[Bacterial multiresistance emergence in South-Western Romania]. / Emergenta multirezistentei bacteriene în partea de Sud-Vest a României.

INTRODUCTION: European Centre for Diseases Control (ECDC), involved in the surveillance of nosocomial infections (NI) and resistance to antimicrobials (AMR) in Europe, estimates 4 million IN/year, among whom 37,000 deceased, out of which half are determined by multiresistant germs (MDR). A phenomenon encountered more and more often is that of pan-resistance of germs, without the option for an optimal antibiotherapy. The allarming increase of AMR is a phenomenon which our country also faces in the present. MATERIAL, METHOD, RESULTS: Resistance rate registered in Intensive Care Units in Timisoara during 2005-2007 (when we participated in the Helics European network) situates us among the last places among the European countries that participated--with 50-60% MRSA strains, 24% E. coli BLSE strains, 62,7% K. pneumoniae BLSE strains, 34% P. aeruginosa BLSE. Furthermore, data registered in ambulatory in the South-West part of Romania during 2006-2007 (processed by the greatest private laboratory in the region) are not more optimistic--26% MRSA strains, 4,25% E. coli BLSE, 12,49% K. pneumoniae BLSE, 8,69% P. aeruginosa BLSE. CONCLUSIONS: As the management of MDR produced infections requires huge costs, a better antibiotic policy in the Romanian hospitals and ambulatory is compulsive, being more efficient to spend for control than for the treatment of these infections.

[Risk factors involved in multiresistant infections with strains of Enterobacteriaceae]. / Factorii de risc implicati în infectiile cu tulpini de Enterobacteriaceae multirezistente.

OBJECTIVE: The present study aims to analyse the risk factors involvement in the cross infectious pathology determined by multiresistant Enterobacteriaceae, in hospitalised patients in the Intensive Care Unit at the County Emergency Clinical Hospital in Timisoara. MATERIAL AND METHOD: We carried out a case-control study with 3 groups of adult inpatients--200 patients with no superadded infectious pathology, 100 patients infected with Enterobacteriaceae strains resistant to 3 classes of antibacterial chemotherapeutic agents and 100 infected with multiresistant strains. Identification of bacterial germs was performed using API ID 20 E manual galleries (BioMérieux) and the inclusion in the resistance phenotypes was done using the Osiris Evolution (BioRad) analyser. RESULTS: Subjects infected with multiresistant strains are mostly male, (p=0.020, OR=1.8 [1.06-3.07], RR=1.49, [1.05-2.11]), with the mean age younger than that of the control group (p=0.011). The mean Charlson Comorbidity Index was 3.34 in Group III and 4.06 in Group I (p=0.027). The logistic regression application keeps as well as independent risk factors for multiresistance--the mechanical ventilation, consciousness impairment, prolonged hospitalization and the higher number of days of antibiotherapy. CONCLUSIONS: In this study, the nosocomial factors and basic pathology prevail to the detriment of other intrinsic risk factors.

[Antibiotic resistance patterns in Acinetobacter spp. strains isolated from hospital environment]. / Pattern-uri de rezistenta la antibiotice ale unor tulpini de Acinetobacter spp. izolate din mediul spitalicesc.

INTRODUCTION: The Acinetobacter species are ubiquitary germs isolated more and more frequently, Acinetobacter baumannii being currently considered the second strictly aerobic microorganism involved in the ethiology of severe nosocomial infections. Acinetobacter baumannii is usually encountered in surgery and intensive care units, especially in patients with depressed immunity, in which various locations are possible, the most frequvent being the respiratory tract infections, urinary tract infections and bacteriemia. MATERIAL AND METHOD: The study used 52 strains of Acinetobacter spp. isolated from 1131 biological samples (bronchial aspirat, urine, wound secretion, blood, pus, CFS) obtained from the patients of the Timisoara Country Hospital. Identification of germs was performed using the API (BioMerieux) system, and the antibiotics sensitivity testing was made by disk diffusion testing (Kirby-Bauer), with automatic reading and phenotyping through the Osiris Evolution (BioRad) system. RESULTS: The study of resistance to beta-lactamines has pointed out the predominance of penicillinase and cephalosporinase producing strains, 55.77% of the tested ones being part of this phenotype. 90.38% of the strains were resistant to one or more aminoglycosides. Of the tested strains 76.93% were resistant to fluoroquinolones, 86.54% to trimethoprim-sulphamethoxazole, and only 21.15% to tethracycline. CONCLUSIONS: Among the emerging pathogens involved in the nosocomial infections, Acinetobacter baumannii strains have become, in the past decades, a real health issue, due to the variety and seriousness of clinical symptoms. Through the constant increase of the cases number, and the difficulty of applying an effective treatment, the above-mentioned strains showed a multiple resistance to antibiotics.

[Phenotype characterisation of Enterococcus spp. strains isolated from urocultures]. / Caracterizarea fenotipica a unor tulpini de Enterococcus spp. izolate din uroculturi.

OBJECTIVES: Our aim is to comparatively study the susceptibility to antibiotics of Enterococcus spp. strains isolated from urocultures of patients admitted in the urology department, as well as from ambulatory patients, and also to establish the resistance phenotypes of these strains. MATERIALS AND METHODS: We studied 33 strains of Enterococcus spp.: 10 isolated from a total of 1889 urocultures from ambulatory patients (of which 431 positive) and 23 isolated from 1871 urocultures from patients admitted in the urology department (of which 462 positive). The antibiotic susceptibility was realised by Kirby-Bauer disk-diffusion tests. Statistical analysis of the antibiograms and determining of the resistance phenotypes were performed with automatic reading methods (Osiris--Bio Rad Laboratories), according to the CLSI/NCCLS standard. RESULTS: The wild phenotype was present in 60% of the strains isolated from ambulatory patients, and only in 39.13% in patients admitted in the urology department. In the urology department a multiresistant strain was isolated, displaying Van A (VRE) phenotype, to which was added resistance to beta-lactams, aminoglycosides, macrolides, tetracycline and nitrofurans. CONCLUSIONS: In the past decades urinary tract infections with Enterococcus spp., especially the nosocomial ones, have become serious health issues because of the increasing number of cases and the difficulty of treatment of infections caused by multi-resistant strains. In order to limit the spread of these strains, especially VRE strains, in the hospital environment, efficient measures must be instituted for the control of nosocomial infections, accompanied by policies for the rational use of antibiotics.

Genotype-phenotype correlation in multiresistant Escherichia coli and Klebsiella pneumoniae strains isolated in Western Romania.

OBJECTIVE: Bacterial multidrug-resistance (MDR) to antimicrobials has become an important public health issue all over the world and it involves both hospital and community-acquired strains. MATERIALS AND METHODS: A number of 75 Escherichia coli and 77 Klebsiella pneumoniae (K.) strains identified in biological samples collected from community (CA) and hospital-acquired (HA) infections were found to be resistant to the third generation cephalosporins. Of these, 93 MDR strains were subjected to microarray analysis to detect the expression of 31 antimicrobial resistance genes. RESULTS: We found that all HA extended-spectrum ß-lactamase (ESBL) producing E. coli strains had at least one resistance gene to third generation cephalosporins, while in 54% of all CA strains genetic substrates justifying their antibiotic resistance were identified. Almost 81% of HA-ESBL (Extended-Spectrum ß Lactamase) K. pneumoniae strains had at least one resistance gene to third generation cephalosporins, while in only 6% of the CA strains a similar genotype was identified. In the HA group, the blaCTX-M-15 genotype proved to be most frequent in multidrug-resistant E. coli strains and second most frequent (after ampC) in K. pneumoniae, while in the CA group, this genotype was the fourth most frequent in ESBL E. coli (after ampC, sul1, tet(R)). CONCLUSIONS: Overall, in 67% of all ESBL producing Enterobacteriaceae strains a genetic substrate justifying the resistance to beta-lactam antibiotics was identified; most of the remaining 33.33% strains were CA with a predominance of K. pneumoniae, in which a different antibiotic resistance genetic substrate (outside the detection limit of the kit used in this study) might have been involved.

[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.

[Bacterial strains isolated in high nosocomial risk departments]. / Tulpini microbiene izolate din sectii cu risc nosocomial crescut.

We collected 312 samples from hospitalized patients in two hospitals in Timisoara between September-December 2003. We isolated 83 strains with nosocomial potential. Identification of the 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 we remarked a high percentage of E. coli, Klebsiella pneumoniae pneumoniae and S. aureus with multiple resistance to antibiotics.

Thymus vulgaris essential oil: chemical composition and antimicrobial activity.

The study was designed to determine the chemical composition and antimicrobial properties of the essential oil of Thymus vulgaris cultivated in Romania. The essential oil was isolated in a yield of 1.25% by steam distillation from the aerial part of the plant and subsequently analyzed by GC-MS. The major components were p-cymene (8.41%), γ-terpinene (30.90%) and thymol (47.59%). Its antimicrobial activity was evaluated on 7 common food-related bacteria and fungus by using the disk diffusion method. The results demonstrate that the Thymus vulgaris essential oil tested possesses strong antimicrobial properties, and may in the future represent a new source of natural antiseptics with applications in the pharmaceutical and food industry.