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Susceptibility of 75 clinical isolates of Enterobacteriaceae to 15 aminoglycosides, beta-lactams and fluoroquinolones was studied. The isolates originated from 3 wards (Pathological neonates, Surgical ICU, and Pediatric cardiology) of the Children's University Hospital in Bratislava, Slovakia. The isolates were collected from patients in April and November 1999 and June 2001. All isolates were resistant to gentamicin, tobramycin, and ampicillin. The majority of isolates were resistant to netilmicin, amikacin, cephalosporins, and azthreonam, but they were susceptible to meropenem and fluoroquinolones. The prevailing number of isolates produced 2 to 4 aminoglycoside-modifying enzymes. All isolates produced beta-lactamases and 80% produced extended-spectrum beta-lactamases (ESBL). Plasmid analysis revealed in the majority of isolates, originating from all 3 wards, a 116 kb plasmid throughout the entire period of study. Restriction analysis suggested a dissemination and persistence of a single nosocomial plasmid at all 3 units of the large pediatric hospital in Bratislava. [ABSTRACT FROM AUTHOR]

Introduction: Melanized or dematiaceous fungi are associated with a wide variety of infectious syndromes. Cladophialophora bantiana is one of the most common and dangerous neurotropic fungi, able to cause brain abscess and disseminated infection., Case Presentation: We report a new case of phaeohyphomycosis brain abscesses caused by C. bantiana in Slovakia. The patient was a 63-year-old man having undergone heart transplantation, with dyspnoea, left-sided bronchopneumonia and fevers. CT (computed tomography) and MRI (magnetic resonance imaging) of the brain revealed numerous abscesses. Bacterial infection was proven by neither the growth of bacteria in culture nor the presence of bacterial antigens. Direct microscopy of the pus from the brain abscess showed Gram-positive hyphae. The isolate was finally identified as C. bantiana based on morphological and physiological features, and on DNA sequence analysis., Conclusion: In spite of appropriate therapy, neurological complications and accelerated respiratory insufficiency resulted in the patient's death. Concerning clinical manifestation of the brain phaeohyphomycosis that can sometimes be a problem to distinguish from malignancy, physicians should also assume infection caused by this serious pathogen.

A total of 201 cases of fungaemia in children in a 12-year national survey from seven University Paediatric Clinics in Slovakia in 1990-2001 was assessed to determine risk factors, therapy and outcome, and to compare those cases with fungaemia in 130 adult cancer patients studied in a similar survey. Four univariate analyses were performed to assess differences in aetiology, antifungal susceptibility and outcome between fungaemia in neonates and paediatric intensive care unit (ICU) patients as well as between paediatric and adult cancer patients with fungaemia. There was a significant difference in aetiology and antifungal susceptibility between the subgroups of children with fungaemia: 83.3% of neonates versus 40.2% in children with cancer were due to Candida albicans. None of the non-albicans Candida spp. (NAC) in neonates but 23.5% of NAC isolates from children with cancer were resistant to fluconazole. C. albicans caused 144 (71.1%) episodes and NAC 48 (23.7%) episodes. Trichosporon beigelii, Blastoschizomyces (Trichosporon) capitatus, Rhodotorula rubra and Cryptococcus laurentii were found less frequently in neonates than in children with cancer (18.8%). There were not many differences in risk factors between paediatric fungaemia and adult cancer fungaemia except C. albicans aetiology, corticosteroid use in therapy, breakthrough fungaemia after ketoconazole prophylaxis and meningitis as a complication, which were observed significantly more frequently among children than in adults, both with cancer and fungaemia. Thirty-three of the paediatric fungaemias were breakthrough cases and appeared frequently in children with cancer. Fifty-one (25.1%) children died with fungaemia (attributable mortality) and 25 (12.7%) due to underlying disease with fungaemia; overall mortality was 37.8% and there was no significant difference in death rates between the subgroups of paediatric patients (neonates, children in ICUs and children with cancer).