Background Diarrhoea is a symptom frequently encountered in hospitalised patients with prolonged antibiotic treatment, which suggests nosocomial infection. The main cause of diarrhoeal illness associated with antibiotics is infection with Clostridium difficile (CD), a bacteria that is frequently encountered in asymptomatic carriers. From these reasons many healthcare settings have implemented screening for Clostridium difficile infection (CDI). Purpose To assess the prevalence of CDI and CD carriage rate in patients undergoing prolonged antibiotic treatments. Material and methods The present study included 189 consecutive patients hospitalised in Clinical Emergency County Hospital of Craiova, Romania (SCJUC) with various comorbidities, following more than 7 days of antibiotic treatment, from which were collected stool specimens. Colonisation/infection with CD was determined by immunochromatographic screening method using kit NADAL–C. Difficile Toxins A and B Test (nal von minden GMBH, Germany) and confirmed by PCR using GeneXpert II (Cepheid, USA). Results Antibiotic associated diarrhoea was encountered in 66 patients (34.92%). Of those, 49 (74.24%) had infection with CD. Thus the CDI rate was 49/189 (25.93%). Of the 123 patients without diarrhoea syndrome, 57 (46.34%) were asymptomatic CD carriers. CDI rate was higher in the intensive care unit (ICU) (58.90%), followed by surgical departments (50.00%) with a lower prevalence recorded in medical wards (43.75%). We observed a higher prevalence of CDI (57.24%) in elderly patients over 60 years, compared with middle aged patients (51.35%, risk ratio=1.114). Multivariate analysis showed that only diarrhoeal syndrome was a significant positive predictor for CDI (OR=3.31, p=0.001). Admission to the ICU unit, age over 60 years and male sex were non-significant positive predictors for CDI. Conclusion CDI had a relatively high frequency in SCJUC in patients treated with antibiotics, being the leading cause of diarrhoea syndrome in these patients. The carriage rate of CD was also significantly increased. Screening for CDI contributes to detection of asymptomatic carriers and orientates therapeutic choices in hospitalised patients with enterocolitis. References and/or acknowledgements Dubberke ER, Olsen, MA. Burden of Clostridium difficile on the healthcare system. Clin Infect Dis2012;55(Suppl 2):S88–92. No conflict of interest

Background The incidence of sepsis and the prevalence of antibiotic resistance of the causative microorganisms are continuously increasing. Purpose Determination of bacterial aetiology and antibiotic resistance of microorganisms isolated from blood cultures. Material and methods From 133 patients admitted to wards in the Clinical County Emergency Hospital of Craiova for a period of 3 months, 153 blood cultures were collected. They were incubated using Bactec BD and positive results were subjected to microbiological diagnosis using Phoenix BD analyser. Results Of the 133 patients tested, 46 (34.59%) had blood cultures positive and 87 (65.41%) negative. With reference to the number of blood cultures, germs were isolated from 47 (30.72%) cultures and the remaining 106 were negative (69.28%). Isolated bacterial species were Enterobacteriaceae (3.92%), Acinetobacter spp (3.27%), Pseudomonas spp (1.96%), Staphylococcus aureus (11.11%), coagulase negative staphylococci (9.15%), Enterococcus spp (65%) and anaerobic bacteria (0.65%). Antibiotic susceptibility testing revealed that Staphylococcus aureus strains, including 73.33% MRSA, were 100% resistant to erythromycin, 85.7% to cefazolin, 63.6% to rifampicin, 61.5% to tetracycline and 57.1% to gentamicin and tetracycline. Coagulase negative staphylococci were resistant to oxacillin (83.3%), erythromycin (75%), cefazolin (66.7%), tetracycline (58.3%) and norfloxacin (55.6%). All strains of staphylococci were susceptible to vancomycin. Enterobacteriaceae were completely resistant to ampicillin, ceforoxim, cefepime, ceftriaxone, 80% resistant to piperacillin/tazobactam, nitrofuratoin and 60% to ceftazidime and ertapenem. ESBL phenotype was identified in 50% of Enterobacteriaceae isolated and CPE in 34.52%. Pseudomonas aeruginosa was 100% resistant to most antibiotics except colistin and amikacin. Non-fermenters gram negative bacilli were 100% resistant to imipenem and meropenem, 87.5% to ceftazidime, 85.7% to ciprofloxacin, ceftriaxone and cefepime, and 71.4% to gentamicin. Conclusion The most common pathogen from blood cultures was Staphylococcus aureus, which had multiple antibiotic resistances, making the management of these invasive infections difficult. No conflict of interest

Background One main objective of clinicians and hospital pharmacists is correct pharmacotherapy according to the pathological context of the inpatient. One principle of pharmacotherapy is to minimise the risk of adverse drug reactions (ADRs). In surgical patients, therapy usually involves antibiotics, analgesics, anti-inflammatory drugs and anticoagulants. Purpose We aimed to determine the incidence and characteristics of ADRs to main medication used in surgical patients, during hospital admission. These data can be used by clinicians for implementing practices for safe drug use. Material and methods This prospective observational study was conducted between January and July 2015 in a clinical emergency hospital and included 376 patients (189 men and 189 women) who underwent surgery over a period of 7 months. ADRs were identified by studying in real time the electronic patient records and directly from the clinicians who observed them. The clinical pharmacist also recorded age, sex and drug usage prior to admission. Results 74 ADRs were observed in 68 patients (18%) during the admission period. 18 (26.43%) of the ADRs could have been prevented. The most frequent ADRs were neurological (22, 31.92%), allergic (10, 15.03%,), gastrointestinal (9, 13.14%) and haematological (6, 8.76%). The drug classes most frequently associated with the occurrence of ADRs were: antibiotics (30, 43.45%), non-steroidal anti-inflammatory drugs (9, 13.14%), glucocorticoids (9, 13.14%), anticoagulants (6, 8.7%) and diabetes mellitus agents (4 patients, 6.6%). Conclusion The study showed a prevalence of ADRs of 18% in surgical patients, mostly neurological, followed by allergic. The very frequent ADRs to antibiotics compared with other studies can be explained by their use in virtually all surgical patients. Our preventable ADR rate of 26.43% was slightly higher that 15.4% reported in other studies1 due to incorrect conduct of the therapy. The only method to evaluate a drug is to assess the risk/benefit ratio. References and/or Acknowledgements de Boer M, Boeker EB, Ramrattan MA, et al. Adverse drug events in surgical patients: an observational multicentre study. Int J Clin Pharm 2013;35:744-52 No conflict of interest.

Background Asymptomatic bacteriuria (ABU) refers to the presence of germs in the urinary tract without clinical symptoms. ABU is frequent in hospitalised patients. Purpose To determine the prevalence of ABU in a clinical emergency hospital in patients who received unjustified antibiotic treatment because they did not show symptoms of urinary tract infections (UTIs). Material and methods We evaluated 76 patients admitted to our hospital between March and August 2015, with average age of 71.4 (±8.2) years, of whom 59 women (77.63%) were women. We excluded patients >85 years old, patients undergoing invasive urological and surgical procedures and immunocompromised patients. Urine samples were collected within 24 h of admission by the midstream method and subjected to bacteriological diagnosis using the calibrated loop method. Identification of isolated microorganisms and antimicrobial sensitivity testing were carried out by an automated method (Phoenix analyser, BD Diagnostics, USA). Results 54 patients (71.05%) were admitted through the emergency room, of whom 3 (3.94%) already had a urinary catheter at the time of admission. In 34 patients (44.73%) the urine sample was contaminated. These samples were collected again and were negative. ABU was present in 26 (34.21%) patients with no UTI symptoms, but with positive urine culture for E coliProteusPseudomonasKlebsiella and Serratia. Of these, 14 patients (53.84%) received antimicrobials. 5 of 14 patients (35.71%) had significant bacteriuria (presence of >100 000 colony forming units/mL urine) and received antimicrobial therapy, and the remaining 9 patients (64.29%) received antibiotics totally unjustified. Many isolated strains had multiple resistance to antibiotics. Conclusion The study demonstrates the importance of bacteriological testing of urine in inpatients for the purpose of screening for silent ITU and prevention of the unjustified empirical treatment of ABU. The hospital clinical pharmacist must actively collaborate with prescribing clinicians to avoid incorrect treatment and to decrease antibiotic consumption. No conflict of interest.

Background Confirmation of infectious aetiology of pleurisy requires a complete microbiological diagnosis. An antibiogram is mandatory for correct and effective treatment. Purpose To investigate the resistance pattern of the flora involved in parapneumonic pleurisy. Material and methods We attempted to identify possible causative organisms and their sensitivity to antibiotics in the pleural fluids collected from 150 patients hospitalised between 01.05.2010 and 01.05.2014. Results In 43.33% of pleural fluids germs were detected such as: Pseudomonas spp., anaerobic bacteria, non-fermentative Gram negative rods, Staphylococcus aureus, MRSA, Escherichia coli, Klebsiella, Streptococcus pyogenes, Enterococcus, Candida albicans. Pseudomonas strains were 100% resistant to ampicillin, amoxicillin, cefpirome, ceftriaxone (91.67%), penicillin (90.00%), cefuroxime (87.50%), ceftazidime (85.00%), amoxicillin with clavulanic acid (75.00%), gentamicin (73.33%) cefepime (71.43%), teicoplanin (9.09%) and linezolid (11.11%). Staphylococcus aureus was 100% resistant to ampicillin, amoxicillin, amoxicillin with clavulanic acid, cefuroxime, cefepime, cefpirome (90.91%), ceftriaxone (87.50%), ceftazidime (87.50%), penicillin (80.00%), amikacin (11.1%) and rifampicin (20.00%). No resistance to linezolid, teicoplanin or piperacillin with tazobactam was observed. Non-fermentative Gram-negative rods were 100% resistant to ampicillin and amoxicillin, cefuroxime (90.91%), cefpirome (88.89%), amoxicillin with clavulanic acid (75.00%), ceftriaxone (75.00%). We found low resistance to piperacillin with tazobactam (20.00%), amikacin (25.00%), and tigecycline (33.33%). Klebsiella pneumoniae was 100% resistant to ampicillin, amoxicillin, clavulanic acid, amoxicillin, ceftazidime, gentamycin, cefpirome, cefuroxime, penicillin (75.00%), rifampicin [JM1] (75.00%), oxacillin (66.67%), tigecycline (66.67%). All strains were 100% susceptible to linezolid, meropenem and teicoplanin. These resistance patterns show the nosocomial potential of these strains. In the evolution of pleurisy, especially due to Pseudomonas, there was a correlation between prolonged hospitalisation and rapid development of resistance to drug treatment once it has started. Conclusion It is recommended to research and evaluate the effectiveness of strategies to prevent the emergence of microbial strains resistant to drug treatment in the case of parapneumonic pleurisy. References and/or Acknowledgements [JM1] No conflict of interest.

Background The most common complications of surgical wounds are abscesses and necrosis. Purpose To establish the aetiology of surgical wound infections in post-surgery patients from the hospital and to assess the resistance of the germs isolated to antimicrobials. Variations in antibiotic resistance profile in relation to the type of suppuration and surgical wards were compared in order to establish the most effective therapeutic protocols. Material and methods From 165 hospitalised and ambulatory patients we collected: pus from abscesses/phlegmons, ear, nose and throat suppurations, discharge from superficial and deep surgical wounds. We performed classical bacteriological diagnosis and Kirby Bauer testing. Results Staphylococcus aureus was isolated in 41.15% of cases, coagulase-negative staphylococci in 4.31% and in the remainder Gram-negative bacilli: Klebsiella spp. (13.88%), Escherichia coli (13.40%), Pseudomonas (8.13%), Proteus (6.22%), non-fermentative Gram-negative bacilli (4.78%), Enterobacter (1.91%) and Citrobacter (0.48%). Staphylococcus aureus was resistant to ceftriaxone (100%), penicillin (91.36%), amoxicillin (83.33%), amikacin (80.00%) and ampicillin (67.92%). E. coli strains were resistant to chloramphenicol (100.00%), amoxicillin clavulanate (87.50%) and ampicillin (64.50%). Klebsiella was resistant to ampicillin (100%), amoxicillin clavulanate (87.50%) and amikacin (50.00%). Pseudomonas was found to be highly resistant to cefpirome (87.50%), meropenem (66.67%) and tigecycline (66.67%). 36.84% of all strains were resistant to more than five antibiotics. The average resistance index of strains isolated from the superficial suppurations was higher than those isolated from the deep suppurations (Student's t = −3.025, p = 0.0014). The resistance index also indicated that the strains isolated from hospitalised patients were more resistant than those from ambulatory patients (Student's t = −3.4237, p = 0.0008). Conclusion This study shows the prevalence of multidrug resistant strains in our hospital and their involvement in surgical wound infections. Continuous microbiological surveillance of germs isolated from surgical suppurations and their resistance to antimicrobials is essential for defining antibacterial policies on surgical wards. References and/or Acknowledgements No conflict of interest.

Background Oral contraceptive pills are medicinal products containing various types of synthetic hormones with a role in preventing pregnancy. Purpose To evaluate the knowledge and attitudes of pharmacists from community pharmacies regarding oral contraceptives (OC) and emergency contraceptive pills (ECP). Materials and methods Interviews were carried out based on questionnaires sent to 42 pharmacists from community pharmacies in Craiova city, Romania during the period March–May 2013. Results All the pharmacists included in the study had sold at least once ECP or OC. 23 (54.76%) knew exactly the active substances contained in ECP or OC, the mode of the action and the pharmacotherapeutic management, side effects and interactions with other drugs; and 7 (16.66%) could not explain the mechanism of the action. 21 (50%) of these have indicated that repeated use for a long time involves health risks. 19 (45.23%) considered that ECP and OC should not be used by teenagers under 18 years old and 15 (35.71%) would not recommend this type of drugs to the women over 40 years old who were approaching the menopause. 16 (38%) believed that the ECP should be used only a few times. 40 (95.23%) agreed with the display of advertising materials with additional information about OC or ECP. Conclusions The results suggest the need for an improvement in the pharmacist’s knowledge about the positive pharmacological effects of OC and ECP. Displaying information related to OC and ECP is useful in pharmacies, thus increasing pharmacists’ and consumers’ knowledge of OC and ECP. No conflict of interest.

Background Patients hospitalised in the Intensive Care Unit (ICU) are often intubated and thus their lower airways are exposed to colonisation by flora in ambient air. Colonisation is often followed by nosocomial pneumopathies; prophylactic antibiotics are used to prevent them, usually associated with the emergence of multi-drug-resistant strains (MDR), the cause of nosocomial infections. One common etiological agent involved in lung disease is Staphylococcus aureus (SA). Purpose To see if there is a correlation between the use of certain antimicrobial agents in the emergency section and the emergence of resistant SA strains isolated from patients hospitalised in the same ward. To establish the resistance profile of strains of SA in theICU, to guide the selection of antimicrobial drugs and to prevent selection of MDR strains. Materials and methods We collected samples of tracheal secretions from 130 endotracheal intubated patients admitted to the ICU ward between 1.03.2012–30.06.2013 and conducted microbiological testing. We identified 138 strains of SA and we tested their susceptibility to the following antimicrobial agents: amoxicillin with clavulanic acid, oxacillin, chloramphenicol, clarithromycin, ciprofloxacin, moxifloxacin, linezolid, rifampicin, tetracycline, teicoplanin, tigecycline and vancomycin. Hospital pharmacy records provided data on the use of antimicrobial agents (number of vials) in ICU. Results The prevalence of Staphylococcus respiratory infections ranged from 17% to 25% in every 3 month period and it correlated with the consumption of moxifloxacin (r = 0.8899, p = 0.0175), linezolid (r = 0.8494, p = 0.0323) and tigecycline (r = 0.5534, p = 0.0774). SA resistance to chloramphenicol was negatively correlated with the consumption of teicoplanin (r = -0.7625, p = 0.0779). Mean antibiotic resistance (MAR) was significantly correlated with the consumption of moxifloxacin (r = 0.4018, p = 0.0983) and inversely correlated with meropenem consumption (r = -0.4517, p = 0.0599). Isolated SA strains were resistant to: ampicillin (100%), penicillin (94.26%), amoxicillin with clavulanic acid (69.32%), oxacillin (67.63%), clarithromycin (54.88%), rifampicin (58.82%), tetracycline (57.89%), ciprofloxacin (45.83%), chloramphenicol (24.51%). We found low resistance to teicoplanin (3.01%), linezolid (2.22%) and tigecycline (1.96%). Conclusions The use of certain antimicrobial agents in ICU correlates with staphylococcal lower respiratory tract infections and the emergence of multidrug-resistant strains. The therapeutic management of patients admitted to ICU requires teams of clinicians, microbiologists, epidemiologists, hygienists, pharmacists, even hospital economists, to benefit each other and especially patients. No conflict of interest.

Background Patients hospitalised in the Intensive Care Unit (ICU) are often intubated and thus their lower airways are exposed to colonisation by flora in ambient air. Colonisation is often followed by nosocomial pneumopathies; prophylactic antibiotics are used to prevent them, usually associated with the emergence of multi-drug-resistant strains (MDR), the cause of nosocomial infections. One common etiological agent involved in lung disease is Staphylococcus aureus (SA). Purpose To see if there is a correlation between the use of certain antimicrobial agents in the emergency section and the emergence of resistant SA strains isolated from patients hospitalised in the same ward. To establish the resistance profile of strains of SA in theICU, to guide the selection of antimicrobial drugs and to prevent selection of MDR strains. Abstract CP-039 Table 1 Quarter Prevalence MAR Consumption Resistance AMP LZD MXF TEC IPM MEM C CLR OX 2012 Q1 25% 0.35 7240 1336 1340 172 1336 2404 0.23 0.54 0.62 2012 Q2 22% 0.47 4680 968 888 100 1184 1556 0.25 0.55 0.65 2012 Q3 18% 0.54 5228 432 640 76 1220 2052 0.35 0.6 0.7 2012 Q4 19% 0.58 3212 796 812 148 1284 2840 0.2 0.75 0.94 2013 Q1 20% 0.43 2088 268 528 92 1120 1932 0.24 0.5 0.59 2013 Q2 17% 0.42 3160 384 536 160 2020 2672 0.17 0.63 0.62 Materials and methods We collected samples of tracheal secretions from 130 endotracheal intubated patients admitted to the ICU ward between 1.03.2012–30.06.2013 and conducted microbiological testing. We identified 138 strains of SA and we tested their susceptibility to the following antimicrobial agents: amoxicillin with clavulanic acid, oxacillin, chloramphenicol, clarithromycin, ciprofloxacin, moxifloxacin, linezolid, rifampicin, tetracycline, teicoplanin, tigecycline and vancomycin. Hospital pharmacy records provided data on the use of antimicrobial agents (number of vials) in ICU. Results The prevalence of Staphylococcus respiratory infections ranged from 17% to 25% in every 3 month period and it correlated with the consumption of moxifloxacin (r = 0.8899, p = 0.0175), linezolid (r = 0.8494, p = 0.0323) and tigecycline (r = 0.5534, p = 0.0774). SA resistance to chloramphenicol was negatively correlated with the consumption of teicoplanin (r = -0.7625, p = 0.0779). Mean antibiotic resistance (MAR) was significantly correlated with the consumption of moxifloxacin (r = 0.4018, p = 0.0983) and inversely correlated with meropenem consumption (r = -0.4517, p = 0.0599). Isolated SA strains were resistant to: ampicillin (100%), penicillin (94.26%), amoxicillin with clavulanic acid (69.32%), oxacillin (67.63%), clarithromycin (54.88%), rifampicin (58.82%), tetracycline (57.89%), ciprofloxacin (45.83%), chloramphenicol (24.51%). We found low resistance to teicoplanin (3.01%), linezolid (2.22%) and tigecycline (1.96%). Conclusions The use of certain antimicrobial agents in ICU correlates with staphylococcal lower respiratory tract infections and the emergence of multidrug-resistant strains. The therapeutic management of patients admitted to ICU requires teams of clinicians, microbiologists, epidemiologists, hygienists, pharmacists, even hospital economists, to benefit each other and especially patients. No conflict of interest.

Background Evidence exists that treatment with antimicrobial agents leads to the development of resistance to the same compound or cross-resistance to other compounds. Purpose To detect correlations between the consumption of antimicrobial agents and bacterial resistance, in monthly and quarterly checks. Materials and methods We studied 252 endotracheal intubated patients hospitalised in the Intensive Care Unit (ICU) between 1.03.2012–30.06.2013. From the tracheal secretion samples we isolated 230 strains of Klebsiella and 115 of Pseudomonas, which we tested for antibiotic susceptibility. We performed correlations between aggregated monthly and quarterly resistances with consumption of antimicrobial agents in the ICU ward, obtained from hospital’s pharmacy records. Significant correlations were verified by regression. Results We detected a strong correlation between the consumption of ciprofloxacin and meropenem with resistance of Pseudomonas (r = 0.8565, p = 0.0066) and between consumption of ampicillin with resistance to ciprofloxacin (r = 0.6570, p = 0.0281). The evolution of a global resistance index (Mean Antibiotic Resistance MAR) correlated with the consumption of piperacillin with tazobactam (r = 0.7852, p = 0.0643). For Klebsiella there was an inverse correlation between ciprofloxacin consumption and gentamicin resistance (r = -0.6311, p = 0.0504) and piperacillin with tazobactam consumption and tigecycline resistance (r = 0.8155, p = 0.0925). The evolution of a global Klebsiella resistance index (MAR) correlated with the consumption of piperacillin with tazobactam (r = 0.7768, p = 0.0692) and strong consumption of moxifloxacin (r = 0.9734, p = 0.0011). Quarterly resistance index of Klebsiella correlated strongly with that of Pseudomonas (r = 0.9690, p = 0.0014), but with significantly different values (Student’s t test, Cohen’s d = 1.802, r = -0.669, p = 0.011). Correlation is maintained for monthly resistance (r = 4552, p = 0.0764). Conclusions The existence of these correlations makes it necessary to monitor anti-bacterial treatment in ICU and bacterial resistance. We need to develop treatment policies for periodical changing of the set of antimicrobial drugs used. No conflict of interest.

Background Plant species Robinia pseudoacacia L. (Fabaceae) has been used as a medicinal plant since ancient times, as its infusions and extracts have antacid, antibacterial, purgative and emenagogic properties. The volatile oil of the flowers is also used in perfumery and cosmetics. Purpose Due to its high content of volatile oil phenolic compounds, flavonoids and tannins with antimicrobial properties, the present study proposed to investigate the antibacterial and antifungal effect of the species Robinia pseudoacacia. Materials and methods The dry powdered flowers, leaves, bark and seeds of Robinia pseudoacacia were subjected to extraction in a Soxhlet extractor with 90% ethanol. The alcoholic extract obtained in the concentration of 100 mg / ml, was tested using sterile discs of Whatman No. 1 filter paper, impregnated with 100 mg extract. Antibacterial and antifungal effects was evaluated by the Kirby-Bauer disc diffusion method, in accordance with the NCCLS / CLSI standard, using the following infectious agents isolated from patients and the corresponding reference strains: methicillin-resistant Staphylococcus aureus and methicillin-sensitive haemolytic S. epidermidis, Streptococcus pyogenes, Enterococcus, Enterobacter aerogenes, Escherichia coli, Salmonella choleraesuis, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus, Candida albicans. Results Extracts from various different parts of the plant had different antibacterial activities. Extracts of flowers and seeds are efficient antibacterials for Gram positive cocci. Bark and leaf extracts were active against Escherichia coli, Pseudomonas, Proteus, Salmonella choleraesuis, Candida albicans. Conclusions These results prove the antimicrobial or antifungal properties of certain extracts of Robinia pseudoacacia L., which offers an alternative treatment with a natural product with synergistic effects with conventional antibacterial treatment.

Background Escherichia coli is the most common bacteria involved in the aetiology of the urinary tract infections (UTI). Purpose The aim of the study is to compare the susceptibility to antibacterial agents of Escherichia coli strains isolated from adults and children. Materials and methods The study was conducted between 1.01.2009-31.12.2010 on 192 patients divided in two groups. Group A-72 hospitalised children under 15 years with clinical signs of UTI. Group B – 120 adult outpatients who had presented various conditions of the reno-urinary tract. Urine samples were investigated using biochemical and microbiological (urine culture) methods. The authors used culture media to isolate specific bacterial species, whose identification was performed with API 20 E galleries. The antibiotic susceptibility test was performed on Mueller Hinton agar plates using the Kirby-Bauer disc diffusion method, according to NCCLS / CLSI – 2009 guidelines. Results The morbidity by UTIs in children was 40.90%, mostly in girls (54.4%), in the age group of 1-3 years (43.91%) and infants (37.16%). The isolated E. coli strains (65.2%) were resistant to Ampicillin (65.14%), Ciprofloxacin (30.12%), Cefuroxime (26.18%) and Nalidixic acid (14.92%). In adults the prevalence of UTIs was 43.33%, the infections were more common in women and in patients over 60 years. The isolated E. coli strains (55.77%) were resistant to Ampicillin (74.25%), Cefuroxime (39.29%), Ciprofloxacin (27.59%) and Nalidixic acid (24.14%). There was a significant difference in antibiotic resistance of the strains isolated from the two patient categories (Student9s T test, p=0.0168). Conclusions The tested strains of Escherichia coli involved in UTIs in adults had a higher resistance to antibiotics, compared with those isolated from children. It is recommended that the neonatologists, paediatricians and family physicians initiate therapy for these infections only after antibiotic susceptibility tests, in order to prevent selection of multidrug-resistant strains.

Background Vulvovaginal candidiasis in pregnant women may affect the physiological development of pregnancy representing a risk factor for premature labour onset. Premature infants can develop respiratory, neurological, cardiovascular and digestive complications which can disturb the normal development of these newborns. Purpose The purpose of this study is to assess the prevalence of vulvovaginal candidiasis in pregnant women, to identify the isolated Candida species and to determine their behaviour towards antifungal agents. Materials and methods The study was conducted between 01.02.2010 – 31.01.2011 on 50 vaginal secretions from women who came to the ambulatory of the Clinical Emergency Hospital of Craiova, Romania, which have been subjected to mycological diagnosis: Giemsa stained smears, isolation on Sabouraud media and chromogenic media (ChromID Candida) in order to identify the Candida species. Antifungal susceptibility test was performed using the standardised systems ATB Fungus 3 (bioMérieux, Marcy l’Etoile, France) and Candifast (EliTech France SAS). It was assessed the susceptibility to: 5-Fluorocytosine, Amphotericin B, Fluconazole, Itraconazole, Voriconazole, Econazole, Miconazole, Ketoconazole and Nystatin. Results Vulvovaginal candidiasis was detected in 30 pregnant women. The isolated Candida species were C. albicans (53.33%), C. glabrata (20.00%), C. tropicalis (13.33%), C. parapsilosis (6.67%) and C. krusei (6.67%). The isolated Candida strains had a high susceptibility to Amphotericin B (96.67%), Voriconazole (96.67%), 5-Fluorocytosine (86.67%), Clotrimazole (80%), Econazole (80%), and Ketoconazole (80%). Conclusions The detection of the vaginal mycosis in pregnant women requires the establishment of an appropriate therapy, according to the antifungigram, that can concur to reduce the risk of premature birth and associated complications.

Background Changes in glucidic metabolism characteristic of diabetes are a contributing factor in causing vulvovaginal candidiasis. Purpose The objective of this study was evaluating the prevalence of morbidity through vaginal candidiasis with Candida albicans in diabetic women and instituting of specific antifungal therapy. Materials and methods The study was conducted on 140 women (aged between 22-40 years) with diabetes, admitted in the Diabetes and Nutrition diseases clinic from Clinical Emergency Hospital of Craiova, Romania, from who were harvested blood and vaginal secretions. Blood sugar levels were determined by biochemical methods. The vaginal secretions were subjected to mycological diagnosis (Gram stain, isolation on Sabouraud media, identification by using chromogenic differential media specific for Candida). The isolates strains were subjected to fungal sensitivity test, using commercial kits: ATB Fungus 3 (BioMerieux, Marcy l’Étoile, France) and Candifast (EliTech France SAS) (5-Fluorocytosine, Amphotericin B, Fluconazole Itraconazole, Voriconazole, Econazole, Miconazole, Ketoconazole and Nystatin). The data was analysed using the Student's t-test. Results The authors isolated 98 strains of Candida albicans, thus the morbidity by candidiasis was 70%, most of the patients had blood sugar levels between 130–180 mg/dl. The condition was more common in patients aged between 51-60 years (39.80%) and 41-50 years (31.63%). The results of antifungigram showed susceptibility to: Ketoconazole (95.92%), Econazole (89.80%), Fluconazole (85.71%) and Itraconazole (85.71%). Conclusions These results demonstrate the existence of a correlation between hyperglycaemia and vaginal candidiasis. Most of the vulvovaginal candidiases were treated successfully with new antifungal drugs. Although regarded as a banal infection by some, the increased incidence of vaginal candidiasis associated with diabetes raises additional issues regarding prevention and patient management.

Background Nigella sativa is a herb from the Mediterranean region with antidiabetic, bronchodilator, antioxidant, hepatoprotective, lipid lowering, anti-inflammatory and analgesic properties. Purpose This study aimed to reveal the antifungal activity of aqueous, methanolic and chloroform extracts obtained from the plant seeds, compared with the effect of traditional antifungals. Materials and methods Using standard mycological diagnostic methodology The authors isolated and identified 20 strains of Candida albicans from pathological products collected from patients hospitalised in different departments of the Craiova Emergency Hospital. Aqueous, methanolic and chloroform extracts were made from the seeds of Nigella sativa, in decreasing dilutions, in which Wattman filter paper discs were soaked and dried and then used to achieve the antifungal graph by using the Kirby-Bauer diffusion technique. Simultaneously, the testing was repeated using standard antifungal disks (Becton Dickinson) and the two sets of results compared. The antifungal effect was assessed by measuring the diameter of the inhibition zone, noting the concentration per disk. Results The results show that methanolic extracts of Nigella sativa have the strongest antifungal effect followed by the chloroform extracts. Aqueous extracts showed no antifungal activity. Conclusions The research shows treatment with natural products in a good light as an alternative for treating fungal infections. The authors envisage Nigella sativa extract enhancing the effect of conventional therapy.

The authors have studied the synthesis of interleukin 1 by articular and circulating macrophages and the effect of two types of interferon alpha (IF) on this synthesis in 20 patients with untreated rheumatoid arthritis (RA). The articular and especially systemic interleukin levels in the RA patients are significantly higher than those of the test subjects. Interferon modifies in a very different way the production of interleukin 1 in the patients and in the test subjects. This is linked with the in vitro experimental conditions as well as the increase in the IL1 levels in the patients. The authors discuss the perspective therapeutics offered by this modulation of interleukin production by interferon.

By using CBA inbred mice as responders, the influence of in vivo B4 Coxsackievirus infection (in two separate experimental procedures) on anti-virus cell-mediated immunity (CMI), natural killer (NK) cell activity and lipopolysaccharide (LPS) induced interleukin-1 (IL-1) production in spleen cells were studied. Both experimental infection schedules were able to induce a "positive" CMI response. NK cell activity was also significantly stimulated, especially by the administration of high virus amounts/inoculum, with frequent injections. On the contrary, LPS-dependent IL-1 synthesis increased particularly following application of the other experimental schedule (low virus amounts, few injections). Some aspects concerning CMI, NK and IL-1 relationships, during several enteroviral diseases, are discussed.