The establishment of resistance phenotypes for bacteria isolated from outpatients in urine cultures.

From 1911 outpatients, who addressed a Timisoara private clinical laboratory, from January to December 2005, we collected 1,889 urine cultures, 431 being positive. Bacteria identification was generally done using morphological, cultural, biochemical characters and pathogenicity tests. Sensitivity testing to antimicrobial medical drugs was done by using the classical diffusion Kirby-Bauer method and the automatic analyzer Osiris, also. The main bacteria involved in the etiology of these infections were represented by Enterobacteriaceae, head of the list being Escherichia coli (81.21%), followed by Klebsiella pneumoniae (8.35%) and Proteus mirabilis (3.02%). We also isolated Gram positive cocci (in a much smaller proportion), mainly represented by Enterococcus faecalis (1.16%), Staphylococcus aureus (0.93%), Streptococcus agalactiae, and also Gram negative non-fermentative bacilli, such as Pseudomonas aeruginosa (0.93%) or Acinetobacter baumanii (0.23%). As soon as we performed the sensitivity tests, we divided them in resistance phenotypes: Most of the Enterobacteriaceae were integrated in the wild phenotype, followed by the penicillinase producing phenotype. An E. coli strain (0.29%) and 3 Klebsiella pneumoniae strains (8.33%) were integrated in the large spectrum, multidrug resistant, beta-lactamase producing phenotype, also associated with resistance to fluoroquinolones and aminoglycosides; Non-fermentative bacilli did not present special resistance problems, the four Pseudomonas aeruginosa strains were integrated in the wild phenotype (secreting induced chromosomal cephalosporinase). As for Staphylococcus aureus it was identified a strain having fluoroquinolone resistance, two strains secreting penicillinase and having a K (Nm) phenotype and a strain secreting penicillinase only. Antibiotic resistance represents a major concern for patients, physicians, healthcare managers, and policymakers. The use of antibiotics is closely linked with the development of acquired antibiotic resistance.

[The sensitivity of some strains of Klebsiella spp. collected in a neonatal department]. / Sensibilitatea unor tulpini de Klebsiella izolate într-o sectie de nou-nascuti.

In order to analyse the evolution of the sensitivity to antibiotics of same strains with nosocomial potential such as Klebsiella isolated in a hospital, we took into study a number of 976 samples, collected in a new-born care department of the "Dr. D. Popescu" hospital Timisoara. The study took place between November-December 2002. The collected samples were pharyngeal swabs, nasal swabs, gastric aspirates, ocular and umbilical secretions, vernix, urines, faeces and blood. From all these samples 803 strains with nosocomial potential were isolated, 84 strains being Klebsiella spp. Most of the isolated strains presented multiple phenotypes of resistance to antibiotics.

[Incidence and sensitivity to antibiotics of germs isolated from surgical wound infections]. / Studiu privind incidenta si sensibilitatea la antibiotice a germenilor izolati din infectii postoperatorii de plaga chirurgicala.

We studied 119 bacterial strains isolated from postoperative infected wounds. All these strains were considered to be strains that derived from the same number of nosocomial infections, all the postoperative infections of the wounds being nosocomial infections. Regarding their frequency, we isolated the following strains: E. coli--68 strains (57%), S. aureus--37 strains (31%), Pseudomonas spp.--9 strains (8%) and Proteus spp.--5 strains (4%). We performed the bacteriological study of these strains and some correlations between them and the surgical diagnosis. In order to help the surgical therapy of the overinfected wounds, we tested the drug sensitivity of all these strains. The results regarding the drug sensitivity show that these strains have different types of resistance to antibiotics, the Pseudomonas strains being the most resistant. We noticed a continuous decrease of the sensitivity of the isolated strains to certain antimicrobial drugs, and this focuses the attention on the necessity of monitoring the antibiotic prescriptions in hospitals. Taking into account the results obtained after this study, we should reconsider the concept of nosocomial infections control through prevention activities, in order to reduce the incidence and to identify the potential causes that can lead to nosocomial infections.

[Evaluation of the sensitivity to meropenem of some bacterial strains with nosocomial potential]. / Evaluarea sensibilitatii la meropenem a unor tulpini bacteriene cu potential nosocomial.

This study analyzes the sensitivity to meropenem of 880 bacterial strains isolated from hospitalized patients in various medical units of County Hospital No. 1 Timisoara. As a result, a high sensitivity of gram-negative pathogens to meropenem (82.01%) has been noticed. Among Enterobacteriaceae, 93.17% of Escherichia coli and 71% of Klebsiella sp. were susceptible to meropenem. For Pseudomonas aeruginosa strains, a high susceptibility was noticed to meropenem (91%), more than 70% to imipenem, but piperacillin + tazobactam had 42% resistance rates.

[Resistance phenotypes circulating in nosocomial high risk departments]. / Fenotipuri de rezistenta circulante în sectii cu risc nosocomial crescut.

OBJECTIVES: Between November 2001-January 2002 we collected 406 samples from patients hospitalized in Intensive Care adults and new-borns Unit (ICU). The aim was to observe the colonization and infection status with bacteria that may have nosocomial potential and to establish circulating phenotypes in ICUs. METHODS: The identification was performed by API (bioMerieux) method, and we have performed the antimicrobial susceptibility tests by both: API method and by Kirby-Bauer disc-diffusion test. RESULTS: We isolated 295 strains with nosocomial potential: 34 MRSA strains, 23 MRCNS strains, 29 ESBL producing gram negative rods, etc. CONCLUSIONS: We observed the presence of multiple drug resistant bacteria which play an important roll in both: massive colonization of patients and in the etiology of nosocomial infections. This leads us to the conclusion that antibiotic resistance pattern should be interpreted by the bacteriologist and a consistent policy concerning the use of antimicrobial drugs in hospital settings should be instituted.

[A comparative study of resistance phenotypes in E. coli strains isolated in urine from hospitalized and ambulatory patients]. / Studiu comparativ al fenotipurilor de rezistenta a tulpinilor de E. coli izolate din uroculturi provenite de la pacienti internati si din ambulator.

112 strains of E coli from 620 urocultures of hospitalized and ambulatory patients where isolated between March-June 2002. Our purpose was to make a comparative study of the susceptibility to antibiotics of 31 strains of E coli isolated in hospital (County Clinical Hospital Nr. 1 Timisoara--Urology Clinic and Intensive Care Unit) and 81 strains collected from ambulatory patients. Identification of germs was performed using the automatic API system, and the susceptibility tests were performed using disc-diffusion and the agar dilution test. By analyzing the extended antibiograms we categorized the germs considering their phenotypes of resistance and remarked a high percentage of E coli strains from hospitalized showing multiple resistance to antibiotics.