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Knowing the bacterial strains in the intensive care unit (ICU) is important for reducing the rate of bacterial transmission and the risk of healthcare-associated infections (HAIs), allowing for targeted interventions to reduce the risk of death by HAIs. We performed a retrospective case-control study in a single center that included 320 bacteriologically screened patients from the ICU of the Infectious Diseases Hospital in Constanta between September 2017 and March 2020. Sixty-five secondary bacterial infections were identified as the cause of hospital admission and 60 bacterial colonizations. There were 20 cases and 300 controls for the mortality rate and risk factors for death. Multivariate analysis identified that hospitalization of patients for HIV infection (OR 11.82, 95% CI: 1.69-83.62, P ≤0.05) and Clostridioides difficile infection (OR 7.38, 95% CI: 1.39 -39.22, P ≤ 0.05) were independent risk factors associated with death. We observed that the number of colonizations or secondary infections in the ICU was similar, and the mortality rate in the ICU was influenced by HIV infection or Clostridioides difficile infection.

The pandemic with the new coronavirus – SARS-CoV-2 – has caused extraordinary changes in our way of life. Infection with this virus has caused a huge number of diseases worldwide. After healing from this infection, many patients continued to show symptoms at a distance after the infection itself. SARS-CoV-2 virus infection is mainly manifested by symptoms related to the lower respiratory tract, such as fever, cough, dyspnea and chest pressure, which could rapidly evolve to acute respiratory distress syndrome (SARS). However, COVID-19 also causes various symptoms related to the upper respiratory tract, including nasal congestion, neck pain and olfactory dysfunction. We aim to review, analyze and compare small-looking research studies. Studies show what the changes in ENT are in COVID-19 pandemic disease, how these symptoms influence the course of the disease and how much immunodepressed the patient this virus.it is found that this virus leaves a very precarious immune system and leaves serious consequences in terms of activating some pathologies and symptoms. We also intend to present an atypical case of a patient infected with the SARS-CoV-2 virus that showed a multitude of ENT manifestations both during the acute state and after healing.

People living with HIV infection are at high risk for cardiovascular events due to inflammation and atherosclerosis. Also, some antiretroviral therapies may contribute to the risk of cardiovascular complications. Immune status is highly dependent on the level of lymphocyte T helper CD4+. There are data suggesting that immune status and CD4+ cell count may be involved in the development of cardiovascular complications in these patients. Our study is longitudinal and retrospective and included a total number of 50 patients with HIV infection associated with acute coronary syndrome, divided into two subgroups based on the nadir of CD4+ cells. This study analyzes the relationship between the immune status of HIV patients, assessed by the nadir of the CD4+ T-cell count, and the outcome of these patients. Also, secondary endpoints were the assessment of the magnitude of coronary lesions and of thrombotic and bleeding risk assessed by specific scores. Clinical and biological parameters and also the extension and complexity of coronary lesions were assessed. Although patients with poor immune status had more complex coronary lesions and increased operative risk and bleeding risk at one year, this was not associated with significant differences in major adverse cardiac and cerebrovascular events at the 30-day and 1-year outcomes.

People living with human immunodeficiency virus have increased cardiovascular risk due to a higher prevalence of traditional and particular risk factors such as chronic inflammation, immune dysregulation, endothelial dysfunction, coagulation abnormalities and antiretroviral therapy. In developed countries, coronary artery disease has become the most frequent cardiovascular disease and an important cause of mortality in these patients. The symptomatology of an acute coronary syndrome can be atypical, and the prevalence of each type of acute coronary syndrome is reported differently. Regarding coronary artery disease severity in people living with HIV, the literature data indicates that the presence of single-vessel disease is akin to that of HIV-negative patients, and their short-term prognosis is unclear. This study aims to assess the clinical characteristics, biological parameters, angiographical features and short-term prognosis of acute coronary syndrome in a cohort of Romanian people living with human immunodeficiency virus.

People living with human immunodeficiency virus have an increased cardiovascular risk due to higher prevalence of traditional risk factors, such as smoking, dyslipidemia, hypertension, diabetes, or obesity, and particular risk factors, such as inflammation, endothelial dysfunction, and antiretroviral therapy. Thus, people living with human immunodeficiency virus can develop accelerated atherosclerosis. The incidence of coronary artery disease in these patients may be twice as high compared with that of HIV-negative individuals with similar characteristics. “Porcelain aorta” is a term used to describe extensive circumferential calcification of the thoracic aorta. The pathophysiology of porcelain aorta is not fully understood. We present a case of a young man who was a smoker and living with HIV since childhood, without other traditional cardiovascular risk factors, who presented to the emergency room with a positive stress test for myocardial ischemia. Transthoracic echocardiography revealed normal regional and global myocardial wall motion, ascending aorta ectasia, and moderate aortic regurgitation. Coronary angiography showed a critical calcified proximal left anterior descending artery stenosis and an important calcification of the thoracic aorta. Therefore, the most important challenge was the management of coronary syndrome in a young person living with HIV, with associated porcelain aorta and aortic regurgitation.

Clostridium difficile infection (CDI) associates in the spectrum of comorbidities, more and more often, chronic toxic metabolic or viral hepatic diseases. Patients with chronic hepatic diseases have more severe episodes of CDI with poorer prognosis than episodes of CDI that have occurred in patients with other comorbidities. The measures of prophylaxis and treatment of CDI in these patients require particularizations according to the risk factors and the clinical-evolutionary specificity of these patients. The present study aims to identify the main risk factors of these patients for CDI, as well as to evaluate the severity of the episodes of CDI, the rate of recurrence and death in these patients, compared to those without liver disease.

The infection with Clostridium difficile (CDI) is a cause of acute gastroenteritis (AGE), which is likely to severely develop into pseudomembranouse colitis (PMC), ileus and toxic megacolon. At the begining, CDI was considered a nosocomial infection, later proven to be communitary-acquired infections. The susceptibility for CDI is related to the alteration in intestinal microbiota after antibiotics or immunosuppressant treatments, postoperative disruption of mucosal barriers, trauma, tumour proliferation, ischemia or necrosis, as well as in other conditions caused by aging, alcoholism, diabetes, neoplasias, immunosuppression, angiopathies. Concern regarding the outbreak of new CDI-epidemics is still high, due to genetic and bacterial variability and spores resistance in outer environment. The diagnosis of CDI is a continuous challenge for clinicians, based on the correlation between clinical, epidemiological data and complex laboratory investigations.

Objective. To determine the prevalence of acquired drug resistance (ADR) and of resistance patterns in treatment-experienced HIV infected patients from Constanta in order to establish the best therapeutic options in NRTI class. Material and methods. A retrospective study which included 144 treatment-experienced HIV patients with confirmed viral failure. The strains isolated from these patients were analysed in the Molecular Genetic Laboratory of „Matei Bals“ National Institute of Infectious Diseases, Bucharest and the resulting sequences were saved in FASTA format. The HIV-1 subtyping was based on „REGA HIV01&2 Automated subtyping tool version 2.0“ algorithm. „Stanford HIVdb Program version 8.4“ was used in order to determine the therapeutic options. For statistical calculations, the R-Project software was used. Graphic representations were performed using GNUPLOT program. Results. The prevalence of the acquired drug resistance was 92.36%. The most frequent mutation occurred at the level of the codon 184. The TAM-2 path was more frequently selected compared to TAM-1. Association between TAM1 and TAM 2 were also found, mutation K65R being rarely met. Conclusions. The prevalence of the acquired drug resistance in our study was high, The most valuable therapeutic option in the INRT class remains tenofovir, due to the mutational profile, which was selected on account of the extensive use of thymidine analogues.

Our study included 505 children hospitalized in the Clinical Hospital of Infectious Diseases Constanta in 2011-2012 with gastroenteritis with rotavirus. We analyzed the medical records of the patients and extracted demographic data, temperature, and frequency of vomiting and diarrheic stools. We divided the group of cases into 4 groups associated with: respiratory disease (RD) – 160 cases, digestive disease (DD) – 52 cases, eruptive disease (ED) – 11 cases, and a group without other associated diseases (simple) – 282 cases. We found significant differences between the four groups regarding the number of stools, the number of vomiting per day, the mean value of maximum temperature, the mean value of hospitalization.

The pathophysiology of accelerated atherosclerosis in people living with Human Immunofediciency virus (HIV) is complex. Coronary artery disease (CAD) has become an important cause of mortality in these patients. They often have atypical symptoms, leading to frequently missed diagnoses. We report a case of a 51-year-old male undergoing antiretroviral therapy who was admitted for acute coronary syndrome. He had severe coronary artery disease that involved difficult management.

Infections with carbapenem-resistant Enterobacteriaceae are emerging as an important challenge in healthcare settings. Currently, carbapenem-resistant Klebsiella pneumoniae (CRKP) are the species of CRE most commonly encountered in hospitals. CRKP is resistant to almost all available antimicrobial agents, and infections with CRKP have been associated with high rates of morbidity and mortality, particularly among persons with prolonged hospitalization exposed to invasive devices. We report nine patients hospitalized in an intensive care unit (ICU) with severe coronavirus disease 2019 (COVID-19) who developed invasive infections due to carbapenemase-producing Klebsiella pneumoniae (CP-Kp), KPC and OXA-48, strains that have not been previously identified in our hospital. Despite ceftazidime/avibactam therapy, five patients died. Coinfections can contribute to a poor prognosis for patients with COVID-19, especially for high-risk populations such as elderly patients. Therefore, it is crucial to establish a rigorous program of antibiotic administration in intensive care units.

Under conditions of increased consumption of antibiotics, pseudomembranous colitis has become a common condition in Romanian hospitals. Severe forms of the disease are becoming more common, recurrences are numerous, and metronidazole and vancomycin therapy has failed to prevent these recurrences. The study aims to identify the characteristics of patients who require a fecal transplant, the time for its performance and what are the short-term and possibly long-term consequences of this method. We analyzed 26 patients who had a fecal transplant with a favorable evolution in 96%. We consider that FMT is an effective method for preventing recurrent CDI but also for those with resistance to the usual antibiotics. [ABSTRACT FROM AUTHOR]

Abstract: This paper shows the results of a retrospective observational analytical study that has enrolled 166 HIV positive patients diagnosed with a neurological complication between June 2012 and June 2020, in Clinical Infectious Diseases Hospital of Constanta. 119 patients (71,69%) were diagnosed with one of the three neurological complications: HIV associated dementia (HAD), Progressive Multifocal Leukoencephalopathy (PML) and CNS Toxoplasmosis (CT). We have noted CD4 levels, viral loads, and the presence/absence of other infections like: HBV, HCV, Treponema pallidum, Mycobacterium Tuberculosis. The results show that PML and CT, in this order, are the main opportunistic infections with important neurological impact. Both, PML and CT are in direct correlation with the immune status, but also with other infections like the infection with HCV or with M. Tuberculosis. CD4 nadir <100 cells/mmc and viral load ≥100000copies/ml have a stronger association with PML (p<0,05). Patients known with HIV and T. pallidum infection are more likely, in case of new sudden neurological signs, to be diagnosed with Neurotoxoplasmosis versus PML, or HAD (p<0,05). Given the fact that HIV patients can have multiple alterations of neurological functions, and spectaculous but complicated neuro imagistic results, knowing the history of the patients, the lab results, and the statistical probability can help the physician, infectious disease specialist or neurologist, to make a faster and precise diagnosis. [ABSTRACT FROM AUTHOR]

In order to control and end the AIDS epidemic, we all need to hit the 0-0-0 target. That means 0 HIV infections, 0 mortality caused by AIDS and 0 discrimination. We performed a retrospective observational analytical study on 166 HIV positive patients with a neurological complication, diagnosed between June 2012 and June 2020, in Clinical Infectious Diseases Hospital of Constanta. We collected data from the observational charts that revealed if the patient was known with HIV infection at the time of the neurological complication diagnosis, information about the treatment (how many treatment regimens, classes of antiretroviral drugs, CNS Penetration-Effectiveness Rank), treatment compliance. The patients were divided into two groups: first group "opportunistic infections (OI)" and second group "other neurological conditions (ONC)". 16 patients (9,6%) have the neurological condition as first manifestation of HIV infection. Opportunistic infections, correlated with a poor immunological status continue to have a high percentage (46,98%) of neurological complications, being associated with a poor treatment compliance (p<0,001). Integrase inhibitors were associated, in this study, more with opportunistic infections and less with other neurological conditions (OR=2,885; 95% IC), this finding needs further research. Long term survivors have problems with treatment compliance manifesting treatment fatigue, even if they have treatment regimens with good CNS penetrability. Poor compliance is associated with high risk of opportunistic infections and opportunistic infections have a higher mortality than other neurological complications. Our task for the future is to find ways to improve treatment adherence in order for HIV patients to have a better and longer life. [ABSTRACT FROM AUTHOR]

The objectives of the study were to determine the efficacy of pegylated interferon alfa 2 b (PegINF) and ribavirin (RBV) treatment in co-infected HIV / HCV patients, to identify predictive factors associated with sustained viral response (SVR) in these patients. Out of the 956 HIV infected patients, 38 were HCVAb (4%) positive, 14 of which had undetectable HCV RNA, only 6 patients met the inclusion criteria. Screening failure was due to: liver cirrhosis Child Pugh B / C, hepatocellular carcinoma, pulmonary TB, thyroid dysfunction, CD4 <200 cells/mm3, detectable HIV RNA and depressive syndrome. We initiated PegINF and RBV therapy for 48 weeks. SVR was achieved in 16.6% of cases (only one patient) and correlated with HCV RNA level, CD4 count, duration of HIV infection, CDC classification and liver fibrosis. In conclusion, our study group has a low prevalence of HIV / HCV co-infection (2.6%) with a large number of patients HCVAb positive but undetectable HCV RNA. Positive predictive factors for SVR were: low levels of HCV RNA, small duration of HIV infection, high levels of CD4, B1/B2 (CDC classification) and low degree of fibrosis. [ABSTRACT FROM AUTHOR]

Purpose: Treatment-related toxicities frequently limit antiretroviral therapy for patients with HIV-1 infection. This study evaluated the changes in treatment-limiting toxicities when the primary toxicity-causing agent was replaced with enfuvirtide. Method: Adult patients with HIV-1 infection (N = 91) with antiretroviral treatment-limiting toxicities were enrolled in this multicenter, open-label, single-arm, 24-week study. Enfuvirtide 90 mg bid was administered instead of a single toxicity-causing component of the previous antiretroviral regimen. Changes in severity of antiretroviral toxicity, safety, tolerability, and maintenance of efficacy of the enfuvirtide regimen were evaluated at baseline and at 4, 8, 12, and 24 weeks. Results: Eighty-four percent of participants completed the study. Injection site reactions with enfuvirtide caused premature withdrawal in 5 participants (5%); a further 10 participants (11%) also withdrew early. Overall antiretroviral-related, treatment-limiting toxicities improved or resolved in 53% of participants switching to enfuvirtide, remained unchanged in 43%, and worsened in 3%. At Week 24, 66% of participants (60/91; intent-to-treat population) maintained or improved their viral load category and 73% of participants (66/91) maintained or improved their CD4 cell counts. Conclusion: Replacing a toxicity-causing antiretroviral with enfuvirtide may reduce toxicity without compromising the efficacy of different antiretroviral regimens. [ABSTRACT FROM AUTHOR]