Background: Antimicrobial resistance is a growing global health threat, with antibiotic misuse in pediatric populations being a significant contributing factor. In Romania, antibiotic consumption and resistance rates are among the highest in Europe. Objective: To assess Romanian parents’ knowledge, attitudes, and practices regarding antibiotic use in children, and to identify key misconceptions and behavioral risks contributing to inappropriate antibiotic use. Methods: A cross-sectional survey was conducted among 400 parents of hospitalized children in a pediatric department in Romania. Participants completed a 15 item structured questionnaire. Data were analyzed using descriptive statistics, chi-square tests, and binary logistic regression to examine associations and control for potential confounding effects between education level, residential environment, and parental misconceptions regarding antibiotic use. Results: Among the 400 surveyed caregivers, 86% (n = 344) held at least one misconception regarding antibiotic use. Additionally, 42.5% (n = 170) of participants reported that they had never heard of the concept of antibiotic resistance. Misconceptions were significantly more prevalent among individuals with lower levels of education and those residing in rural areas (p < 0.001). While 89.8% (n = 359) stated that they had never administered antibiotics to their children without a physician’s recommendation, a separate subset of 28% (n = 112) acknowledged that they had asked a doctor to prescribe antibiotics for their child. Moreover, 23.3% (n = 93) reported seeking a second medical opinion when antibiotics were not initially prescribed. Conclusions: Despite high adherence to medical advice, widespread misconceptions persist. These findings highlight the need for targeted, population-specific educational interventions to promote rational antibiotic use and address AMR in high-burden settings like Romania.

Background: The introduction of the “trace” category in the Xpert MTB/RIF Ultra assay has significantly improved the sensitivity of molecular tuberculosis diagnostics. While it enhances sensitivity, especially in paucibacillary and extrapulmonary cases, its specificity remains debatable, making its interpretation outside select populations a topic of clinical uncertainty. Objectives: This study evaluates the diagnostic and clinical significance of trace-positive results obtained with the Xpert MTB/RIF Ultra assay in the context of a high-incidence TB setting, examining their association with clinical, imaging, and microbiological findings. Methods: A retrospective analysis was conducted on 65 samples with trace-positive Xpert Ultra results, collected over a six-year period from 59 distinct patients in a general hospital in Romania. Correlations were assessed with microscopy, culture, clinical features, imaging, treatment initiation, and prior TB history. A composite reference standard was used for diagnostic accuracy evaluation. Results: Of the 65 trace-positive samples, 29 (44.6%) were culture-positive and 5 (7.7%) were smear-positive. A high proportion of patients, 56 (94.9%), presented with TB-compatible symptoms, and 47 (79.6% of those with imaging) had highly suggestive radiological findings. Based on the composite reference standard, 47 patients (79.7%) were ultimately diagnosed with active TB. Anti-TB treatment was initiated in 44 patients (74.5%). Trace positivity was observed across various specimen types, including sputum, pleural fluid, and cerebrospinal fluid. Conclusions: In high TB burden environments, trace-positive Xpert Ultra results frequently reflect true disease when interpreted within the appropriate clinical and imaging framework. Our findings indicate that, in regions with high tuberculosis incidence such as Romania, trace-positive Xpert Ultra results may contribute meaningfully to clinical decision-making when interpreted alongside clinical and radiological findings, in alignment with current WHO guidance.

Background/Objectives: The global threat of antimicrobial resistance is a significant public health challenge, leading to prolonged hospitalizations, increased costs, and elevated mortality. Romania faces one of Europe’s highest burdens of antimicrobial consumption and resistance. This study aimed to investigate the factors that influence antibiotic prescribing practices among physicians in pediatric care in Romania. Method: This quantitative, cross-sectional study collected data using a self-administered, structured questionnaire from 154 healthcare professionals (family physicians, pediatricians, and other specialists) providing pediatric care in Romania. Participants were recruited via non-probability convenience sampling. The 29-question survey gathered demographic data and explored perceptions and practices regarding antibiotic therapy in children using a 5-point Likert scale. Results: The majority of participants were family physicians (64.94%) with over 15 years of experience (53.90%), primarily practicing in urban settings (61.69%). Only 21.43% had attended an antibiotic stewardship course in the last three years. Physicians generally base their prescribing on clinical symptoms. While physicians strongly agreed they follow guidelines, personal experience also held significant weight. High parental demand for antibiotics was perceived, but physicians largely denied ceding to parental tone or insistence without a medical indication. A strong consensus existed on antibiotic overuse in Romanian children, and a high interest in continuous education on rational antibiotic use was noted. Pediatricians showed significantly higher guideline adherence and diagnostic test use than family physicians. Rural physicians reported lower guideline adherence and less frequent diagnostic testing. Stewardship course participation and access to rapid diagnostic tests were associated with more evidence-based practices. Conclusions: Romanian physicians exhibit a nuanced approach to antibiotic prescribing, balancing guidelines with personal experience and facing significant perceived parental pressure. Professional profile (specialty, experience, practice environment) and access to diagnostic resources significantly influence prescribing decisions.

Background/Objectives: Type 1 diabetes mellitus (T1DM) is a common chronic disease of childhood, with a rising incidence worldwide, across Europe, and in Romania. This retrospective, descriptive, single-centre study aimed to describe the demographic features, the temporal distribution and the approximate incidence of T1DM in children diagnosed in Bihor County, Romania. Methods: Of 174 children with newly diagnosed T1DM at Emergency Clinical County Hospital Bihor (2014–2024), 172 residing in Bihor County were analysed (two were excluded because they resided outside the county; none was excluded for missing data) for sex, age at onset, residence, and year and month of onset. The incidence was approximated using an assumed pediatric population (83,000–105,000 children aged 0–17 years), and the findings were set against official administrative registry data (INSP-CNSSP) for Bihor County and Romania. Results: The sex ratio was close to unity (47.1% girls; 95% confidence interval (CI) 39.8–54.5%). The rural share of cases (45.3%) did not differ significantly from the rural share of the county’s general all-ages population in the 2021 census (52.7%; p = 0.054), a non-age-matched comparison that should be interpreted cautiously. Mean age at onset was 9.2 ± 4.5 years (girls 9.7 ± 4.3, boys 8.7 ± 4.6 years; p = 0.135); the largest proportion of cases (37.8%) was observed at ages 10–14 years. The annual number of recorded new cases ranged from 11 to 23 without a statistically significant temporal trend (Poisson regression of case counts, without population offset, p = 0.185; rate ratio 1.27 for 2019–2024 versus 2014–2018, 95% CI 0.93–1.76, p = 0.126). The approximate crude incidence was 14.9–18.8 cases per 100,000 children/year (point estimate 16.6); this is an indicative estimate that is not directly comparable with national estimates for children aged 0–14 years. Administrative registry data (INSP-CNSSP), which cover all forms of diabetes and children in active follow-up, showed an increase in the number of children aged 0–14 years in follow-up from 32 (2012) to 187 (2021) and prevalence above the national average, but cannot confirm trends in pediatric T1DM incidence or prevalence. Conclusions: This descriptive single-centre series broadly followed national and European patterns in sex ratio, age distribution and seasonality, with a relatively stable number of recorded annual cases. Given the single-centre case ascertainment and approximate denominators, the findings should not be regarded as population-based incidence estimates or as evidence of a higher local incidence or burden of T1DM; confirmation through multi-source case ascertainment or registry linkage is needed.

Background/Objectives: Distinguishing perforated from non-perforated appendicitis preoperatively is difficult, and routine scores diagnose appendicitis rather than grade severity. We examined whether two inflammatory markers and one sonographic sign, combined in a model, discriminate between perforated and non-perforated appendicitis, and how this compares with a bedside score. Methods: Retrospective single-center cohort of 142 children aged 3–17 years undergoing initially attempted laparoscopic appendectomy (October 2022–December 2023). Log-transformed neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) were prespecified; sonographic free peritoneal fluid was selected from four signs using the outcome, and reported in-sample performance is an upper bound. Predictors were fitted by Firth penalized logistic regression with bootstrap validation. Results: Perforation occurred in 27 patients (19.0%). All three were independent predictors (odds ratios: CRP 2.583, NLR 3.045, free peritoneal fluid 3.638). The area under the curve was 0.900 (0.890 optimism-corrected). At the Youden-optimal threshold, sensitivity was 96.3% and negative predictive value 98.9%. The Pediatric Appendicitis Score reached 0.855 (difference not significant, p = 0.375); at matched sensitivity its specificity was 38.9% versus 74.8%. Conclusions: The model’s potential value lies in excluding perforation rather than establishing it, and applies after the decision to operate has been taken, informing antibiotic selection, operative urgency and family counselling rather than the indication for surgery. Overall discrimination did not differ significantly from the Pediatric Appendicitis Score, the advantage lying in the operating point rather than in the area under the curve. These findings are hypothesis-generating and require external validation.

Background/Objectives: Cystic fibrosis (CF) care in Romania underwent a major transition in 2022 with the near-simultaneous introduction of newborn screening (NBS) and national reimbursement of CFTR modulator therapies. This study aimed to compare age at diagnosis between screen-detected and symptom-detected patients, describe clinical outcomes according to modulator status, and estimate regional case-detection ratios in Bihor County. Methods: This was a retrospective observational study with cross-sectional assessment of 46 CF patients followed at the National Cystic Fibrosis Centre in Timișoara during 2025. Nonparametric methods were used for exploratory comparisons. Case-to-live-birth ratios were estimated for pre-screening (2008–June 2022) and post-screening (July 2022–2024) periods in Bihor County. Results: Median age was 8.96 years (IQR 7.06–15.25); 58.7% of patients were male. Screen-detected patients (n = 5) were diagnosed earlier than symptom-detected patients (median 0.00 vs. 0.60 years; p = 0.016). F508del was present in 65.2% of alleles, with 22 distinct variants identified. Modulator therapy was received by 84.8% (76.1% elexacaftor/tezacaftor/ivacaftor). Median percent-predicted FEV₁ (ppFEV₁) was 99.0% (n = 38), comparable to ECFSPR 2024 pediatric values, while median BMI Z-score (−0.32) remained below Western European benchmarks. Chronic Pseudomonas aeruginosa and MRSA colonization rates were 11.4% (pediatric) and 15.2% (overall), respectively. ppFEV₁ correlated strongly with BMI Z-score (ρ = 0.625, p < 0.001). The Bihor County case-to-live-birth ratio was 1:7820, with a descriptive 1.45-fold increase post-NBS. Conclusions: CF characterization in western Romania demonstrates rapid modulator uptake and preserved lung function while highlighting persistent gaps in nutritional status, microbiological burden, and case detection relative to Western European populations. Longitudinal nationally representative studies are needed to confirm these findings.