Costin Damian

Neonatal sepsis remains a leading cause of morbidity and mortality in the first month of life, yet its presentation is nonspecific, and its microbiological confirmation is uniquely difficult. Low-circulating bacterial loads, small obtainable blood volumes, frequent intrapartum antibiotic exposure, and the ambiguity of skin-commensal isolates erode the sensitivity and specificity of blood culture, the long-standing reference standard, so that most evaluated infants are treated empirically despite sterile cultures. This review synthesizes current evidence on the integrated microbiological evaluation of the newborn: the host- and specimen-related diagnostic challenge; the etiologic spectrum and its antimicrobial-resistance burden; conventional culture; rapid and molecular methods, including mass spectrometry and syndromic and broad-range PCR; metagenomic and cell-free-DNA sequencing; host-response biomarkers; and antimicrobial-susceptibility determination. The evidence indicates that newer methods accelerate or supplement culture but do not yet replace it, each addressing one limitation while introducing caveats of its own. Notably, much of the evidence for direct-from-blood molecular testing, microbial cell-free DNA, and metagenomic sequencing is extrapolated from adults, whereas neonatal data are stronger for several biomarkers. The greatest benefit arises from integrating complementary modalities within diagnostic- and antimicrobial-stewardship frameworks. Neonatal-specific validation, standardized thresholds, and outcome-driven trials remain the principal priorities.

(1) Background: Candida-positive cultures in pregnancy and the postpartum period are frequently identified in obstetric and gynecological practice. This study evaluated species distribution and associated maternal and obstetric variables in amniotic fluid, vaginal discharge, and lochial cultures. (2) Methods: A retrospective, single-center, cross-sectional comparative study was conducted at the “Cuza Vodă” Clinical Hospital of Obstetrics and Gynecology, Iași, including Candida-positive samples collected in 2024 (242 amniotic fluid, 2020 vaginal discharge, and 827 lochial isolates). Fungal identification was performed using Sabouraud and chromogenic media, with species-level identification in most cases and classification as Candida spp. when differentiation was not possible. (3) Results: Candida albicans predominated across all compartments (69.8%, 55.3%, and 66.9%, respectively), followed by non-albicans species, mainly Pichia kudriavzevii. Vaginal discharge cultures, obtained from both pregnant and non-pregnant women and analyzed after stratification by pregnancy status, showed multiple significant associations with maternal and obstetric variables; apparent associations with fetal variables were largely attributable to the inclusion of non-pregnant women and were not retained within the pregnant stratum. Amniotic fluid and lochial cultures demonstrated limited associations. Older maternal age was the only consistent independent correlate of non-albicans Candida isolation, whereas the remaining associated variables were compartment-specific. Multivariable models identified compartment-specific correlates of non-albicans Candida isolation but showed limited discriminatory performance, with low sensitivity in most strata. (4) Conclusions: Candida species distribution is compartment-dependent, with greater clinical heterogeneity in vaginal discharge and more limited patterns in amniotic fluid and lochia. These culture-positive findings support species-level identification for microbiological surveillance and provide perinatal microbiological context for future integrated maternal–neonatal studies; because antifungal susceptibility and neonatal outcomes were not assessed, no therapeutic or neonatal inferences can be drawn.

Background: Early-onset neonatal listeriosis is a rare, life-threatening infection of vertical origin caused by Listeria monocytogenes. First-line therapy is intravenous ampicillin combined with an aminoglycoside; acquired β-lactam resistance is exceptionally uncommon. Case Presentation: A 34-week preterm female neonate (birth weight 1990 g, appropriate for gestational age) was born to a febrile primigravida with fetid greenish amniotic fluid at a regional secondary maternity and transferred at 30 h of life to our tertiary NICU with respiratory failure requiring mechanical ventilation. L. monocytogenes was recovered from blood, gastric aspirate, pharyngeal exudate, ocular secretion, and skin swab. Gradient strip susceptibility testing reported ampicillin and trimethoprim–sulfamethoxazole non-susceptibility, although confirmatory broth microdilution was unavailable. Broad-spectrum empirical therapy was revised on Day 5 to include ampicillin–sulbactam, with piperacillin–tazobactam and gentamicin continued. A follow-up blood culture on Day 9 remained sterile through 7 days. The hospital course was complicated by thrombocytopenia, transiently elevated aminotransferases, and a Grade I subependymal hemorrhage; tertiary NICU length of stay was 25 days. Conclusions: Recovery under a multi-agent regimen precludes attribution of effect to any single component. Discordant gradient strip susceptibility results in L. monocytogenes should be confirmed by broth microdilution before any therapeutic change; survivors of severe early-onset listeriosis require structured multidisciplinary follow-up.

Background/Objectives: Acinetobacter baumannii is a major cause of hospital-acquired and ventilator-associated pneumonia and is associated with high mortality among critically ill patients. Although antimicrobial resistance remains a major therapeutic challenge, the relative contribution of clinical severity, organ dysfunction, and laboratory parameters to patient outcomes requires further clarification. Methods: We conducted a retrospective single-center cohort study including 165 patients with microbiologically confirmed A. baumannii pneumonia admitted to the Clinical Hospital of Pneumology Iași, Romania, between 2019 and 2025. Clinical, laboratory, and outcome data were analyzed, and multivariable logistic regression was performed to identify independent predictors of in-hospital mortality. Results: In-hospital mortality was independently associated with older age (OR: 1.05 per year, 95% CI: 1.01–1.08, p = 0.005), sepsis (OR: 5.23, 95% CI: 1.93–16.5, p = 0.002), and mechanical ventilation (OR: 6.71, 95% CI: 3.02–15.6, p < 0.001). In exploratory analyses restricted to patients with available lactate measurements, lactate levels were not significantly associated with mortality, whereas acute kidney injury and dynamic renal deterioration were associated with increased mortality. Inflammatory markers, particularly neutrophil-to-lymphocyte ratio and C-reactive protein at 72 h, were significantly higher in non-survivors. Conclusions: These findings suggest that mortality in A. baumannii pneumonia is more closely associated with clinical severity, sepsis, respiratory failure, and evolving organ dysfunction than with isolated laboratory parameters. Early recognition of sepsis, acute kidney injury, and respiratory failure, together with serial assessment of inflammatory biomarkers, may support improved risk stratification in this high-risk population.

Background: Oral dysbiosis during pregnancy has been associated with adverse outcomes, including preterm birth, premature rupture of membranes (PROM), and low birth weight, yet oral health remains an underappreciated component of routine prenatal care. Dental caries and gingival bleeding are frequently reported during pregnancy and may remain clinically relevant in the immediate postpartum period, but their relationship with specific oral pathogens in postpartum women has been insufficiently characterised, particularly in Eastern European populations. Methods: This exploratory cross-sectional, single-centre study included 60 postpartum women recruited consecutively at “Cuza-Vodă” Clinical Hospital of Obstetrics and Gynecology, Iași, Romania, between December 2025 and February 2026. All participants completed a structured questionnaire covering obstetric history, demographic characteristics, and oral hygiene behaviours and underwent a standardised clinical oral examination by two calibrated examiners. Before study initiation, the two examiners underwent a joint calibration session based on the predefined visual oral assessment criteria used in this study and agreed on uniform recording procedures for visible dental caries, self-reported gingival bleeding during brushing, tooth mobility, and overall oral status. Saliva samples were collected after delivery. Genomic DNA was extracted using a magnetic-bead protocol and analysed by Real-Time PCR using TaqMan-based assays to detect four oral pathogens: Porphyromonas gingivalis, Streptococcus mutans, Mycoplasma salivarium, and Fusobacterium nucleatum. Results: Most participants were primiparous (55.0%) and delivered at term (≥37 weeks of gestation; 78.3%). The prevalence of pathogen detection was: P. gingivalis 38.3% (23/60), S. mutans 70.0% (42/60), M. salivarium 71.7% (43/60), and F. nucleatum 100% (60/60). Poly-microbial carriage was common: 15.0% of participants carried all three variable pathogens simultaneously (S. mutans, M. salivarium, and P. gingivalis), and the most frequent two-pathogen combination was S. mutans + M. salivarium (30.0%). No statistically significant associations were identified between pathogen detection and clinical or obstetric variables, consistent with limited statistical power in this small convenience sample. Conclusions: This exploratory study provides the first salivary prevalence estimates for these four oral pathogens in postpartum women in Northeast Romania. The high prevalence of poly-microbial carriage, including the novel quantitative estimate for M. salivarium, provides an empirical foundation for power calculations and future confirmatory research integrating standardised periodontal assessment with pregnancy outcome data.

Neonatal infections remain a leading cause of morbidity and mortality worldwide, particularly among preterm and low-birth-weight infants and in low- and middle-income countries. This burden has intensified with the global increase in multidrug-resistant (MDR) bacteria, especially in neonatal intensive care units, where prolonged hospitalization, invasive interventions, and exposure to broad-spectrum antibiotics promote colonization, transmission, and invasive infection. In this narrative review, we explore the epidemiology and microbiological characteristics of MDR bacterial infections in newborns, alongside their associated risk factors, diagnostic challenges, treatment outcomes, and prevention strategies. Across different settings, Gram-negative pathogens, particularly Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii, account for a substantial proportion of severe neonatal infections, whereas methicillin-resistant Staphylococcus aureus remains important in selected units. The risk of MDR infection is driven by a complex interplay of factors, ranging from maternal and perinatal exposures to the inherent immunological vulnerability of newborns, hospital-based transmission, antibiotic selection pressure, and structural deficiencies in healthcare infrastructure. Diagnosis remains challenging because clinical presentations are nonspecific and culture-based methods are constrained by low blood volumes, prior antimicrobial exposure, and delayed turnaround times. Treatment is increasingly complicated due to resistance to standard empirical regimens, substantial regional variation in susceptibility profiles, and limited neonatal pharmacokinetic and safety data for reserve agents. Current evidence mainly supports surveillance-informed empirical therapy, susceptibility-guided treatment adjustment, antimicrobial stewardship, and strict infection prevention measures. Future progress will require neonatal-specific clinical trials, harmonized surveillance systems, stronger molecular epidemiology, and more equitable access to microbiological diagnostics and effective treatment.

Kidney transplant recipients (KTRs) remain vulnerable to infectious complications and malignancies due to chronic immunosuppression, both of which may contribute to allograft dysfunction and adverse clinical outcomes. This study aimed to evaluate the prevalence of viral infections and post-transplant malignancies among hospitalized KTRs and to identify factors associated with acute kidney injury (AKI) and chronic graft dysfunction. We conducted a prospective observational study including 215 adult KTRs admitted to a tertiary transplant center over a one-year period. Clinical data, malignancy history, and viral detection for BK polyomavirus (BKV), cytomegalovirus (CMV), Epstein–Barr virus (EBV), and parvovirus B19 were analyzed. AKI occurred in 65.6% of patients, while chronic graft dysfunction was present in 21.4%. Viral positivity was detected in 16.7% of the cohort, most frequently BKV and CMV. Infectious etiologies represented the most common cause of AKI. Viral positivity was significantly associated with infectious mechanisms of AKI and was independently associated with AKI in multivariable analysis (adjusted OR 3.01, p = 0.02). In a separate multivariable model, malignancy history (aOR 9.30), viral positivity (aOR 3.33), and concurrent AKI (aOR 3.42) were independently associated with chronic graft dysfunction. These findings suggest that viral reactivation and malignancy history cluster with clinical states of increased graft vulnerability in hospitalized KTRs. Integrated evaluation of infectious, immunologic, and clinical factors may improve risk stratification and management of transplant recipients presenting with acute illness.

Background/Objectives: Severe respiratory infections remain a major cause of morbidity and mortality in critically ill patients admitted to an intensive care unit (ICU), particularly in the context of increasing antimicrobial resistance (AMR). This study aimed to describe the clinical, microbiological and resistance profiles of ICU patients diagnosed with hospital-acquired or ventilator-associated pneumonia. Methods: We conducted a retrospective, single-center observational study including adult ICU patients admitted between January and December 2025, with clinically significant positive endotracheal aspirates. Clinical severity scores (APACHE II, SOFA, SOFA-2), inflammatory biomarkers (neutrophil-to-lymphocyte ratio—NLR, platelets-to-lymphocyte ratio—PLR, C-reactive protein—CRP), microbiological findings, antimicrobial resistance patterns and ICU-related outcomes were analyzed. Results: Out of the 606 endotracheal aspirates collected, 76 (12.5%) were culture-positive and 62 (10.2%) patients met the final inclusion criteria. Ventilator-associated pneumonia accounted for 90% of infections, 25 episodes (44.6%) being classified as early-onset and 31 cases (55.4%) as late-onset, without significant differences in bacterial distribution between the two subtypes. In total, 85.5% of infections were monomicrobial, with Gram-negative bacteria representing 76% of isolates. Acinetobacter baumannii and Pseudomonas aeruginosa were the most frequently isolated pathogens, with high resistance rates. Acute kidney injury occurred in 25.8% of patients and was associated with higher APACHE II, SOFA, and SOFA-2 scores. Conclusions: Severe respiratory infections in critically ill patients were predominantly caused by Gram-negative, frequently drug-resistant pathogens and were associated with high disease severity and poor outcomes. These findings provide insight into the local epidemiology and antimicrobial resistance patterns of severe respiratory infections in critically ill patients.

Antimicrobial resistance constitutes a major global public health challenge, with Romania among the European countries affected. Acinetobacter baumannii and Pseudomonas aeruginosa was designated by the World Health Organization (WHO) as priority pathogens, are frequently implicated in healthcare-associated infections (HAIs), including pneumonia, surgical site infections, urinary tract infections, and bacteremia. We have narratively synthesized surveillance studies published in different regions of Romania, encompassing date whit the period 2001–2024. A total of 13 studies reporting data on P. aeruginosa (2003–2024) and 15 studies on A. baumannii (2001–2024) were included. The strains were isolated from various pathological products, including urine, sputum, tracheobronchial aspirate, blood, bronchoalveolar lavage, pus, peritoneal fluid, and cerebrospinal fluid, from hospitalized patients in different clinical departments. This review evaluated long-term trends in antimicrobial resistance profiles of A. baumannii and P. aeruginosa strains circulating in various regions of Romania. The findings revealed both temporal variability in resistance rates within comparable intervals and differences across distinct time periods. These long-term trends underscore the need for sustained national surveillance systems, harmonized reporting practices, and reinforced antimicrobial stewardship programs.

Toxocarosis is one of the most widespread zoonotic parasitic diseases, caused by Toxocara canis and Toxocara cati. Studying the epidemiological situation is a real challenge for specialists in the field worldwide. The aim of this study was to highlight the epidemiological aspects of the prevalence rate in Europe, and we found that the distribution of Toxocara infection is uneven, depending on geographical, climatic and socio-economic factors. Currently, there is a continuous spread of this parasite in many regions, including economically developed countries, but the exact prevalence is not known because there are no regular reports and statistical evidence regarding toxocarosis. The presence of nonspecific symptoms and subclinical disease may delay diagnosis and treatment, with long-term implications for the patient, and because of this, we discussed the possible Toxocara detection methods, with several novel and interesting approaches. Toxocarosis is included among the neglected parasitic diseases, requiring seroprevalence studies to be carried out to develop programs to reduce the frequency of this parasitosis.