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Background. Severe immunosuppression caused by various types of surgical procedures, such as ureteral catheterization, can increase the risk of tuberculosis (TB) reactivation and can be involved in the appereance of disseminated TB (1). Pseudomonas aeruginosa is the third most common organism, after Escherichia coli and Proteus mirabilis, isolated from patients with urinary tract infections in the hospital setting. Despite the progress made in the research field of antibiotics, mortality and morbidity associated with this etiology are still increased (2). Miliary TB is a form of disseminated TB that can be fatal in the absence of an early diagnosis and treatment. This form of disease mainly affects young immunosuppressed patients, and has a higher prevalence in women (1,3). Materials and methods. We present the case of a 25 year-old female, who was admitted at Victor Babes Clinical Hospital for Infectious and Tropical Diseases for a postdiscectomy tuberculous spondylodiscitis (T11- T12). The hospital admission was for two reasons: to treat the post surgery wounds super infected with methicilin-resistant Staphylococcus aureus and Pseudomonas aeruginosa and secondly, to obtain a bacteriological confirmation for the tuberculous spondylodiscitis (at T11-T12) in order to start an anti-tuberculous drug regimen. Results. After the diagnosis and treatment initiation with meropenem, colistin, vancomycin and anti-tuberculous drugs the outcome of the patient was favorable. The clinical, bacteriological and radiological parameters normalized after one month of therapy. Conclusions. When a infection is bacteriologically confirmed, early antibiotic susceptibility testing and treatment are essential for the prevention of serious local and systemic complications associated with surgical procedures.

Introducere. Imunodepresia severă, apărută în contextul unor multiple intervenţii chirurgicale şi proceduri precum cateterizarea ureterală, poate favoriza reactivarea infecţiei tuberculoase şi apariţia unor forme diseminate ale acesteia (1). Pseudomonas aeruginosa este a treia cea mai frecventă bacterie gram negativă, după Escherichia coli şi Proteus mirabilis, ce determină infecţii urinare asociate îngrijirilor medicale. Morbiditatea şi mortalitatea asociate acestei etiologii rămân crescute, în pofida descoperirilor în domeniul terapiei antimicrobiene (2). Tuberculoza miliară reprezintă o formă diseminată a bolii, fatală în lipsa unui diagnostic şi a unui tratament precoce. Această formă afectează predominant adolescenţii şi adulţii tineri, cu preponderenţă sexul feminin (1,3). Materiale şi metode. Prezentăm cazul unei paciente în vârstă de 25 de ani, care se internează în Spitalul de Boli Infecţioase şi Tropicale „Dr. Victor Babeş“ pentru osteodiscită tuberculoasă la nivel T11-T12, operată şi confirmată bacteriologic, asociată cu tuberculoză miliară, precum şi pentru sterilizarea plăgilor postchirurgicale infectate cu Pseudomonas aeruginosa multirezistent şi Staphilococcus aureus meticilino-rezistent. Rezultate. În urma administrării unei combinaţii de antibiotice cu meronem, colistin şi vancomicină şi a medicaţiei antituberculoase, pacienta a avut o evoluţie favorabilă din punct de vedere clinic, paraclinic, bacteriologic şi radiologic. Concluzii. Efectuarea precoce a culturilor din prelevatele biologice intraoperatorii şi din secreţiile plăgilor postoperatorii, dar şi administrarea precoce a terapiei antibiotice asociate, empiric sau conform antibiogramei, atunci când există culturi pozitive, sunt esenţiale în prevenirea complicaţiilor locale şi sistemice asociate intervenţiilor chirurgicale.

Objective. Analyzing the dynamycs of global antibiotic resistance of some bacterial species isolated from patients admitted to the „Dr. V. Babes” Hospital for Infectious and Tropical Diseases, between the years 2000 to 2015. Material and methods. Antibiotic resistance profiles of bacteria isolated from inpatients, were identified by the standard diffusion method and MIC values by VITEK2C and E-test methods. (CLSI and EUCAST standards). Screening of carbapenemases – producing isolates were performed by phenotipic methods, and the confirmation by RealTimePCR: “MasterPure™ Complete DNA and RNA Purification Kit” (Epicentre), „Primer Design™ Kit” (blaOXA48; blaKPC, blaNDM, blaVIM)/ LightScanner 32 Instrument/LS32 (Idaho Technology), and GeneXpert. Internal quality control: Staphylococcus aureus ATCC29213, Streptococcus pneumoniae ATCC49619, E. coli ATCC25922, Pseudomonas aeruginosa ATCC27853. Results. The incidence of St. aureus meticilino-rezistent (MRSA) highlights an increase from 12.2% (2002) to 40.4% (2015). In the past 3 years SVB microbiology lab found a sharp increase in the incidence of erytromycin resistant strains of Streptococcus pyogenes. In 2015 we registered 20.3% of macrolide resistant strains. Global resistance to penicillin G for Str. pneumoniae (non-meningeal infections) was 45.3%- 54.5% until 2009, and 2.7% in 2013. Enterococcus faecium strains showed 0% resistance to vancomycin between 2000 and 2012. A significant growth was recorded in 2015 of 11%. Isolation rate of Klebsiella pneumoniae ESBL producing strains has increasewd progressively from 17.6 in 2000 to 57% in 2015. Carbapenems – resistant K. pneumoniae isolated strains were 18,8% in 2015. Carbapenemases types identified by phenotypic and genetic methods where: 35/ Oxa48, 8 KPC and 21/MBL (NDM-1). Resistance to carbapenems recorded an upward trend: 23.9% in 2004 to 37.9% in 2015, and for Acinetobacter baumannii 69%. Conclusions. Antibiotic resistance of bacteria is a major challenge for public healts. Therapeutic solutions are extremely limited.