Biochemical Changes and Risk Factors in the Prognosis of Antibiotics Susceptibility in Urinary Tract Infections

The aim of our study was evaluation of prevalence of uncomplicated and complicated urinary tract infections (UTIs) among patients with UTIs associated with Gram - negative bacteria and analysis of prognostic risk factors in complicated UTIs. Weretrospectivelyanalyzed the medical records of inpatients with diagnosis of UTI based on clinical, biological and microbiological assay. Susceptibility tests for different antimicrobial categories were performed. Risk factors in complicated UTIs were correlated with pathogens� susceptibility. A total of 96 eligible patients were analyzed. Complicated UTIs were identified in 66.67% cases. The most frequent uropathogens isolated were E.coli and Klebsiella species. Exrtrarenal factors and nephropathic disease were the most common factors associatedwith an increased prevalence of multi -drug resistant isolates. Knowledge of the spectrum of the possible pathogens and local resistance patterns are very important for the antibacterial treatment outcome.

Predictive Value of Laboratory Markers in HIV-Positive Patient Diagnosed With Severe Sepsis

Nowadays opportunistic infections are not the only threat in the case of HIV-infected patients, being upstaged by microbial or fungal severe infections, especially after the introduction of ultimate generation antiretroviral therapy. The aim of this study is to investigate the factors that are predictive for an unfavourable prognosis and the causality of severe sepsis in HIV-immuno-depressed hosts. The study included 42 HIV-seropositive patients, found out in the evidence of HIV/AIDS Regional Centre from Iasi, that have been diagnosed with severe sepsis with confirmed etiology between the January 2012 and December 2016. The study group was subdivided in two subgroups: the first batch represented by twenty patients HIV-infected in childhood (pediatric cohort) and the second batch represented by 22 patients HIV-infected in adulthood. The medium age at the time of the sepsis diagnosis was significantly lower in the first group compared to the second one (25.0�2.58 vs 34.9�11.8). The lowest CD4 cells levels were noted in the case of patients infected in childhood, being in C2/C3 disease stage. The bacterial etiology was variate in both studied subgroups, with the predominance of Escherichia coli (33.3%), Staphylococcus aureus meticilino-rezistent (26.2%) and Streptococcus pneumoniae (19%) strains. The liver and kidney disfunctions were frecvently present in HIV-infected patients with severe sepsis (n=28 respectiv 31). A high percentage of patients associated criptocococcosis meningoencephalitis (33.3%), the most affected were those from the second subgroup (40.9%). Systemic infections in HIV-seropositive patients presumes an additional risk of unfavourable outcome, especially in the context of non-adherence and non-compliance to ARV-therapy and a long-term HIV infection history.

Characterization of MRSA strains by phenotypic and OCR-based methods

With the emergence and spread of new methicilin resistant Staphylococcus aureus (MRSA) strains, control of dissemination, both in hospitals and in the community, requires the molecular characterization of the circulating strains in order to establish their dynamics and identify the sources of infection. During this study we analyzed the MRSA isolates by means of PCR-based methods in order to improve epidemiological surveillance and early application of prevention measures. The presence of mecA, nuc, lukF-PV and lukS-PV genes, as well as SCCmec types was assessed in relation to clinical characteristics and multidrug resistance (MDR) for 86 MRSA isolates and showed that 51% of MDR strains were carriers of mobile genetic elements SCCmec IV and the majority of non-MDR SCCmec type IV strains were PVL-positive (81.8%). Comparison of diagnostic methods showed that PBP2 detection represents an extremely useful alternative to PCR for the rapid screening of MRSA isolates, in laboratories that lack facilities necessary for molecular diagnosis, such as PFGE (Pulse Field Gel Electrophoresis), spa-typing and/or MLST (Multilocus Sequence Typing).

High Prevalence of Escherichia coli-Producing CTX-M-15 Extended-Spectrum Beta-Lactamases in Poultry and Human Clinical Isolates in Romania

Use of antibiotics in food animals may contribute to development and spread of resistant organisms, particularly so in some countries. The aim of this study was two-fold; first, to establish the prevalence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli in chicken production in a region within Romania. Second, to study the relatedness of ESBL-producing E. coli isolates recovered from broilers, abattoir workers where the chickens were slaughtered and from the human clinical specimens from two regional hospitals. The results indicated a very high (69%) rate of carriage of ESBL and AmpC-producing E. coli in chickens with 36% CTX-M producers. Sequencing showed that chickens in Romania have the highest worldwide prevalence (53%) of blaCTX-M-15 reported in poultry E. coli isolates. The majority (53%) of the extended-spectrum cephalosporin-resistant E. coli carried plasmid-mediated blaampC genes, mostly blaCMY-2 type, one of the highest prevalences reported in Europe. The predominant CTX-M type found in the human clinical E. coli isolates was blaCTX-M-15 and most isolates coharbored blaOXA-1, blaTEM, and aac(6')-ib-cr. The majority (60%) of the human clinical isolates belonged to the pandemic virulent clone B2-ST131. The clonal relationship between broiler and the human CTX-M-producing E. coli isolates was assessed by macrorestriction pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST), which indicated strain diversity with no common STs found between human and poultry isolates. Moreover, IncI1 was the most prevalent replicon found in broiler ESBL-producing E. coli isolates and also in transconjugants, indicating that plasmids and not clonal spread may play a role in the transfer of blaCTX-M genes. This study identifies a high prevalence of ESBL-producing E. coli from broiler chickens in Romania with a high occurrence incidence of blaCTX-M-15, which reflects the main ESBL type found in human E. coli infections in this country.

Bacterial meningitis during sepsis in diabetic patient

The aim of the study was to evaluate the etiology, clinical features and outcome in diabetic patients with bacterial meningitis, as a nervous system determination during invasive infections.

MATERIAL AND METHODS

In a retrospective study, conducted over a period of three years, we have analyzed clinical and etiological aspects of 445 patients over 18 years old, diagnosed with sepsis of known (positive cultures from normally sterile sites) or suspected etiology (positive cultures from pus), 95 of them being included in the diabetic group.

RESULTS

Bacterial meningitis was diagnosed in 16 of 95 diabetic patients (16.8%) and 43 of 350 (12.3%) non-diabetic patients (chi2 = 0.98; GL = 1; p = 0.322). Among the multiple co morbidities associated in diabetic patients, as suggested by a higher Charlson score (5.44 vs. 3.25) (p = 0.001), the most common underlying condition was chronic liver disease (31.3% vs. 25.6%) (p = 0.916). The isolation of the microorganism concurrently from cerebro-spinal fluid and other sites (blood cultures and pus) was more frequently encountered in diabetics. The clinical picture was dominated by altered consciousness (68.8% vs. 23.3%) (p = 0.003), while fever was less present (37.5% vs. 88.4%) (p = 0.0003). The most frequently involved microorganism in the etiology of meningitis was S. aureus (31.3 vs. 23.3%) (p = 0.771) and Gram negative bacilli: E. coli (12.5% vs. 4.7%) (p = 0.629) and Klebsiella spp. (12.5% vs. 9.3%) (p = 0.902).

CONCLUSIONS

Altered consciousness was more frequent in diabetic patients group (68.8% vs. 23.3%) (p = 0.003) where the absence of fever at admission was a more common finding than in non-diabetic septic patients with meningitis (37.5% vs. 88.4%) (p = 0.0003).

Severe invasive listeriosis--case report

Listeriosis is a rare food borne infection which, in the invasive form, presents as bloodstream infection, central nervous system infection, materno-fetal infection, or focal infection. Certain immunosuppressive conditions have been identified as risk factors for severe invasive disease. The invasive forms of listeriosis are associated with a high case fatality rate. We present the case of a 62-year-old male with an unremarkable medical history admitted to the Iasi Infectious Diseases Hospital for fever. headache, ataxia, and diplopia. Physical examination revealed high temperature, confusion, relative bradycardia, and signs of meningeal irritation. Laboratory test showed leukocyt osis with neutrophilia. pathological CSF findings (high WBC count with predominance of neutrophils, low glucose and high protein levels), increased liver enzymes (ALAT, ASAT, AP, gammaGT), and important renal impairment (normal levels at presentation). No abnormalities at chest x-ray, cranial CT and abdominal ultrasound. CSF and blood cultures were positive for Listeria monocytogenes. Under antibiotics (ampicillin and ciprofloxacin), the course was marked by respiratory failure requiring mechanical ventilation, coma, hypotension, tachycardia. and death 12 days after admission. The particularity of this case consists in the association of the two classical forms of invasive listeriosis, meningitis and bacteriemia, with a focal infection. acute hepatitis, and a course marked by multiple organ dysfunction syndromes and exitus in a previously apparently healthy individual.

Emergence of a new group CTX-M enzyme in Romania and risk factors for extended spectrum beta-lactamase producing E. coli infections

Antibiotic resistance rates in E. coli are rapidly rising, with worrisome aspects especially regarding community--acquired resistance to third- and fourth-generation cephalosporins and fluoroquinolones. The objectives of this prospective cohort study was to determine the resistance profile of E. coli for two categories of patients (< 49 years and > or = 50 years), risk factors for ESBL positivity and to investigate the molecular epidemiology of ESBL type CTX-M enzymes. A total of 885 strains of E. coli were isolated in the Infectious Diseases Hospital laboratory between June 2008 and June 2011 and E. coli resistance due to ESBL production was noted in 17% of cases. We found that previous therapy with cephalosporins, hospitalization and urinary catheter were risk factors for ESBL positivity. We noted significant differences concerning resistance rate between patients under 49 years and aged more than 50 years for ciprofloxacin (19% and 38%, respectively, p = 0,0001), for gentamicin (15% and 23%, p = 0,008), ceftazidime (15% and 24%, p = 0,001) and ESBL positivity (14% and 20%, p = 0.009). This study highlights the predominance of CTX-M producing strains (92.5% of ESBLs-positive E. coli harboured bla CTX-M genes); CTX-M-15 producing isolates were the most common, accounting for 96% of isolates. Only 4% were belonging to CTX-M group-9, an emerging ESBL group which is newly described in Romania.

[Use of real time PCR for testing Staphylococcus aureus isolates from the Iaşi Infectious Diseases Hospital]

S. aureus is capable of producing a wide spectrum of diseases and can quickly develop resistance to antibiotics. These features require a careful monitoring of these organisms, by detection of resistance genes and virulence factors, such as Panton-Valentine leukocidin (PVL).

AIM

To determine the presence of mecA and pvl genes in S. aureus isolates by a Real Time-PCR technique (RT-PCR) in order to shorten the detection time.

MATERIALS AND METHODS

We tested 119 strains isolated from pus, using phenotypic methods for methicillin resistance characterization, according to CLSI 2008-2010 guidelines. Detection of mecA and pvl genes was done with hydrolysis probes.

RESULTS

The prevalence rate of methicilin resistant S. aureus (MRSA) was 40,33%, and pvl was detected in 52,08% of those strains. The results of the conventional methods for methicillin resistance detection were validated by those obtained by RT-PCR CONCLUSIONS: RT-PCR is useful in epidemiological surveillance of MRSA and PVL-producing strains and validation of test results for phenotypic resistance to oxacillin.

[Clostridium difficile infections: what is new?]

C. difficile is the most common infectious cause of healthcare-associated diarrhea but now is increasingly recognized as a cause of diarrhea in outpatients and persons without apparent health care contacts. Emergence and spread of new epidemic clones of C. difficile 027 (PCR-ribotype) and 078/126 (toxinotype) with increase toxin production, an aditional binary toxin and high level resistance to fluoroquinolones and increasing incidence of more rapidly progressive severe disease, require prompt clinical recognition and new tools to predict severity and to prevent recurrences. Although antibiotics are effective at inhibiting C. difficile and treating symptoms, these drugs could not reestablish normal bowel flora and the rate of recurrences is 25%. During the past years we assisted to an impressive search for new and more effective therapy that shoud be save, with low potential for the development of resistance, with low levels of systemic absorbtion and high levels of active drug in the colon and should be associated with a low rate of recurrence after treatment. By consequence, different approaches to the management of recurrent infections have been studied such as new antibiotics (fidaxomicin), human monoclonal antibodies against C. difficile toxins A and B, intravenous human immunoglobulin, active immunization, and probiotic therapy.

Optimization of triplex real time PCR for detecting Staphylococcus aureus mecA, pvl and nuc genes

Multiplex polymerase chain reaction (PCR) allows simultaneous detection of two or more genes, using the same reaction conditions, and so it is possible the rapid detection of methicillin resistant Staphylococcus aureus strains (MRSA) in clinical specimens. This study aimed to implement, for the first time in our laboratory, a triplex real time PCR (RT-PCR) technique for detection of genes encoding resistance to oxacillin and synthesis of Panton Valentine leukocidin (pvl), a pathogenicity factor characteristic for community acquired strains (CA-MRSA). The application of this method will permit the epidemiological surveillance of circulating strains and early application of prevention measures.

[Antimicrobial resistance of Streptococcus pneumoniae, 2003-2009]

Streptococcus pneumoniae is the most important respiratory tract pathogen in otitis, sinusitis, bronchitis, and community-acquired pneumonia.

MATERIAL AND METHODS

A total of 155 patient isolates of S. pneumoniae were collected between February 2003 and December 2009 from the Iaşi "Sf. Parascheva" Infectious Diseases Hospital. Susceptibility to antibiotics was assessed by disk diffusion method (CLSI 2003-2008); minimum inhibitory concentrations (MIC) to penicillin and cefotaxime were determined by broth dilution method or E-test method.

RESULTS

Of these isolates, 32.6% were penicillin non-susceptible (MIC > or = 0.12 microg/mL for nonmeningeal isolates before 2008 and all meningeal isolates and MIC > or =2 microg/mL for nonmeningeal isolates after 2008). The percentage of penicillin resistance increased from 0% to a maximum of 50% in 2008. Resistance rates (intermediate and resistant strains) among non-beta-lactam agents were as follows: macrolides, 30.9%; clindamycin, 9%; tetracycline, 34.3%; chloramphenicol, 2.1%; and trimethoprim-sulfamethoxazole, 57.5%. No resistance to vancomycin, linezolid and quinupristin-dalfopristin was observed. Resistance to non-beta-lactam antibiotics was higher among penicillin-resistant strains than penicillin-susceptible strains. Overall, antimicrobial resistance was higher among isolates from respiratory tract comparing with isolates from cerebrospinal fluid and blood.

CONCLUSIONS

Resistance rates with S. pneumoniae have markedly increased in Romania during the last years. Pneumococcal isolates from laşi, Romania are often resistant to beta-lactams and available non-beta-lactam agents, especially if penicillin non-susceptible.

[MecA and pvl genes detection in Staphylococcus aureus strains isolated from lower respiratory tract infections]

Although community-acquired Staphylococcus aureus pneumonia with highly virulent Panton-Valentine leukocidin (PVL)-positive strains, a severe disease with significant lethality, is rare, especially in adult and adolescent patients, recent reports highlight that these infections are on the rise. On the other hand, methicillin-resistant S. aureus (MRSA) is one of the high-risk and potential multi-drug resistant microorganisms.

OBJECTIVES

The aim of this study was to investigate the prevalence of mecA and pvl genes in S. aureus strains isolated from lower respiratory tract infections and to assess the antibiotic resistance profile of these strains.

MATERIAL AND METHOD

The antibiotic susceptibility testing was performed by the disk diffusion method according to CLSI recommendations in 32 consecutive non-repeated S. aureus strains isolated from sputum specimens and endotracheal aspirates of hospitalized patients over the period from January 2005 to December 2009. Only 20 strains (2008-2009) were tested for the presence of mecA and pvl genes by real-time PCR and detection with specific fluorescence probes.

RESULTS

Of the 32 S. aureus isolates, 68.7% were MRSA. MRSA strains showed higher resistance rates to gentamicin, tetracycline, rifampicin, fluoroquinolones comparing to the methicillin susceptible ones. Only one strain produced pvl; it was isolated from a 7 year old child with lethal sepsis with pulmonary and meningeal secondary localisations.

CONCLUSIONS

Glicopeptides and linezolid are therapeutic options indicated in the treatment of staphylococcal pneumonia produced either by MRSA strains or pvl positive S. aureus strains.

[Analysis of 62 cases of nosocomial staphylococcal meningitis admitted to the Iaşi Hospital of Infectious Diseases over a period of 21 years]

AIM

To analyze the clinical features, evolution and treatment of nosocomial staphylococcal meningitis admitted to Hospital of Infectious Diseases Iaşi between 1988 and 2007.

MATERIAL AND METHOD

The data were gathered from the archive of Hospital of Infectious Diseases Iaşi. We studied the clinical and laboratory features of 62 cases of nosocomial staphylococcal meningitis admitted in the study period.

RESULTS

The development of nosocomial meningitis was subsequent to interventions on the central nervous system for haematoma, ventriculo-peritoneal shunts, tumors, spinal anesthesia. The symptoms were fever, headache, stiff neck and vomiting. The etiological agents were: Staphylococcus aureus 37 in cases and coagulase negative staphylococci in 25 cases. The treatment was according to their susceptibility rates, using systemic quinolones and ceftazidime or colymicin. The evolution was favorable in 52 patients and unfavorable in another 10.

CONCLUSION

Nosocomial staphylococcal meningitis remains a serious condition due to the fact that the etiological agents are resistant to the classical antistaphylococcal antibiotics and increasingly resistant to methicillin.

[Study of nosocomial bacillary meningitis admitted in the Clinic of Infectious Diseases Iaşi on a 20 years period]

AIM

To analyze the clinical features, etiology and evolution of nosocomial bacillary meningitis admitted to the Clinic of Infectious Diseases Iaşi between 1988 and 2007.

MATERIAL AND METHOD

The data were gathered from the archive of the Clinic of Infectious Diseases Iaşi. We studied the clinical and laboratory features of 28 cases of nosocomial bacillary meningitis admitted in the study period.

RESULTS

The development of nosocomial meningitis was subsequent to interventions on the central nervous system for hematoma, ventriculo-peritoneal shunts, tumors, rah anesthesia. The symptoms were fever, headache, stiff neck and vomiting. The etiological agents were: Acinetobacter spp--35.71%, Pseudomonas spp.--25%, Klebsiella pneumoniae--17.85%, Escherichia coli--14.28%, and mixed etiology, in 3.57% of the cases each. The treatment was according to their susceptibility, using systemic quinolones and ceftazidime or colymicin. The evolution was favorable in 13 patients and unfavorable in another 15.

CONCLUSION

Nosocomial meningitis caused by Gram negative bacilli is a severe infection, with diverse etiology, which raises therapeutical problems due to antibiotic resistance and a high mortality rate.

[Community acquired acute bacterial meningitis--a 10 year review]

Bacterial meningitis is still an important topic for the infectious diseases specialist, due to it's high incidence, severity and it's high mortality rate.

MATERIAL AND METHOD

We retrospectively studied 679 patients diagnosed with community acquired bacterial meningitis in the Infectious Diseases Hospital Iaşi, Romania between 1998 and 2007.

RESULTS

The annual number of admissions slightly decreased in the last years. Most patients were males (62.1%). Predisposing factors were present in 34.9% of cases. Seizures were described in 19.6% of cases, more frequent in children. The CSF was purulent only in 69.4% of patients, 29.6% of them receiving antibiotics prior to admission; the albumin level in the CSF of pneumococcal meningitis was higher than in other meningitis. The etiology was established in 51.6% of cases, more frequent in sucklings (68.1%). N. meningitidis was the most common cause of community acquired acute bacterial meningitis (CABM) (28.5%) followed by S. pneumoniae (14%). S. pneumoniae was susceptible to penicillin in 79% of cases. The mean mortality rate was 13.1%.

CONCLUSION

Factors associated with a poor prognosis were: pneumococcal etiology, age over 60, and the presence of seizures or coma at admission.

[Sepsis with Staphylococcus aureus in immunocompromised patients]

The aim of our study was to analyze clinical and biological characteristics of immunocompromised patients with staphylococcal sepsis and to compare with the same data in non-immunocompromised patients.

MATERIAL AND METHOD

The diagnosis of sepsis was made based on Bone criteria. MiniAPI system ID 32 STAPH was used for identification and antibiotic susceptibility was assessed by ATB STAPH method and by E-test for oxacillin and vancomycin.

RESULTS

Among the 147 patients with Staphylococcus aureus sepsis--66.67% had concomitant immunosuppressive conditions (diabetes mellitus, liver diseases, renal failure, corticotherapy, etc). We have found a significant correlation between the immunosuppressed status and MRSA (methicillin-resistant Staphylococcus aureus) involvement (p = 0.0018) and also, between this group of patients and treatment failure (p = 0.0012).

CONCLUSION

Because of the high rate of MRSA involvement in systemic infections in the Eastern region of Romania first intention treatment of patients with staphylococcal infections and conditions of immunosuppression must include antibiotics effective against methicillin-resistant strains.

[Clinical and microbiological characteristics of Staphylococcus aureus infections in infectious diseases hospital Iaşi]

We assessed clinical and microbiological characteristics of Staphylococcus aureus (SA) infections in hospitalized patients during a period of three years (October 2005 - October 2008) in the Clinic Hospital of Infectious Diseases Iaşi.

MATERIAL AND METHODS

The study included 169 patients with SA infections (sepsis, meningitis, skin infections and urinary tract infections). MiniAPI system ID 32 STAPH was used for identification and antibiotic susceptibility was assessed by ATB STAPH method and by E-test for oxacillin and vancomycin.

RESULTS

The rate of methicillin resistance (MR) was 48%, all strains being susceptible to linezolid, vancomycin, teicoplanin. In our study MRSA was susceptible in approximately 94% of cases to clindamycin and cotrimoxazole. Infections were defined as nosocomial in 51% of patients with a rate of MR of 52% and community-acquired in 49% with a rate of MR of 23% (p = 0.001). Clinical profile was: localized infection in 41% of patients with MRSA and systemic infection (sepsis with at least one organ involvement or bacteremia) in 59% of patients with MRSA infections (p = 0.53). Initial treatment was inadequate in 46% of MRSA infections. One third of strains had MIC of vancomycin 2 mg/mL.

CONCLUSIONS

The high level of methicillin resistance of S. aureus straints isolated from infections (48 %) justifies a particular approach of initial antistaphylococcal therapy.

[Antimicrobial resistance profile of E. coli and Klebsiella spp. from urine in the Infectious Diseases Hospital Iaşi]

The increasing frequency of extended-spectrum beta-lactamases (ESBLs) producing Enterobacteriaceae among nosocomial and community-acquired infections is an important problem for both microbiologists and clinicians, because of the difficulty in correctly detecting, reporting and treating such infections.

RESULTS

In the Clinical Hospital of Infectious Diseases Iaşi the most frequent etiological agents of urinary tract infections were: E. coli - 64%, Klebsiella spp. 11% and Enterococcus spp - 5%. The resistance rate of E. coli and Klebsiella spp. was 41% and 60%, respectively to amoxicillin-clavulanic acid, 29.6% and 72.5%, respectively to third generation cephalosporins, 26% and 24%, respectively to ciprofloxacin. The most active antimicrobial agents against cephalosporins resistant strains of E. coli and Klebsiella spp were carbapenems (susceptibility rate 99% and 94%, respectively) and colimycin (susceptibility rate 89% and 83%, respectively).

[Cryptococcus meningitis, five years of experience and literature review]

The aim of this study was to determine the distribution and antifungal susceptibility profile of Cryptococcus spp. isolated from patients in northeast Romania.

MATERIAL AND METHOD

Fungi isolated from blood and cerebrospinal fluid (CSF) cultures were identified by ID32C strips (bioMerieux, France). Susceptibility testing was performed using ATB FUNGUS2 strips (bioMerieux, France).

RESULTS

A total of 20 significant strains have been isolated. Overall, Cryptococcus neoformans was the most frequent isolate (95%). We mention the first Cryptococcus albidus meningitis in Romania (strain with multiple resistance). All cryptococci tested were susceptible to amphotericin B with minimal inhibitory concentration (MIC) =1 microg/mL; 90% strains were susceptible to flucytosine. Resistance to fluconazole and itraconazole was observed in 2 and 1 case, respectively. Most of the patients had an associated infection, tuberculosis in 37.5% cases. Despite appropriate therapy 4 patients died (21%).

CONCLUSION

First choice induction therapy with amphotericin B plus flucytosine followed by fluconazole is highly recommended since resistance to antifungal agents is still very low.

Synthesis and characterization of some new bishydrazones derived from isatin

The scientific literature states that isatin and its derivatives exhibit antibacterial, antifungal, anticonvulsant, cytotoxic and anti-HIV activities. The aim of our study was to enlarge the number of isatin derivatives.

MATERIAL AND METHOD

We synthesized some new hydrazones and then, the corresponding bishydrazones using salicylaldehyde. By condensing isatin and its derivatives (methyl-, nitro-, brom-) with hydrazine, corresponding hydrazones were obtained. The bishydrazones were synthesized by refluxing the obtained hydrazones with salicylaldehyde in methanolic solution. The structure of new compounds was confirmed by elemental and spectral analysis. The lipophilicity of the synthesized derivatives was expressed by clog P values. The antibacterial and antifungal activities of the compounds were determined using disk-diffusion method against Gram positive, Gram negative bacteria, and Candida albicans.

RESULTS

New bishydrazines derived from isatin have been synthesized; their structures have been confirmed by elemental and spectral analysis.

[Screening methods for detection of metallo-beta-lactamase producing gram negative rods]

Modified Hodge test and a method using a disk with imipenem plus 1000 mg of EDTA were used to determine the presence of metallo-beta-lactamase producing gram-negative rods among 166 clinical isolates from hospitals in Iaşi and Galaţi. Of 9 imipenem resistant strains found, only one Pseudomonas aeruginosa gave positive results with both tests and other two P. aeruginosa clinical isolates gave negative results with both tests. The rest of the strains (2 P. aeruginosa, 2 Acinetobacter baumanii, 1 Sphingomonas paucimobilis) did not give conclusive results. These screening methods are useful, simple and accessible to clinical laboratories. PCR is needed to confirm the presence of metallo-beta-lactamase gene in bacteria and to determine the type of the enzymes.

[Erysipelothrix rhusiopathiae--rare etiology of persistent febrile syndrome]

Erysipelothrix rhusiopathiae is a Gram-positive rod, carried by many domestic and pet animals and very resistant in the environmental habitat, causing an anthropo-zoonosis infection in humans. It can determine, most frequently, a skin infection and may cause also septic arthritis or systemic infection, usually associated with aortic endocarditis. Bacteremia without endocarditis is a very rare presentation, generally seen in immunocompromised patients. We report such an unexpected diagnosis in a 75-years old woman, with mitral regurgitation, who was investigated for a persistent febrile syndrome, with no evidence of vegetation on repeated echo examinations and no evidence of the entry portal and who recovered successfully from an E. rhusiopathiae bacteremia with Ampicillin iv. therapy for 14 days.

[Direct detection by ligase chain reaction of Mycobacterium tuberculosis complex in pleural fluid]

Our purpose was to investigate the utility of the DNA amplification by ligase chain reaction (LCR) for the direct detection of Mycobacterium tuberculosis complex (MTC) in pleural fluid specimens from patients suspected for tuberculous pleural effusion. We have used the LCx M. tuberculosis kit (Abbott) which uses the amplification of the gene that encodes for antigen b. We have examined 81 pleural fluid specimens by isolation (on Löwenstein-Jensen medium and MB/BacT system) and by LCR. Out of 10 positive specimens in culture, 4 were also positive by LCR; out of 71 negative specimens in culture, 8 were positive by LCR. We have re-evaluated the LCR results according to the clinical diagnosis, sustained by the successful therapy, and to the pathological diagnosis on the pleural biopsy. The sensitivity and specificity of LCR in the diagnosis of tuberculous pleural effusion were 31.5% and 100%. This commercial LCR kit is a rapid, specific, but less sensitive test for the routine diagnosis of the tuberculous pleural effusion.

[Comparing population means using the ANOVA method]

ANOVA is the abbreviation of the ANalysis Of Variance. It was developed for inferences concerning more than two populations. The tested hypothesis is the equality of the means of several normal populations. Some mathematical aspects are presented and also advantages and drawbacks of the method are marked out. Finally a practical example (implementing the ANOVA test) using the SPSS statistical software and also Microsoft Excel are shown.

[Assessment of Tc-99m MIBI uptake mechanism in Mycobacterium tuberculosis and normal cells (fibroblasts and myocytes) cultures]

One of the factors which can explain the scintigraphic Tc-99m MIBI positives images in pulmonary tuberculosis could be the Mycobacterium tuberculosis radiotracer uptake; this can be investigated in vitro, on cell culture, in comparison with normal cell types known to have high (myocites) or low (fibroblasts) uptake. Mycobacterium tuberculosis cultures were realised on Löwenstein Jensen medium, by standard methodology. Myocites and fibroblasts cultures were realized from neonatal rat hearts. Monolayer cells culture were incubated with a same 1.85 kBq/?l Tc-99m MIBI concentration, at 37 degrees C for 15, 60 and 90 minutes. The kinetic was stopped by rapidly washing the cells, with a 4 degrees C physiological saline solution and than scrapped cells were counted for the uptaken radioactivity. The results show that radiotracer cellular uptake (reported at the protein concentration) in myocites was maximum at 60 minutes. Cellular uptake in fibroblasts was very low at all the intervals. In Mycobacterium tuberculosis a peak was observed after 15 minutes, the uptake being similar to that of 60 minutes incubated myocites, considered 100%. After 90 minutes the Mycobacterium tuberculosis uptake was smaller than the 15 minutes value (65.82%). In conclusion, Mycobacterium tuberculosis in vitro uptake results could explain the more positives scintigraphic images in BK positive patients obtain at 15 minutes, in comparison with the delayed images.

Gas chromatographic detection of Mycobacterium tuberculosis complex in pure cultures from respiratory specimens

It is important to identify mycobacteria to the species level in order to establish their clinical significance and to take the appropriate therapeutical decision. Biochemical tests on primary cultures take time (3-6 weeks) until the report of results; that's why more rapid techniques are needed. We have used gas chromatography with flame-ionisation detection (GC-FID) as an alternative identification method for 53 mycobacterial strains isolated from respiratory specimens. We have extracted fatty acids from whole mycobacterial cells, then derivatized them into methylesters, detectable by GC-FID. All the strains were identified as M. tuberculosis complex (MTC), using the Microbial Identification System (MIS) software. The specificity of the identification by GC-FID of MTC is 100%. In conclusion, pulmonary mycobacteriosis are dominated by MTC; GC-FID is a rapid and accurate method for the identification of MTC.