Etiology and Multi-Drug Resistant Profile of Bacterial Infections in Severe Burn Patients, Romania 2018-2022.

Infections in severe burns and their etiology are and will remain a big concern for the medical field. The multi-drug resistant strains of bacteria are a challenge of today's medicine. The aim of our study was to identify the etiological spectrum of bacterial infections in severe burn patients in Romania and their multi-drug resistant patterns. We performed a prospective study that included 202 adult patients admitted to the intensive care unit (ICU) of the Clinical Emergency Hospital of Plastic, Reconstructive Surgery and Burns, Bucharest, Romania (CEHPRSB), from 1 October 2018 to 1 April 2022, a period which includes the first 2 years of the outbreak of COVID-19. From each patient, wound swabs, endotracheal aspirates, blood for blood culture, and urine were collected. The most frequently isolated bacterium was Pseudomonas aeruginosa (39%), followed by Staphylococcus aureus (12%), Klebsiella spp. (11%), and Acinetobacter baumannii (9%). More than 90% of Pseudomonas aeruginosa and Acinetobacter baumannii were MDR, regardless of the clinical specimen from which they were isolated.

Microbiologic Safety of the Transareolar Approach in Breast Augmentation.

BACKGROUND: In aesthetic breast augmentation, especially by the transareolar approach, there is increasing concern regarding the occurrence of capsular contracture and its potential correlation with intraoperative implant contamination from putative endogenous breast flora of the nipple and lactiferous ducts. However, detectable bacteria cannot be considered synonymous with established resident microflora. OBJECTIVES: The authors sought to elucidate the existence of endogenous breast flora and assess the microbiologic safety of transareolar breast augmentation. METHODS: In this prospective study (BREAST-MF), the authors collected microbiologic samples from the breast skin, ductal tissue, and parenchyma of 39 consecutive female patients who underwent breast procedures in a plastic surgery clinic. Swabs collected pre-, intra-, and postoperatively were processed for bacterial and fungal growth. Positive cultures underwent identification through VITEK and MALDI-TOF, as well as antimicrobial susceptibility testing. RESULTS: Staphylococcus species accounted for 95 of 106 (89.6%) positive results from native breast skin, 15 of 18 (83.3%) positive results from decontaminated breast skin, and 4 of 4 (100%) positive results from the breast parenchyma. Methicillin resistance was present in 26.4% of S. epidermidis, 25.3% of S. hominis, and 71.4% of S. haemolyticus strains. CONCLUSIONS: During transareolar breast augmentation, in the nipple-areola region it is more likely to find bacteria populating the skin, rather than endogenous breast flora, as previously considered. Appropriate preoperative decontamination is essential for minimizing the risk of postoperative infections. LEVEL OF EVIDENCE 3: Risk.

[Incidence and resistance patterns of pathogens from lower respiratory tract infections (LRTI)]. / Incidenta si pattern-ul de rezistenta bacteriilor patogene izolate din tractul respirator inferior.

The aim of present study was to evaluate the incidence and antibiotic susceptibility of pathogens in LRTI for patients in ICU/Surgery and pneumological wards from Marius Nasta Institute. A number of 938 strains isolated between September 1st 2004 and September 1st 2005 were identified by standard procedures and antimicrobial resistance was determined following CLSI approved standard. Imipenem-EDTA Double Disk Synergy test and Etest were used for detection of metallo-beta-lactamase producing isolates of P.aeruginosa. There were isolated 744 Gram-negative strains: H. influenzae 34.6%, P. aeruginosa 17.7%, H. parainfluenzae 15.9%, K. pneumoniae 8.6% and another spp. and 194 Gram-positive strains: 54.1% S.aureus and 45.9% S.pneumoniae. Among H. influenzae and H. parainfluenzae isolates, the highest resistance rate was to trimethoprim/sulfametoxazole (SXT 30.9% and 31.1%), followed by ampicillin (AMP 11.6% and 13.4%), chloramphenicol (C 4.5% and 5.1%) and clarithromycin (1.6% and 13.6%). P. aeruginosa strains showed a resistance rate between 7.9% to amikacin and 38.3% to cefoperazone. The resistance to imipenem (IPM) and meropenem (MEM) was close: 28.2% and 26.0%. From 36 P. aeruginosa IPM and multidrug resistant strains tested, 8 were probably producing metallo-beta-lactamase. For S. aureus the highest resistance rate was to penicillin 93.3% followed by erythromycin (E 45.7%), oxacillin 41.9% and CIP (33.3%); all strains were susceptible to vancomycin, teicoplanin and linezolid. From S. pneumoniae strains 13.4% were high resistant to penicillin and 39.3% were intermediate resistant. The resistance rate for other antibacterial agents was 64.0% to SXT, 18.8% to E, 8.3% to C and all strains were susceptible to levofloxacin. K. pneumoniae strains were resistant to cefepime (11.3%), CIP (7.8%) and there was no resistant strain to IPM and MEM.

[Bacteria isolated from pleural fluid and their resistance to antimicrobials]. / Bacterii izolate din lichidul pleural si rezistenta lor la antibiotice.

The aim of this study is to evaluate the frequency of microorganisms isolated from pleural fluids and their resistance to antimicrobial agents. A total of 272 pleural fluids were studied between July 2004 - July 2005 from the patients hospitalized in ICU/surgery (127) and respiratory diseases wards (145) at Marius Nasta Institute. The laboratory investigations included: direct microscopy, cultures for aerobic and anaerobic bacteria, identification, disk diffusion method according with CLSI recommendations for resistance and Etest for detection of metallo-beta-lactamase producing isolates of Pseudomonas aeruginosa. Microorganisms were isolated from 159 samples (58.4%), 48 pleural fluids were positive only in microscopy (17.6%). The most frequent isolated strain was P. aeruginosa (49.6%), followed by Staphylococcus aureus (12.8%) and Enterobacteriaceae (11.2%) polymicrobial infections were mostly due to combinations of Pseudomonas with Enterobacteriaceae. For P. aeruginosa the resistance rate was higher than 71% for all beta-lactams. For aminoglycosides the lower resistance rate was to amikacin (18.0%). For quinolones, resistance of P. aeruginosa was 67.8% to ciprofloxacin. P. aeruginosa isolated from patients hospitalized in ICU/surgery were more resistant to some antimicrobials than the strains isolated in the respiratory diseases wards: resistance to amikacin was 24.5% versus 10% respectively. From 21 P. aeruginosa imipenem and multidrug resistant strains tested, 3 were probably producing of metallo-beta-lactamase. S. aureus showed 47.1% oxacillin resistance, 38.9% resistance to gentamicin and ciprofloxacin and 27.7% to erythromycin. All S.aureus strains were susceptible to linezolid, teicoplanin and vancomycin. The resistance of Enterobacteriaceae strains was high to ampicillin (80.0%), amoxicillin/clavulanic acid and trimethoprim/sulfamethoxazole e(57.6%); the lowest resistance rate was to cefoperazone/sulbactam (7.7%) and to imipenem and ciprofloxacin (10.8%).