"Primum, non nocere": The Epidemiology of Toxigenic Clostridioides difficile Strains in the Antibiotic Era-Insights from a Prospective Study at a Regional Infectious Diseases Hospital in Eastern Europe.

Clostridioides difficile infection (CDI), though identified nearly five decades ago, still remains a major challenge, being associated with significant mortality rates. The strains classified as hypervirulent, notably 027/NAP1/BI, have garnered substantial attention from researchers and clinicians due to their direct correlation with the severity of the disease. Our study aims to elucidate the significance of toxigenic Clostridioides difficile (CD) strains in the clinical and therapeutic aspects of managing patients diagnosed with CDI. We conducted a single-center prospective study, including patients with CDI from north-eastern Romania. We subsequently conducted molecular biology testing to ascertain the prevalence of the presumptive 027/NAP1/BI strain within aforementioned geographic region. The patients were systematically compared and assessed both clinically and biologically, employing standardized and comparative methodologies. The study enrolled fifty patients with CDI admitted between January 2020 and June 2020. Among the investigated patients, 43 (86%) exhibited infection with toxigenic CD strains positive for toxin B genes (tcdB), binary toxin genes (cdtA and cdtB), and deletion 117 in regulatory genes (tcdC), while the remaining 7 (14%) tested negative for binary toxin genes (cdtA and cdtB) and deletion 117 in tcdC. The presence of the presumptive 027/NAP1/BI strains was linked to a higher recurrence rate (35.56%, p = 0.025), cardiovascular comorbidities (65.1% vs. 14.2%, p = 0.016), and vancomycin treatment (55.8% vs. 14.3%, p = 0.049). The findings of our investigation revealed an elevated incidence of colitis attributed to presumptive 027/NAP1/BI. Despite the prevalence of the presumptive 027 strain and its associated heightened inflammation among the patients studied, no significant differences were observed regarding the clinical course or mortality outcomes.

Comparison of C-reactive protein with distinct hyperinflammatory biomarkers in association with COVID-19 severity, mortality and SARS-CoV-2 variants.

C-reactive protein (CRP) has been one of the most investigated inflammatory-biomarkers during the ongoing COVID-19 pandemics caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The severe outcome among patients with SARS-CoV-2 infection is closely related to the cytokine storm and the hyperinflammation responsible for the acute respiratory distress syndrome and multiple organ failure. It still remains a challenge to determine which of the hyperinflammatory biomarkers and cytokines are the best predictors for disease severity and mortality in COVID-19 patients. Therefore, we evaluated and compared the outcome prediction efficiencies between CRP, the recently reported inflammatory modulators (suPAR, sTREM-1, HGF), and the classical biomarkers (MCP-1, IL-1ß, IL-6, NLR, PLR, ESR, ferritin, fibrinogen, and LDH) in patients confirmed with SARS-CoV-2 infection at hospital admission. Notably, patients with severe disease had higher serum levels of CRP, suPAR, sTREM-1, HGF and classical biomarkers compared to the mild and moderate cases. Our data also identified CRP, among all investigated analytes, to best discriminate between severe and non-severe forms of disease, while LDH, sTREM-1 and HGF proved to be excellent mortality predictors in COVID-19 patients. Importantly, suPAR emerged as a key molecule in characterizing the Delta variant infections.

What Doesn't Kill Them Makes Them Stronger: The Impact of the Resistance Patterns of Urinary Enterobacterales Isolates in Patients from a Tertiary Hospital in Eastern Europe.

(1) Background: The evolution of bacterial resistance to antibiotics is one of the factors that make infectious pathology an extremely dynamic field, also inducing a significant burden on public health systems; therefore, continuous updates on the bacterial resistance to antibiotics and their particular regional patterns is crucial for the adequate approach of various infectious diseases. (2) Methods: We retrospectively analyzed 354 patients with Enterobacterales urinary tract infections (UTIs), determined their antibiotic resistance pattern, thus aiming to correlate them with the outcome and other specific markers of poor prognosis. (3) Results: The most frequent causative agent was Escherichia coli, representing 64.6% of all UTIs. We identified 154 patients resistant to multiple antibiotic classes, of which 126 were multidrug-resistant (MDR), 17 were extensive drug-resistant (XDR) and 11 were pandrug-resistant (PDR). Moreover, 25 isolates were resistant to carbapenems (CRE), 25 were difficult-to-treat (DTR), and 84 were extended-spectrum cephalosporin-resistant (ESC), with only 95 isolates susceptible to all tested antibiotics. Mortality ranged from 1% for UTIs caused by isolates susceptible to all tested antibiotics, to 24% for the ones caused by DTR or CRE isolates. Other significant risk factors associated with mortality were: prolonged hospital stay (p = 0.0001), Charlson comorbidity index ≥ 3 (p = 0.02), urinary catheterization (p = 0.001), associated respiratory pathologies (p = 0.004), obesity (p = 0.047), a history of previous hospitalizations (p = 0.007), inappropriate empiric antibiotic regimen (p = 0.001), or hyper inflammatory status (p = 0.006). Basically, we observed that a multiple regression model comprising urinary catheterization, inappropriate empiric anti-biotherapy, obesity, and respiratory comorbidities exhibits the best correlation with mortality rate in patients with UTI (R = 0.347, R2 = 0.12). (4) Conclusions: By focusing on the novel resistance patterns, our study provides complementary evidence concerning the resistance profiles found in an Eastern European region, as well as their prognostic implications in patients with UTI.

Diabetes Mellitus-A Risk Factor for Unfavourable Outcome in COVID-19 Patients-The Experience of an Infectious Diseases Regional Hospital.

Early research into the implications concerning the evolution of the infection caused by the new coronavirus in people with glucose metabolism dysfunction, in this case diabetics, shows that severe forms of the disease predominate in this risk category. Moreover, it seems that even in patients with normal glycaemic status, COVID-19 may predispose to the development of hyperglycaemia which modulates immune mechanisms and inflammatory responses, with direct effects on morbidity and mortality. Thus, taking into account these scientific data, as well as the increased frequency of diabetes in the general population, we aimed to assess the risk of an unfavourable outcome of diabetic patients, which is in a strong connection with the presence and severity of pulmonary disease such as interstitial pneumonia/bronchopneumonia, as well as the effectiveness of Tocilizumab administration. The results of our study indicate a three-fold higher risk of death in patients with diabetes and COVID-19 (RR = 3.03; IC95%: 2.37-3.86; p = 0.001),compared to nondiabetic patients, and the risk of developing severe forms of acute respiratory failure was 1.5 times higher in the first studied category. In conclusion, we can say that the diabetic diagnosed with SARS-CoV-2 infection is more predisposed to immunological and organic dysfunctions that may ultimately result in death, and treatment with monoclonal anti-IL-6 antibodies was more effective in diabetic patients than non-diabetics (p < 0.05). The effectiveness of Tocilizumab was significant in both studied groups, but diabetic patients responded better to this therapy compared to non-diabetes-mellitus (DM) ones (76.7% vs. 35% p = 0.001).

THE NEED FOR HBV GENOTYPING: A COST-EFFICIENT APPROACH.

The outcome of chronic HBV infection is variable; approximately one half of individuals transition to an inactive carrier state, 30% progress to cirrhosis, and the remainder to chronic hepatitis. Ten different HBV genotypes and many subtypes have been identified with distinct geographical distributions. Over the years, a lot of studies presented the efficiency of different genotyping methods; for this reason we aimed to present a cost efficient genotyping diagnosis algorithm of CHB infected patients, especially useful to identify those at risk of disease progression and determine optimal anti-viral therapy as useful instrument for physicians.

ETIOLOGY AND RESISTANCE PROFILE OF ISOLATED STRAINS FROM SEVERE SYSTEMIC INFECTIONS IN PATIENTS WITH IMMUNODEPRESSION--EXPERIENCE OF THE IASI INFECTIOUS DISEASES HOSPITAL 2011-2014.

UNLABELLED: Microbial resistance is an increasingly serious threat to global public health and it is linked to patient's age, immune status, and also antibiotic overuse or misuse and repeated hospitalizations. The high incidence of infections caused by multidrug-resistant bacteria requires rethinking the first-line therapeutic schemes. AIM: Retrospective study of the etiologic and antibiotic resistance profile of the bacterial strains isolated from immunocompromised hosts diagnosed with severe systemic infections, aimed at gaining a better understanding of the potential infectious sources and optimizing the antibiotic therapy. MATERIAL AND METHODS: 178 cases of severe sepsis associated with immunosuppression (caused by diabetes, malignancies, liver cirrhosis, chronic alcohol abuse, kidney failure) were admitted to the "St. Parascheva" Infectious Diseases Hospital Iasi in the interval January 2011- December 2014. RESULTS: The mean age of the study patients was 61 years, most patients being female (53%) and living in urban areas (51%). The causal agents were: Escherichia coli (20.2%), Klebsiella pneumoniae (16.8%), Pseudomonas aeruginosa (14.6%), Methicillin-Sensitive Staphylococcus aureus (MSSA) (11.2%), Enterococcus spp. (10.1%), Methicillin-Resistant Staphylococcus aureus (MRSA) (8.9%), Proteus spp.(5%), Acinetobacter baumanii (5%), Streptococcus pyogenes (1.6%), Staphylococcus epidermidis (1.1%) and Citrobacter (0.5%). As to the resistance profile the following were found: 100% susceptibility of MRSA and Enterococcus species to vancomycin, as well as for the Enterococcus species; 27% of E. coli strains were resistant to beta-lactams and 20% of Klebsiella pneumoniae to carbapenems. Antibiotic therapy associated two or three drugs with an immediate result and a favorable outcome in 84.2% of the cases. CONCLUSIONS: The etiological agents implicated in the occurrence of severe sepsis in patients with acquired immunosuppression were Gram-positive bacteria (GPB) as well as Gram-negative bacteria (GNB) with moderate resistance to usual antibiotics. The infections caused by GNB were predominant in immunocompromised patients, but also in those with associated urinary and respiratory tract infections and chronic indwelling urinary catheters. In our severe sepsis patients Gram positive bacteria caused mainly skin and joint infections.