Monica Marilena Tantu

Burn injuries are associated with significant morbidity and mortality, largely driven by infectious complications. Disruption of the skin barrier, systemic inflammation, and postburn immunosuppression promote microbial colonization and progression to local and systemic infections, a challenge further exacerbated by the increasing prevalence of multidrug-resistant organisms (MDRO). Patients with extensive burns, inhalation injury, prolonged hospitalization, and invasive device use are particularly vulnerable. The microbiological profile of burn wound infections evolves dynamically, shifting from early Gram-positive predominance to Gram-negative and multidrug-resistant (MDR) pathogens, including members of the ESKAPE group, in later stages. Effective management, therefore, requires an integrated approach combining early surgical intervention, strict infection control measures, continuous microbiological surveillance, and targeted antimicrobial therapy. This narrative review synthesizes current evidence on the pathophysiology, risk factors, and microbiological dynamics of burn-associated infections, alongside contemporary prevention and treatment strategies, including topical therapies, advanced biomaterials, systemic antibiotic approaches, and antimicrobial stewardship. Emerging strategies such as nanoparticle-based systems and artificial intelligence-driven predictive models highlight a shift toward precision medicine in burn care; however, their clinical translation remains limited by insufficient validation and standardization. In conclusion, optimizing outcomes in burn-associated infections will depend on integrating evidence-based clinical practices with innovative technologies, while reinforcing antimicrobial stewardship and developing validated predictive tools to address the growing burden of antimicrobial resistance.

Background and Objectives: Healthcare-associated infections (HAIs) remain a major cause of morbidity and mortality among hospitalized patients. During the COVID-19 pandemic, SARS-CoV-2 infection emerged as a major contributor to HAIs, alongside Clostridioides difficile infection (CDI) and other bacterial infections. This study aimed to evaluate the clinical characteristics and outcomes of HAIs in surgical departments and to identify factors associated with in-hospital mortality. Materials and Methods: We conducted a retrospective observational study including 170 patients with documented HAIs admitted between July 2018 and June 2022 in surgical departments of a county emergency hospital. Patients were categorized into SARS-CoV-2 infection (n = 85), CDI (n = 73), and other bacterial infections (n = 12), the latter being included for descriptive purposes only due to limited sample size. Clinical variables, comorbidities, prior antibiotic exposure, length of hospital stay, and in-hospital mortality were analyzed. Survival analysis and logistic regression were performed to identify predictors of mortality. Results: SARS-CoV-2 infection represented the largest subgroup, followed by CDI. Overall, in-hospital mortality was 15.9%, with comparable rates between SARS-CoV-2 infection (17.6%) and CDI (16.4%), while no deaths were observed in the small subgroup of other bacterial infections. CDI patients had a significantly higher burden of comorbidities (p = 0.004). Kaplan–Meier analysis did not show a statistically significant difference in survival between SARS-CoV-2 and CDI groups (log-rank p = 0.28). In univariate analysis, acute respiratory failure (OR ≈ 13.5, p < 0.001), chronic kidney disease (OR ≈ 4.4, p = 0.018), and number of comorbidities (p = 0.019) were associated with mortality, but none remained significant in multivariable analysis. Conclusions: In-hospital mortality was similar between SARS-CoV-2 infection and CDI, highlighting the persistent clinical impact of CDI in hospitalized patients. Comorbidity burden and acute complications, particularly respiratory failure, were key determinants of mortality. These findings highlight the persistent clinical impact of CDI and the role of comorbidity burden and acute complications, particularly respiratory failure, in shaping in-hospital mortality. The absence of independent predictors in multivariable analysis should be interpreted cautiously given the limited sample size.

Background: Chronic hepatitis B and C remain major causes of progressive liver disease, while HBV–HCV coinfection is associated with accelerated fibrosis and hepatocellular injury. Methods: This study evaluated integrated biochemical, histopathological, and immunohistochemical features in patients with chronic hepatitis B (CHB, n = 29), chronic hepatitis C (CHC, n = 15), and CHB+C coinfection (CHB+C, n = 10). Liver biopsies were assessed using Ishak and METAVIR scoring systems, alongside immunohistochemical analysis of α-smooth muscle actin (α-SMA), transforming growth factor-β1 (TGF-β1), CD5L, and glial fibrillary acidic protein (GFAP), quantified by H-score. These findings were correlated with biochemical, hematological, and prognostic parameters. Results: Coinfected patients exhibited significantly higher serum ALT, AST, and GGT levels (p ≤ 0.011) and increased CD5L expression (median H-score 197.5 vs. 135 in CHB, p = 0.009), indicating enhanced macrophage-associated inflammatory activity. Although fibrosis stages were comparable across groups, median H-scores for α-SMA, TGF-β1, and GFAP showed a consistent upward trend in CHB+C, suggesting intensified profibrogenic signaling. Principal Component Analysis identified distinct biochemical clusters related to hepatocellular injury, hepatic functional impairment (synthetic and excretory axis), and lipid metabolism. Conclusions: These findings highlight a multidimensional pattern of liver injury in chronic viral hepatitis, with CHB+C coinfection amplifying profibrogenic and hepatocellular markers, both biochemically and histologically.

Background/Objectives: Healthcare-associated infections (HAIs), particularly those caused by multidrug-resistant (MDR) bacteria, remain a major challenge for Romanian hospitals. This study aimed to evaluate the epidemiological burden of MDR-related HAIs and to characterize the distribution of MDR bacterial isolates and their antimicrobial resistance patterns over four consecutive semesters in a Romanian tertiary care hospital. Methods: A retrospective study was conducted using data from the Electronic Registry of HAIs, clinical observation sheets, and microbiology laboratory records. An epidemiological analysis was performed on patients diagnosed with MDR-related HAIs, while a separate microbiological analysis included all MDR bacterial isolates identified during the study period. Descriptive and comparative statistical analyses were applied to assess temporal trends, pathogen distribution, and resistance profiles. Results: Of the 327 HAIs identified, 56 cases (17.13%) were caused by MDR bacteria. Most MDR-HAIs originated from the Intensive Care Unit (≈60%), with Acinetobacter baumannii and Klebsiella spp. as the predominant pathogens. Overall mortality among patients with MDR-HAIs was high (51.79%), particularly in infections caused by A. baumannii and K. pneumoniae. Microbiological analysis of MDR isolates (n = 406) revealed consistently high resistance rates to ciprofloxacin, cefepime, and ceftazidime, exceeding 95% in 2023–2024, while resistance to carbapenems surpassed 90% by the end of the study period. Temporal variability in MDR burden was observed across semesters, suggesting an influence of clinical and institutional factors. Conclusions: MDR-related HAIs represent a significant and persistent problem in Romanian acute-care hospitals, particularly in Intensive Care Units. The dominance of carbapenem-resistant A. baumannii and extended-spectrum beta-lactamase-producing and carbapenem-resistant Klebsiella spp. highlights the urgent need for strengthened antimicrobial stewardship, enhanced microbiological surveillance, and reinforced infection prevention strategies.

Objective: To analyze demographic traits, clinical complications, and healthcare use in patients with chronic liver disease across major etiologies in a large Romanian cohort. Methods: A retrospective study (2019–2023) of 2359 patients with chronic hepatitis C (CHC), hepatitis associated with alcohol (ALH), cirrhosis associated with alcohol (ALC), or non-alcoholic cirrhosis (NALC). Data on demographics, clinical outcomes, and hospitalizations were analyzed using descriptive statistics, regression modeling, and clustering in IBM SPSS 27.0.1. Results: CHC patients were oldest (mean 67.5 ± 12.3 years), while ALH patients were youngest (56.0 ± 11.0 years). CHC prevalence increased with age (10.0% in ≤30-year-olds to 87.1% in ≥81-year-olds; γ = 0.535, p < 0.001). Females comprised 60–70% of CHC cases, males > 85% of ALH and >78% of ALC. Mean hospitalization duration decreased from 13.80 days (2019) to 9.10 days (2023), yet cirrhotic patients had the longest stays (NALC: 16.37 ± 14.34; ALC: 17.66 ± 12.96) versus CHC (10.38 ± 10.14). Etiology was the strongest predictor of hospitalization length. Portal hypertension (PH) was the most common complication (54.3%), with males bearing more severe hepatic complications (ascites—38.3%; PH—66.8%). Conclusions: Hospital-based Romanian cohort analysis revealed that patient presentation and outcomes are fundamentally shaped by the interplay of etiology, sex, and age. We found a distinct female predominance in CHC, a pronounced male predominance in alcohol-related diseases, and evolving trends in non-alcoholic cirrhosis. These determinants dictate specific epidemiological patterns, hospitalization burdens, and complication risks, underscoring the critical need for a paradigm shift toward personalized, etiology-driven, and sex-tailored clinical management.

Background: Antimicrobial resistance (AMR) is a major public health concern. Urinary tract infections (UTIs) account for up to 85–90% of community-acquired cases. The COVID-19 pandemic disrupted healthcare access and may have influenced resistance patterns. In this context, we retrospectively evaluated the antibiotic resistance dynamics of various bacterial strains isolated between 2019 and 2023 in a hospital unit; Methods: A total of 8217 clinical specimens (urine, wound secretions, sputum, pharyngeal exudate, nasal exudate, tracheal secretions, vaginal and cervical secretions, puncture fluids, purulent secretions, blood, ear secretions, eye secretions) were processed using standard microbiological techniques. Pathogen identification and susceptibility testing were performed with the VITEK 2 Compact system, following CLSI guidelines. Results: Following the analysis of 8217 clinical samples collected over a five-year period (2019–2023), a total of 2900 microorganisms were isolated and identified. Among these, the most frequently encountered were E. coli strains, with 1204 isolates. Urine cultures represented 71.3% of all processed samples. Out of these 5860 urine cultures, 1530 (26%) were positive. The resistance of E. coli strains to ampicillin (48–55.2%), trimethoprim/sulfamethoxazole (22.9–34%), and ciprofloxacin (21.4–31.5%) remained high throughout the period. ESBL-producing strains peaked at 17.6% in 2020, with multidrug resistance rates ranging from 14% to 22.4%. Conclusions: E. coli strains displayed persistently high resistance to ampicillin, trimethoprim/sulfamethoxazole, and ciprofloxacin, with peaks in ESBL production and multidrug resistance during the COVID-19 pandemic. These trends underscore the importance of continuous surveillance and antibiotic stewardship, with direct implications for empirical UTI therapy and broader strategies to mitigate the public health impact of antimicrobial resistance.

Introduction: The clinical implementation of noninvasive tests for liver fibrosis assessment has attracted increasing attention, particularly for diagnosing advanced fibrosis (≥F3). This observational study aimed to evaluate the stratification accuracy of nine direct and seven indirect biomarkers across four etiologies: chronic hepatitis B (CHB), chronic hepatitis C (CHC), alcoholic liver cirrhosis (ALC), and nonalcoholic liver cirrhosis (NALC). Materials and Methods: Our study was conducted on 116 participants, including 96 with chronic liver disease (16 CHB, 15 CHC, 49 ALC, and 16 NALC) and 20 healthy controls. The values of direct (aspartate aminotransferase, alanine aminotransferase, total bilirubin, serum albumin, platelet count, international normalized ratio, gamma-glutamyl transpeptidase, CD5 antigen-like, and transforming growth factor-beta 1) and indirect non-serological biomarkers (De Ritis ratio, albumin–bilirubin score, gamma-glutamyl transpeptidase-to-platelet ratio, aspartate aminotransferase-to-platelet-ratio index, fibrosis-4 index, INR-to-platelet ratio, and fibrosis quotient) were analyzed for their discriminative power in fibrosis stratification. Results: Statistical analyses revealed a significant correlation (0.05 level; two-tailed), and AUC 95% CI ranged within 0.50–1.00 between the direct and indirect biomarker values across all etiologies. Among the evaluated biomarkers, the recorded AUC was 0.998 in CHB for APRI, 0.981 in CHC for FIB-4, and 1.000 in ALC and NALC for APRI and AST, respectively, while CD5L consistently achieved an AUC of 1.000 across all etiologies. Conclusions: These findings suggest that applying a multifactorial approach in liver pathology may improve diagnosis accuracy compared to the use of individual biomarkers and can provide data that may inform the development of clinically applicable mathematical models.

With an incidence of approximately 30% of all oral cavity neoplasms, lip cancer significantly impacts the patient quality of life (QoL). The frequent localization is in the lower lip, predominantly affecting men aged between 60–70 years old. The surgical treatment aims at aesthetic and functional reconstruction of the lip. The present study aims at defining a demographic profile of patients with lip cancer and at establishing correlations between tumor characteristics and reconstruction methods. The analysis of the group of 26 patients showed that the lip cancer patient was predominantly female, urban, with a mean age of 73.27±11.17 years old, with squamous cell carcinoma of the lower lip, mean diameter of 1.52 cm and mean depth of 0.72 cm. The tumor characteristics revealed a guide of the decision on the method of lip reconstruction, considering the correlations between a variety of factors, including the size of the affected area, etiology and location of the formation, integration of the flap into the relaxed skin tension lines, the patient general condition, and the degree of cooperation. Regardless of the reconstructive method chosen, the aim is to preserve the functions of the lip in mastication, speech and definition of facial expression. Complex cases require extensive reconstructive interventions involving combinations of various types of flaps. Multidisciplinary management of these patients leads to improved QoL and prevention of recurrences.

Background/Objectives: Healthcare professions impose high physical and mental demands, potentially affecting health. Despite advocating for active lifestyles, many physiotherapists do not meet recommended physical activity levels (PALs). This study explores physical activity patterns and recreational engagement among practicing physiotherapists. Methods: A cross-sectional correlational design examined the relationship between physical activity and recreational participation among 60 physiotherapists (38 females, 22 males, mean age 38.62 ± 9.78 years). Data were collected using the International Physical Activity Questionnaire—Short Form (IPAQ-SF) and the Pittsburgh Enjoyable Activities Test (PEAT). The analysis focused on bivariate correlations between PAL, energy expenditure (MET), recreational habits (PEAT score), and sociodemographic and anthropometric variables. Results: The IPAQ-SF results indicated that 38.3% of participants had a low PAL, 40.0% a moderate level, and 21.7% a high level. Average energy expenditure was 1927.62 ± 1479.73 MET-minutes/week. PEAT data indicated moderate engagement in recreational activities (mean score: 22.63 ± 7.76), with participants predominantly involved in low-intensity, passive leisure. Significant positive correlations were observed between PEAT scores and both MET values (Kendall’s tau-b = 0.669, p ≤ 0.01) and PALs (Kendall’s tau-b = 0.804, p ≤ 0.01), indicating that higher engagement in recreational activities is associated with greater energy expenditure and overall physical activity levels. Conclusions: Despite the physical demands of their profession, many physiotherapists report low activity levels. The positive correlations between physical activity, energy expenditure, and recreational engagement highlight the need for structured exercise to support both personal health and professional integrity. Future research should include larger samples and objective assessments.

Healthcare-associated infections (HAIs), previously known as nosocomial infections, represent a significant threat to healthcare systems worldwide, prolonging patient hospital stays and the duration of antimicrobial therapy. One of the most serious consequences of HAIs is the increase in the rate of antibiotic resistance (AR) generated by the prolonged, frequent, and sometimes incorrect use of antibiotics, which leads to the selection of resistant bacteria, making treatment difficult and expensive, with direct consequences for the safety of patients and healthcare personnel. Therefore, timely and accurate diagnosis of HAIs is mandatory to develop appropriate infection prevention and control practices (IPC) and new therapeutic strategies. This review aimed to present the prevalence, risk factors, current diagnosis, including artificial intelligence (AI) and machine learning approaches, future perspectives in combating HAIs causative bacteria (phage therapy, microbiome-based interventions, and vaccination), and HAIs surveillance strategies. Also, we discussed the latest findings regarding the relationships of AR with climate change and environmental pollution in the context of the One Health approach. Phage therapy is an emerging option that can offer an alternative to ineffective antibiotic treatments for antibiotic-resistant bacteria causing HAIs. Clinical trials dealing with vaccine development for resistant bacteria have yielded conflicting results. Two promising strategies, fecal microbiota transplantation and probiotic therapy, proved highly effective against recurrent Clostridium difficile infections and have been shown to reduce HAI incidence in hospitalized patients undergoing antibiotic therapy. Artificial intelligence and machine learning systems offer promising predictive capabilities in processing large volumes of clinical, microbiological, and patient data but require robust data integration. Our paper argues that HAIs are still a global challenge, requiring stringent IPC policies, computer vision, and AI-powered tools. Despite promising avenues like integrated One Health approaches, optimized phage therapy, microbiome-based interventions, and targeted vaccine development, several knowledge gaps in clinical efficacy, standardization, and pathogen complexity remain to be answered.