Ramona Mihaela Stoicescu

Objectives: Intra-abdominal infections (IAIs) requiring surgical intervention represent a significant cause of morbidity in pediatric patients, often leading to prolonged hospitalization and increased antimicrobial exposure. This study aimed to characterize the distribution of pathogenic bacteria, antimicrobial resistance patterns, and clinical associations in pediatric intra-abdominal infections complicated by surgical site involvement. Methods: A retrospective observational study was conducted on children aged 0–16 years, who underwent surgery for intra-abdominal infections with microbiological confirmation. Peritoneal fluid, pus, and other intraoperative or postoperative specimens were analyzed using standard microbiological techniques. Infections were classified as monomicrobial or polymicrobial, and antimicrobial susceptibility was assessed phenotypically. Associations between bacterial pathogens, patient age, underlying diagnosis, surgical procedures, and antibiotic susceptibility patterns were analyzed. Results: 177 pediatric patients were included. Appendicitis was the most common diagnosis (53.53%), followed by intra-abdominal abscesses (32.94%). Gram-negative (GN) bacteria predominated (44.07%), with Escherichia coli being the most frequently isolated pathogen (83.33%). Double and triple GN and GP associations were identified in approximately 25% of cases, particularly in abscesses, complicated appendicitis, and surgical site infections. Our findings revealed that piperacillin–tazobactam and carbapenems were expected to be effective against almost all GN pathogens identified in surgical specimens of pediatric patients. Pathogen distribution and antimicrobial susceptibility varied significantly according to age group and clinical diagnosis. Conclusions: In pediatric patients, intra-abdominal infections requiring surgical management were mainly caused by Gram-negative bacteria and polymicrobial associations. Effective treatment relies on prompt surgical source control and empiric broad-spectrum antimicrobial therapy, followed by culture-guided de-escalation to support antimicrobial stewardship.

Background/Objectives: Intra-abdominal infections requiring surgical intervention represent a significant cause of morbidity in pediatric patients, often leading to prolonged hospitalization and increased antimicrobial exposure. Pediatric-specific data regarding microbiological profiles and antimicrobial susceptibility are limited, and treatment strategies are frequently extrapolated from adult guidelines. This study aimed to characterize pathogen distribution, antimicrobial resistance patterns, and clinical associations in pediatric intra-abdominal infections complicated by surgical site involvement. Methods: A retrospective observational study was conducted including children aged 0–16 years who underwent surgery for intra-abdominal infections with microbiological confirmation. Peritoneal fluid, pus, and other intraoperative or postoperative specimens were analyzed using standard microbiological techniques. Infections were classified as monomicrobial or polymicrobial, and antimicrobial susceptibility was assessed phenotypically. Associations between pathogens, patient age, underlying diagnosis, surgical procedures, and antibiotic susceptibility patterns were analyzed. Results: A total of 177 pediatric patients were included, predominantly male adolescents. Appendicitis was the most common diagnosis, followed by intra-abdominal abscesses. Gram-negative bacteria predominated, with Escherichia coli being the most frequently isolated pathogen. Polymicrobial infections were identified in approximately one-quarter of cases, particularly in abscesses and complicated appendicitis. The highest susceptibility rates were observed for cephalosporins and combination regimens, whereas penicillins demonstrated limited efficacy. Pathogen distribution and antimicrobial susceptibility varied significantly according to age group and clinical diagnosis. Conclusions: In pediatric patients, intra-abdominal infections requiring surgical management are mainly caused by Gram-negative and polymicrobial pathogens. Effective treatment relies on prompt surgical source control and empiric broad-spectrum antimicrobial therapy, followed by culture-guided de-escalation to support antimicrobial stewardship. Pediatric-specific microbiological data are essential for optimizing therapeutic strategies and improving clinical outcomes.

Background and Objectives: Psoriasis is a chronic immune-mediated inflammatory disease requiring reliable diagnostic and monitoring tools. Salivary interleukins have emerged as promising non-invasive biomarkers, reflecting systemic inflammation and offering practical advantages such as ease of collection and improved patient compliance. Materials and Methods: This review synthesizes the current evidence on key salivary cytokines—IL-1β, IL-6, TNF-α, and IL-17—in relation to psoriasis pathogenesis, diagnosis, and treatment monitoring. It also compares saliva to blood-based diagnostics, emphasizing benefits like cost-effectiveness and suitability for repeated sampling. Methodological challenges, including heterogeneity in collection protocols and limited longitudinal data, are critically examined. Results: Advances in biologic therapies have deepened the understanding of psoriasis immunopathogenesis, highlighting interleukins as central biomarkers. Recent findings identify IL-37 and IL-38 as novel regulatory cytokines with anti-inflammatory roles. While elevated serum TNF-α levels in psoriatic patients are well documented, some inconsistencies persist. Notably, saliva has proven to be a viable alternative diagnostic fluid, supporting large-scale screening and routine clinical monitoring. Conclusions: Salivary interleukins—particularly IL-1β, IL-6, TNF-α, and IL-17—represent valuable, non-invasive biomarkers for early detection, disease severity assessment, and therapeutic response monitoring in psoriasis. Standardizing saliva-based methods and conducting large-scale studies are essential next steps to support their integration into personalized clinical practice.

Background/Objectives: Pertussis remains a significant cause of respiratory illness in children, particularly in regions with suboptimal vaccination coverage. This retrospective study analyzes the clinical presentations, co-infections, treatment, and outcomes of pediatric patients diagnosed with Bordetella pertussis at the Constanța County Clinical Emergency Hospital “St. Apostle Andrew” between 1 January and 30 September 2024. Methods: Thirty-eight children, predominantly under the age of 3 years (81.58%), were included. Demographic data, clinical features, coinfecting pathogens, antimicrobial regimens, and hospital outcomes were reviewed. Results: Only 7 out of 38 children (18.42%) had received pertussis vaccination, and none benefited from maternal immunization. The highest incidence occurred in infants under 1 year (44.74%). Intensive care was required in 18.42% of cases, and macrolides were the most frequently used antibiotics (68.42%). Co-detection of respiratory pathogens—particularly Streptococcus pneumoniae, enteroviruses, and human rhinoviruses—was common. Severe cases often exhibited hyperleukocytosis, which was associated with complications such as heart failure. Conclusions: These findings underscore the need for timely recognition and management of pertussis and its complications. Although macrolides remain the first-line therapy, adjunctive treatments like leukoreduction may be considered in critical cases. The persistence of pertussis despite vaccination efforts highlights the challenges posed by waning immunity and diagnostic limitations, reinforcing the need for strengthened public health strategies.

Bordetella pertussis infection is a leading cause of respiratory illness in pediatric patients globally, especially in areas with lower vaccination coverage. This study aims to investigate the clinical characteristics, coinfections, treatment regimens, and outcomes in pediatric patients with B. per-tussis infection in Southeast Romania. A retrospective clinical study was conducted on 38 pediatric patients, most up to 3 years old (81.58%). They were hospitalized with B. pertussis infection in the Pediatric Departments of Constanta County Clinical Emergency Hospital "St. Apostle Andrew" between January 1, 2024, and September 30, 2024. Data on demographics, clinical manifestations, coinfections, antimicrobial treatments, and hospital outcomes were extensively analyzed. Although pertussis is recognized as a vaccine-preventable disease, our findings show that only 7/38 pediatric patients (18.42%) received the B. pertussis vaccine; moreover, none benefitted from maternal im-munization. Therefore, the highest incidence of whooping cough was recorded in infants < 1 year (17/38, 44.74%). Among the 38 children, 18.42% required intensive care, with macrolides being the most commonly administered antibiotics (68.42%). Codetection of respiratory pathogens was common, with Streptococcus pneumoniae, Enterovirus, and Human Rhinovirus identified frequently. Severe cases were characterized by elevated white blood cell counts, with hyperleukocytosis iden-tified as a significant risk factor for complications, including heart failure. This study emphasizes the importance of early recognition and management of coinfections and hyperleukocytosis in pediatric pertussis patients. Macrolides remain a cornerstone of treatment, but further research into leuko-reduction therapies could improve outcomes in severe cases. Despite vaccination campaigns, Bor-detella pertussis remains a public health challenge due to waning immunity and diagnostic limita-tions. Ongoing research and targeted public health initiatives are essential to reduce the disease burden and ensure sustained protection against pertussis.

Background/Objectives: The gut microbiota is involved in modulating gastrointestinal function and consequently contributes to the manifestation of functional gastrointestinal disorders (FGIDs). The aim of the study was to analyze the composition of the gut microbiota in infants with functional gastrointestinal disorders (infantile colic, functional constipation, gastroesophageal reflux, functional diarrhea) according to age, environmental factors, and clinical manifestations. Methods: The study involved the clinical and laboratory examination of 134 infants divided into two groups: group I (n = 82) with FGIDs according to Rome IV criteria, divided into four subgroups (infantile colic, functional constipation, gastroesophageal reflux, and functional diarrhea), and group II (n = 52) without FGIDs. To assess the composition of intestinal microbiota, a bacteriological analysis of fecal samples was performed. Results: Infants with functional gastrointestinal disorders presented an imbalance of intestinal microflora, which was characterized by a significant decrease in the main representatives of acidifying flora represented by Lactobacillus, Bifidobacterium, and Enterococcus and high abundance of proteolytic microorganisms from the Enterobacteriaceae family such as Klebsiella species and Escherichia coli. In infants born by cesarean section or artificially fed, the incidence of functional gastrointestinal disorders and intestinal dysbiosis was significantly higher. Conclusions: The imbalance of acidifying and proteolytic microbial composition in the gut could be the key to the occurrence of functional gastrointestinal disorders in the first year of life.

The world has changed forever as a result of the COVID-19 pandemic. Antimicrobial resistance is a primary global health concern that places a significant financial and health burden on nations. Patients with Campylobacter-caused infections were the subject of the retrospective investigation. The data show that children aged 1–6 are the most commonly affected by Campylobacter enteritis. Resistance levels fluctuated over the course of the two periods. Nine isolates were sensitive to macrolides, and only one was responsive to tetracycline, which indicated inadequate sensitivity across all classes throughout the pandemic. This pattern raises serious concerns about the potential impact on public health. Tetracyclines and fluoroquinolones rank highest in terms of bacterial resistance. Regardless of the species, macrolides remain a practical and sufficient treatment for Campylobacter enteritis. Reassurance is still provided by much lower numbers in the post-pandemic period. There is no evidence to support the alarming claims made in the international literature about macrolides in Romania.

Cystic echinococcosis (CE) is a neglected tropical parasitic disease linked with significant social and economic burdens worldwide. The scientific community has minimal information on echinococcosis in Romanian people, and hospital medical records are the only sources that may be used to investigate its status. A 7-year retrospective clinical study on pediatric patients with CE from Southeast Romania was performed, and 39 children and adolescents were included, aged 2–15 years old. They were hospitalized with cystic echinococcosis in the Pediatric Department and Pediatric Surgery Department of Constanta County Clinical Emergency Hospital “St. Apostle Andrew” between 1 January 2017 and 1 October 2024. Twenty-nine (74.36%) pediatric patients came from rural zones, and 10 (25.64%) had urban residences. In total, 28 children (71.79%) had contact with four different animals (dogs, goats, pigs, and sheep); only four were from urban zones, and they had contact only with dogs. Data regarding the length of hospital stay, cyst location, and complications were collected and analyzed. According to the medical files, the diagnosis was established using imaging techniques and serological tests for CE. IgE and IgG reported appreciable variations in correlation with all parameters, and significant differences (p < 0.05) were recorded. IgE levels considerably increased in cases of no animal contact, pulmonary involvement, complications, surgical treatment, and multiple hospitalizations. Moderate IgE values were recorded in cases of urban residences, pig and sheep contact, and hepatic involvement. The IgG concentration considerably increased with sheep contact and moderately increased in cases of rural zones, hepatic involvement, complications, and surgical treatment. The results show that incidental discovery, symptoms, complications, multiple dissemination, pulmonary involvement, and dog and pig contact increase the hospitalization time. Extensive data analysis supports our results. Our findings highlight the complexity of managing E. granulosus infections in children and evidence the importance of a multidisciplinary approach, combining early diagnostic tools, tailored medical therapy, and careful surgical intervention when necessary.

Cystic echinococcosis (CE) is a neglected tropical parasitic disease linked with significant social and economic burdens worldwide. The scientific community has minimal information on echinococcosis in Romanian people, and hospital medical recordings are the only sources that may be used to investigate its status. A 7-year retrospective clinical study on pediatric patients with CE from South-Eastern Romania was performed, and 39 children were included, 2-15 years old. They were hospitalized with cystic echinococcosis in the Pediatric Department and Pediatric Surgery Department from Constanta County Clinical Emergency Hospital "St. Apostle Andrew," between 1 January 2017 and 1 October 2024. Twenty-nine (74.36%) pediatric patients came from rural zones, and 10 (25.64%) had urban residences. 28 children (71.79%) had contact with four different animals (dogs, goats, pigs, and sheep); only 4 were from urban zones, and they had contact only with dogs. Data regarding length of hospital stay, cyst location, and complications were collected and analyzed. According to the medical files, the diagnosis was established using imaging techniques and serological tests for CE. IgE and IgG reported appreciable variations in correlation with all parameters, and significant differences (p<0.05) were recorded. IgE levels considerably increased in cases of no animal contact, pulmonary involvement, complications, surgical treatment, and multiple hospitalizations. Moderate IgE values were recorded in urban residences, pig and sheep contact, and hepatic involvement. The IgG concentration considerably increased sheep contact and moderately increased in patients from rural zones, hepatic involvement, complications, and surgical treatment. The results show that incidental discovery, symptoms, complications, multiple dissemination, pulmonary involvement, and dog and pig contact increase the hospitalization time. Extensive data analysis supports our results. Our findings highlight the complexity of managing E. granulosus infections in children and evidence the importance of a multidisciplinary approach, combining early diagnostic tools, tailored medical therapy, and careful surgical intervention when necessary.