Background/Objectives: This study aims to characterize antibiotic resistance (AR) and virulence markers in Salmonella spp. isolated from Romanian outpatients’ stool samples. Methods: In 2019, community-acquired Salmonella strains were collected and identified using MALDI-TOF mass spectrometry, antibiotic susceptibility profiles have been determined with the MicroScan system, and soluble virulence factors were evaluated using specific culture media, while biofilm formation was quantified in 96-well plates. Molecular analysis targeted resistance genes for β-lactams (e.g., bla_TEM and bla_SHV); tetracyclines (e.g., tet(A)); sulphonamides; and quinolones, as well as virulence genes (e.g., invA, spvC, pldA, and held). Whole-genome sequencing (WGS) was performed on 19 selected isolates. A silver nanoparticles (AgNPsol) alternative to conventional antibiotics was tested for effectiveness against multidrug-resistant (MDR) isolates. Results: From the total of 309 Salmonella isolates (65.05% from children under 4 years of age) belonging to four subtypes and four serovars, 27.86% showed resistance to at least one antibiotic, most frequently to tetracycline, ampicillin, and piperacillin. The strains frequently expressed haemolysin (67%), aesculinase (65%), and gelatinase (62%). Resistance to trimethoprim-sulfamethoxazole was encoded by the sul1 gene in 44.83% of the strains and to tetracyclines by the tet(A) gene (59.52%). The ESBL genes bla_TEM, bla_SHV, and bla_CTX-M were detected by PCR in 16.18%, 2.91%, and 0.65% of the strains, respectively. Additionally, 98.63% of the strains carried the invA marker, with notable positive associations between bla_SHV, qnrB, and sul1 with spvC. Conclusions: The present findings revealed significant patterns in Salmonella isolates, subtypes, serovars, AR, and virulence, emphasising the need for continuous surveillance of Salmonella infections. Additionally, the potential of AgNPs as an alternative treatment option was demonstrated, particularly for paediatric S. enterica infections.

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.

Purpose: The aim of this study is to describe the evolution of cefoperazone-sulbactam consumption in Romania between 2011 and 2024. The use of this fixed-dose combination is not recommended by the World Health Organisation as it may result in selection of antimicrobial resistance. Methods: This retrospective study analyzed the data on antibiotic consumption collected by the National Center for Surveillance and Control of Communicable Diseases which is based on data provided by the National Health Insurance Fund and the IQVIA–Multinational Integrated Data Analysis System. Antibiotic sales were converted into defined daily doses (DDDs) per 1,000 inhabitants per day. Results: The consumption of cefoperazone-sulbactam in Romania between 2011 and 2024 ranged from 0.016 to 0.021 DDD per 1000 inhabitants per day, with an average of 0.019 DDD per 1000 inhabitants per day. When adjusted for population, the RO1 macroregion registered the highest average consumption (0.033 DDDs per 1000 inhabitants per day). One-way ANOVA on DDD per 1,000 inhabitants per day data suggested that there were no statistically significant differences between macroregions (F = 2.78, p = 0.054). Although differences are observed in the mean values, they can be explained by counties with abnormally high consumption. Conclusion: Educational and training activities focused on the outlier counties are necessary to raise awareness about the risk of increased selection of antimicrobial resistance. In line with the rejection of the reclassification proposal of cefoperazone-sulbactam in the updated 2025 WHO AWaRe classification of antibiotics, new government policies to ensure the discontinuation of cefoperazone-sulbactam use in Romania are needed.