Flavia Liliana Turcu

Lower respiratory tract infections represent the world’s deadliest infectious disease, responsible for approximately 2.5 million deaths worldwide. The aim of the study was to determine the distribution and antimicrobial susceptibility profiles of the main critical and high priority Gram-negative bacteria isolated from endotracheal aspirates obtained from Intensive Care Unit (ICU) patients. We conducted a four-year microbiological surveillance study (2022–2025) in a tertiary Romanian ICU. A total of 1529 Gram-negative bacterial isolates were detected in 1391 endotracheal aspirates. Most frequently reported were Pseudomonas aeruginosa (422–27.60%), Acinetobacter baumannii (296–19.36%), Escherichia coli (274–17.92%) and Klebsiella pneumoniae (271–17.73%). The prevalence of MDR Acinetobacter baumannii declined to approximately 40% in 2025, whereas XDR isolates increased to 13.51%, twice the 2022 value. Carbapenem resistance among Acinetobacter baumannii remained high (around 70%) in 2025, despite a significant decline from 2022 (p < 0.001). Approximately 65% of K. pneumoniae isolates were MDR/XDR, with an increase in carbapenem resistance. MDR Pseudomonas aeruginosa increased significantly from 14.14% in 2022 to 39.84% in 2025 (p < 0.001) and a significant upward trend in carbapenem resistance was registered, exceeding 70% for imipenem in 2025. These findings underscore the need for continuous microbiological and epidemiological surveillance and targeted interventions to prevent the spread of highly resistant pathogens.

Background: Acute kidney injury (AKI) is associated with poor outcomes in patients with cirrhosis. However, most studies evaluate AKI as a single clinical entity, whereas predictors of mortality and renal recovery, specifically in non-hepatorenal syndrome AKI (non-HRS-AKI), remain poorly defined. Methods: We performed a retrospective cohort study including consecutive patients with liver cirrhosis admitted with non-HRS-AKI to a multidisciplinary emergency hospital between 1 January 2024 and 31 December 2025. Only variables available at hospital admission were included in the multivariable analyses. Independent predictors of in-hospital mortality and factors associated with incomplete renal recovery in survivors at hospital discharge were identified using multivariable logistic regression. Results: A total of 139 patients were included. Overall, 57 patients (41.0%) died during hospitalization. Among the 82 survivors, complete renal recovery occurred in 35 cases (42.7%), whereas 47 patients (57.3%) had incomplete renal recovery at discharge. Independent predictors of in-hospital mortality were a higher MELD-Na score (adjusted OR 1.16 per 1-point increase, 95% CI 1.07–1.26; p < 0.001), an advanced AKI stage (KDIGO stage 3 vs. stage 1, adjusted OR 6.71, 95% CI 1.73–26.04; p = 0.006), the absence of pre-existing chronic kidney disease (adjusted OR 0.233, 95% CI 0.085–0.644; p = 0.005), and higher admission C-reactive protein (adjusted OR 1.12 per 10 mg/L increase, 95% CI 1.01–1.23; p = 0.029). Factors independently associated with incomplete renal recovery among hospital survivors at hospital discharge were pre-existing heart failure (adjusted OR 3.07, 95% CI 1.10–8.62; p = 0.033) and higher admission C-reactive protein (adjusted OR 1.17 per 10 mg/L increase, 95% CI 1.00–1.34; p = 0.047). Conclusions: In patients with cirrhosis-associated non-HRS-AKI, in-hospital mortality was primarily associated with the severity of liver disease and AKI, whereas incomplete renal recovery at hospital discharge was independently associated with pre-existing heart failure. Admission C-reactive protein was independently associated with both outcomes, supporting the role of systemic inflammation in determining short-term prognosis and suggesting that C-reactive protein may serve as a simple, readily available biomarker for early risk stratification.

Antimicrobial resistance (AMR) remains a public health problem in European Union countries, and elderly patients represent a vulnerable category due to aging and its associated risk factors. In this research, we investigated the trend of the antimicrobial resistance pattern of Gram-negative pathogens isolated in samples collected from elderly patients (over 65 years) hospitalized in the intensive care unit (ICU) between 2022 and 2024. A total of 2510 samples, including blood, tracheal aspirate, sputum, urine, pus/wound swabs, exudates, intravascular catheters, cerebrospinal fluid, and sterile fluids, were collected from 1864 elderly patients. Almost two-thirds of clinical specimens were harvested from the respiratory tract. The most frequently reported pathogens from 3094 Gram-negative bacterial isolates were Klebsiella spp., Acinetobacter spp., and Escherichia coli. During the studied period, almost 40% of all the Klebsiella spp. strains were multidrug-resistant (MDR)/extensively drug-resistant (XDR), with a significant increase in the resistance to cephalosporins (p ≤ 0.05), fluoroquinolones (p ≤ 0.05), and carbapenems (imipenem—(p ≤ 0.05), ertapenem—p < 0.001). The proportion of carbapenem-non susceptible Klebsiella spp. rose from 24.41% in 2023 to 32.48% in 2024, p = 0.01. Two-thirds of Acinetobacter spp. isolates were MDR/XDR, and over 80% were carbapenem-non-susceptible in 2023–2024. The results draw attention to the need to quickly adopt measures to reduce the prevalence, limit the transmission of MDR/XDR pathogens, and improve therapeutic protocols in this age category.

Worldwide, urinary tract infections (UTIs) have an increased incidence, especially in women. Recurrent UTIs (rUTIs) appear in less than three months in 80% of the cases, being associated with age, sexual activity, or diabetes mellitus. Antibiotics represent the first line of treatment for rUTIs after the diagnosis based on a positive mid-stream urine (MSU) culture. Alternative therapies including low-dose antibiotic treatment, immunoprophylaxis, cranberry extracts, probiotics, D-mannose, intravesical instillations, methenamine, and estrogens may reduce the recurrence of UTIs in female patients. Multimodal therapy seems to be the future in preventing and treating rUTIs. The main aim of this narrative review is to present the actual therapeutic challenges and the most efficient prophylaxis options in women diagnosed with rUTIs.

Background/Objectives: In this research, we aimed to analyze the trend of the antimicrobial resistance pattern of Gram-negative isolated in blood samples collected from patients with severe invasive infections hospitalized in the intensive care unit in selected periods during and after COVID-19. Methods: A retrospective study of bacterial pathogens was performed on 481 patients admitted to the ICU between 2020 and 2023. The resistance patterns were analyzed using the Vitek 2 Compact system. Results. A total of 686 Gram-negative bacterial isolates were obtained. The most frequently detected Gram-negative pathogens were Klebsiella spp. (30.91%), Acinetobacter spp. (24.64%), and Escherichia coli (18.95%). Almost 50% of all the pathogens were multidrug-resistant, with a statistically significant increase post-pandemic (p < 0.05). Post-pandemic, the study highlighted a significantly higher percentage of the Klebsiella strains (p < 0.05), and a significant increase in the antibiotic resistance rate against colistin (p < 0.001) and tigecycline (p = 0.005). A very high percentage of MDR Acinetobacter spp. isolates was found, with a significant increase in the antibiotic resistance rate against colistin (p < 0.001). A significantly lower resistance was recorded for the Escherichia coli strains in the case of ceftazidime (p = 0.03) and aminoglycosides (gentamicin—p = 0.01, amikacin—p < 0.001). An increase in the percentage of carbapenem-resistant Klebsiella spp., Acinetobacter spp., and Enterobacter spp. strains was observed, and a significant decrease in the in the case of Proteus spp. (p = 0.01). Conclusions: Our findings revealed a statistically significant increase in the resistance rate to last-line antibiotics and in the percentage of MDR Gram-negative strains isolated in the blood samples in the post-COVID-19 era.

Introduction: The objective of this study was to collect and analyze data on patient demographics, lifestyle, abdominal cavity characteristics, and their impact on intra-abdominal pressure before and after minimally invasive treatment of large parietal defects in hernia pathology. Additionally, the study examines the role of the CT scan as a reliable and valid measure of defect and muscle characteristics, which can help establish the indication for performing Transversus Abdominis Release (TAR) and evaluate the outcomes of this procedure along with differences in intra-abdominal pressure (IAP) and plateau pressure (Pplat). Methods: This prospective study involved 20 patients with parietal defects wider than 10 cm, treated over four years at the Central Military Hospital in Bucharest. All procedures were performed using the laparoscopic TAR technique by the same surgical team. Preoperative assessments included CT imaging to measure defect size, volumes, and IAP. Data including defect dimensions, muscle measurements, IAP, and Pplat were systematically recorded in a dedicated database with a follow-up at 6 months with clinical and imaging evaluations. Results: In our cohort of 20 patients, all female, the mean BMI was 26.81Ã+-3.05, and the hernia sac volume (HSV) averaged 159.01+-189.79 cm³. The defect area was 69.53 cm² (+-30.11). IAP decreased from 5 cmH2O (+-1.28) preoperatively to 1.91 cmH2O (+-1.93) postoperatively. The reduction in Pplat was similarly significant. Pressure variations were influenced by the topographic location of the defect, with higher pressures seen in epigastric defects, and by the characteristics of the peritoneo-fascial defects, including number, size, and localization, which affect pressure outcomes. Additionally, dimensions of the anterior-lateral abdominal muscles correlated with pressure changes. These findings highlight the importance of comprehensive preoperative assessment of defect characteristics, muscular anatomy, and defect location for predicting pressure reductions and guiding surgical planning. Conclusions: Higher BMI and large, multiple parietal defects predict increased IAP and Pplat postoperatively. Preoperative volumetric and morphometric parameters, defect localization, and topographic characteristics significantly influence pressure outcomes. The TAR technique effectively manages large defects while minimizing pressure increases, but consideration of morphological factors is crucial for optimal results. Further research is needed to refine patient selection and surgical strategies.