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Background and Objectives: The COVID-19 pandemic has had a significant impact on global health, with serious outcomes, such as lung damage, being major determinants of patient morbidity and mortality. Immunization has been essential in attenuating these outcomes. This study aimed to evaluate the impact of COVID-19 vaccination on disease severity, particularly focusing on pulmonary involvement, among hospitalized patients. Materials and Methods: A retrospective cohort study was conducted at Victor Babes Hospital, Timisoara, involving 3005 patients diagnosed with COVID-19 between December 2020 and March 2022. Patients were stratified into vaccinated and unvaccinated groups. Results: The study found that vaccinated patients had significantly lower rates of severe pulmonary involvement compared to unvaccinated patients. Specifically, only 24.24% of vaccinated patients experienced severe lung involvement, compared to 35.64% in the unvaccinated group (p < 0.001). Vaccinated individuals had shorter hospital stays (8.96 ± 6.40 days vs. 10.70 ± 6.29 days), but this difference was not statistically significant (p = 0.219). Additionally, chronic pulmonary diseases and stroke were less prevalent among vaccinated patients, highlighting the protective effect of vaccination. Conclusions: COVID-19 vaccination significantly reduces the severity of disease, particularly in preventing severe pulmonary involvement, which is a major determinant of patient outcomes. These findings underscore the importance of ongoing vaccination efforts and the need for booster doses to maintain immunity, especially as new variants emerge. The study supports the continued prioritization of vaccination in public health strategies to mitigate the long-term impact of COVID-19.

Background and Objectives: this study aimed to research links between C-reactive protein (CRP), lactate dehydrogenase (LDH), creatinekinase (CK), 25-OH vitamin D (25-OHD), ferritin (FER), high-density lipoprotein cholesterol (HDL)cholesterol and clinical severity in patients from the western part of Romania, and compare their potential use as biomarkers for intensive care units (ICU) admission and death in children, adults and elders. Materials and Methods: this study is a retrospective cohort study, performed on patients positively diagnosed with COVID-19. Available CRP, LDH, CK 25-OH vitamin D, ferritin, HDL cholesterol and clinical severity were recorded. The following were assessed: median group differences, association, correlation and receiver operating characteristic. Results: 381 children, 614 adults and 381 elders were studied between 1 March 2021 and 1 March 2022. Most children and adults presented mild symptomatology (53.28%, 35.02%, respectively), while most elders presented severe symptomatology (30.04%). ICU admission was 3.67% for children, 13.19% for adults and 46.09% for elders, while mortality was 0.79% for children, 8.63% for adults and 25.1% for elders. With the exception of CK, all other biomarkers showed some significant associations with clinical severity, ICU admission and death. Conclusions: CRP, LDH, 25-OH vitamin D, ferritin and HDL are important biomarkers for COVID-19 positive patients, especially in the pediatric population, while CK was mostly within normal ranges.

Background and Objectives: Proteus and Providencia are related genera of opportunistic pathogens belonging to the Morganellaceae family, often a cause of infections in the immunocompromised hosts, such as diabetic patients. Their clinical significance has increased due to their intrinsic resistance to polymyxins, which is often associated with acquired resistance mechanisms. In this study we evaluated the infections caused by Proteus mirabilis and Providencia stuartii in two groups of patients, with diabetes (group 1) and without diabetes (group 2) admitted to the intensive care unit and surgical wards. The infections were investigated in terms of infection type, risk factors, clinical course, predictive factors for unfavourable outcomes and antibiotic resistance profile. Materials and Methods: An observational, retrospective, cross-sectional study was conducted, comprising all patients infected with these pathogens. Bacterial identification and antibiotic sensitivity testing were performed using the Vitek2C automated system. Results: Comparison of the two groups showed that the statistically significant common infectious risk factors were found less frequently among diabetic patients when compared with non-diabetic patients, and that antimicrobial resistance was significantly lower in the diabetic patient group. However, survival rates did not differ between the two groups, drawing attention to the implications of diabetes as comorbidity. Additionally, with regard to the antibiotic resistance profile, 38.89% of P. stuartii strains isolated from diabetic patients belonged to the difficult-to-treat (DTR) phenotype, contributing to the severity of these infections compared with those caused by P. mirabilis, of which 32% were wild type strains and 0% were DTR phenotype. The DTR/extended spectrum beta-lactamase producing P. stuartii isolates more than doubled the risk of mortality, while the presence of nasogastric nutrition tripled the risk. Conclusions: P. stuartii infections that occurred in diabetic patients proved to be more difficult to treat, the majority of them being healthcare-associated bacteremias.

Background/Objectives: Antimicrobial resistance (AMR) is a critical global health threat, leading to increased morbidity, mortality, and healthcare costs. This study aimed to identify the most common bacterial pathogens and their resistance profiles from 2179 positive clinical cultures from inpatients at “Victor Babes” Hospital of Infectious Disease and Pneumoftiziology Timisoara in 2023. Methods: Samples were collected from sputum, bronchial aspiration, hemoculture, urine, wound secretions, catheter samples, and other clinical specimens. Results: Key pathogens identified included Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii, with notable resistance patterns, observed K. pneumoniae exhibited high resistance rates, notably 41.41% in Quarter 1, while E. coli showed 35.93% resistance in the same period. S. aureus, particularly MRSA, remained a persistent challenge, with 169 cases recorded over the year. A. baumannii and P. aeruginosa displayed alarming levels of multi-drug resistance, especially in Quarter 3 (88.24% and 22.02%, respectively). Although there was a general decline in resistance rates by Quarter 4, critical pathogens such as S. aureus and K. pneumoniae continued to exhibit significant resistance (81.25% and 21.74%, respectively). Conclusions: The study’s findings align with the broader antimicrobial resistance trends observed in Romania, where high resistance rates in K. pneumoniae, E. coli, S. aureus (MRSA), Acinetobacter, and Pseudomonas species have been widely reported, reflecting the country’s ongoing struggle with multi-drug-resistant infections. Despite some reductions in resistance rates across quarters, the persistent presence of these resistant strains underscores the critical need for strengthened antimicrobial stewardship, infection control measures, and continuous surveillance to combat the growing threat of AMR in Romania and similar healthcare settings.

The etiology and resistance pattern of bacterial conjunctivitis varies depending on the patient’s care setting and age. A retrospective, observational study was conducted in a tertiary care teaching hospital. A total of 126 patients—76 adults and 50 children—diagnosed with conjunctival infection during inpatient or ambulatory care were analyzed. In the samples of adult patients, isolates were represented by Gram-positive cocci (57.7%; Staphylococcus spp., S. pneumoniae) followed by Enterobacterales (17.97%; P. mirabilis, E. coli, Klebsiella spp.), and non-fermenters (7.69%; Pseudomonas spp., A. baumannii). Multidrug-resistant (52.17%) and extensively drug-resistant (21.73%) pathogens (predominantly Gram-negative bacilli) were identified in conjunctival swabs of hospitalized adult patients. The main isolates (55.77%) identified in children’s conjunctival swabs belonged to S. aureus, H. influenzae, and S. pneumoniae, followed by Enterobacterales (19.22%; E. coli, P. mirabilis, M. morganii) and fungi (3.48%). Methicillin-resistant S. aureus (35.71%) and extended-spectrum beta-lactamase-producing K. pneumoniae (8.7%) were identified in the pediatric subgroup of patients. In critically ill adult patients assisted in the intensive care or burn functional units, bacterial conjunctivitis followed the pattern of infections and antimicrobial resistance specific to these categories of patients. In the case of hospitalized children, conjunctivitis was an integral part of the age-related pathology.

Background/Objectives: Bacterial conjunctivitis is a common ocular infection requiring prompt treatment, particularly in vulnerable patients, and may influence perioperative outcomes. This study aimed to characterize conjunctival bacterial isolates phenotypically and genotypically, to evaluate their biofilm-forming capacity, and to investigate the relationship between resistance gene carriage, resistance phenotypes, and biofilm-associated antimicrobial resistance (AMR). Methods: A prospective, single-center, cross-sectional study was conducted on bacterial isolates from conjunctival samples of patients examined in an ophthalmology department. Antimicrobial susceptibility testing (AST) was performed to determine the minimum inhibitory concentrations (MICs). Resistance genes were detected by quantitative PCR. Biofilm-forming capacity was assessed using the microtiter plate assay, and biofilm susceptibility to amikacin (AK) and levofloxacin (LEV) was evaluated using a biofilm susceptibility assay. Results: A total of 78 isolates were analyzed; Gram-positive cocci prevailed (GPC, 84.6%), being significantly more frequent than Gram-negative bacilli (GNB, p < 0.001). Among GPC, 65.2% were multidrug-resistant, with Staphylococcus epidermidis emerging as the most frequent species (p < 0.001). Resistance gene carriage was detected in 33.3% of GNB. Strong biofilm formation was observed in 22.7% of GPC versus 58.3% of GNB. It should be noted that the relatively small number of GNB may limit the statistical robustness of comparisons between Gram-positive and Gram-negative groups. A statistically significant association between resistance genes and biofilm capacity was found only in Staphylococcus aureus (p = 0.027). Biofilm-embedded bacteria showed increased antimicrobial tolerance, particularly for AK in S. aureus and for both AK and LEV in S. epidermidis (p < 0.001). Conclusions: The prevalence of multidrug-resistant conjunctival isolates and their biofilm-forming capacity highlights the clinical importance of biofilm-related resistance and support integrating AMR profiling with biofilm assessment to optimize empirical therapy in bacterial conjunctivitis.

Background/Objectives: According to the European Centre for Disease Prevention and Control, improved antimicrobial stewardship programs (ASPs) combined with rapid diagnostic tests could potentially prevent thousands of deaths caused by multidrug-resistant organisms annually. This study aimed to compare the results obtained using the Unyvero system/hospital-acquired pneumonia (HPN) panel with those obtained using classic microbiological diagnostic methods to evaluate the potential of introducing this rapid diagnostic test into routine diagnosis and improving local ASPs. Methods: A single-center, observational, cross-sectional, analytical study was performed; it included patients admitted to the intensive care unit (ICU) with the presumptive diagnosis of community- or hospital-acquired pneumonia. One hundred non-repetitive endotracheal aspirates were collected and subjected to analysis using both methods. The concordance between the results obtained via the standard-of-care (SoC) culture and Unyvero was analyzed. Results: Of the results generated using Unyvero/HPN, 51% were fully concordant with those obtained via culture, 48% were partially concordant, and only 1% represented failure. It was also more efficient in identifying multiple organisms in a single sample than the SoC culture (1.32 versus 1.1 per sample). The three most common isolates identified via both methods were Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The most common resistance markers identified with Unyvero were sul1 (41%), tem and ndm (25%), and kpc, imp, vim, and gyrA87 (2% of results). Conclusions: Unyvero/HPN, if associated with appropriate diagnostic stewardship, could be used to manage critically ill patients to ensure an appropriate ASP.

Romania is one of the European countries that has been hit the hardest by the severe acute respiratory syndrome caused by the new coronavirus SARS-CoV-2, with over 1.91 million reported cases and over 59,257 deaths. The aim of this study was to identify the main predictors of death in hospitalized patients. In the period from 1 March 2020 to 30 June 2021, an observational, retrospective, randomized, case-control study was conducted, which included a sample of 139 patients who died in hospital and another sample of 275 patients who had been discharged in an improved or healed condition. Confirmation of COVID-19 cases was performed by RT-PCR from nasopharyngeal and oropharyngeal exudates. Statistical data were analyzed by logistic regression, Cox regression and a comparison of survival curves by the log-rank (Mantel-Cox) test. The most powerful logistic regression model identified the following independent predictors of death: history of coagulopathy HR = 30.73 [1.94-487.09], p = 0.015; high percentage of neutrophils HR = 1.09 [1.01-1.19], p = 0.027; and decreased blood-oxygenation HR = 53881.97 [1762.24-1647489.44], p < 0.001. Cox regression identified the following factors that influenced the evolution of cases: history of coagulopathy HR = 2.44 [1.38-4.35], p = 0.000; O saturation HR = 0.98 [0.96-0.99], p = 0.043; serum creatinine HR = 1.23 [1.08-1.39], p = 0.001; dyspnea on admission HR = 2.99 [1.42-6.30], p = 0.004; hospitalization directly in the ICU HR = 3.803 [1.97-7.33], p < 0.001; heart damage HR = 16.76 [1.49-188.56], p = 0.022; and decreased blood-oxygenation HR = 35.12 [5.92-208.19], p < 0.001. Knowledge of the predictors of death in hospitalized patients allows for the future optimization of triage and therapeutic case management for COVID-19.

Purpose: Since the initial documentation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in late December 2019, the coronavirus disease 2019 (COVID-19) pandemic has become a leading cause of morbidity and mortality worldwide. Under these circumstances, the present study aimed to analyze the characteristics of hospitalized cases, according to the progression and severity of the disease, to reveal the main independent risk factors for death by COVID-19 in the western Romanian population. Patients and Methods: This retrospective study included 936 patients admitted to Victor Babes Clinical Hospital of Infectious Diseases Timisoara, with COVID-19 between 1 February 2020 and 31 January 2021. The patients were divided into three subsamples based on disease severity: subsample I (n = 344), comprising patients with mild forms of the disease; subsample II (n = 475) comprising patients with moderate disease; and subsample III (n = 117) for patients with severe disease. Biochemical analysis and assessment of disease severity were performed on all patients. Results: The mean age was 48.76 years (two months to 94 years). The median values for age, number of hospitalization days, and disease duration days before hospital admission varied with high statistical significance between the three subsamples (p < 0.001). A statistically significant difference was also observed regarding body mass index (BMI), with higher values in subsample III (p < 0.001). The in-hospital fatality rate was zero in subsample I, 3.58% in subsample II, and 71.79% in subsample III (p < 0.001). Of the deceased patients, 69.31% were over the age of 65 years, 29.70% were aged 36-64 years, and 0.99% were aged 19-35 years. Cumulated comorbidities were recorded in 92.08% of the deceased patients. Conclusion: Older age, the number of disease duration days before hospital admission, BMI, and renal pathology are independent risk factors for mortality in COVID-19 and can help clinicians to identify patients with poor prognosis and who are at high risk for mortality at an early stage. Keywords: severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, fatality rate, disease severity, risk factors

This study shows the epidemiological profile of the first gastroenteritis outbreak of GII.P17 in the Romanian territory. An outbreak with such large amplitude in a European territory was previously undocumented. Using a cross-sectional design, with the susceptible-infected-recovered (SIR) deterministic compartmental model for a fixed population, and the cluster method for establishing the high-incidence zones, we carried out our investigation by means of questionnaires containing personal data, affected collectivities, disease onset and duration, symptoms displayed, medical assistance provided, previous antibiotic intake where applicable, food consumption and water sources, and sanitation conditions. The confirmation of cases was done based on the typical norovirus gastroenteritis symptomatology and using three laboratory confirmations (by molecular diagnosis) for GII.P17-GII.17 genotype noroviruses from three patients. A gastroenteritis outbreak occurred in October-November 2015, affecting 328 people in Arad, a county in Western Romania, covering 44 neighbouring localities with a total population of 35,440 people. The study detected an inter-human transmission of the infection, with an intrafamilial risk of disease of 2.26 (95% CI 1.76 to 2.90) compared with the community transmission (in school collectivity). The basic reproduction number dropped from 1.26 to 0.18 during weeks 43:44, after controlling the transmission by decontamination and isolation. SIR made it possible to highlight the expansion of the emerging norovirus strain infection from community to family collectivities. This study provides practical solutions to limit disease cases, even in the absence of etiology, and shows the importance of sometimes underestimated traditional control methods.