Background: Carbapenem-resistant Klebsiella pneumoniae (Cr-Kpn) is becoming a growing public health problem through the failure of adequate treatment. This study’s objectives are to describe the sources of Cr-Kpn in our hospital over 22 months, associating factors with the outcome of Cr-Kpn-positive patients, especially those with NDM+OXA-48-like (New Delhi Metallo-β-Lactamase and oxacillinase-48), and the effectiveness of the treatments used. Methods: A retrospective observational cohort study including all hospitalized patients with Cr-Kpn isolates. We reported data as percentages and identified independent predictors for mortality over hospital time through multivariate analysis. Results: The main type of carbapenemases identified were NDM+OXA-48-like (49.4%). The statistical analysis identified that diabetes and co-infections with the Gram-negative, non-urinary sites of infection were factors of unfavorable evolution. The Cox regression model identified factors associated with a poor outcome: ICU admission (HR of 2.38), previous medical wards transition (HR of 4.69), and carbapenemase type NDM (HR of 5.98). We did not find the superiority of an antibiotic regimen, especially in the case of NDM+OXA-48-like. Conclusions: The increase in the incidence of Cr-Kpn infections, especially with NDM+OXA-48-like pathogens, requires a paradigm shift in both the treatment of infected patients and the control of the spread of these pathogens, which calls for a change in public health policy regarding the use of antibiotics and the pursuit of a One Health approach.

Klebsiella pneumoniae, a member of the Enterobacterales Order, often colonises the gut and causes diverse infections, including bloodstream, urinary, and respiratory infections. The rise in carbapenem-resistant sFtrains, especially those producing enzymes like K. pneumoniae carbapenemase (KPC), New Delhi metallo-β-lactamase (NDM), Oxacillinase 48 (OXA48), or combinations (NDM+OXA48-like), poses a significant threat across Europe, notably in Romania. These strains spread rapidly via mobile genetic elements, complicating treatment. Methods: A retrospective study of multidrug-resistant (MDR) K. pneumoniae strains isolated from clinical samples collected at an infectious diseases hospital in Romania. Results: We analysed the evolution of carbapenemases and their combinations from 2010 to 2024, with the rising antibiotic consumption, particularly during the COVID-19 pandemic. The prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) rose from 4.9% in 2010 to 41.6% in 2024. There was an overall antibiotic use increase, especially colistin (186%) between 2019–2024. Additionally, we examined the dynamics of antibiotic susceptibility that decreased in 2023–2024 and found that susceptibility of NDM+OXA48-like isolates to colistin was 16.5% and to cefiderocol 58.5%. Conclusions: The rising prevalence of K. pneumoniae strains with complex resistance mechanisms, coupled with a significant reduction in available treatment options, demands a fundamental paradigm shift in the management of these infections.

Background and Objectives: Infective endocarditis (IE) remains a severe infection with high morbidity and mortality, particularly among people who inject drugs (PWID). Data from Eastern Europe are limited, despite the increasing burden of intravenous drug use in the region. Materials and Methods: We conducted a retrospective, observational cohort study of 153 patients diagnosed with IE and admitted to the “Dr. Victor Babeș” Clinical Hospital for Infectious and Tropical Diseases in Bucharest, Romania, between August 2019 and July 2024. Patients were classified into PWID (n = 51) and non-PWID (n = 102). Clinical characteristics, microbiological profiles, echocardiographic findings, complications, and outcomes (in-hospital, 10-week, and 12-month mortality) were compared between groups. Results: PWID were significantly younger (mean 34.0 ± 6.6 years vs. 64.3 ± 13.1 years; p < 0.001), predominantly male (86.3% vs. 62.7%; p = 0.003) and had higher rates of HIV (64.7%) and HCV (98.1%). Right-sided IE and larger vegetations were more common in PWID, whereas non-PWID had more left-sided disease, pre-existing valvular pathology, and prosthetic valve involvement. Staphylococcus aureus predominated in PWID (68.6% vs. 27.5%; p < 0.001), while non-PWID had more Streptococcus spp. and Coxiella burnetii cases. Embolic complications, particularly pulmonary emboli, and valvular rupture were significantly more frequent in PWID, while non-PWID had higher rates of heart failure and surgical interventions. In-hospital mortality was similar (17.6% vs. 11.8%; p = 0.318), but 12-month mortality was higher in PWID (27.5% vs. 13.7%; p = 0.038). Conclusions: IE in PWID shows a distinct clinical and microbiological profile, with more aggressive complications and worse long-term survival. Tailored management, early diagnosis, harm reduction programs, and dedicated follow-up are urgently needed in this high-risk population.

Introduction: Hypervirulent Klebsiella pneumoniae (hvKp) is an emerging global pathogen that causes severe liver abscesses and metastatic infections. Despite rising concerns regarding multidrug-resistant convergence, molecular data in Romania remain limited. This study characterizes the epidemiological, clinical, and genomic profiles of hvKp liver abscesses in a tertiary hospital, aiming to describe the local virulence landscape and inform clinical management. Results: This study characterizes 15 cases of hvKp liver abscesses in a tertiary hospital. The cohort was predominantly male, with high rates of type 2 diabetes. Although clinical presentation was severe, featuring complications like endogenous endophthalmitis, the outcomes following prolonged antibiotic therapy were generally favorable. Phenotypically, 93.3% of isolates retained a wild-type susceptible profile, while a single ESBL-positive case highlighted the risk of resistance convergence. Genomic sequencing confirmed the presence of the ST23-K1 pandemic lineage carrying key virulence determinants (rmpA, iuc, and peg-344). Crucially, cgMLST analysis revealed genetic heterogeneity, suggesting sporadic community acquisition rather than a clonal nosocomial outbreak. Conclusions: These findings represent the first detailed molecular description of hvKp in Romania, confirming the local circulation of high-risk ST23 clones and underscoring the necessity for early detection and surveillance.

Background: Measles re-emergence has been reported across Europe, with Romania being among the most affected countries in 2023–2024. Although ocular manifestations are recognized in measles, their frequency and inflammatory correlates in hospitalized adults have not been well characterized. Methods: This study retrospectively analyzed the medical records of adults treated for laboratory-confirmed measles at a Bucharest hospital between July 2023 and July 2024. Data from specialist eye examinations were used to compare patients with keratitis against those with other ocular issues. Results: A total of 250 adult patients were included. Of the 88 patients referred for ophthalmologic examination, 93.2% showed ocular lesions. Keratitis was the primary form, identified in 64.6% of these cases. Patients with keratitis had blood markers indicating a more activated inflammatory profile (higher neutrophile-to-lymphocytes ratio). Pneumonia and respiratory failure were not associated with ocular lesion status; inflammatory markers were more strongly linked to respiratory failure than to ocular involvement. Conclusions: Ocular lesions were highly prevalent in hospitalized adult measles cases during the 2023–2024 Romanian epidemic wave, and keratitis was common. Ocular involvement correlated with mucosal disease expression and systemic inflammatory activation. Systematic ophthalmologic assessment should be considered during measles epidemic peaks to improve early identification of clinically relevant ocular complications.

Background: Early identification of Staphylococcus spp. infective endocarditis (IE) remains clinically challenging but essential for timely initiation of targeted antimicrobial therapy. We aimed to characterize pathogen-specific clinical phenotypes and to develop a pragmatic bedside prediction model for staphylococcal etiology. Methods: We conducted a retrospective cohort study including 112 patients diagnosed with definite IE. Demographic, clinical, echocardiographic, and laboratory data were analyzed. Independent predictors of staphylococcal etiology were identified using multivariable logistic regression, with internal validation by bootstrap resampling. A simplified clinical risk score was derived from regression coefficients. Platelet kinetics were evaluated as a potential complementary biomarker. Results: Patients with staphylococcal IE (n = 66) were younger and exhibited a distinct clinical profile characterized by a high prevalence of intravenous drug use, right-sided valve involvement, and a markedly elevated inflammatory response. Independent predictors included intravenous drug use (OR 7.1, 95% CI 2.45–20.6, p < 0.001), higher C-reactive protein levels (OR 1.08 per unit increase, p = 0.025), and lower oxygen saturation (OR 0.75 per 1% increase, p = 0.007). The model demonstrated good discrimination (AUC 0.82, 95% CI 0.74–0.90) and calibration. The simplified exploratory risk score stratified patients into low-, intermediate-, and high-risk groups, with observed probabilities of 27%, 82%, and 94%, respectively. Conclusions: Staphylococcal IE represents a distinct clinical phenotype. A simple three-variable model enables early bedside identification of high-probability cases and may support risk-adapted management decisions. Nevertheless, external validation is required before clinical implementation of a score.