Background: The antimicrobial resistance (AMR) of Klebsiella pneumoniae recorded a steep upward trend over the last two decades, among which carbapenem-resistant Klebsiella pneumoniae (CRKP) is one of the most concerning strains considering the development and spread of AMR. The aim of this study was to analyze the evolution of AMR for Klebsiella pneumoniae and to describe the risk factors of AMR for Klebsiella pneumoniae, including the COVID-19 pandemic. Methods: We conducted a retrospective study on Klebsiella pneumoniae non-duplicative isolates collected from patients admitted to a tertiary hospital in Bucharest, Romania, from January 2019 to December 2021. We evaluated AMR changes by comparing resistance between 2019 and the mean of 2020–2021. Results: The rates of AMR increased for third-generation cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and colistin and decreased for trimethoprim/sulfamethoxazole (TMP/SMX), 45.7% in 2019 vs. 28.3% in 2021. A longer length of hospital stay (ꭓ² = 49.68, p < 0.01); recent antibiotic consumption, RR = 1.38, 95% CI [1.21, 1.57]; and recent contact with hospital settings, RR = 1.54, 95% CI [1.32, 1.8] were risk factors for multidrug-resistant (MDR) Klebsiella pneumoniae. Conclusions: The AMR of Klebsiella pneumoniae increased during 2020–2021 for most of the potential active antibiotics; only TMP/SMX resistance decreased, and it may represent a treatment option for CRKP or MDR Klebsiella pneumoniae infections. Decreasing the excessive use of antibiotics and the implementation of prevention and control measures in healthcare settings are mandatory for avoiding further increases in the AMR rate of Klebsiella pneumoniae.

Clostridioides difficile infection (CDI) is one of the main causes of morbidity associated with antibiotic use, producing both healthcare-associated infections and community infections. This study aims to describe the epidemiological characteristics, the clinical outcomes, previous antibiotic exposure, and other risk factors of hospitalized patients with CDI in a tertiary infectious disease hospital in Bucharest, Romania. We performed a descriptive analysis based on four-year surveillance data, collected in a tertiary infectious disease hospital in Bucharest, Romania. The annual incidence of CDIs varied from 65.1 cases per 10,000 discharges in 2020 to 211.7 cases per 10,000 discharges in 2023, with a continuously ascending trend. Most of the cases were hospital-acquired cases. There was a high share of antibiotic consumption three months before admission (61.3%). Third-generation cephalosporins, β-lactams with inhibitor combination, and carbapenems were the most used antibiotics, with shares of 46.0%, 25.2%, and 18.6%, respectively. Hospitalization in the previous 12 months and contact with a confirmed CDI case were other frequent factors in the study group, the occurrences of which were recorded as 66.2% and 2.4%, respectively. The surveillance data identified that the annual trend in CDIs is very variable, suggesting the need for continuous and multiannual analysis.

Purpose: This study describes a pseudo-outbreak of Bacillaceae spp. bloodstream infections that spanned five months starting in May 2023 and the infection prevention measures implemented to control it. Methods: This retrospective study was conducted at a tertiary infectious disease hospital in Bucharest, Romania. An observational audit of the blood culture collection practice in our hospital was performed, and the materials used during blood culture collection were sampled. Bacterial colonies were identified using MALDI Biotyper. The Bacillaceae blood culture positivity rates in the previous four years were compared using the Kruskal‒Wallis rank test. Results: Bacillaceae spp.-positive blood cultures were recovered from 60 patients over a five-month period. In the case of 58 patients, Bacillaceae spp.-positive blood cultures were considered contaminated. Two patients were treated for Bacillus spp. bacteraemia. The audit revealed significant variation during the preparation of the venipuncture site step and the use of nonsterile medical cotton wool. Medical cotton wool contaminated with species of Bacillaceae was found in 10 out of 12 wards. The control measures included repeated training on the blood culture collection procedure and the removal of Bacillaceae spp.-contaminated cotton wool. Conclusions: The pseudo-outbreak was caused by the unjustified use of medical cotton wool for disinfection of the skin and blood culture bottle septums. The investigation of this pseudo-outbreak highlighted a gap in blood culture collection practices at our facility and thus allowed for its improvement.

Introduction: Sepsis-induced cardiac dysfunction (SICD) is a transient cardiac disfunction, with variable described prevalence and uncertain prognostic. This study aimed to characterize the laboratory and microbiological findings in critically ill patients with sepsis who developed left ventricular (LV) or biventricular systolic dysfunction. Methods: Patients who required intensive care unit hospitalization for sepsis were screened retrospectively. Only patients with positive cultures and echocardiography performed within 24 h from admission were included. The exclusion criteria were infective endocarditis, acute coronary syndrome, history of cardiomyopathy, severe valve disease, end-stage organ or oncological disease. Cardiac function was appreciated on transthoracic echocardiography, using LV ejection fraction for the left ventricle and tricuspid annular plane systolic excursion (TAPSE) for the right ventricle. SICD was confirmed if the systolic dysfunction found upon admission was reversible within 7–10 days. Results: A total of 100 patients with positive cultures were included. The median age was 73 and 55% were male. SICD was diagnosed in 14% of patients. Patients with SICD were more likely to develop septic shock and had longer hospital and intensive care unit stay. In-hospital mortality was 44% with no significant difference between SICD and non-SICD patients. Laboratory markers upon hospital admission showed that SICD patients had significantly higher values of lactate and transaminases. Cardiac (troponin and NT-proBNP) and inflammation markers (leukocytes, neutrophils, NLR, C-reactive protein, procalcitonin) had higher values in patients with SICD but the difference did not reach statistical significance. Streptococcal infections and polymicrobial cultures were risk factors for developing SICD. Higher rates of infections with Enterobacterales were seen in the SICD group but the difference was not significant. Conclusions: SICD patients had higher lactate, inflammation, and cardiac biomarkers levels upon admission and significantly higher rates of streptococcal infections and polymicrobial cultures.

This study analyses all cases of acute hepatitis E diagnosed in a southern Romanian hospital from 2019 to 2023. Patients with positive anti-HEV IgM antibodies were included in three groups: group A1—96 patients with probable HEV infection and ALT levels over 2.5-fold the upper limit of normal (ULN); group A2—44 patients with probable HEV infection and ALT levels under 2.5-fold ULN; group B—43 patients with probable HEV coinfection with another hepatotropic virus. Between 2019 and 2023, 642 patients were diagnosed with acute viral hepatitis. Positive anti-HEV IgM antibodies were detected in 183 (28.5%) cases, HEV being the second most common cause of acute viral hepatitis. Patients from group A were older than those from group B (47.26 ± 15.13 years vs. 35.95 ± 14.83 years, p < 0.01). Patients from group A were less likely to present clinical features compared to those from group B: digestive symptoms (73.8% vs. 97.2%, p < 0.01), jaundice (38.9% vs. 88.4%, p < 0.01), hepatomegaly (64.1% vs. 88.6%, p = 0.02). Patients from group A, compared to patients from group B, had lower levels of ALT (18.2 ± 29.9 ULN vs. 83.7 ± 56.2 ULN, p < 0.01) and total bilirubin (3.08 ± 5.2 mg/dL vs. 7.82 ± 5.25 mg/dL, p < 0.01) at admission. Patients from group A had higher levels of anti-HEV IgM antibodies (4.3 ± 3.22 vs. 2.55 ± 1.34, p < 0.01) than those from group B. Nearly all patients had no history of travel; therefore, autochthonous origin of HEV is involved in a large majority of cases. Currently, hepatitis E virus is not an uncommon aetiology of acute hepatitis in Romania, more often in adults and elderly patients. The epidemiological and clinical features of HEV infections plead for a zoonotic transmission in most cases. The significant number of cases of hepatitis E diagnosed in a single centre in Bucharest justifies the need to include early testing for HEV in patients with acute hepatitis.

Healthcare-associated infections (HAIs) in long-term care facilities (LTCFs) are a public health problem worldwide. The aim of this narrative review is to summarize and to provide a comprehensive overview of the current surveillance methods used in LTCFs. We conducted a search of the PubMed database starting from 2000 onward. We found 324 articles that were systematically evaluated by the titles, abstracts, and full texts, and we selected 42 records. These articles were dispersed across North America, Europe, Australia, and Asia. We identified articles describing the results from active or passive surveillance and from a point prevalence study (PPS). The most frequently used method was PPSs in 30 studies, followed by 12 articles reporting active surveillance results and 3 articles describing active surveillance findings. The case definitions applied in 16 articles were those provided by the Centers for Disease Control and Prevention, followed by the McGeer and European Centre for Disease Prevention and Control definitions in 15 and 13, respectively. Twenty-six studies described the method used to calculate the HAI indicator (incidence, incidence density, or prevalence). The articles on PPSs reported prevalence per 100 patients (22 articles), whereas those on active and passive surveillance reported the incidence density per 1000 patient-days. PPSs effectively identified HAIs in LTCFs through standardized data collection and essential interpretive information. The variability in surveillance methods, case definitions, HAI types, and indicator calculation approaches highlights the need for standardized surveillance protocols and methodologies in LTCFs worldwide. Furthermore, these findings emphasize the importance of implementing appropriate surveillance systems and targeted public health measures to effectively address the specific needs and vulnerabilities of the LTCF population in our country.