Romanian Hospitals Research Articles

Antimicrobial consumption, costs and resistance patterns: a two year prospective study in a Romanian intensive care unit

BackgroundDue to the vulnerable nature of its patients, the wide use of invasive devices and broad-spectrum antimicrobials used, the intensive care unit (ICU) is often called the epicentre of infections. In the present study, we quantified the burden of hospital acquired pathology in a Romanian university hospital ICU, represented by antimicrobial agents consumption, costs and local resistance patterns, in order to identify multimodal interventional strategies.MethodsBetween 1st January 2012 and 31st December 2013, a prospective study was conducted in the largest ICU of Western Romania. The study group was divided into four sub-samples: patients who only received prophylactic antibiotherapy, those with community-acquired infections, patients who developed hospital acquired infections and patients with community acquired infections complicated by hospital-acquired infections. The statistical analysis was performed using the EpiInfo version 3.5.4 and SPSS version 20.ResultsA total of 1596 subjects were enrolled in the study and the recorded consumption of antimicrobial agents was 1172.40 DDD/ 1000 patient-days.The presence of hospital acquired infections doubled the length of stay (6.70 days for patients with community-acquired infections versus 16.06/14.08 days for those with hospital-acquired infections), the number of antimicrobial treatment days (5.47 in sub-sample II versus 11.18/12.13 in sub-samples III/IV) and they increased by 4 times compared to uninfected patients. The perioperative prophylactic antibiotic treatment had an average length duration of 2.78 while the empirical antimicrobial therapy was 3.96 days in sample II and 4.75/4.85 days for the patients with hospital-acquired infections. The incidence density of resistant strains was 8.27/1000 patient-days for methicilin resistant Staphylococcus aureus, 7.88 for extended spectrum β-lactamase producing Klebsiella pneumoniae and 4.68/1000 patient-days for multidrug resistant Acinetobacter baumannii.ConclusionsSome of the most important circumstances collectively contributing to increasing the consumption of antimicrobials and high incidence densities of multidrug-resistant bacteria in the studied ICU, are represented by prolonged chemoprophylaxis and empirical treatment and also by not applying the definitive antimicrobial therapy, especially in patients with favourable evolution under empirical antibiotic treatment. The present data should represent convincing evidence for policy changes in the antibiotic therapy.

Abundance of antibiotics, antibiotic resistance genes and bacterial community composition in wastewater effluents from different Romanian hospitals

Antimicrobial resistance represents a growing and significant public health threat, which requires a global response to develop effective strategies and mitigate the emergence and spread of this phenomenon in clinical and environmental settings. We investigated, therefore, the occurrence and abundance of several antibiotics and antibiotic resistance genes (ARGs), as well as bacterial community composition in wastewater effluents from different hospitals located in the Cluj County, Romania. Antibiotic concentrations ranged between 3.67 and 53.05 μg L−1, and the most abundant antibiotic classes were β-lactams, glycopeptides, and trimethoprim. Among the ARGs detected, 14 genes confer resistance to β-lactams, aminoglycosides, chloramphenicol, macrolide-lincosamide-streptogramin B (MLSB) antibiotics, sulfonamides, and tetracyclines. Genes encoding quaternary ammonium resistance and a transposon-related element were also detected. The sulI and qacEΔ1 genes, which confer resistance to sulfonamides and quaternary ammonium, had the highest relative abundance with values ranging from 5.33 × 10−2 to 1.94 × 10−1 and 1.94 × 10−2 to 4.89 × 10−2 copies/16 rRNA gene copies, respectively. The dominant phyla detected in the hospital wastewater samples were Proteobacteria, Bacteroidetes, Firmicutes, and Actinobacteria. Among selected hospitals, one of them applied an activated sludge and chlorine disinfection process before releasing the effluent to the municipal collector. This conventional wastewater treatment showed moderate removal efficiency of the studied pollutants, with a 55–81% decrease in antibiotic concentrations, 1–3 order of magnitude lower relative abundance of ARGs, but with a slight increase of some potentially pathogenic bacteria. Given this, hospital wastewaters (raw or treated) may contribute to the spread of these emerging pollutants in the receiving environments. To the best of our knowledge, this study quantified for the first time the abundance of antibiotics and ARGs in wastewater effluents from different Romanian hospitals.

HOSPITALIZED MORBIDITY BY TB IN ROMANIA

BACKGROUND: The strategic role of the National TB Control Programme planning and implementation is essential for the community disease controlling, these programs effectively integrating results of anti-tuberculosis therapy progress with implementation of socio-economic effective measures. AIM: the main scope is to provide valid evidence on hospitalized morbidity by tuberculosis, to support planning and implementation of strategies for prevention, treatment and TB control in Romania. METHODOLOGY: This study is performed as a descriptive analysis of secondary data reported by Romanian hospitals for 2011-2016 period and is focused on identification of some TB hospitalizations patterns, especially for the year 2015. The DRG data were aggregated at district and type of tbc location. RESULTS: In Romania, the downward trend in the TB rate in the population overlaps the constant decrease in need for hospital services for patients with tuberculosis. The decrease was recorded for all TB locations. In Romania, the hospital services consumer profile can be summarized as being predominantly for: active people, women, rural, jobless, with referral from a specialist and being discharged in an improved condition.CONCLUSIONS: In Romania, the implementation of National Programs for the TB Control managed to reduce spectacular the TB incidence in the general population, up to the 66 new TB cases (2014) compared to the peak level recorded in the year 2003 (139 new TB cases). Evidence emerged from this kind of analyzes can be a good support for planning and strategic decisions at national level, given that tuberculosis is still representing one of the public health problems in Romania, through the magnitude of phenomenon, the disease consequences in the context of existing effective opportunities and progress in this field. Keywords : hospitalized morbidity, tb, control, prevention, Romania Normal 0 21 false false false RO X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Table Normal; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Times New Roman; mso-bidi-theme-font:minor-bidi; mso-fareast-language:EN-US;}

A Lyme borreliosis diagnosis probability score – no relation with antibiotic treatment response

Objectives: (1) To describe epidemiological and clinical data of patients that present with the suspicion of Lyme borreliosis (LB); (2) to evaluate a previous published score that classifies patients on the probability of having LB, following-up patients’ clinical outcome after antibiotherapy.Methods: Inclusion criteria: patients with clinical manifestations compatible with LB and Borrelia (B.) burgdorferi positive serology, hospitalized in a Romanian hospital between January 2011 and October 2012. Exclusion criteria: erythema migrans (EM) or suspicion of Lyme neuroborreliosis (LNB) with lumbar puncture performed for diagnosis. A questionnaire was completed for each patient regarding associated diseases, tick bites or EM history and clinical signs/symptoms at admission, end of treatment and 3 months later. Two-tier testing (TTT) used an ELISA followed by a Western Blot kit. The patients were classified in groups, using the LB probability score and were evaluated in a multidisciplinary team. Antibiotherapy followed guidelines’ recommendations.Results: Sixty-four patients were included, presenting diverse associated comorbidities. Fifty-seven patients presented positive TTT, seven presenting either ELISA or Western Blot test positive. No differences in outcome were found between the groups of patients classified as very probable, probable and little probable LB. Instead, a better post-treatment outcome was described in patients with positive TTT.Conclusion: The patients investigated for the suspicion of LB present diverse clinical manifestations and comorbidities that complicate differential diagnosis. The LB diagnosis probability score used in our patients did not correlate with the antibiotic treatment response, suggesting that the probability score does not bring any benefit in diagnosis.

Measuring Patient Safety Culture in Romania Using the Hospital Survey on Patient Safety Culture (HSOPSC).

Purpose To explore patient safety culture among Romanian staff, using the U.S. Hospital Survey on Patient Safety Culture (HSOPSC). Material and Methods:A cross-sectional study was carried out in six hospitals, located in four Romanian regions (Craiova, Cluj-Napoca, Bucharest and Brasov), based on staff census in the Units/hospitals which volunteered to participate in the study (N=1,184). The response rate was 84%. The original questionnaire designed by the American Agency for Healthcare Research and Quality was translated into Romanian (with back translation), pre-tested before application and psychometrically checked. It consists of 42 questions grouped in 12categories, covering multiple aspects of patient safety culture (dimensions). Percentages of positive responses (PPRs) by question and category were analyzed overall and by staff profession. Results:Most respondents were nurses (69%). The main work areas were surgery (24%) and medicine (22%). The highest PPRs were for Supervisor/Manager Expectations & Actions Promoting Safety (88%), Teamwork Within Units (86%), Handoffs and Transitions (84%), Organizational Learning-Continuous Improvement (81%), Overall Perceptions of Safety (80%), Feedback & Communication About Error (75%). The lowest PPRs were for: Staffing (39%), Frequency of Events Reported (59%) and Non-punitive Response to Errors (61%). Nurses exhibited significantly higher PPRs than doctors.Conclusions:This small-scale study of staff’s attitude towards patient safety in Romanian hospitals suggests that there is room for future improvement, especially within the doctor category. Further research should assess the relationship between patient safety culture and frequency of adverse events.

Active surveillance scheme in three Romanian hospitals reveals a high prevalence and variety of carbapenamase-producing Gram-negative bacteria: a pilot study, December 2014 to May 2015.

We report the findings of an active surveillance scheme for detection of asymptomatic carriers with carbapenemase-producing Gram-negative bacteria (CP-GNB) in Romanian hospitals. During a pilot study from December 2014 to May 2015, faecal cultures were screened in three hospitals (two large, one medium-size) for patients newly admitted to selected wards or inpatients transferred from other wards to an intensive-care unit. The study revealed a high prevalence of CP-GNB detected in 22/27 and 28/38 of the carbapenem non-susceptible isolates from Hospitals 1 and 3, respectively. CP-GNB identified through faecal screening included NDM-1-producing Serratia marcescens and Klebsiella pneumoniae, OXA-48-producing K. pneumoniae and OXA-23-producing Acinetobacter baumannii. The distribution of the CP-GNB varied between the hospitals, with NDM-1-producing S. marcescens and K. pneumoniae being prevalent in the north-central part of the country and OXA-23/24-producing A. baumannii, OXA-48-producing K.pneumoniae, Morganella morganii and VIM-2-producing Escherichia coli/Pseudomonas aeruginosa detected in the north-east of the country. Conjugation studies showed that carbapenem resistance was transferable and PCR-based replicon typing identified blaNDM-1 on IncFIIs in S. marcescens and K. pneumoniae from Hospital 1 and blaOXA-48 on IncL plasmids in all Klebsiella spp. isolates from Hospitals 1 and 3. Our findings underline the importance of active surveillance for detection of CP-GNB asymptomatic faecal carriers and suggest a likely endemic spread of CP-GNB in Romania.

Patient Mobility in Times of Austerity: A Legal and Policy Analysis of the Petru Case.

The case-law of the Court of Justice (ECJ) on patient mobility was recently challenged by a ruling that a patient could go to Germany for treatment when facilities in Romanian hospitals were inadequate. Given the reported impact of austerity measures in the field of health care this raises the question; what is the impact of the ECJ's ruling on how Member States can manage expenditure and limit outflows of patients and how should such measures be legally evaluated? The objective of this article is to analyse potential impact on health systems in the context of increasing pressure on public financing for health. While the ECJ mainly referred to the requirement of treatment in due time, we also analyse possible austerity reductions of the basket of care against the background of EU law (i.e., EGJ case-law, patient mobility directive, Charter of Fundamental rights and social security regulation).

Potentially Life-threatening Vascular Events (Myocardial and Cerebral Infarction) - Geographical Distribution and Temporal Evolution in Romania

As worldwide, the non communicable diseases are a matter of concern in Romania, especially the cardio and cerebrovascular diseases that are the leading cause of death. The study of the geographical distribution and temporal evolution of these diseases could bring useful information for targeting cost-effective interventions that will avoid a great part of these deaths. The main objective of the study is to identify nationwide, regional and county-level the distribution of two types of life-threatening vascular diseases, myocardial and cerebral infarction and their temporal evolution. A cross-sectional study was conducted for period 2010-2014 by using validated hospital activity data reported at patient level by Romanian hospitals. The inclusion criteria considered all hospitals reporting data included in National Diagnosis Related Groups (DRG) database; data extraction targeted the selection of demographic and socioeconomic factors for DRG codes related to both health conditions. In the last 5 years the total number of potential life-threatening vascular events such as stroke and myocardial infarction increased, almost constantly the number of cerebrovascular events being several times higher than cardiovascular events. There are registred important differences among regions, the most affected being Bucharest area and several counties, both in myocardial and cerebral infarction. Men are almost twice affected by cardiac events, while in case of stroke there is a slight predominance for women in the last 2 years. Data indicates a constantly increasing predominance of patients residents in urban areas, the most affected being those over 65 and patients between 41-64 years of age. Further studies are required on the risk factors for these diseases in the most affected areas than targeted interventions should be designed and implemented in order to decrease morbidity and to prevent complications and loss of lives due to cardio and cerebrovascular diseases.

A Model of Optimising Activity in Emergency Hospitals’ MATUCC Type Divisions

The MATUCC (Monitoring and Advanced Treatment Units of Critical Cardiac patients) concept launched in 2010 by the Romanian Ministry of Health aims an increase of quality standards in coronary care in Romania. The MATUCC of Emergency County Hospital Pitesti was founded in 2013 in the current building. Learning from the experience of some prestigious hospitals, we conceived a new model of MATUCC, more appropriate to the new standard of care for the critical coronary patient in an Emergency Hospital. The present paper displays the new model created in our hospital, harmonized with regulatory authorities exigencies published in 2012, model that may be uptaken and adjusted for other Romanian hospitals. Keywords: MATUCC, new standard, emergency zonal hospital

Diagnostic accuracy of three biomarkers in identifying serious bacterial infections in children younger than 36 months with fever without source / Acurateţea diagnostică a trei biomarkeri în identificarea infecţiilor bacteriene severe la copiii cu vârsta sub 36 luni cu febră fără focar

Abstract Objectives: Our study aimed to evaluate and compare the accuracy of C-reactive protein, Procalcitonin and Interleukine-6 in identifying serious bacterial infections (SBI) in children with fever without source. Methods: 139 children, aged 7 days to 36 months, addressing the Emergency Department from a Romanian university hospital, were prospectively enrolled during 2013. C-reactive protein, Procalcitonin and Interleukin-6 were determined for every patient. SBI diagnosis was based on cultures results and chest radiographs. Results: 31 patients (22.3%) had SBI. C-reactive protein [AUC: 0.87 (95%CI: 0.81-0.92)] and Procalcitonin [AUC: 0.83 (95%CI: 0.76-0.89)] proved strong prediction value for SBI and performed better than Interleukin-6 [AUC: 0.77 (95%CI: 0.69-0.84)]. For the group of children with the duration of fever less than 8 hours, Interleukin- 6 was the best predictor [AUC: 0.88 (0.76-0.95)]. Conclusions: Both C-reactive protein and Procalcitonin are strong and similar predictors for SBI, and Interleukin- 6 might be a better SBI screening tool for children with shorter duration of fever.

Patient mobility in the context of austerity and an enlarged EU: The European Court of Justice's ruling in the Petru Case

Since 1998, the European Court of Justice (EUCJ) has established a set of principles concerning patient mobility across Member States. At present, these principles are challenged against a new background, i.e., an enlarged EU and austerity-driven measures in the field of healthcare. This is even more relevant in view of the significant differences between countries and between services on healthcare access. In the Petru case, a Romanian woman sought healthcare in Germany due to an alleged lack of basic infrastructure in her local Romanian hospital. A crucial question arises in this context of whether the patient′s interests (i.e., right to cross-border healthcare) or the Member State′s interests (i.e., financial stability of the healthcare system) prevail. We analyse this case and its implications for future patient mobility. From the point of view of patients, the EUCJ′s decision implies that also a lack of medication and basic medical supplies can be claimed as “undue delay”, however for Member States it is sufficient to provide quality treatments in at least one hospital. Although the Court has provided a solution for the Petru case, we argue that major challenges remain, such as the definition of the international state-of-the-art or other limitations to reductions of the health basket.

Romanian medical exposure to ionising radiation in 2012

Medical exposure, the main source of artificial exposure, shows an increasing trend in the last years, manifested both by increasing the number of examinations with ionising radiation and by increasing the patient dose level. Annual results obtained for medical exposure to ionising radiation based on the data collected from Romanian hospitals are useful for the update of the national database and optimisation of diagnostic procedures in radiology and nuclear medicine. Medical exposure level is expressed in terms of annual collective dose and is evaluated from annual frequencies and the average effective dose per procedure for different types of radiological and nuclear medicine procedures. The Romanian hospitals reported during 2012 a number of 5,505,792 radiological examinations and 17,088 diagnostic procedures of nuclear medicine. Based on the data reported, the average effective doses and their contributions to the collective dose were evaluated. The main contributions to the collective dose of the radiological procedures are registered for CT abdomen and pelvis region, followed by thorax CT and head CT examinations. The next positions are fluoroscopic examination of the thorax and gastrointestinal disease and radiographic examination of the lumbar spine and thorax, which in spite of their low effective dose have an important contribution to the collective dose due to the large number of examinations. For nuclear medicine procedures, major contributions to collective dose are given by bone scintigraphy, followed by PET-CT and thyroid scintigraphy.

Undernutrition and obesity in pediatric patients admitted in a Romanian hospital

Aims. The determinants of children nutrition status varies around the globe in relation with socio-economic particularities, dietary habits and family lifestyle. The present study attempted to evaluate the changes and determinants of nutritional status of a representative children population from South Romania. Materials and methods. A prospective cross section study was performed in Grigore Alexandrescu Emergency Children’s Hospital from Bucharest between December 2010-February 2011. We enrolled 1529 children and anthropometric, dietary assessment and interview schedule were used for all the participants. Study design was similar with the one used in 2005, on similar condition (timing and participants). The population was divided in 2 age groups: 0-2 years and 2-18 years. Data analyze used SPSS software and the Data Analysis module of MICROSOFT EXCEL 2007. Chi-Squared Test was performed for hypothesis testing involving nominal variables (categorical), non-parametric Wilcoxon-Mann-Whitney Test for comparing values of two independent cohorts, Independent Sample T Test for comparing average values of two independent cohorts, and the ‘Correlate’ function /Pearson coefficient for proving associations between the parameters being considered. Results. The overall rate of undernutrition was 11% while 13% subjects were obese/overweight. Half of subjects with undernutrition came from low-income families. Compared to non-obese children, obese subjects regularly consume sweets and hyper caloric drinks (p<0.001), spend more time watching TV and less time doing physical activity (p<0.001). Comparing data 2005/2011 we revealed that there is a decreasing level of malnutrition for both age groups and there is a warring prevalence of overweight/obese children. Conclusions. Almost a quarter of subject had nutritional status modifications. Inappropriate dietary habits (hypercaloric, hyperglucidic) and sedentary lifestyle were the main determinants of overweight/ obesity. This study provides data for national database and it represents an important argue in order to establish children nutritional diseases prevention programs.

The Healing Power of Play: Therapeutic Work with Chronically Neglected and Abused Children.

This article concerns a therapeutic intervention with a group of abandoned children living in a Romanian pediatric hospital. The children, ranging in age from one to ten years old, had suffered chronic neglect and abuse. They had previously spent most of their lives tied in the same cot in the same hospital ward. They were poorly fed and their nappies were rarely changed. Although able to see and hear the other abused children, they experienced little in the way of social interaction. The article focuses on the play-based methods that were employed to aid the children’s recovery, while at the same time highlighting the general benefits of this very specific therapeutic approach to children’s recovery and development. In particular, there is an exploration of concepts such as symbolic representation, negative capability, joining, and the significance of play cues. However, despite the clear value of these individually focused techniques, the article proposes the tentative hypothesis that the most powerful healing factor was the unfettered playful interaction between the children themselves. In other words, the children in a very real sense may have healed each other while playing.

Antibiotic susceptibility of 33 Prevotella strains isolated from Romanian patients with abscesses in head and neck spaces

The purpose of this study was to investigate the susceptibility of a series of 33 Prevotella strains isolated from patients with abscesses in the head and neck spaces, presented to one Romanian hospital. The Etest was applied to determine the value of the minimum inhibitory concentrations for: penicillin G, ampicillin, amoxicillin-clavulanate, metronidazole and clindamycin. In addition, the beta-lactamase activity was detected by the chromogenic cephalosporin disc method. The results indicated that 11 isolates were resistant to both penicillin G and ampicillin due to the beta-lactamase production. All the 33 Prevotella strains were susceptible to the other 3 antimicrobial agents tested, except for only one penicillin G – ampicillin resistant isolate of Prevotella buccae (MIC > 32 and MIC = 12 mg/L, respectively), which showed high resistance to clindamycin (MIC > 256 mg/L) too. Our data underline the necessity for antimicrobial testing including monitoring of beta-lactamase production in cases of oro-maxillo-facial mixed anaerobic infections where antimicrobial treatment is required in addition to the surgical drainage. The results of the study indicated that amoxicillin-clavulanate, like metronidazole, was fully active against the tested Prevotella strains. However, local and multicentre surveys on drug resistance among the clinically significant anaerobic isolates should be carried out periodically.

Diarrheal diseases burden and causes in an Infectious Diseases department during the era of Clostridium difficile infection

Background Classically, the diarrheal diseases were a top diagnosis in Romanian infectious diseases hospitals during summer. The increasing incidence of Clostridium difficile infection (CDI) after 2011 might change this seasonality of diarrheal diseases, as warm season illnesses. Aim: to estimate the burden of different diarrheal diseases in an Infectious Diseases department and to evaluate if the seasonality still exists.

PO-0358 Concomitant Ceftriaxone-induced Nephrolithiasis And Biliary Pseudolithiasis In A Small Toddler

<h3>Introduction</h3> Ceftriaxone is a frequent choice in Romanian hospitals for empiric antimicrobial therapy because of its broad spectrum, long half-life, safety and tolerability. However, some relatively rare side effects as renal lithiasis and biliary pseudolithiasis may occur. <h3>Case report</h3> A 5 month male toddler was admitted into our unit with extreme agitation and mild respiratory symptoms. The child had interstitial pneumonia and received ceftriaxone intravenously for 7 days in a county hospital. Clinical examination showed productive cough, fine crackles, mild systolic murmur and small crystals in the in diaper. Ultrasound examination of the kidneys revealed the presence of sediment in the bladder and a hyperechoic image of 4 mm in the gallbladder. Complete blood count, urea, creatinine, creatinine clearance, serum glucose, calcium (total and ionised), serum phosphorus, bilirubinemia, alkaline phosphatase were within normal limits. Urinalysis showed calcium carbonate deposit and increased calcium/creatinine ratio. Chest X-Ray revealed discrete bilateral interstitial infiltrate. The echocardiography found permeable foramen ovale and moderate left ventricular diastolic dysfunction. Treatment consist in suspending ceftriaxone administration, antispasmodics, hydrochlorothiazide 6,25 mg/daily and adequate hydration. The child was dismissed after 3 days in good general condition, disappearance of bladder sediment but persistant gallbladder image that disappeared within 3 weeks. <h3>Conclusions</h3> This is a particular case of a very young patient with renal and vesicular pseudolithiasis induced by ceftriaxone; the negative family history of kidney stones, a normal intake of vitamin D3 and normal liver and renal function excluded any other cause of lithiasis except the antibiotic itself.

Etiology of Bacteremic Syndromes and Bacterial Susceptibility of Blood Culture Isolates in a Romanian County Hospital

Abstract Aim: To present the etiology of bacteremic syndromes and antibiotic susceptibility of blood culture isolates from a Romanian county hospital, as well as their distribution within different wards. Methods: We retrospectively analyzed the blood culture data collected from patients hospitalized in the County Emergency Clinical Hospital of Tirgu Mures over a period of two years. We followed aspects regarding the identified bacterial species, their distribution by sex, age groups and wards, the spectrum of resistance to antibiotics and main resistance phenotypes. Results: Most positive samples came from ICU, nephrology and urology. The most isolated bacteria were coagulase-negative staphylococci, Escherichia coli, and Staphylococcus aureus. All isolates showed a high resistance to most classes of antibiotics, staphylococci being susceptible to glycopeptides, oxazolidinones and glycylcyclines, and the enterobacteria to aminoglycosides and carbapenems. The resistance in non-fermentative bacilli exceeded 80% to most classes of antibiotics. The methicillin-resistance was 36% for coagulase-negative staphylococci and 82% for Staphylococcus aureus; the percentage of extended-spectrum beta-lactamase producing strains was 30%. Conclusions: The etiology of bacteremic syndromes is specific to the ward profile, the Staphylococcus spp. being primarily isolated from wards where invasive procedures are frequently performed, while the enterobacteria from urology and nephrology wards. The level of antibiotic resistance is higher in surgery and ICU wards, with also higher percentage of resistance phenotypes than in medical wards.

Why is an ethical and integrated audit accreditation process required for Romanian hospitals

Nowadays, a third generation of ethics has come to the fore, whereby ethical issues are approached in an integrated manner, emphasising the management of ethics, which entails a cause-effect relation. One of its evaluation instruments is the ethical audit.This paper presents the findings of research focused on 47 executives involved in the management of quality in Romanian hospitals. The research concerns, in particular, the relevance and the opportunity for an ethical audit and the assessment of its possible effects.The data were gathered using a questionnaire.The research shows that Romanian managers consider the introduction of the ethical audit within theaccreditation process as being relevant and pertinent. They believe that ethical monitoring is beneficial for the activity of healthcare institutions, but also that these institutions are as yet not sufficiently prepared toimplement ethical audits. This study might be useful for sounding an alarm bell or for suggesting a direction for the qualitative and quantitative improvement of accreditation criteria and for the management of changein healthcare institutions worldwide.

Epstein-Barr virus in the cerebrospinal fluid of HIV-positive patients. Observational cross-sectional study

Different viruses are detected in the cerebrospinal fluid (CSF) of HIV-positive patients, with controversial implications in central nervous system (CNS) impairment. Objectives: to evaluate the presence, frequency and associations of Epstein-Barr virus (EB) in the CSF in HIV-positive patients. We retrospectively analyzed CSF samples from HIV-positive adult patients (≥18 years old), with or without CNS impairment, collected between Oct 2011 and Oct 2012 in a Romanian tertiary infectious diseases hospital. We performed a multiplex PCR coupled with electrospray ionization – time-of-flight mass spectrometry (Abbott Molecular) which can simultaneously detect: herpesviruses (1-5 and 8), polyomaviruses, enteroviruses, adenoviruses and parvoviruses. The patients were characterized based on the immunological and virological HIV status, neurological findings (including neuroimagery and CSF exam) and comorbidities. A number of 55 patients were analyzed, with a mean age of 33.4 years (31.5 median) and a male:female ratio of 1.9:1. The CD4 count had a mean of 32 (75 median and IQR=225). The most frequently detected virus was EB in 20/55 cases. The EB-positive subgroup had a similar mean age of 33.5 years (median of 31.0) but a different male:female ratio, of 1.2:1. The CD4 count had a mean of 105.7 (59.5 median and IQR=156). The following analyses refer to the EB-positive group: 17/20 patients had neurologic impairment. Imagery was performed in 15 cases and was normal in 5. CSF cellularity had a median of 2/cmm, IQR=10, CSF-glucose a median of 48.0 mg/dL, IQR=34 and CSF-protein a median of 55.5mg/dL, IQR=49.5. In 8/20 cases EB was found as singular agent in the CSF and in 12/20 it was associated with other microorganisms: other herpesviruses (3 cases), JC virus (4 cases), Mycobacterium tuberculosis (2 cases), Cryptococcus neoformans (2 cases) and Toxoplasma gondii (one case). The CSF-HIV viral load was available in 12/20 cases, being detectable in 10 cases. Regarding the neurological events (totalizing the neurological signs/symptoms, CSF exam and imagery), EB was probably causal in 4/20 cases, possibly causal in another 4/20 cases and was a bystander in 12/20 (3 cases with no impairment and 9 cases in which the impairments were strongly attributable to another germ). EB is the most frequent agent found in the CSF (40% of HIV-positive cases), mainly in women. It can be mono-detected but it especially appears in multiple associations. In more than half of the cases EB acts as an innocent bystander.