G. Lo Cascio - Academia.edu (original) (raw)

Papers by G. Lo Cascio

Journal of Clinical Microbiology, 2007

We report a case of fungemia caused by Candida magnoliae , a yeast never associated with human di... more We report a case of fungemia caused by Candida magnoliae , a yeast never associated with human disease. The infection occurred in a 42-year-old Chinese patient with gastric cancer complicated by peritoneal carcinosis. Multiple blood cultures were positive for yeast; the species was well identified with biochemical and molecular methods. The phylogenetic analysis showed a close relationship of C. magnoliae to Candida krusei .

Journal of Clinical Microbiology, 2004

We report on a case of cutaneous infection caused by Alternaria infectoria in a cardiac transplan... more We report on a case of cutaneous infection caused by Alternaria infectoria in a cardiac transplant recipient. A rapid molecular diagnosis was obtained by sequence analysis of the internal transcribed spacer domain of the 5.8S ribosomal DNA region amplified from colonies developed on Sabouraud medium. Treatment consisted of a combination of systemic antifungal therapy, first with amphotericin B and then with itraconazole.

International Conference on the Epidemiology and Control of Biological, Chemical and Physical Hazards in Pigs and Pork, 2007

S 1on 3 V1rusos. parasites, other pathogens Safe pork 2007-Verona (Italy

Microbiologia Medica, 2005

Journal of Chemotherapy, 2002

The MYSTIC program is an international, multicenter surveillance study that compares the activity... more The MYSTIC program is an international, multicenter surveillance study that compares the activity of meropenem, in centers that are prescribers, with that of imipenem, ceftazidime, piperacillin/tazobactam, ciprofloxacin and gentamicin. These Italian data are from 3 centers (neutropenia, cystic fibrosis and intensive care units). A total of 2,072 (238 Gram-positive and 1,834 Gram-negative) aerobic microorganisms were collected during the study. Pseudomonas aeruginosa (33.4%) was the most isolated species followed by Escherichia coli (14.4%). All except one Enterobacteriaceae strain isolated were fully susceptible to meropenem. Moreover, the activity of meropenem against Enterobacteriaceae was about eight-fold greater than that of imipenem and four- to eight-fold more active than that of ceftazidime. Meropenem was highly active against non-fermentative Gram-negative microorganisms, exceeding the activity of most of the other antimicrobial agents tested. Moreover, meropenem showed increasing activity during the 4 years of study (starting from 86.2% in 1997 to 94.0% in 2000). In conclusion, our results indicate that meropenem has excellent potency and spectrum of activity despite being prescribed for the treatment of seriously ill patients, and appears to be a reliable option for the initial empirical treatment of serious nosocomial infections.

Journal of Antimicrobial Chemotherapy, 1998

European Journal of Clinical Microbiology & Infectious Diseases, 2006

La tassonomia dei funghi filamentosi lievito-simili del genere Geotrichum ha subito negli anni nu... more La tassonomia dei funghi filamentosi lievito-simili del genere Geotrichum ha subito negli anni numerose revisioni (Blastoschizomyces, Dipodascus ecc). Recentemente l\u2019analisi di sequenze della regione ITS ha consentito di distinguere G. clavatum associato all\u2019anamorfo Saprochaete clavata da G. capitatum associato a Magnusiomyces capitatus. Frequentemente le due specie vengono confuse a causa della loro somiglianza fenotipica e anche il ricorso alla biologia molecolare pu\uf2 essere fuorviante per la presenza di database limitati o non corretti (Desnos-Olivier 2014). Le recenti segnalazioni in Lombardia di un numero crescente di fungemie da Geotrichum/Saprochaete/Magnusiomyces ci ha indotto ad analizzare i ceppi clinici di queste specie isolati dal 1985 al 2016 con l\u2019obiettivo di una corretta identificazione mediante biologia molecolare e di saggiare la sensibilit\ue0 in vitro agli antifungini. Per l\u2019identificazione molecolare il DNA genomico \ue8 stato amplificato e la regione ITS1-5.8S-ITS2 \ue8 stata sequenziata utilizzando i primers ITS1e ITS4. Le sequenze ottenute sono state confrontate con le sequenze presenti nel CBS database. La sensibilit\ue0 in vitro a 10 antifungini \ue8 stata saggiata mediante microbrododiluizione (metodica EUCAST, CLSI e YeastOne). Per saggiare l\u2019attivit\ue0 di isavuconazolo \ue8 stato impiegato anche Etest. Dei 41 ceppi, isolati ognuno da un singolo paziente, 25 sono stati identificati come M. capitatus, 15 come S. clavata e 1 come G. candidum. Tra i 21 isolati da emocoltura \ue8 stata osservata una prevalenza di S. clavata (15 ceppi, isolati prevalentemente da pazienti ematologici e in un periodo successivo all\u2019anno 2003) rispetto a M. capitatus (6 ceppi, isolati soprattutto da pazienti chirurgici e negli anni \u201980-90). M. capitatus \ue8 risultato prevalente (19/20) tra gli isolati da altri materiali biologici, rappresentati in particolare da secrezioni respiratorie. Le sensibilit\ue0 in vitro hanno confermato la resistenza intrinseca di queste specie alle echinocandine, hanno evidenziato una buona sensibilit\ue0 agli azoli itra, posa e vori. Per quanto riguarda isavuconazolo e flucitosina si evidenziano differenti pattern di sensibilit\ue0 tra le due specie, S. clavata ha MIC di flucitosina inferiori e MIC di isavuconazolo superiori rispetto a M. capitatus. Con sempre maggior frequenza sono segnalate le infezioni da Saprochaete/Magnusiomyces in particolare dall\u2019Europa meridionale. Tuttavia risulta difficile confrontare l\u2019eziologia data le difficolt\ue0 di identificazione. Dall\u2019analisi della nostra casistica emerge una differente distribuzione delle due specie (S. clavata e M. capitatus) nei differenti materiali biologici e un considerevole aumento negli anni pi\uf9 recenti della S. clavata da emocoltura in particolare da pazienti ematologici. La resistenza intrinseca di queste specie alle echinocandine, antifungini di sempre maggior impiego, potrebbe essere il motivo dell\u2019emergenza di queste infezioni rare

Journal of Global Antimicrobial Resistance, 2020

This study was conducted to assess the prevalence of azole resistance in Aspergillus isolates fro... more This study was conducted to assess the prevalence of azole resistance in Aspergillus isolates from patients with haematological malignancies or who were undergoing haematopoietic stem cell transplantation and to identify the molecular mechanism of resistance. Methods: In this 28-month prospective study involving 18 Italian centres, Aspergillus isolates from surveillance cultures were collected and screened for azole resistance, and mutations in the cyp51A gene were identified. Resistant isolates were genotyped by microsatellite analysis, and the allelic profiles were compared with those of resistant environmental and clinical isolates from the same geographical area that had been previously genotyped. Results: There were 292 Aspergillus isolates collected from 228 patients. The isolates belonged mainly to the section Fumigati (45.9%), Nigri (20.9%), Flavi (16.8%) and Terrei (4.8%). Three isolates showed itraconazole resistance: Aspergillus fumigatus sensu stricto, Aspergillus lentulus (section Fumigati) and Aspergillus awamori (section Nigri). The itraconazole resistance rates were 1% and 1.48% considering all Aspergillus spp. isolates and the Aspergillus section Fumigati, respectively. The prevalence of azole resistance among all the patients was 1.3%. Among patients harbouring A. fumigatus sensu stricto isolates, the resistance rate was 0.79%. The A. fumigatus isolate, with the TR 34 /L98H mutation, was genotypically distant from the environmental and clinical strains previously genotyped.

European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2015

Invasive fungal infections (IFIs) are an increasing problem in intensive care units (ICUs), and c... more Invasive fungal infections (IFIs) are an increasing problem in intensive care units (ICUs), and conventional diagnostic methods are not always reliable or timely enough to deliver appropriate antimicrobial therapy. The dosage of fungal antigens in serum is a promising diagnostic technique, but several confounding factors, such as treatment with immunoglobulins (Ig), albumin, or antifungals, could interfere with the correct interpretation of the (1,3)-beta-D-glucan (BG) assay. This study assessed the reliability of the BG assay and the influence of timing and dosage of major confounding factors on circulating levels of IFI biomarkers. 267 ICU patients who underwent a BG assay were retrospectively studied. The timing and dosage of albumin, use of azole treatment, and infusions of intravenous IgG, red blood cells, concentrated platelets, and frozen plasma were analyzed to find possible correlations with the BG results. The sensitivity and specificity of the BG assay were calculated. Th...

Journal of Global Antimicrobial Resistance, 2013

ABSTRACT The aim of this study was to determine the accuracy of commercial systems (VITEK® 2, Ete... more ABSTRACT The aim of this study was to determine the accuracy of commercial systems (VITEK® 2, Etest and Sensititre®) in determining the minimum inhibitory concentrations of vancomycin, teicoplanin and linezolid of Staphylococcus aureus strains and to evaluate the reproducibility of each system in a clinical microbiology laboratory. In total, 115 strains of S. aureus isolated from blood cultures were tested with all three commercial methods as well as the broth microdilution method, which is designated as the standard for glycopeptides and linezolid. Fourteen different S. aureus strains were included in a reproducibility test for all methods and antibiotics. For these strains, antimicrobial susceptibility testing was repeated 10 times on different days with all four methods, each time using the same inoculum. All three commercial methods exhibited similar performance in categorisation of nearly all of the meticillin-susceptible S. aureus (MSSA) isolates. Discrepancies were registered for meticillin-resistant S. aureus (MRSA); 2.5% of the strains in the intermediate or resistant category with the VITEK 2 system were not recognised as resistant by Etest and Sensititre. Moreover, none of the three commercial methods provided accurate results compared with homemade broth microdilution. Reproducibility of vancomycin and teicoplanin was 100% with VITEK 2 and Sensititre and 98.75% with Etest. Microdilution showed a reproducibility of 95.6% with vancomycin and 83.1% with teicoplanin. In contrast to previous reports, the best agreement with microdilution was exhibited by VITEK 2 both for MSSA and MRSA. For the antibiotics tested, the best reproducibility was obtained with the VITEK 2 and Sensititre systems.

Diagnostic Microbiology and Infectious Disease, 2015

Cerebral spinal fluid from a patient affected by a brain abscess caused by Nocardia abscessus gav... more Cerebral spinal fluid from a patient affected by a brain abscess caused by Nocardia abscessus gave a positive result for (1-3)-β-D-glucan (BG) assay, in absence of any fungal infection. This study aimed to assess whether Nocardia spp. show cross-reactivity with BG assay. All Nocardia spp. analyzed provided positive reactions.

Microbial Drug Resistance, 2001

A total of 53 vancomycin-resistant vanA-positive enterococci isolates from poultry farms (17 Ente... more A total of 53 vancomycin-resistant vanA-positive enterococci isolates from poultry farms (17 Enterococcus faecium; 8 Enterococcus durans) and from different hospitals (23 E. faecium; 5 Enterococcus faecalis) in northeastern Italy were compared on the basis of their antibiotic susceptibilities, their SmaI pulsed-field gel electrophoresis (PFGE) patterns, and the organization of their Tn1546-related elements. Ampicillin resistance was similar in both groups of isolates (52 and 60.7%, respectively), whereas human strains were more resistant to high-level gentamicin and streptomycin. A total of 52% of animal strains and 60% of human strains were resistant to tetracycline, and 56% and 46.4% to quinupristin/dalfopristin, respectively. In E. faecium and E. durans animal isolates, nine and six distinct PFGE patterns, respectively, were found: in two instances indistinguishable isolates were found from different farms. In E. faecium and E. faecalis human isolates, nine and six distinct PFGE patterns, respectively, were found; among E. faecium strains, 12 were identical or closely related and were isolates from the same hospital. Elements mediating vanA-glycopeptide resistance were characterized by PCR with primers that amplified 10 overlapping fragments of Tn1546. A total of 84.6% of animal strains and 64.2% of human strains contained elements indistinguishable from the prototype Tn1546. In addition, nine different types were identified, but none was common to animal and human strains.

Microbial Drug Resistance, 2007

Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were used to invest... more Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were used to investigate the genetic relatedness of a total of 41 Enterococcus faecium isolates from different backgrounds (hospital outbreaks, n ϭ 9; documented sporadic infections, n ϭ 10; asyntomatic sporadic carriage of hospitalized patients, n ϭ 9; healthy persons, n ϭ 3; non-human sources, n ϭ 10) over the period 1996-2004 in comparison with clones that have spread in Italy since 1993. Thirty six isolates were vancomycin-resistant and five were vancomycin-susceptible. eBURST analysis of MLST sequence types generated two groups: (1) group 1 (27 isolates) forming a clonal complex (CC17) with the predicted founder corresponding to ST17, a genotype identified in 1994, that included esp-positive and-negative clones isolated from hospitalized patients; and (2) group 2 (14 isolates) including esp-negative clones from different sources (hospitalized patients, healthy persons and non-human sources). The hyl gene was found in five strains with different PFGE types, all belonging to group 1, whereas cylA, gelE, and asa1, were not detected in any of the isolates. Our data showed that the evolution of the MLST C1 epidemic lineage has been continuing in several Italian areas and generating new clones with different PFGE patterns. The main, though not the sole, mechanism that has driven this evolution was confirmed to be linked to the presence of the esp gene.

Journal of Hospital Infection, 2006

This article reports a catheter-related outbreak of bacteraemia involving 38 patients in two haem... more This article reports a catheter-related outbreak of bacteraemia involving 38 patients in two haemodialysis units in Verona. Burkholderia cepacia complex strains were isolated from human blood and from an individually wrapped disinfection napkin that was contained in a commercially available, sterile dressing kit used to handle central venous catheters. Microorganisms isolated from blood cultures and from the napkin were identified by standard procedures and confirmed as B. cenocepacia (genomovar III) by molecular analysis. Using pulsed-field gel electrophoresis analysis, the clinical isolates were indistinguishable or closely related to the B. cenocepacia isolated from the napkin. In conclusion, this study found that a contaminated commercial napkin soaked in quaternary ammonium, even when quality certified, was the source of infection.

Journal of Chemotherapy, 2012

The rapid emergence of KPC-producing Klebsiella pneumoniae has become a serious problem in health... more The rapid emergence of KPC-producing Klebsiella pneumoniae has become a serious problem in healthcare settings, increasing in frequency worldwide. These infections are worrisome, since the antimicrobial treatment options for infections due to multidrug-resistant strains are very limited, and outbreaks must be rapidly detected and controlled. A semi-automated, repetitive-sequence-based PCR (rep-PCR) instrument (DiversiLab system) was evaluated in comparison with the pulse-field gel electrophoresis (PFGE) and multilocus sequence typing to investigate the outbreak of KPC-producing K. pneumoniae in a surgery unit at the University Hospital of Verona, Italy, as a rapid method for outbreak investigations. A selection of seven epidemiologically related K. pneumoniae showing resistance to carbapenem and three epidemiologically unrelated K. pneumoniae isolates were collected from patient with hospital-acquired infection. Among the epidemiologically related isolates, PFGE and Rep-PCR identified a unique pattern with more than 90% of homology. The concordance between DiversiLab and PFGE results confirmed the usefulness of rapid molecular techniques to investigate outbreaks due to multidrug-resistant bacteria. Moreover, this result could meet the international need for a harmonised typing tool, allowing the implementation of strict control measures to prevent dissemination of these organisms in health-care settings.

International Journal of Antimicrobial Agents, 2007

Objectives: To characterise four isolates of linezolid-resistant S. haemolyticus obtained from di... more Objectives: To characterise four isolates of linezolid-resistant S. haemolyticus obtained from different patients. Methods: Identification and preliminary susceptibility testing of organisms were performed with the WalkAway system. Linezolid MICs were determined by reference microdilution and Etest assays, according to CLSI guidelines and manufacturer's instructions, respectively. Detection of the G2576T mutation was performed by PCR amplification and sequencing of the domain V of 23S rRNA gene (Tsiodras et al, Lancet 2001). Clonal relationship of the isolates was examined by PFGE of SmaI macrorestricted genomic fragments. Results: Four linezolid-resistant S. haemolyticus isolated in pure cultures from blood samples (n = 3) or bile (n = 1) were identified among 17 organisms of this species obtained in our laboratory in the period March-April 2006. All four isolates were from different patients admitted to ICUs of our hospital. Reference MICs of linezolid were 64 mg/L for 3 isolates and 128 for the other one. Etest yielded one twofold dilution lower in all isolates. The G2576T mutation was detected in all four isolates and all of them were homozygous. Similar resistance phenotype (WalkAway) was observed for all 4 isolates, being resistant to oxacillin, teicoplanin, ciprofloxacin, clindamycin, erythromycin, gentamicin, tobramycin, amikacin, rifampin, trimethoprim-sulfamethoxazol and susceptible to vancomycin, tetracycline and quinupristin-dalfopristin. Two closely related PFGE-patterns were observed for the 4 isolates, each one corresponding to two isolates. Conclusions: We have identified the emergence of multiresistant S. haemolyticus isolates presenting homozygous resistance to linezolid.

Infection, 2013

Purpose We compared the risk factors, the diagnostic tools and the outcome of filamentous fungal ... more Purpose We compared the risk factors, the diagnostic tools and the outcome of filamentous fungal infections (FFIs) in hematological patients (HAEs) and non-hematological patients (non-HAEs). Methods Prospective surveillance (2009-2011) of proven and probable FFIs was implemented in 23 Italian hospitals. Results Out of 232 FFIs, 113 occurred in HAEs and 119 in non-HAEs. The most frequent infection was invasive aspergillosis (76.1 % for HAEs, 56.3 % for non-HAEs), and the localization was principally pulmonary (83.2 % for HAEs, 74.8 % for non-HAEs). Neutropenia was a risk factor for 89.4 % HAEs; the main underlying condition was corticosteroid treatment (52.9 %) for non-HAEs. The distribution of proven and probable FFIs was different in the two groups: proven FFIs occurred more frequently in non-HAEs, whereas probable FFIs were correlated with the HAEs. The sensitivity of the galactomannan assay was higher for HAEs than for non-HAEs (95.3 vs. 48.1 %). The overall mortality rate was 44.2 % among the HAEs and 35.3 % among the non-HAEs. The etiology influenced the patient outcomes: mucormycosis was associated with a

European Journal of Clinical Microbiology & Infectious Diseases, 2011

We report an outbreak of linezolid-resistant Staphylococcus haemolyticus strains (MIC 32 mg/L) in... more We report an outbreak of linezolid-resistant Staphylococcus haemolyticus strains (MIC 32 mg/L) in patients admitted to the Verona University Hospital Intensive Care Unit. The strains proved to be clonally related at pulsed field gel electrophoresis. All the strains showed the G2576T mutation responsible for linezolid-resistance and retained their resistance even after several passages on antibiotic-free medium. After a decade of linezolid use, multifocal emergence of linezolid resistance in coagulasenegative staphylococci has become an important matter of concern and mandates stricter control over the use of this antibiotic in order to preserve its clinical utility.