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BACKGROUND Candidemia is one of the leading causes of bloodstream infections in the pediatric intensive care unit (PICU). The aim of this study was to define characteristics and risk factors for candidemia in the PICU setting and propose a predictive model to identify the patients at risk. METHODS This was a retrospective matched case-control study in the PICU during a 9-year period. Patients with candidemia were studied and matched with control patients without candidemia. Univariate analysis was performed for potential risk factors and multivariate analysis was conducted to determine the prediction score for candidemia. RESULTS Forty-two cases of candidemia were matched with 84 control patients. Candida parapsilosis was the most common (71.4%) species. Risk factors independently associated with candidemia were: the use of >2 antibiotics in a maximum period of 4 weeks before the candidemia (odds ratio [OR]: 10.59; 95% confidence interval [CI]: 2.05-54.83), a previous bacterial infection in a maximum period of 4 weeks before the candidemia (OR: 5.56; 95% CI: 1.44-21.5) and the duration of PICU stay of >10 days (OR: 4.22; 95% CI: 1.02-17.41). The proposed predictive scoring system has a sensitivity of 95.24%, specificity of 76.12%, OR 64.0, 95% CI 14.2-288.6, the positive predictive value of 66.67% and the negative predictive value of 96.97%. CONCLUSIONS Previously reported risk factors for candidemia have been confirmed and some new have been detected. The presented scoring system can help identify patients who would benefit from prophylactic antifungal therapy.

The aim of this study was to determine the molecular types and antifungal susceptibility of Cryptococcus neoformans species complex isolates from environmental sources in Croatia. Swab samples of tree hollows and bird excreta in the soil beneath trees were collected. Samples included 472 (92.73%) samples obtained from tree hollows and 37 (7.27%) samples from bird excreta. Four C. neoformans species complex isolates were recovered from tree hollow swabs along the Mediterranean coast, while there were no isolates recovered from bird excreta or from the continental area. Three isolates were identified as molecular types VNI and one as VNIV. All tested antifungals showed high in vitro activity against the four isolates. This is the first report proving the presence of C. neoformans species complex in the environment of Croatia. The results of the study suggest a major risk of exposure for inhabitants living along the Croatian coast and that both VNI and VNIV molecular types can be expected in clinical cases of cryptococcosis. Susceptibility to antifungals confirmed that no resistance should be expected in patients with cryptococcosis at the present time. This is the first report proving the presence of C. neoformans species complex species complex in the environment of Croatia.

Pneumocystis jirovecii pneumonia is a difficult invasive infection to diagnose. Apart from microscopy of respiratory specimens, two diagnostic tests are increasingly used including real-time quantitative PCR (qPCR) of respiratory specimens, mainly in bronchoalveolar lavage fluids (BAL), and serum &beta, 1,3-d-glucan (BDG). It is still unclear how these two biomarkers can be used and interpreted in various patient populations. Here we analyzed retrospectively and multicentrically the correlation between BAL qPCR and serum BDG in various patient population, including mainly non-HIV patients. It appeared that a good correlation can be obtained in HIV patients and solid organ transplant recipients but no correlation can be observed in patients with hematologic malignancies, solid cancer, and systemic diseases. This observation reinforces recent data suggesting that BDG is not the best marker of PCP in non-HIV patients, with potential false positives due to other IFI or bacterial infections and false-negatives due to low fungal load and low BDG release.

Background Lasers have been recommended in final root canal disinfection protocol, however, there is no clear evidence about their efficacy against bacteria in biofilms. The aim of the study was to evaluate and compare the disinfection effect of antimicrobial photodynamic therapy (aPDT), Nd:YAG laser and QMiX solution against Enterococcus faecalis biofilm. Methods The study sample consisted of 65 dentine slices, which were inoculated with E. faecalis and incubated anaerobically for three weeks. The dentine discs were randomly allocated to one of the following experimental groups: aPDT (100 mW, 10 mg/ml phenothiazinium chloride, 1 min), Nd:YAG laser (2 W, 15 Hz, 4 × 5 s), QMiX solution (1 min). Positive controls did not receive any treatment and negative controls were treated with 5.25% NaOCl. To harvest surviving adherent cells, each dentine sample was transffered to a test tube containing of TSB, serial ten-fold dilutions were made and aliquot of 1 ml was plated onto blood agar plates and incubated for 48 h. Colony forming units grown were counted and transformed into actual counts based on the dilution factor. The remaining viable cells after each protocol were analysed by FISH. Results The aPDT and the QMiX solution were equally effective, with the reduction rate of E. faecalis CFUs of 98.8% and 99.3% respectively ( p = 1.107). The Nd:YAG laser caused 96% reduction of E. faecalis ( P Conclusion The aPDT and the QMiX solution showed similar antibacterial efficacy against old E. faecalis biofilm, followed by Nd:YAG irradiation.

Acinetobacter baumannii is an opportun-istic nosocomial pathogen and one of the six most important multidrug-resistant microorganisms in intensive care units (ICU). The aim of this study was to determine the prevalence of antimicrobial resistant A. baumannii strains in ICU. We analysed antibiotic susceptibility of A. baumannii isolates collected in University Hospital Centre Zagreb over a four-year period (2011-2014) based on the hospital computer system data (BIS). The data were interpreted according to Clinical and Lab-oratory Standards Institute criteria.All strains from 2014 were found to be resistant to meropenem, which is a sig-nificant increase when compared to 1.4% in 2011 and 81.8% in 2012. The resistance rate to imipenem increased to 95.8% in 2014 from 91.4% in 2011 and 81.8% in 2012. Colistin resistance, confirmed by E test, was found only in one strain in 2013. The resistance rates of other antimicrobial agents were as follows: ampicillin/sulbac-tam 8.6% and 73.9%, netilmicin 70.6% and 83.3%, gentamicin 48.6% and 91.7%, ami-kacin 82.4% and 80.0% and ciprofloxacin 100% and 100% in 2011 and 2014 respec-tively.Our data confirmed a multidrug-resist-ance phenotype in Acinetobacter bauman-nii strains isolated in ICU at the Clinical Hospital Centre, with a significant increase in resistance rates between 2011 and 2014 against certain antimicrobial agents in-cluding ampicilin/sulbactam and carbap-enems.

Among 585 Streptococcus pneumoniae strains isolated in 22 Croatian hospitals 21 strains (3.6%) were quinolone nonsusceptible. MICs of all quinolones were high for seven strains tested with the same serotype (23F) and mutations in gyrA , parC , and parE . The remaining 14 strains were more heterogeneous and had mutations only in parC and/or parE , and the MICs of quinolones were lower for these strains.