRNA. Conclusions. C. nivariensis should be regarded as an emerging pathogen which requires molecular methods for a definitive identification. Our patient was successfully treated with caspofungin(AU)

[First case report of catheter-related fungemia by Candida nivariensis in the Iberian Peninsula]. / Primer caso de fungemia asociada a catéter por Candida nivariensis en la Península Ibérica.

BACKGROUND: In recent years the incidence of candidemia caused by non-albicans Candida species has been increasing. Two cryptic species have been described within the Candida glabrata complex, Candida nivariensis and Candida bracarensis, which may be troublesome in laboratory identification and have lower susceptibility to fluconazole. AIMS: To describe the first isolation of C. nivariensis in the Iberian Peninsula from a patient suffering from a catheter-related fungemia. CASE REPORT: An 81-year-old man was hospitalized for surgical treatment of an intestinal fistula that was associated to a severe malnutrition. Cultures of the patient's central venous catheter tip and blood yielded white colonies in BD CHROMagar Candida(®) medium, which could not be identified by conventional microbiological methods. Although intravenous fluconazole was administered, blood cultures continued being positive 5 days later. The MIC values of the isolate were as follows: 1 µg/ml for amphotericin B, 0.015 µg/ml for anidulafungin, 0.125 µg/ml for caspofungin, 0.015 µg/ml for micafungin, 4 µg/ml for fluconazole, 0.25 µg/ml for itraconazole, 0.25 µg/ml for posaconazole, and 0.03 µg/ml for voriconazole. Antifungal treatment was changed to intravenous caspofungin for 2 weeks. The intestinal fistula was surgically treated. There was no evidence of relapse during the following month, and the patient was discharged. The isolate was identified as C. nivariensis based on DNA sequencing of the ITS regions of rRNA. CONCLUSIONS: C. nivariensis should be regarded as an emerging pathogen which requires molecular methods for a definitive identification. Our patient was successfully treated with caspofungin.

Prevalence and antifungal susceptibility patterns of new cryptic species inside the species complexes Candida parapsilosis and Candida glabrata among blood isolates from a Spanish tertiary hospital.

OBJECTIVES: There is scarce information on the clinical relevance and antifungal susceptibility of Candida bracarensis, Candida nivariensis, Candida orthopsilosis and Candida metapsilosis. The objective of this study was to assess the prevalence and in vitro antifungal susceptibility of these cryptic species among 173 blood isolates previously identified as Candida glabrata or Candida parapsilosis at the Hospital of Cruces (Barakaldo, Spain). The survey was extended to 518 clinical isolates from the culture collection of the Universidad del País Vasco-Euskal Herriko Unibertsitatea (UPV-EHU; Bilbao, Spain). METHODS: In vitro susceptibilities to 5-fluorocytosine, amphotericin B, anidulafungin, caspofungin, fluconazole, itraconazole, micafungin, posaconazole and voriconazole were tested. RESULTS: All isolates of C. glabrata were identified as C. glabrata sensu stricto. Inside the C. parapsilosis complex, 2.4% of isolates from the Hospital of Cruces and 5.8% from the UPV-EHU were C. metapsilosis or C. orthopsilosis. Of 457 isolates, 435 (95.19%) were C. parapsilosis sensu stricto, 11 (2.41%) C. metapsilosis and 11 (2.41%) C. orthopsilosis. Only seven blood isolates were C. metapsilosis (0.44%) or C. orthopsilosis (1.09%). These cryptic species were also isolated from other relevant clinical specimens. Four C. parapsilosis sensu stricto (5.6%) were susceptible dose-dependent, and one was resistant to both fluconazole and voriconazole (1.4%). Moreover, 19 isolates of C. parapsilosis sensu stricto (26.4%) were intermediately susceptible to itraconazole and higher concentrations of echinocandins were needed to inhibit this species. Most C. orthopsilosis and C. metapsilosis were susceptible to all antifungal agents tested, but one otic isolate of C. metapsilosis was resistant to fluconazole and 5-fluorocytosine. CONCLUSIONS: C. metapsilosis and C. orthopsilosis are associated with human disease and show a different antifungal susceptibility profile compared with C. parapsilosis sensu stricto.

Outbreak of vim-1-carbapenemase-producing Enterobacter cloacae in a pediatric intensive care unit.

Pediatric patients are rarely infected with metallo-ß-lactamase-producing Enterobacteriaceae. We describe 3 cases of children infected with VIM-1-producing clonal Enterobacter cloacae. Patients were treated with amikacin and cotrimoxazole. The blaVIM-1 gene was carried into a class 1 integron and an IncHI2 incompatibility group plasmid. Emergence of pediatric infections caused by carbapenemases-producing Enterobacteriaceae is a critical issue as they are resistant to most ß-lactam antibiotics.

Pneumococcal bacteremia in febrile infants presenting to the emergency department 8 years after the introduction of pneumococcal conjugate vaccine in the Basque Country of Spain.

We included 3088 well-appearing infants aged between 3 and 36 months with fever without a source with a blood culture done as part of their study of fever. Rate of positive blood cultures for Streptococcus pneumoniae occult bacteremia (OB) was 0.58%. Rate of OB caused by PCV7-serotypes and nonvaccine serotypes were 0.16% and 0.42%, respectively. A total of 18 cases of S. pneumoniae OB were identified between January 1, 2006 and December 31, 2009. None of the 5 infants who had S. pneumoniae OB caused by vaccine serotypes had received PCV7. The decline in pneumococcal OB rates observed after PCV7 introduction in our area (Basque Country, Spain) continues 8 years later. There is no evidence of an OB rate increase caused by non-PCV7 serotypes.

Activities of fluconazole and voriconazole against bloodstream isolates of Candida glabrata and Candida krusei: a 14-year study in a Spanish tertiary medical centre.

The aim of this study was to evaluate the in vitro activities of voriconazole and fluconazole against Candida glabrata and Candida krusei isolated from blood during a 14-year period (1990-2003) at the tertiary care hospital of Cruces (Barakaldo, Spain). The in vitro activities of fluconazole and voriconazole against 28 isolates of C. glabrata and 15 isolates of C. krusei were determined by the Clinical and Laboratory Standards Institute disk diffusion method. Of the 28 C. glabrata isolates tested, 24 (85.7%) were susceptible (S) to fluconazole, 2 (7.1%) were susceptible dose-dependent (S-DD) and 2 (7.1%) were resistant (R). All C. krusei isolates were classified as R to fluconazole. Resistance to voriconazole was observed in one isolate each of C. glabrata (3.6%) and C. krusei (6.7%), and one isolate of each species was S-DD. These results were confirmed by the Sensititre YeastOne and Etest methods, with good comparative results. Voriconazole was very active in vitro against C. glabrata and C. krusei blood isolates and the resistance observed was not related to the introduction of voriconazole in the therapeutic schedule of the hospital. These facts support the usefulness of voriconazole as a therapeutic tool for candidaemia caused by these species.