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BackgroundNew Delhi metallo-beta-lactamase (NDM)-producing Providencia stuartii has been reported from European Union/European Economic Area (EU/EEA) countries with increasing frequency. During 2018 to 2022, 355 cases of NDM-producing P. stuartii were detected in seven hospitals reporting on NDM-production in Enterobacterales in Romania.AimOur aim was to determine the extent of spread of NDM-producing P. stuartii in hospitals in Romania.MethodsWe analysed whole genome sequences and epidemiological data of 74 P. stuartii isolates collected in six hospitals from December 2021 to September 2023.ResultsWe identified four multi-hospital clusters including isolates detected over more than a year, indicating sustained spread of bla NDM-1 -carrying P. stuartii within the healthcare system. These clusters consisted of isolates from up to four hospitals and three regions. Three multi-hospital clusters were caused by a specific multidrug-resistant P. stuartii sequence type 46 lineage carrying bla NDM-1 and a large set of additional resistance markers. Investigation in an international context showed that this lineage had already been detected in nine countries (Bulgaria, France, Germany, Ireland, the Netherlands, Romania, Switzerland, United Kingdom, United States) since 2015.ConclusionOur results alert about the risk of carbapenem-resistant P. stuartii transmission in healthcare settings. Enhanced infection prevention and control measures should be instituted as soon as cases are detected in healthcare facilities. National surveillance systems in EU/EEA countries should, in addition to carbapenem-resistant and/or carbapenemase-producing Klebsiella pneumoniae and Escherichia coli , consider reporting carbapenem-resistant and/or carbapenemase-producing P. stuartii and other Enterobacterales where relevant.

Dysbiosis is a condition that can cause various clinical disorders, from gastrointestinal problems to allergies or even cancer. Resetting the microbiota using antibiotics and/or probiotics could be a possible therapy for many diseases. The aim of this study was to evaluate the effects of three treatment regimens in patients with irritable bowel syndrome (IBS). The regimens were short-term rifaximin treatment (10 days) followed by either a nutraceutical agent (G1) or a low- Fermentable, Oligo-, Di-, Monosaccharide and Polyol (FODMAP) diet (24 days) (G3) or treatment with MegaSporeBiotic a mixture of spores of five Bacillus spp. for medium-term (34 days) (G2). Ninety patients with IBS without constipation were enrolled and divided into three groups (G1, G2, G3). Patients in G1 and G3 were evaluated over four visits (baseline/first day (V1), 10 days (V2), 34 days (V3), 60 days (V4)), and, those in G2 over three visits (V1, V3, V4). Severity score, quality of life, and parameters from the rectal volume sensation test were determined. The results demonstrated that patients treated with MegaSporeBiotic, compared with those treated with rifaximin followed by nutraceutical or low-FODMAP diet, had similar severity scores and rectal volume sensation test results for all parameters tested and statistically significant improvement in measurements of quality of life., Competing Interests: The authors declare no conflict of interest.

This study presents the first characterization of carbapenem-non-susceptible Klebsiella pneumoniae isolates by means of a structured six-month survey performed in Romania as part of an Europe-wide investigation. Klebsiella pneumoniae clinical isolates from different anatomical sites were tested for antibiotic susceptibility by phenotypic methods and confirmed by PCR for the presence of four carbapenemase genes. Genome macrorestriction fingerprinting with XbaI was used to analyze the relatedness of carbapenemase-producing Klebsiella pneumoniae isolates collected from eight hospitals. Among 75 non-susceptible isolates, 65 were carbapenemase producers. The most frequently identified genotype was OXA-48 (n = 51 isolates), eight isolates were positive for blaNDM-1 gene, four had the blaKPC-2 gene, whereas two were positive for blaVIM-1. The analysis of PFGE profiles of OXA-48 and NDM-1 producing K. pneumoniae suggests inter-hospitals and regional transmission of epidemic clones. This study presents the first description of K. pneumoniae strains harbouring blaKPC-2 and blaVIM-1 genes in Romania. The results of this study highlight the urgent need for the strengthening of hospital infection control measures in Romania in order to curb the further spread of the antibiotic resistance.

Chronic wounds represent an important burden on the healthcare system, requiring frequent hospitalizations and expensive treatments. It is now recognized that a primary factor contributing to a non-healing trajectory and a low therapeutic response is the biofilm infection. The purpose of this study was to identify the bacterial isolates collected from chronic skin wounds of hospitalized patients and to evaluate their antimicrobial susceptibility profiles, virulence factors, as well as the ability to develop biofilms in vitro. A number of 44 wound samples were collected from 39 patients. The isolated strains belonged to seven different microbial species, i.e.: Staphylococcus aureus (32 strains), followed by Pseudomonas aeruginosa (4), Escherichia coli (3), Klebsiella pneumoniae (2), Proteus mirabilis (1), Citrobacter freundii (1), group G β-hemolytic streptococci (1). In comparison to the other isolates, P. aeruginosa strains exhibited the highest capacity to develop complex biofilm structures in vitro, followed by S. aureus, with insignificant differences between MRSA and non-methicillin resistant isolates. The Enterobacteriaceae strains expressed less virulent phenotypes, lower adherence to epithelial cells and biofilm forming capacity, but also significant resistance phenotypes with a potential of unfavorable epidemiological outcome. The isolation of MRSA, ESBL-producing microorganisms and multiple antibiotic resistant P. aeruginosa suggests the potential risk of nosocomial spread and the potential severe outcome in case of bacteremia and sepsis. This study represents an important step in elucidating the host-wound microbiome interaction, by describing various resistance and virulence threats of microorganisms colonizing and/or infecting the chronic wounds. However, in order to establish a statistical relevant correlation, larger studies are needed.