Daniela Tălăpan

Microbiologic Safety of the Transareolar Approach in Breast Augmentation

BACKGROUND In aesthetic breast augmentation, especially by the transareolar approach, there is increasing concern regarding the occurrence of capsular contracture and its potential correlation with intraoperative implant contamination from putative endogenous breast flora of the nipple and lactiferous ducts. However, detectable bacteria cannot be considered synonymous with established resident microflora. OBJECTIVES The authors sought to elucidate the existence of endogenous breast flora and assess the microbiologic safety of transareolar breast augmentation. METHODS In this prospective study (BREAST-MF), the authors collected microbiologic samples from the breast skin, ductal tissue, and parenchyma of 39 consecutive female patients who underwent breast procedures in a plastic surgery clinic. Swabs collected pre-, intra-, and postoperatively were processed for bacterial and fungal growth. Positive cultures underwent identification through VITEK and MALDI-TOF, as well as antimicrobial susceptibility testing. RESULTS Staphylococcus species accounted for 95 of 106 (89.6%) positive results from native breast skin, 15 of 18 (83.3%) positive results from decontaminated breast skin, and 4 of 4 (100%) positive results from the breast parenchyma. Methicillin resistance was present in 26.4% of S. epidermidis, 25.3% of S. hominis, and 71.4% of S. haemolyticus strains. CONCLUSIONS During transareolar breast augmentation, in the nipple-areola region it is more likely to find bacteria populating the skin, rather than endogenous breast flora, as previously considered. Appropriate preoperative decontamination is essential for minimizing the risk of postoperative infections. LEVEL OF EVIDENCE 3: Risk.

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.

Clinical and microbiological characterization of Clostridium difficile infection in Romania (2013-2014); a hospital-based study

Methods We collected data for all 398 confirmed or probable cases of CDI admitted during 15 November 2013-28 February 2014 in 11 hospitals: 5 from Bucharest, and 7 from Cluj, Iasi, Timisoara, Târgu Mures and Brasov. PCR ribotyping was performed at Cantacuzino Institute and E-test (for moxifloxacin and metronidazole) and binary toxin gene identification (PCR) were performed at Matei Bals Institute. The hospitals sent a maximum 20 feces samples for each test.

The Recent Emergence of Clostridium Difficile Infection in Romanian Hospitals is Associated With a High Prevalence of Polymerase Chain Reaction Ribotype 027

Aims: To investigate the epidemiology of Clostridium difficile infection in Romanian hospitals. Methods: A survey was conducted at nine hospitals throughout Romania between November 2013 and February 2014. Results: The survey identified 393 patients with Clostridium difficile infection. The median age was 67 years (range: 2-94 years); 56% of patients were aged >65 years. The mean prevalence of Clostridium difficile infection was 5.2 cases per 10.000 patient-days. The highest prevalences were 24.9 and 20 per 10.000 patient-days in hospitals specializing in gastroenterology and infectious diseases, respectively. Clostridium difficile infections were health care-associated in 70.5% patients and community-acquired in 10.2%. The origin was not determined in 19.3%. Clostridium difficile infection was severe in 12.3% of patients, and the in-hospital all-cause mortality was 8.8%. Polymerase chain reaction ribotype 027 had the highest prevalence in all participating hospitals and represented 82.6% of the total ribotyped isolates. The minimum inhibitory concentration of moxifloxacin was >4 μg/mL for 59 of 80 tested isolates (73.8%). Of 59 isolates, 54 were highly resistant to moxifloxacin (minimum inhibitory concentration ≥32 μg/mL), and the majority were polymerase chain reaction ribotype 027 (p<0.0001). Conclusion: The ribotype 027 was the predominant cause of Clostridium difficile infections in Romania. In some specialized hospitals, the prevalence of Clostridium difficile infection was higher than the European mean prevalence, and this demonstrates the need for strict adherence to infection control programs.

Sonication – further progress in the microbiological diagnosis in implant-associated infections

Sonication – further progress in the microbiological diagnosis in implant-associated infections Daniela Tălăpan, Raluca Mihăilescu, Olga Mihaela Dorobăț, Vlad Predescu, Rodica Marinescu, Olivera Lupescu, Florian Purghel, Marius Niculescu, Răzvan Ene, Alexandru Hera, Daniela Munteanu, Mariana Constantin, Emilia Căpraru, Angelica Tenita, Dana Jianu, Oana Săndulescu, Anca Streinu-Cercel, Monica Cârstoiu, Cătălin Cârstoiu, Victoria Aramă, Adrian Streinu-Cercel, Alexandru Rafila

A retrospective study concerning specific therapy and evolution of invasive fungal infections diagnosed in the National Institute for Infectious Diseases "Prof. Dr. Matei Bals".

Results 18 patients met the inclusion criteria for the studied period, representing 40% of the patients with potentially invasive fungal infections. The majority of patients were male, and the average age was 44 years. Only 2 of the patients apparently were not immunocompromised, the other 16 presenting HIV infection or fungal infections risk factors. The fungal species identified were Cryptococcus neoformans in 8 cases (40%) and Candida spp in 12 cases (60%), out of which 75% consisted of non-albicans species. The invasive fungi were isolated from blood cultures in 9 cases (52.4%), cerebrospinal fluid in 8 cases (38.1%), tips of central venous catheters in one case and from other pathological products in one case. The average period from admission to identification was 9.6 days. The antifungal susceptibility test indicated that 16 out of the 20 cases (80%) were sensitive to fluconazole and only 20% were dose-dependent sensitivity types. The patients were treated mainly using monotherapy – 1 antifungal in 10 cases (55%). Fluconazole was the most used agent, in 14 cases (77.8%) followed by voriconazole in 7 cases and posaconazole in 4 cases. The average treatment duration was 37.7 days, the shortest being one day, and the longest 120 days. 6 out of 18 patients (33.3%) deceased: one patient presenting severe bacterial infection treated with prolonged antibiotherapy and 5 presenting C. neoformans meningitis associated with HIV infection.

Bacteriological diagnosis of β-hemolytic streptococci of the upper respiratory tract

Methods Between January 1 2014 – July 15 2014, 5038 throat swabs were sampled from patients hospitalized in INBI Matei Bals according to standard methods. All beta-hemolytic streptococci suspected colonies were tested with bacitracin (0.04%) disks and we used the latex agglutination kit Omega Latex Diagnostic Avipath Strep. Erythromycin resistance testing was performed by disc 2μg Oxoid and clindamycin 2μg Oxoid on the blood M-H medium.

Risk factors in HIV/AIDS patients with cryptococcal meningitis

Cryptococcosis represents a major life-threatening fungal infection in patients with severe HIV infection. Cryptococcal meningoencephalitis is the most common manifestation of cryptococcosis in patients with advanced immunosuppression. Objectives: evaluating risk factors for severe evolution of patients with HIV infection and meningitis. Possible risk factors were analyzed in 33 HIV-infected patients with meningitis, of the 2,100 patients monitored for HIV infection in the National Institute for Infectious Diseases “Prof. Dr. Matei Bals” during 2011-2013. Epidemiological data, CD4 serum and glycorrhachia values were collected from patient records. Etiological diagnosis was made by direct microscopic examination, stained smears microscopy, India ink test, cryptococcus antigen identification by latex agglutination and culture. Identification and antifungal susceptibility testing were performed with Vitek 2C analyzer. HIV-1 genotyping was performed in protease (PR) and partial reverse transcriptase (RT) regions by using DNA sequencing and Viroseq™ HIV-1 Genotyping System. For subtyping purposes the sequences were analyzed with REGA HIV-1&2 automated subtyping tool version 2.0. A number of 12 patients were found positive for Latex agglutination cryptococcus test. Half of the patients were parenterally infected children in the late ’80s and the rest were sexually infected. All patients were in immunological suppression of C3 stage and without therapy on admission. The fatal evolution was associated with tuberculosis (TB, 4 cases) and HBV infection (1 case). CD4 serum values ranged from 42 cells/cmm (7 patients alive) to 22 cells/cmm (5 dead). Cerebrospinal fluid glucose was 33 mg/dL in the 7 alive patients and 23.6 mg/dL in the 5 deceased. All samples having positive latex, had India Ink positive. Only three samples showed no growth in culture. The analyzed patients were infected with subtype F1 HIV-1 viruses, as indicated by subtyping analysis. All the patients had antiretroviral (ARV) therapy interrupted at the moment of cryptococcal meningitis diagnosis. As expected, resistance mutations were not present in PR and RT genes, with few exceptions such as K103N, E138A. The cryptococcal meningitis is very rare among Romanian HIV-1 infected patients, frequently associated with advanced immune suppression, lack of ARV therapy and other comorbidities (TB and HBV infection).