The objective of this study was to assess the cumulative incidence of invasive candidiasis (IC) in intensive care units (ICUs) in Europe. A multinational, multicenter, retrospective study was conducted in 23 ICUs in 9 European countries, representing the first phase of the candidemia/intra-abdominal candidiasis in European ICU project (EUCANDICU). During the study period, 570 episodes of ICU-acquired IC were observed, with a cumulative incidence of 7.07 episodes per 1000 ICU admissions, with important between-center variability. Separated, non-mutually exclusive cumulative incidences of candidemia and IAC were 5.52 and 1.84 episodes per 1000 ICU admissions, respectively. Crude 30-day mortality was 42%. Age (odds ratio [OR] 1.04 per year, 95% CI 1.02–1.06, p < 0.001), severe hepatic failure (OR 3.25, 95% 1.31–8.08, p 0.011), SOFA score at the onset of IC (OR 1.11 per point, 95% CI 1.04–1.17, p 0.001), and septic shock (OR 2.12, 95% CI 1.24–3.63, p 0.006) were associated with increased 30-day mortality in a secondary, exploratory analysis. The cumulative incidence of IC in 23 European ICUs was 7.07 episodes per 1000 ICU admissions. Future in-depth analyses will allow explaining part of the observed between-center variability, with the ultimate aim of helping to improve local infection control and antifungal stewardship projects and interventions.

Nasopharyngeal carriage of potential pathogens was studied in 425 healthy 3- to 6-year-old children attending 16 day-care centres (DCCs) in nine Czech cities during the winter 2004–2005. The overall carriage of pathogens was 62·8% (Streptococcus pneumoniae, 38·1%; Haemophilus influenzae, 24·9%; Moraxella catarrhalis, 22·1%; Staphylococcus aureus, 16%). An age-related downward trend was observed for colonization with respiratory pathogens in contrast to Staph. aureus whose carriage was significantly higher among older children. The following serotypes of colonizing S. pneumoniae were the most predominant: 23F (20·6%), 6A (15·1%), 6B (12·7%), 18C (7·8%), 15B and 19F (6% each). The majority (94·3%) of H. influenzae isolates were non-typable; among capsulated isolates, serotype b was not found. Decreased susceptibility to penicillin was determined in 3% of pneumococci; 4·6% of H. influenzae strains and 85·1% of M. catarrhalis strains produced β-lactamase. As for non-β-lactam antibiotics, pneumococci resistant to trimethoprim–sulphamethoxazole were the most common (15·7%) among the attendees.

High occurrence of the non-macrolide-lincosamide-streptogramin B resistance genes msrA (53%) and linA / linA ′ (30%) was found among 98 methicillin-resistant coagulase-negative staphylococci additionally resistant to macrolides and/or lincosamides. The gene msrA predominated in Staphylococcus haemolyticus (43 of 62 isolates). In Staphylococcus epidermidis , it was present in 7 of 27 isolates. A novel mechanism of resistance to lincosamides appears to be present in 10 genetically related isolates of S. haemolyticus in the absence of ermA , ermC , msrA , and linA / linA ′.

To estimate the invasive disease potential of Streptococcus pneumoniae serotypes, invasive isolates (n=138) were compared with nasopharyngeal isolates (n=153) from children under 6 years of age in the Czech Republic. Odds ratios (ORs) based on a comparison of the distribution of S. pneumoniae serotypes amongst invasive and carriage isolates were calculated for individual serotypes and 172 strains were characterized using multilocus sequence typing. The ORs of serotypes 9V and 14 were significantly greater than 1, suggesting an association with invasive disease, while serotypes 6A and 23F were significantly associated with carriage (ORs less than 1). A single predominant clone with high invasive disease potential was found in each of the 9V, 7F, 14 and 1 serotypes while carriage-associated serotypes were highly heterogeneous.