Clostridioides difficile infection (CDI), though identified nearly five decades ago, still remains a major challenge, being associated with significant mortality rates. The strains classified as hypervirulent, notably 027/NAP1/BI, have garnered substantial attention from researchers and clinicians due to their direct correlation with the severity of the disease. Our study aims to elucidate the significance of toxigenic Clostridioides difficile (CD) strains in the clinical and therapeutic aspects of managing patients diagnosed with CDI. We conducted a single-center prospective study, including patients with CDI from north-eastern Romania. We subsequently conducted molecular biology testing to ascertain the prevalence of the presumptive 027/NAP1/BI strain within aforementioned geographic region. The patients were systematically compared and assessed both clinically and biologically, employing standardized and comparative methodologies. The study enrolled fifty patients with CDI admitted between January 2020 and June 2020. Among the investigated patients, 43 (86%) exhibited infection with toxigenic CD strains positive for toxin B genes (tcdB), binary toxin genes (cdtA and cdtB), and deletion 117 in regulatory genes (tcdC), while the remaining 7 (14%) tested negative for binary toxin genes (cdtA and cdtB) and deletion 117 in tcdC. The presence of the presumptive 027/NAP1/BI strains was linked to a higher recurrence rate (35.56%, p = 0.025), cardiovascular comorbidities (65.1% vs. 14.2%, p = 0.016), and vancomycin treatment (55.8% vs. 14.3%, p = 0.049). The findings of our investigation revealed an elevated incidence of colitis attributed to presumptive 027/NAP1/BI. Despite the prevalence of the presumptive 027 strain and its associated heightened inflammation among the patients studied, no significant differences were observed regarding the clinical course or mortality outcomes.

Introduction: Antimicrobial resistance (AMR) is currently a growing concern among healthcare providers, underscoring the importance of describing the regional susceptibility profile for common microorganisms that are associated with urinary tract infections (UTIs). This knowledge serves as the foundation for proper empirical therapeutic recommendations tailored to local susceptibility patterns. Results: We found a high prevalence of ESBL-producing strains (36.9%), with Escherichia coli and Klebsiella spp. being the most prevalent isolated bacteria. Among the catheterized patients, Klebsiella spp. emerged as the primary etiology, with a significant correlation between catheterization and Proteus spp. (p = 0.02) and Providencia stuartii (p < 0.0001). We observed significant correlations between urinary catheterization and older age (68.9 ± 13.7 years vs. 64.2 ± 18.1 years in non-catheterized patients, p = 0.026) and with the presence of an isolate with extensive drug resistance (p < 0.0001) or even pandrug resistance (p < 0.0001). Susceptibility rates significantly decreased for almost all the tested antibiotics during the study period. Notably, susceptibility was markedly lower among catheterized patients, with the most pronounced differences observed for carbapenems (59.6% versus 83.4%, p < 0.0001) and aminoglycosides (37.1% versus 46.9%, p = 0.0001). Materials and Methods: We conducted a retrospective study analyzing the susceptibility profiles of 724 extended-spectrum beta-lactamases (ESBL)-producing Enterobacterales isolated from urine cultures. Our focus was on highlighting susceptibility profiles among isolates associated with urinary catheterization and assessing the shifts in the susceptibility rates over time. Conclusions: The constant rise in AMR rates among Enterobacterales presents significant challenges in treating severe infections, particularly among urinary catheterized patients. This trend leaves clinicians with limited or no effective treatment options. Consequently, the development and implementation of personalized treatment protocols are imperative to ensure efficient empirical therapies.

IL-6 remains a key molecule of the cytokine storms characterizing COVID-19, exerting both proinflammatory and anti-inflammatory effects. Emerging research underscores the significance of IL-6 trans-signaling over classical signaling pathways, which has shifted the focus of therapeutic strategies. Additionally, the synergistic action of TNF-α and IFN-γ has been found to induce inflammatory cell death through PANoptosis, further amplifying the severity of cytokine storms. Long COVID-19 patients, as well as those with cytokine storms triggered by other conditions, exhibit distinct laboratory profiles, indicating the need for targeted approaches to diagnosis and management. Growing evidence also highlights the gut microbiota’s crucial role in modulating the immune response during COVID-19 by affecting cytokine production, adding further complexity to the disease’s immunological landscape. Targeted intervention strategies should focus on specific cytokine cutoffs, though accurate cytokine quantification remains a clinical challenge. Current treatment strategies are increasingly focused on inhibiting IL-6 trans-signaling, which offers promise for more precise therapeutic approaches to manage hyperinflammatory responses in COVID-19. In light of recent discoveries, this review summarizes key research findings on cytokine storms, particularly their role in COVID-19 and other inflammatory conditions. It explores emerging therapeutic strategies targeting cytokines like IL-6, TNF-α, and IFN-γ, while also addressing open questions, such as the need for better biomarkers to detect and manage cytokine storms. Additionally, the review highlights ongoing challenges in developing targeted treatments that mitigate hyperinflammation without compromising immune function, emphasizing the importance of continued research in this field.

Optimizing the entire therapeutic regimen in septic critically ill patients should be based not only on improving antibiotic use but also on optimizing the entire therapeutic regimen by considering possible drug–drug or drug–nutrient interactions. The aim of this narrative review is to provide a comprehensive overview on recent advances to optimize the therapeutic regimen in septic critically ill patients based on a pharmacokinetics and pharmacodynamic approach. Studies on recent advances on TDM-guided drug therapy optimization based on PK and/or PD results were included. Studies on patients <18 years old or with classical TDM-guided therapy were excluded. New approaches in TDM-guided therapy in septic critically ill patients based on PK and/or PD parameters are presented for cefiderocol, carbapenems, combinations beta-lactams/beta-lactamase inhibitors (piperacillin/tazobactam, ceftolozane/tazobactam, ceftazidime/avibactam), plazomicin, oxazolidinones and polymyxins. Increased midazolam toxicity in combination with fluconazole, nephrotoxic synergism between furosemide and aminoglycosides, life-threatening hypoglycemia after fluoroquinolone and insulin, prolonged muscle weakness and/or paralysis after neuromuscular blocking agents and high-dose corticosteroids combinations are of interest in critically ill patients. In the real-world practice, the use of probiotics with antibiotics is common; even data about the risk and benefits of probiotics are currently spares and inconclusive. According to current legislation, probiotic use does not require safety monitoring, but there are reports of endocarditis, meningitis, peritonitis, or pneumonia associated with probiotics in critically ill patients. In addition, probiotics are associated with risk of the spread of antimicrobial resistance. The TDM-guided method ensures a true optimization of antibiotic therapy, and particular efforts should be applied globally. In addition, multidrug and drug–nutrient interactions in critically ill patients may increase the likelihood of adverse events and risk of death; therefore, the PK and PD particularities of the critically ill patient require a multidisciplinary approach in which knowledge of clinical pharmacology is essential.

The aim of this study was to analyze the serum concentration of interleukin-6 (IL-6), C-reactive protein (CRP), D-dimer, lactate dehydrogenase (LDH), ferritin, and procalcitonin in COVID-19 patients with different forms of the disease. We performed a prospective cohort study on 137 COVID-19 consecutive patients, divided into four groups according to the severity of the disease as follows: 30 patients in the mild form group, 49 in the moderate form group, 28 in the severe form group, and 30 in the critical form group. The tested parameters were correlated with COVID-19 severity. Significant differences were registered between the form of COVID-19 depending on the vaccination status, between LDH concentrations depending on the virus variant, and in IL-6, CRP, and ferritin concentrations and vaccination status depending on the gender. ROC analysis revealed that D-dimer best predicted COVID-19 severe forms and LDH predicted the virus variant. Our findings confirmed the interdependence relationships observed between inflammation markers in relation to the clinical severity of COVID-19, with all the tested biomarkers increasing in severe and critical COVID-19. IL-6, CRP, ferritin, LDH, and D-dimer were increased in all COVID-19 forms. These inflammatory markers were lower in Omicron-infected patients. The unvaccinated patients developed more severe forms compared to the vaccinated ones, and a higher proportion of them needed hospitalization. D-dimer could predict a severe form of COVID-19, while LDH could predict the virus variant.

The Coronavirus disease 2019 (COVID-19) pandemic has brought new challenges across medical disciplines, particularly in infectious disease medicine. In Romania, the incidence of SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) infection increased dramatically since March 2020 until March 2022. Antibiotic administration for pulmonary superinfections in COVID-19 intensified and, consequently, increased rates of Clostridioides difficile infection (CDI) were hypothesized. We conducted a single-center, retrospective, observational study on patients from North-Eastern Romania to assess clinical characteristics and outcomes of COVID-19 and Clostridioides difficile (CD) coinfection, and to identify risk factors for CDI in COVID-19 patients. The study enrolled eighty-six CDI and COVID-19 coinfected patients admitted during March 2020-February 2021 (mean age 59.14 years, 53.49% men, 67.44% urban residents) and a group of eighty-six COVID-19 patients. On admission, symptoms were more severe in mono-infected patients, while coinfected patients associated a more intense acute inflammatory syndrome. The main risk factors for severe COVID-19 were smoking, diabetes mellitus, and antibiotic administration. Third generation cephalosporins (55%) and carbapenems (24%) were the main antibiotics used, and carbapenems were significantly associated with severe COVID-19 in patients coinfected with CD during hospitalization. Coinfection resulted in longer hospitalization and poorer outcomes. The extensive use of antibiotics in COVID-19, particularly carbapenems, contributed substantially to CD coinfection.

Polymicrobial meningitis is a rare entity in the adult population, especially in the antibiotic era. However, disorders such as chronic suppurative otitis media (CSOM) or even poor oral hygiene are considered risk factors for the development of such cerebral infection. We report a case of polymicrobial meningitis associated with oto-mastoiditis in a 64-year-old female patient known to have CSOM. The patient presented atypical symptoms for community-acquired meningitis, showing subacute evolution of headache, without fever or neck stiffness. The aerobe microorganisms Streptococcus anginosus and Corynebacterium spp., sensitive to beta-lactamines, and the anaerobe Prevotella spp., resistant to penicillin and metronidazole, were isolated from CSF specimens, while Proteus mirabilis and Enterococcus faecalis were identified from the ear drainage. The diversity of pathogens identified in our case led us to the hypothesis of two different sources of meningitis: otogenic and/or odontogenic. Favorable evolution was obtained after a multi-disciplinary approach, combining surgery and broad-spectrum antibiotics. In addition, we performed a literature review that highlights the low incidence of polymicrobial mixed aerobe–anaerobe meningitis.

Background and Objectives. The intensive care unit (ICU), especially in an infectious disease hospital, is both an area with a high consumption of antibiotics (atb) and a “reservoir” of multidrug-resistant bacteria. We proposed the analysis of antibiotic therapy practices in such a department that treated, in conditions of a pandemic wave, patients with COVID-19 and its complications. Materials and Methods. This was a retrospective transversal study of 184 COVID-19 patients treated in the ICU of a regional infectious disease hospital of Iaşi, Romania, in a 3-month interval of 2020 and 2021. Results. All the included patients (Caucasians, 53% males, with a median age of 68 years, and a Charlton comorbidity index of 3) received at least one antibiotic during their stay in the ICU (43% also had antibiotics prior to hospital admission and 68% in the Infectious Diseases ward). Only 22.3% of the ICU patients had only one antibiotic. A total of 77.7% of them started with an association of two antibiotics, and 19.6% of them received more than three antibiotics. The most-used ones were linezolid (77.2%), imipenem (75.5%), and ceftriaxone (33.7%). The median atb duration was 9 days. No change in the number or type of atb prescription was seen in 2021 (compared to 2020). Only 9.8% of the patients had a microbiological confirmation of bacterial infection. A total of 38.3% of the tested patients had elevated procalcitonin levels at ICU admission. The overall fatality rate was 68.5%, with no significant differences between the two analyzed periods or the number of administered antibiotics. More than half (51.1%) of the patients developed oral candidiasis during their stay in the ICU, but only 5.4% had C. difficile colitis. Conclusion. Antibiotics were widely used in our ICU patients in the presence of a reduced microbiological confirmation of a bacterial co-infection, and were justified by other clinical or biological criteria.

Controlling the spread of coronavirus disease 2019 (COVID-19) includes institute isolation, quarantine measures and appropriate clinical management, which all require effective screening, diagnostic and prognostic tools. The present study aimed to analyze severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunoglobulin (Ig)A detection and determine the potential association with the clinical course of COVID-19 and the levels of inflammation. In the present study, the presence of IgA and IgG SARS-CoV-2 antibodies in 75 consecutive patients with confirmed COVID-19 infection was investigated. No significant differences were found between the IgA positive and negative groups, regarding the presence of symptoms, haematological and inflammatory variables, or the presence of pneumonia. In the majority of cases, antibody detection was comparable, for example, 79.7% of patients in the IgA positive group exhibited both types of antibodies, while 80.9% of patients in the IgA negative group were also IgG negative. A total of four patients in the IgA negative group presented with anti-SARS-CoV-2 IgG antibodies. Early detection of IgA was more frequent in patients who later developed severe forms of the disease. In addition, the IgG SARS-CoV-2 antibody response was higher in patients with the severe form of the disease.

(1) Background: The outbreak of the COVID-19 pandemic represented a real challenge for all of humanity. Characterized by a complex spectrum of signs and symptoms, by various severity degrees, the disease spread rapidly around the world. After more than two and half years since the beginning of COVID-19 pandemic, in the context of a paradoxical, enigmatic, and relentless COVID-19, the objective of the current study was to evaluate the characteristics and evolution of patients with SARS-CoV-2 infection, hospitalized in “St. Parascheva” Clinical Hospital of Infectious Diseases (Iasi, Romania). (2) Methods: This is a retrospective study that used the medical database recorded between July and November 2021 in order to highlight the characteristics of SARS-CoV-2 infection in patients from the northeastern region of Romania. (3) Results: We enrolled in the study a total of 1732 SARS-CoV-2 infected patients, mean age 67 ± 3.4 years, the female gender predominating (987 cases; 56.98%) as well as patients from the urban environment (982 patients; 56.69%). Moderate form of the disease predominated (814 cases; 47%), pulmonary imaging changes were found in 1042 (60.16%) cases, and 1242 (71.71%) patients had at least one underlying disease. After a median length of hospitalization of 9.5 days, 1359 (78.46%) patients were discharged cured, 48 (2.77%) were transferred to other services by decompensating the associated pathologies, 302 (17.43%) patients needed extensive support in the intensive care unit and there were 325 (18.76%) deaths. (4) Conclusions: The epidemiological characteristics of SARS-CoV-2 infection recorded in our study were mostly the same as characteristics of COVID-19 from all over the world.

Meningitis is a disease with global presence that represents a worldwide issue, with the West Nile Virus as an etiological factor. The severity of viral meningitis depends on different factors such as age, immune system and etiological agents. Aim: The aim of the study was to study the frequency of West Nile Virus meningitis and to bring a contribution to the existing knowledge of the WNV distribution on adult in-dividuals in Romania. Results: They showed a complete etiological and symptomatic picture for WNV meningitis with the main cause being the climatic changes experienced for the sudden appearance of an increased number of WNV infections. Conclusions: This retrospec-tive study may constitute a foundation for a plan to prevent a possible epidemic of meningi-tis caused by the West Nile virus.

Background and Objectives. Being an enterically transmitted pathogen with a growing prevalence in developed countries, hepatitis E virus (HEV) infection remains an underdiagnosed disease in Eastern Europe. As far as Romania is concerned, only a few studies address this issue. Our goal was to estimate the prevalence of serum anti-HEV IgA/IgM/IgG antibodies in a group of patients admitted to the Clinical Hospital for Infectious Diseases "St. Parascheva" Iasi. Materials and Methods. The cross-sectional study consisted of enrollment of 98 patients admitted to the clinic for COVID-19 over a period of three months in 2020. Results. The median age in our study was 73 years, with an equal gender ratio and with a predominance of people from the urban environment (75%). The overall HEV antibody seroprevalence was 12.2%. The main risk factors associated with HEV infection were consumption of water from unsafe sources (58.3% HEV-positive patients vs. 26.7% HEV-negative patients, p = 0.026) and improperly cooked meat (58.3% HEV-positive patients vs. 23.2% HEV-negative patients, p = 0.01). Zoonotic transmission was an important criterion in our study, with patients reporting contact with pigs, poultry, rats, or other farms animals, but no significant differences were found between HEV antibody positive and negative groups. Conclusions. The seroprevalence rate of HEV antibodies was similar to other previous reports from our area but higher than in most European countries. The fact that HEV antibodies were detected in patients without identifiable risk factors for hepatitis E is evidence of subclinical infection as a silent threat.

(1) Background: There are limited clinical data in patients from the Eastern European regions hospitalized for a severe form of Coronavirus disease 2019 (COVID-19). This study aims to identify risk factors associated with intra-hospital mortality in patients with COVID-19 severe pneumonia admitted to a tertiary center in Iasi, Romania. (2) Methods: The study is of a unicentric retrospective observational type and includes 150 patients with severe COVID-19 pneumonia divided into two subgroups, survivors and non-survivors. Demographic and clinical parameters, as well as comorbidities, laboratory and imaging investigations upon admission, treatments, and evolution during hospitalization were recorded. First, we sought to identify the risk factors associated with intra-hospital mortality using logistic regression. Secondly, we assessed the correlations between D-Dimer and C-reactive protein and predictors of poor prognosis. (3) Results: The predictors of in-hospital mortality identified in the study are D-dimers >0.5 mg/L (p = 0.002), C-reactive protein >5 mg/L (p = 0.001), and heart rate above 100 beats per minute (p = 0.001). The biomarkers were also significantly correlated the need for mechanical ventilation, admission to intensive care unit, or multiple organ dysfunction syndrome. By area under the curve (AUC) analysis, we noticed that both D-Dimer (AUC 0.741) and C-reactive protein (AUC 0.707) exhibit adequate performance in predicting a poor prognosis in patients with severe viral infection. (4) Conclusions: COVID-19′s outcome is significantly influenced by several laboratory and clinical factors. As mortality induced by severe COVID-19 pneumonia is considerable, the identification of risk factors associated with negative outcome coupled with an early therapeutic approach are of paramount importance, as they may significantly improve the outcome and survival rates.

Aim: To evaluate the clinical and viro-immunological status in order to manage multiple organ disfunction of HIV-infected patients admitted to Intensive Care Unit (ICU) during active antiretroviral therapy. Material and Methods: Retrospective study, using medical data of HIV infected patients from the Regional HIV/AIDS Center of the "Sf. Parascheva" Infectious Diseases Clinical Hospital Iasi, admitted to the ICU, between 1st January 2016-31 December 2018. Results: In this study were included 21 patients with different HIV/AIDS stages and a depressed clinical status requiring evaluation and monitoring in the ICU. They were predominantly male with an average age of 34 years old. The viral-immunological status revealed the CD4 lymphocytes value less than 50 cells/mmc for most of the cases (19 patients), and a viral load significantly increased. As opportunistic infections were recorded: Tuberculosis (8 cases), Cryptococcal meningitis (1 case), Mycobacterium avium infection (1 case), Cytomegalovirus infection (6 cases). The most common complications were: respiratory distress syndrome and bacterial pneumonia (8 cases); and severe sepsis (4 cases), being evaluated and surveilled in ICU. Nine patients needed oral tracheal intubation and vasopressor support. All patients received antiretroviral therapy in association with specific antibiotherapy or antifungals depending on complication. Only one case had favorable evolution, the rest of the patients died. Conclusions: The survival rate of HIV-infected patients admitted to the ICU was extremely low even if they had critical care for severe complications and opportunistic infections.

Aim of study: This study assessed the sedation levels, the changes of the physiological parameters and the rates of the adverse events during various procedural sedation techniques in ambulatory patients undergoing pre-implant and implant oral surgical procedures. Methods: 120 patients (aged 20-72 years), undergoing pre-implant (sinus lift, bone grafts) and implant procedures were sedated by inhalosedation, midazolam i.v. or propofol and fentanyl under full monitoring (ECG, blood pressure, SaO2). It were assessed and recorded the sedation levels (Ramsey scores) after induction, at the beginning of surgical procedures and at the end of surgical procedures, the changes of physiological parameters (heart rate, blood pressure, SaO2), as well as the adverse events (hyperexcitability, euphoria, respiratory disorders, vaso-vagal reactions). Results. During the sedation procedures desaturation was absent in inhalosedation procedure and was recorded in sedation with midazolam i. v.(20%) and sedation with propofol and fentanyl (22,5%). Hypertension was recorded for 10% patients under sedation with propofol and fentanyl. Abnormal behaviour (hyperexcitability, euphoria) was recorded for 8,5% patients under sedation with midazolam i. v. Respiratory disorders were recorded for 3,4% patients under sedation with midazolam i. v. or propofol and fentanyl. Conclusion. All sedation procedures used in the dentist office for the patients candidate to dental implant have a moderate rate of adverse events but of minor intensity. Patients can be maintained safe by monitoring of the vital signs and by proper therapy of the physiological parameters changes and adverse events.

Introducere. Pseudomonas aeruginosa este un agent patogen periculos, greu de tratat, din cauza faptului că este frecvent rezistent la multiple antibiotice. Acest model de susceptibilitate este influenţat de mai mulţi factori şi are frecvent un caracter regional sau local, diferit pentru fiecare spital sau unitate de terapie intensivă. Material şi metode. Am analizat şi am comparat caracteristicile a 62 de pacienţi şi ale tulpinilor de P. aeruginosa izolate de la aceştia, trataţi în Spitalul de Boli Infecţioase „Sfânta Parascheva“ din Iaşi în perioada ianuarie-decembrie 2011 (lot 1 – 25c) şi între ianuarie şi decembrie 2016 (lot 2 – 37c). Sensibilitatea a fost testată prin testul de difuzie pe disc. Au fost utilizate standardele CLSI. Rezultate. Vârsta medie a fost mai mare la lotul 2 (63 ani) faţă de lotul 1 (52 ani, p = 0,04), în ambele loturi fiind afectaţi mai mulţi bărbaţi (59,2 vs. 57,5%). În lotul 2, tulpinile au fost izolate din urină (50%), spută (17,5%), secreţii de plăgi (15%), culturi de sânge (10%) sau catetere venoase centrale (7,5%); mai mult de jumătate pot fi de origine nosocomială. Infecţia a apărut în principal la pacienţii cu comorbidităţi semnificative, spitalizare pe termen lung (mediană – 15 zile), îngrijire în secţii de terapie intensivă (TI) sau cu ventilaţie mecanică. Nu am găsit o creştere semnificativă a ratelor de rezistenţă în lotul 2 pentru antibioticele testate; acestea rămânând ridicate pentru aproape fiecare medicament: 55 faţă de 60% pentru imipenem, 70 faţă de 62% pentru meropenem, 31 faţă de 41,7% pentru ceftazidim, 68 faţă de 75% pentru ciprofloxacin, 50 faţă de 42,8% pentru gentamicin, 63,6 pentru 45,8% 46 faţă de 30% pentru piperacilină-tazobactam. Toate izolatele au fost susceptibile la colistin. Ponderea izolatelor MDR a fost uşor mai mare în lotul 2 (52 vs 61%, p = 0,4). Tratamentul acestor infecţii a fost dificil, cu o durată medie de 15 zile; 20% dintre pacienţi au decedat. Concluzii. În spitalul nostru, infecţiile cu P. aeruginosa au apărut preponderent la pacienţii vârstnici, adesea în asociere cu asistenţa medicală, au fost asociate cu rezistenţa multiplă la antibiotice şi, uneori, au avut un prognostic rezervat. Ratele de susceptibilitate la antibiotice nu au variat semnificativ în cele două intervale de timp pe care le-am analizat.

Background. Pseudomonas aeruginosa is a dangerous, hard to treat pathogen, due to an increasing frequency of resistance to multiple antibiotics. This susceptibility pattern is influenced by multiple factors and it frequently has a regional or local character, different for each hospital or intensive care unit. Methods. We analysed and compared the characteristics of 62 patients and their isolated P. aeruginosa strains, treated in the “Sfânta Parascheva” Infectious Diseases Hospital of Iasi City between January and December 2011 (Group 1 – 25c) and between January and December 2016 (Group 2 – 37c). The susceptibility was tested by disk diffusion test; CLSI standards were used. Results. The median age was higher in group 2 (63 years) vs group 1 (52 years, p=0.04), more men were affected in both groups (59.2 vs 57.5%). In group 2 the strains were isolated from urine (50%), sputum (17.5%), wound secretions (15%), blood cultures (10%) or central venous catheters (7.5%); more than half may be of nosocomial origin; the infection mainly occurred in patients with significant comorbidities, long-term hospitalization (median - 15 days), ICU care or mechanical ventilation. We did not find a significant increase in the resistance rates in group 2 for the tested antibiotics; they remain high for almost every drug: 55 vs 60% for imipenem, 70 vs 62% for meropenem, 31 vs 41.7% for ceftazidime, 68 vs 75% for ciprofloxacin, 50 vs 42.8% for gentamicin, 63.6 vs 45.8% for amikacin, 46 vs 30% for piperacillin-tazobactam. All isolates were susceptible to colistin. The share of MDR isolates was slightly higher in group 2 (52 vs 61%, p=0.4). The treatment of these infections was difficult, with an average duration of 15 days; 20% of patients died. Conclusions. In our hospital, P. aeruginosa infections appeared predominantly in elderly patients, often in association with medical care, were associated with multidrug resistance to anti-biotics and sometimes had a guarded prognosis. The antibiotic susceptibility rates did not vary significantly in the two time intervals that we analysed.

The diagnosis and management of medical emergencies represents a current issue for dental practitioners, considering the high prevalence of medical disorders, patients receiving polypharmacy as well as the preoperative fear and anxiety among patients receiving dental care. In-depth knowledge of the factors that regulate the chronically disease processes, and pharmacodynamics of drug action, complete medical history and physical examination, as well as stress reduction protocols are requested for effective prevention of medical emergencies in dental office.

The purpose of this study is to quantify the existing interrelationship between the anesthetic substances used in the implanto-prosthetic rehabilitation procedures with the general state of the patient, as well as the specific implant rehabilitation work.The analyzed lot brought together 110 patients, candidates for implanto-prosthetic rehabilitation, subjected to a general and local evaluation protocol for choosing general anesthesia in accordance with the general state and complexity of the implanto-prosthetic algorithm. Regarding connection between therapeutic approaches in oral implantation and types of anesthesia , we obtained correlative aspects between the use of inhalosedation and implantation algorithm in 80% clinical cases and augmentation with implantation was found in 20%.General anesthesia with Midazolam has been correlated with implantation and augmentation in 77% clinical cases and sinus lift and implantation was found in 23% clinical cases.General anesthesia with Midazolam was used in 64% clinical cases with implantation and sinus lift and 36% clinical cases with implantation.Careful monitoring of the patient and proper dental surgery where the intervention is performed are the key for a therapeutic success regarding sedation and anesthesia.