Alexandru Rafila

Carbapenemase-Producing Klebsiella pneumoniae in Romania: A Six-Month Survey.

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

Type-specific herpes simplex virus-1 and herpes simplex virus-2 seroprevalence in Romania: comparison of prevalence and risk factors in women and men

OBJECTIVE To determine herpes simplex virus (HSV)-2 and HSV-1 seroprevalence in women and men in Romania. METHODS A cross-sectional seroprevalence survey was conducted between 2004 and 2005 on a total of 1058 women and men representative of the population of Bucharest. All participants were aged 15-44 years and completed a structured questionnaire. A blood sample was collected to detect IgG anti-HSV-1 and HSV-2 serum antibodies using the HerpeSelect ELISA (Focus Diagnostics). RESULTS A total of 761 women (median age 29 years) and 297 men (median age 29 years) were included. Overall, HSV-2 seroprevalence (15.2%) increased with age. Among women, HSV-2 seroprevalence increased from 11.0% in 15-19-year-olds to 38.3% in 40-44-year-olds. Among men, seroprevalence increased from 4.0% in 20-24-year-olds to 27.1% in 40-44-year-olds. HSV-2 seroprevalence was significantly higher among women than men (17.0% vs. 10.8%). HSV-1 seropositivity was high (87.2%) in all age groups, with no clear trend by age or by sex. In addition to older age and female sex, risk factors for HSV-2 included greater number of lifetime sexual partners, lower educational attainment, and history of genital vesicles. Lower educational level and rural residence were associated with a higher risk of HSV-1 seropositivity. CONCLUSIONS In Romania, HSV-2 seroprevalence was higher in women than men, and was within European limits and lower than that in Africa and the USA. In contrast, HSV-1 seroprevalence was generally higher than that previously recorded in similarly aged populations in Western Europe.

Occurrence of Clostridium difficile infections due to PCR ribotype 027 in Bucharest, Romania.

INTRODUCTION Little is known about prevailing ribotypes of Clostridium difficile infection in Romania where CDI is not a mandatory notifiable disease. METHODOLOGY We studied 64 non-duplicate C. difficile isolates from patients hospitalised at the National Institute of Infectious Diseases, Bucharest, Romania between March 2011 and March 2012. RESULTS Sixty-three of the 64 C. difficile isolates produced toxins A and B whereas 44 (69%) isolates produced a binary toxin. Ribotype 027 accounted for 43 (68%) of the 63 toxigenic strains. The remaining 20 isolates belonged to ribotypes 018 (n = 9), 012 (n = 3), and, with one isolate each, 014, 031, 081, 416, 433, 500, 507 and PR03035 (new ribotype). Information on hospital mortality was available for 62 of the 64 patients; among these 62 cases, 4 (6.4%) ended fatal. Recurrence was documented for 11 (18.3%) of the 60 patients for whom this information was available. Multilocus variable-number tandem repeat analysis of the 43 isolates of ribotype 027 yielded a unique cluster for the Romanian isolates when compared to Austrian or Italian isolates. CONCLUSION Our findings sustain the hypothesis of a recent emerged outbreak of C. difficile PCR ribotype 027 infections in the area of Bucharest.

Case Study – Romania

Countering bioterrorism, as other health threats caused by infectious agents, requires good preparedness, and early warning and response, which can be achieved by an efficient epidemiological surveillance system. In 1990, Romania inherited a functional and quite efficient epidemiological surveillance system from the former communist regime, based on pyramidal and autocratic principles where the state control was absolute. In 2001, the assessment conducted by WHO/Europe showed many unsatisfactory elements of the remaining epidemiological surveillance system for communicable diseases, with a lack of procedures, poor microbiology laboratory capacities, and overlapping responsibilities. The lack of a coordinating body was evident, especially during bioterrorist threats following 9/11 attacks in New York. In 2003 and 2004, the PHARE Project offered an important opportunity for Romania to improve the Romanian System of Epidemiological Surveillance and Control of Communicable Diseases. At the end of this project many of the technical capacities had been improved, specialized trainings of epidemiologists and microbiologists were carried out, and a coordinating body of the epidemiological surveillance network was established [1]. Furthermore, a National Plan of Action was approved by the Minister of Health with the declared objective to improve the system in order to comply with EU standards. At present, the National Institute of Public Health hosts the National Center for Communicable Diseases Surveillance and Control which coordinates the epidemiological network and serves as the Romanian focal point for international institutions such as WHO and ECDC. Each year, comprehensive reports regarding surveillance in Romania of many communicable diseases are published, including diseases potentially related to bioterrorism. Until now, no evidence of a bioterrorism event has been registered in Romania.

Bio-behavioural HIV and STI surveillance among men who have sex with men in Europe: the Sialon II protocols

BackgroundGlobally, the HIV epidemic continues to represent a pressing public health issue in Europe and elsewhere. There is an emerging and progressively urgent need to harmonise HIV and STI behavioural surveillance among MSM across European countries through the adoption of common indicators, as well as the development of trend analysis in order to monitor the HIV-STI epidemic over time. The Sialon II project protocols have been elaborated for the purpose of implementing a large-scale bio-behavioural survey among MSM in Europe in line with a Second Generation Surveillance System (SGSS) approach.Methods/DesignSialon II is a multi-centre biological and behavioural cross-sectional survey carried out across 13 European countries (Belgium, Bulgaria, Germany, Italy, Lithuania, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the UK) in community settings. A total of 4,966 MSM were enrolled in the study (3,661 participants in the TLS survey, 1,305 participants in the RDS survey). Three distinct components are foreseen in the study protocols: first, a preliminary formative research in each participating country. Second, collection of primary data using two sampling methods designed specifically for ‘hard-to-reach’ populations, namely Time Location Sampling (TLS) and Respondent Driven Sampling (RDS). Third, implementation of a targeted HIV/STI prevention campaign in the broader context of the data collection.DiscussionThrough the implementation of combined and targeted prevention complemented by meaningful surveillance among MSM, Sialon II represents a unique opportunity to pilot a bio-behavioural survey in community settings in line with the SGSS approach in a large number of EU countries. Data generated through this survey will not only provide a valuable snapshot of the HIV epidemic in MSM but will also offer an important trend analysis of the epidemiology of HIV and other STIs over time across Europe. Therefore, the Sialon II protocol and findings are likely to contribute significantly to increasing the comparability of data in EU countries through the use of common indicators and in contributing to the development of effective public health strategies and policies in areas of high need.

Early findings in outbreak of haemolytic uraemic syndrome among young children caused by Shiga toxin-producing Escherichia coli, Romania, January to February 2016

As at 29 February 2016, 15 cases of haemolytic uraemic syndrome with onset between 25 January and 22 February were reported among children between five and 38 months in Romania, and three of them died. Cases were mostly from southern Romania. Six cases tested positive for Escherichia coli O26 by serology. Fruits, vegetables, meat and dairy products were among the possible common food exposures. Investigations are ongoing in Romania to control the outbreak.

Nasopharyngeal carriage of Streptococcus pneumoniae in Romanian children before the introduction of the pneumococcal conjugated vaccination into the national immunization programme: a national, multi-centre, cross-sectional observational study.

OBJECTIVES We analysed the distribution of vaccine and non-vaccine Streptococcus pneumoniae serotypes and the antimicrobial susceptibility of pneumococcal strains isolated from healthy Romanian children. METHODS A multi-centre cross-sectional study was performed in four counties to evaluate carried strains of S. pneumoniae isolated from 2000 children aged 0-5 years. RESULTS S. pneumoniae carriage was detected in 25.25% of the tested children. Carriage increased from 16.7% among infants to 29.4% in 3-5-year-old children (p<0.0001). The proportions of the serotypes included in pneumococcal conjugate vaccines PCV7, PCV10, and PCV13 among our isolates were 39.9%, 40.1%, and 58.7%, respectively. Erythromycin resistance was 72.5%, and it was significantly lower in non-vaccine serotypes compared with PCV13 serotypes: 57.3% versus 83.6% (p<10(-7)). Penicillin minimum inhibitory concentrations (MICs) >0.064mg/l were recorded in 71.6%, but the penicillin MIC was >2mg/l for only 8.4% of tested isolates. CONCLUSIONS In Romanian children, the majority of carried S. pneumoniae isolates are vaccine serotypes. The isolates with MICs defining macrolide resistance were very frequent, as well as the isolates with MICs defining penicillin resistance in the case of meningitis or penicillin dose-dependent susceptibility for other infections, mainly for the strains belonging to PCV13 serotypes. The implementation of PCV13 within the Romanian national immunization programme could reduce the circulation of these strains with higher macrolide and/or penicillin MICs.

Gut microbiota and its complex role. The experience of the National Institute for Infectious Diseases “Prof. Dr. Matei Balş” in fecal bacteriotherapy for Clostridium difficile infection

Gut microbiota and its complex role. The experience of the National Institute for Infectious Diseases “Prof. Dr. Matei Bals” in fecal bacteriotherapy for Clostridium difficile infection Cătălin Apostolescu, Ruxandra Moroti, Violeta Molagic, Valeriu Gheorghiță, Daniela Tălăpan, Mona Popoiu, Smaranda Botea, Alexandru Rafila, Marilena Palaghiță, Anca Budulac, Lavinia Ivănescu, Mirela Trifan, Gheorghiță Ciobanu, Adrian Streinu-Cercel

The role of sonication in the microbiological diagnosis of implant-associated infections – the experience of the National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest

The role of sonication in the microbiological diagnosis of implant-associated infections – the experience of the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest Raluca Mihăilescu, Daniela Tălăpan, Olga Dorobăț, Alexandru Rafila, Emilia Capraru, Daniela Munteanu, Anca Streinu-Cercel, Oana Streinu-Cercel, Vlad Predescu, Florian Purghel, Cătălin Cârstoiu, Razvan Ene, Dana Mihaela Jianu, Cristina Popescu, Victoria Aramă, Adrian Streinu-Cercel

Antimicrobial resistance of germs isolated from invasive infections – Romania 2012

Background Antimicrobial resistance has become a serious threat to public health undermining the efficacy of existing antimicrobials (including the last-resort ones) while very few novel antimicrobial agents are in the development pipeline. The interventions aimed to contain antimicrobial resistance need a continuous surveillance of new mechanisms of resistance emergence and the spread of existing ones. Romania participated since 2002 as member of European Antimicrobial Resistance Surveillance Network (EARS) for invasive infection; it is a network which collects data for the most important bacteria and clinically relevant antibiotics. We analyzed the antimicrobial resistance results obtained in 2012 in Romania, in order to support national guidelines for antimicrobial treatment and chemoprophylaxis.