Background: Clostridioides difficile infection (CDI) in liver transplant (LT) recipients often occurs during complex postoperative care. We compared clinical characteristics and total hospital length of stay (LOS) between LT-CDI and non-LT CDI records. Materials and Methods: We analyzed 562 CDI-associated hospital records from 2014 to 2024 (35 LT-CDI; 527 non-LT CDI). The primary endpoint was total hospital LOS; LOS > 30 days was the main secondary endpoint, and >60 and >90 days were post hoc exploratory thresholds for very prolonged stays. LOS was available in 35 LT-CDI and 521 non-LT records. Results: Median LOS was 59 versus 20 days. The crude median difference was 39.0 days (95% CI, 7.0 to 64.0), and the care/antimicrobial-adjusted difference was 28.5 days (95% CI, 0.5 to 50.3). Median LT-to-CDI time was 13 days [IQR, 7 to 36; n = 34]; in 25/35 records (71.4%), infection occurred within 30 days. The adjusted RR for LOS > 30 days was 1.15 (95% CI, 0.85 to 1.55); exploratory RRs were 2.33 (95% CI, 1.45 to 3.73) for >60 days and 2.28 (95% CI, 1.11 to 4.67) for >90 days. Conclusions: LT-CDI records had longer total LOS, clustered early after transplantation, and had a clinically complex course. These findings provide a same-center benchmark for overall hospitalization burden among CDI records by transplant status; estimating CDI-attributable LOS would require an LT group without CDI.
Background: Candida species are among the most frequently isolated fungi from respiratory specimens in hospitalised patients, yet the clinical significance of their presence—infection versus colonisation, treatment versus observation—remains an unresolved challenge in clinical microbiology. Data from dedicated pulmonology centres in Eastern Europe are scarce. This study aimed to characterise the three-year epidemiology, species distribution, temporal trends, colony-load profiles, and longitudinal mycological trajectories of fungal respiratory isolates at a Romanian tertiary pulmonology hospital. Methods: We retrospectively analysed 1000 microbiological records from bronchial aspirates and other respiratory specimens collected between January 2022 and December 2024. Variables included patient demographics, clinical ward, primary diagnosis, fungal species, and semi-quantitative colony counts. Patients with multiple records were identified and analysed as a longitudinal sub-cohort. Results: Candida albicans predominated (45.5%), with a declining proportional trend across the study period. Candida krusei—intrinsically resistant to fluconazole—increased from 5.3% of isolates in 2022 to 9.7% in 2024. The intensive care unit (ICU) accounted for 25.8% of all records. Patients were predominantly male (67.5%) with a mean age of 63.4 years; acute respiratory failure was the most frequent underlying diagnosis (41.7%). High-load colonisation (>100 colony-forming units/mL) was documented in 19.0% of quantified specimens. Among 91 patients with serial cultures, 26 demonstrated inter-sample species shifts—several consistent with antifungal selection pressure—and 29 showed escalating colony loads, suggesting progression from colonisation toward probable infection. Conclusions: In a clinical setting where fluconazole has historically served as the default empirical antifungal agent, a C. krusei proportion approaching 10% of annual isolates constitutes a clinically actionable finding. Species-level identification of all fungal respiratory isolates is strongly warranted, as it directly influences therapeutic decision-making in approximately one in ten cases.
Background: Human brucellosis remains an important One Health problem, yet no vaccine is licensed for human use despite decades of antigen discovery and experimental vaccine development. This review examines why promising Brucella vaccine candidates have not progressed toward human application, with particular attention to the relationship between immune-evasion mechanisms, experimental evidence of protection, and the barriers that arise during translation. Methods: A critical narrative review of peer-reviewed literature on Brucella immunopathogenesis, immune evasion, protective immunity, antigen discovery, vaccine platforms, and human translational requirements was conducted. The evidence was interpreted according to experimental maturity, distinguishing computational or hypothesis-generating studies, mechanistic in vitro or ex vivo evidence, animal immunogenicity studies without challenge, and challenge-supported protection. Additional consideration was given to safety, durability, cross-species protection, model relevance, manufacturing, and regulatory requirements. Results: Brucella uses multiple mechanisms to limit innate recognition, alter intracellular trafficking and antigen presentation, and modulate host immune responses. These mechanisms provide a biological rationale for mechanism-informed vaccine design, but direct evidence that individual vaccine strategies overcome specific immune-evasion pathways remains limited. Across the vaccine literature, many candidates remain at the computational, antigen-production, or immunogenicity stages, whereas fewer have demonstrated protection after experimental challenge. Even challenge-supported candidates rarely address durability, cross-species breadth, human-relevant correlates of protection, extended safety, reproducible manufacturing, or readiness for clinical development. Conclusions: The absence of a licensed human brucellosis vaccine is better explained by attrition across successive stages of development than by a shortage of candidate antigens or vaccine platforms. Progress is likely to depend on advancing fewer, better-supported candidates through an integrated evidence pathway that links mechanistic rationale and challenge protection with durability, safety, species breadth, product quality, and human clinical relevance.
Introduction: Improving adult pneumococcal vaccination is a public-health priority in Romania, and evidence regarding patient-level outcomes following different approaches to physician training remains limited. Materials and methods: This non-randomised, multicentre, quasi-experimental implementation study examined patient-level changes across three geographically distinct Romanian settings between August and November 2025. Physicians in Iași and Dolj counties received in-person training combining medical content with communication techniques based on motivational interviewing, whereas physicians in the webinar group received online medical training without a dedicated communication module. Eligible adult patients completed questionnaires before and after counselling and reported whether they had been vaccinated or had scheduled a vaccination appointment. Results: The analysis included 295 questionnaire pairs from patients nested within 29 physicians. Baseline attitudes differed markedly across settings (composite score of 5.64 in the webinar group, 5.29 in Dolj County, and 4.09 in Iași County; p < 0.001), as did strong baseline vaccination intention (75.6%, 48.1%, and 27.2%, respectively). Using a composite score comprising all seven attitude items, with item 7 reverse-coded and vaccination intention analysed separately, the cluster-robust group-by-time model indicated different mean changes between settings (global p = 0.001): +0.28 in the webinar group, +1.02 in Iași, and +0.60 in Dolj. Strong vaccination intention increased within each setting, but the magnitude of change did not differ between settings (group-by-time p = 0.929). The combined self-reported vaccination-or-scheduling outcome was observed in 81.5% of patients in the webinar group, 49.4% in Iași, and 73.3% in Dolj; after adjustment for baseline intention, there was no longer evidence of an overall group difference (p = 0.651). Discussion and conclusions: Because training approach, delivery modality, geographical setting, physician cohort, and patient population were not independently allocated, and because baseline levels differed markedly between settings, the findings should be interpreted as exploratory implementation patterns rather than causal comparative effects.
Introduction: Syphilis is a preventable sexually transmitted infection (STI) with severe health outcomes, yet it is not included in Saudi Arabia's national premarital and antenatal STI screening programs. This study assessed knowledge, attitudes, and practices (KAP) toward syphilis in Saudi Arabia and identified predictors of acceptance for including syphilis testing in such programs. Methods: A cross-sectional online survey was conducted among 935 participants aged >= 20 years. Data included sociodemographic characteristics and measures of KAP and screening acceptance. Continuous variables were summarized as medians (IQR) and categorical variables as frequencies and percentages, with bivariate and multivariate logistic regression used to identify predictors of screening acceptance. Results: Knowledge and preventive practices were low, while attitudes were predominantly neutral (median attitude score: 34 IQR 32-38). Although intentions for personal testing were low (17%), support for syphilis testing in premarital (60.8%) and antenatal (48.9%) programs was considerable. Employment in the health sector, older age, and positive attitudes predicted acceptance of screening policies. Knowledge and practice showed a weak correlation (r = 0.14), whereas knowledge and attitude were moderately correlated (r = 0.55). Conclusion: KAP toward syphilis is influenced by specific sociodemographic factors. Although acceptance of screening is high at the policy level, individual-level preventive behaviors remain low.
