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The 12th Edition of the Scientific Days of the National Institute for Infectious Diseases “Prof. Dr. Matei Bals” and the 12th National Infectious Diseases Conference

Bucharest, Romania. 23–25 November 2016
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BMC Infectious DiseasesBMC series – open, inclusive and trusted201616:1877

https://doi.org/10.1186/s12879-016-1877-4

  • Published:

Table of contents

A1 The outcome of patients with recurrent versus non-recurrent pneumococcal meningitis in a tertiary health-care hospital in Bucharest

Cristian-Mihail Niculae, Eliza Manea, Raluca Jipa, Simona Merisor, Ruxandra Moroti, Serban Benea, Adriana Hristea

A2 Influence of bacteriophages on sessile Gram-positive and Gram-negative bacteria

Alina Cristina Neguț, Oana Săndulescu, Anca Streinu-Cercel, Dana Mărculescu, Magdalena Lorena Andrei, Veronica Ilie, Marcela Popa, Coralia Bleotu, Carmen Chifiriuc, Mircea Ioan Popa, Adrian Streinu-Cercel

A3 The utility of inflammatory biomarkers in the prognostic evaluation of septic patients – past, present and future

Alina Orfanu, Cristina Popescu, Anca Leuștean, Remulus Catană, Anca Negru, Alexandra Badea, Radu Orfanu, Cătălin Tilișcan, Victoria Aramă, Ştefan Sorin Aramă

A4 Etiologic and clinical features of bacterial meningitis in infants

Constanța-Angelica Vișan, Anca-Cristina Drăgănescu, Anuța Bilașco, Camelia Kouris, Mădălina Merișescu, Magdalena Vasile, Diana-Maria Slavu, Sabina Vintilă, Endis Osman, Alina Oprea, Sabina Sandu, Monica Luminos

A5 The diagnostic and prognostic role of neutrophil to lymphocyte count ratio in sepsis

Alina Orfanu, Victoria Aramă, Ştefan Sorin Aramă, Anca Leuştean, Remulus Catană, Anca Negru, Gabriel Adrian Popescu, Cristina Popescu

A6 Whooping cough in a HIV positive patient

Ramona Georgiana Stanculete, Ana Vaduva Enoiu, Adelina Raluca Marinescu, Voichita Lazureanu

A7 Cronobacter sakazakii sepsis in varicella patient

Adelina-Raluca Marinescu, Alexandru Crișan, Voichița Lăzureanu, Virgil Musta, Narcisa Nicolescu, Ruxandra Laza

A8 Anaerobes an underdiagnosed cause of prosthesis joint infection

Anca-Ruxandra Negru, Daniela-Ioana Munteanu, Raluca Mihăilescu, Remulus Catană, Olga Dorobăț, Alexandru Rafila, Emilia Căpraru, Marius Niculescu, Rodica Marinescu, Olivera Lupescu, Vlad Predescu, Adrian Streinu-Cercel, Victoria Aramă, Daniela Tălăpan

A9 Streptococcus pneumoniae meningitis presenting with normal CSF – case presentation

Ramona Ștefania Popescu, Luminița Bradu, Dragoș Florea, Adrian Streinu-Cercel

A10 Extrapulmonary manifestations of infection with Mycoplasma pneumoniae – study on 24 cases

Daniela Anicuta Leca, Elena Bunea, Andra Teodor, Egidia Miftode

A11 The molecular diagnosis of severe bacterial sepsis in pediatric population

Mădălina Merișescu, Gheorghiță Jugulete, Adrian Streinu-Cercel, Dragoș Florea, Monica Luminos

A12 Acute Staphylococcus aureus endocarditis with multiple septic complications in a patient with diabetes mellitus – case presentation

Ramona Ștefania Popescu, Anamaria Dobrotă, Adina Ilie, Liliana Lucia Preoțescu

A13 Is Streptococcus suis meningitis an under-diagnosed zoonosis?

Adriana Hristea, Raluca Jipa, Nicoleta Irimescu, Irina Panait, Eliza Manea, Simona Merisor, Cristian Niculae, Daniela Tălăpan

A14 Klebsiella pneumoniae isolated from blood. Antimicrobial resistance – past and present

Liana Cătălina Gavriliu, Otilia Elisabeta Benea, Șerban Benea, Alexandru Rafila, Olga Dorobăț, Mona Popoiu

A15 Antibiotics resistance in Staphylococcus aureus isolated from blood cultures

Livia Dragonu, Augustin Cupşa, Iulian Diaconescu, Irina Niculescu, Lucian Giubelan, Florentina Dumitrescu, Andreea Cristina Stoian, Camelia Guţă, Simona Puiu

A16 Predominance of CTX-M enzymes in extended-spectrum β-lactamase-producing Enterobacteriaceae in two hospitals of Quebec City

Bunescu Irina, Marilyse Vallée, Ann Huletsky, Dominique K. Boudreau, Ève Bérubé, Richard Giroux, Jean Longtin, Yves Longtin, Michel G. Bergeron

A17 Postoperative meningoencephalitis with Acinetobacter baumannii XDR – a therapeutic challenge - Case report

Cleo Nicoleta Roșculeț, Dalila-Ana Toma, Catrinel Ciuca, Daniela Tălăpan, Cătălin Apostolescu, Andrei Rogoz, Andrei Stangaciu, Viorica Mitescu, Tudor Vladoiu, Doina Iovănescu

A18 Septic arthritis with Burkholderia cepacia

Michaela Oana, Simona Costin

A19 A novel approach for managing hard-to-treat infections

Alina Cristina Neguț, Oana Săndulescu, Anca Streinu-Cercel, Maria Magdalena Moțoi, Mircea Ioan Popa, Adrian Streinu-Cercel

A20 Nineteen months surveillance for multidrug resistant organisms (MDRO) by detecting asymptomatic colonization

Daniela Tălăpan, Olga Mihaela Dorobăț, Mona Popoiu, Alexandru Mihai, Doina Iovănescu, Cleo Roşculeț, Cătălin Apostolescu, Gabriel-Adrian Popescu, Adrian Abagiu, Ruxandra Moroti-Constantinescu, Adriana Hristea, Victoria Aramă, Otilia Benea, Mădălina Simoiu, Rodica Bacruban, Adrian Streinu-Cercel, Alexandru Rafila

A21 Antimicrobial resistance of Gram-positive cocci isolated from clinical specimens in the National Institute of Infectious Diseases “Prof Dr. Matei Balș” between 2009–2015

Olga Mihaela Dorobăț, Daniela Tălăpan, Alexandru Mihai, Ioana Bădicuț, Mona Popoiu, Alina Borcan, Alexandru Rafila

A22 The high percentage of carbapenem-resistant Gram-negative bacilli in Romania: an analysis and some proposals

Gabriel Adrian Popescu

A23 Etiological, clinical and therapeutic considerations on 78 cases of healthcare associated meningitis or ventriculitis admitted in the “Sf. Parascheva” infectious diseases clinical hospital, Iași, from 2011 to 2015

Mihnea Hurmuzache, Georgiana Enache, Alexandra Ciocan, Mircea Bararu, Madalina Popazu

A24 Nosocomial infection dynamics in an Intensive Care Department – an overview (epidemiological and clinical monitoring, advanced therapeutic intervention).

Doina Viorica Iovănescu, Cleo Nicoleta Roșculeț, Andrei Rogoz Cătălin Gabriel Apostolescu, Viorica Mitescu, Tudor Vladoiu, Dalila Toma, Catrinel Ciuca

A25 Safety and efficacy of interferon free treatment in patients with HCV chronic hepatitis- experience of a single Internal Medicine center

Laura Iliescu, Georgiana Minzala, Letitia Toma, Mihaela Baciu, Alina Tanase, Carmen Orban

A26 Viusid in treatment of chronic viral hepatitis B and C

Victor Pantea, Gheorghe Placinta, Valentin Cebotarescu, Lilia Cojuhari, Paulina Jimbei

A27 The management of hyperbilirubinemia in HCV cirrhotic patients who underwent therapy with direct acting antivirals

Cristina Popescu, Anca Leuștean, Cristina Dragomirescu, Alina Orfanu, Cristina Murariu, Laurențiu Stratan, Alexandra Badea, Cătălin Tilișcan, Daniela Munteanu, Raluca Năstase, Violeta Molagic, Mihaela Rădulescu, Remulus Catana, Victoria Aramă

A28 The efficacy of ombitasvir-paritaprevir/ritonavir, dasabuvir and ribavirin in patients with genotype 1 HCV compensated cirrhosis

Cristina Popescu, Laurențiu Stratan, Remulus Catana, Anca Leuștean, Cristina Dragomirescu, Alexandra Badea, Cristina Murariu, Raluca Năstase, Violeta Molagic, Daniela Munteanu, Cătălin Tilișcan, Mihaela Rădulescu, Alina Orfanu, Ioan Diaconu, Anca Negru, Iulia Bodosca, Violeta Niță, Victoria Aramă

A29 The efficacy of direct acting antivirals regimen without ribavirin in HCV genotype 1b infected patients with compensated cirrhosis

Anca Leuștean, Victoria Aramă, Alina Orfanu, Remulus Catana, Laurențiu Stratan, Cristina Dragomirescu, Cristina Murariu, Alexandra Badea, Cătălin Tilișcan, Daniela Munteanu, Violeta Molagic, Raluca Năstase, Mihaela Rădulescu, Cristina Popescu

A30 Liver decompensation during ombitasvir-paritaprevir/ritonavir-dasabuvir and ribavirin regimen in HCV infected patients with Child-Pugh A cirrhosis

Cristina Popescu, Cristina Dragomirescu, Anca Leuștean, Cristina Murariu, Laurențiu Stratan, Alexandra Badea, Remulus Catană, Alina Orfanu, Raluca Mihaela Năstase, Violeta Molagic, Daniela Munteanu, Cătălin Tilișcan, Victoria Aramă

A31 The safety of direct acting antivirals in HCV compensated cirrhotic patients - an interim analysis

Victoria Aramă, Remulus Catană, Cristina Dragomirescu, Cristina Murariu, Anca Leuștean, Laurențiu Stratan, Alexandra Badea, Alina Orfanu, Anca Negru, Raluca Năstase, Violeta Molagic, Daniela Munteanu, Cătălin Tilișcan, Mihaela Rădulescu, Ioan Diaconu, Violeta Niță, Iulia Bodoșca, Cristina Popescu

A32 The access of patients with HCV compensated cirrhosis to the National Program of therapy with direct acting antivirals

Cristina Popescu, Alexandra Badea, Anca Leuștean, Alina Orfanu, Anca Negru, Laurențiu Stratan, Cristina Dragomirescu, Remulus Catană, Cristina Murariu, Violeta Molagic, Raluca Năstase, Cătălin Tilișcan, Daniela Munteanu, Mihaela Rădulescu, Ioan Diaconu, Violeta Niță, Iulia Bodoșca, Victoria Aramă

A33 Severe reactivation of chronic hepatitis B after discontinuation of nucleos(t)ide analogues – a case series

Cristina Popescu, Alina Orfanu, Anca Leuștean, Alexandra Badea, Laurențiu Stratan, Remulus Catană, Cătălin Tilișcan, Victoria Aramă

A34 The dynamic of hematological disorders during direct acting antivirals therapy for HCV compensated cirrhosis

Cristina Popescu, Cristina Murariu, Cristina Dragomirescu, Anca Leuștean, Laurențiu Stratan, Alina Orfanu, Alexandra Badea, Remulus Catană, Anca Negru, Cătălin Tilișcan, Daniela Munteanu, Mihaela Rădulescu, Violeta Molagic, Raluca Mihaela Năstase, Ioan Alexandru Diaconu, Iulia Bodoșca, Violeta Niță, Victoria Aramă

A35 Behaviors, attitudes and risk factors for viral hepatitis in international medical students vs. the general population in Romania

Yagmur Erturk, Oana Săndulescu, Alina Cristina Neguț, Claudiu Mihai Șchiopu, Adrian Streinu-Cercel, Anca Streinu-Cercel

A36 Characteristics of hepatitis C virus reactivation due to immunosuppressive therapy in Romanian HCV infected patients with hematological malignancies

Violeta Molagic, Cătălin Tilișcan, Cristina Popescu, Raluca Mihăilescu, Daniela Munteanu, Raluca Năstase, Anca Negru, Angelica Tenita, Victoria Aramă, Ștefan Sorin Aramă

A37 The dynamic IFN-gamma serum levels during successful peginterferon-a 2a/ribavirin therapy in HCV chronic infection

Simona Alexandra Iacob, Diana Gabriela Iacob, Monica Luminos

A38 Overlapping risk factors for transmission of HBV, HCV and HIV in the general population in Romania

Anca Streinu-Cercel, Oana Săndulescu, Mioara Predescu, Alexandra Mărdărescu, Cătălin Tilișcan, Mihai Săndulescu, Claudiu Mihai Șchiopu, Adrian Streinu-Cercel

A39 Acute hepatitis - an uncommon neurological complication

Cleo Nicoleta Roșculeț, Catrinel Olimpia Ciuca, Dalila Ana Toma, Cătălin Gabriel Apostolescu, Andrei Rogoz, Cristina Elena Mitu, Andrei Stangaciu, Viorica Daniela Mitescu, Tudor Gheorghe Vladoiu, Doina Viorica Iovănescu

A40 Regression of liver fibrosis following sustained virological response in patients with chronic HCV infection and cirrhosis

Oana Săndulescu, Anca Streinu-Cercel, Monica Andreea Stoica, Liliana Lucia Preoțescu, Daniela Manolache, Gabriela Jana Ceapraga, Maria Magdalena Moțoi, Luminița Bradu, Adina Ilie, Gabriela Mircea, Ionel Durbală, Adrian Streinu-Cercel

A41 Preliminary results of treatment with sofosbuvir and daclatasvir of patients with chronic hepatitis C

Irina Russu, Tiberiu Holban, Tatiana Pantilimonov, Galina Chiriacov, Arcadie Macvovei, Elena Scorohodico, Oleg Dmitriev

A42 HIV-syphilis coinfection

Diana Alexandra Costache, Anca Benea, Eliza Manea, Cristian Niculae, Raluca Jipa, Adriana Hristea, Elisabeta Benea, Ruxandra Moroti, Șerban Benea

A43 Thrombophilia – additional risk factor for the evolution of pregnancy in HIV-positive patients

Mihai Mitran, Carmen Georgescu, Loredana Mitran, Simona Vladareanu

A44 The incidence of oropharyngeal candidiasis in hospitalized HIV infected pediatric Romanian cohort between 1 January - 31 December 2015

Andreea Ioana Magirescu, Viorica Andreev, Cristina Nicolau, Alexandra Largu, Carmen Dorobat, Carmen Manciuc

A45 TB incidence in HIV infected patients during the year of 2015

Viorica Andreev, Andreea Ioana Magirescu, Ina Isac, Cristina Nicolau, Alexandra Largu, Carmen Dorobat, Carmen Manciuc

A46 Retrospective analysis of HIV/AIDS deaths recorded in the Clinical Infectious Diseases Hospital, Constanța in the period 01 January 2014–30 June 2016. Epidemiological considerations.

Iulia Gabriela Șerban, Ghiulendan Resul, Consuela Marcaș

A47 Acute liver failure with favorable evolution in an HIV-HBV coinfected patient

Iosif Marincu, Patricia Poptelecan, Bogdan Trincă, Sorina Mitrescu, Anca Tudor, Daliborca Vlad, Livius Tirnea

A48 Lifestyle impact on HIV management

Nurcan Baydaroglu, Alina Cristina Neguț, Oana Săndulescu, Daniela Manolache, Gabriela Ceapraga, Monica Andreea Stoica, Anca Streinu-Cercel, Adrian Streinu-Cercel

49. HIV positive mothers newborns - clinical experience from January 2012 to June 2016

Carmen Manciuc, Mariana Pagute, Cristina Nicolau, Carmen Dorobăț, Alexandra Largu

A50 Rediscovering HIV-associated progressive multifocal leukoencephalopathy and HIV encephalopathy: clinical suspicion and subsequent brain autopsies

Ioan-Alexandru Diaconu, Laurențiu Stratan, Daniela Ion, Luciana Nichita, Cristina Popescu, Raluca Năstase, Daniela Munteanu, Violeta Molagic, Cătălin Tilișcan, Mihaela Rădulescu, Alexandra Diaconu, Anca Negru, Alina Orfanu, Cristina Dragomirescu, Remulus Catană, Anca Leuștean, Irina Duport-Dodot, Cristina Murariu, Iulia Bodoșca, Violeta Niță, Alexandra Badea, Victoria Aramă

A51 Antenatal surveillance of pregnant women with risk behavior and its impact on mother-to-child HIV transmission in Romania

Mariana Mărdărescu, Cristina Petre, Marieta Iancu, Rodica Ungurianu, Alina Cibea, Ruxandra Drăghicenoiu, Ana Maria Tudor, Delia Vlad, Sorin Petrea, Carina Matei, Dan Oțelea, Carmen Crăciun, Cristian Anghelina, Alexandra Mărdărescu

A52 Noninvasive assessments (APRI, Fib-4, transient elastography) of fibrosis in patients with HIV and HIV/HBV infection

Elena Dumea, Adrian Streinu-Cercel, Sorin Rugină, Lucian Cristian Petcu, Stela Halichidis, Simona Claudia Cambrea

A53 Undetectable HIV viral load – the main goal in the management of HIV-infected patients

Carmen Chiriac, Nina-Ioana Bodnar, Iringo-Erzsebet Zaharia-Kezdi, Cristina Gîrbovan, Andrea Incze, Anca Meda Georgescu

A54 LPS serum levels and correlation with immunological, virological and clinical outcome in HIV infected patients

Simona Alexandra Iacob, Diana Gabriela Iacob, Eugenia Panaitescu, Monica Luminos, Manole Cojocaru

A55 LL37 human cathelicidin serum levels are positively correlated with IFN gamma and alanine aminotransferase level in HCV infection

Simona Alexandra Iacob, Diana Gabriela Iacob, Monica Luminos

A56 Early diagnosis of pulmonary tuberculosis in a non-compliant HIV/AIDS late presenter patient

Vochita Laurențiu, Vochita Andreia, Opreanu Radu, Trinca Bogdan, Rosca Ovidiu, Marincu Iosif

A57 Evolution of antiretroviral regimens in naϊve patients in 2016

Ramona Zamfir, Alina Angelescu, Alena Andreea Popa, Raluca Jipa, Ruxandra Moroti, Adriana Hristea, Liana Gavriliu, Șerban Benea, Elisabeta Benea

A58 The unfavorable risk factors for HIV infected persons with positive blood cultures hospitalized at the National Institute for Infectious Diseases “Prof. Dr. Matei Balș” in 2015

Alena-Andreea Popa, Georgeta Ducu, Daniela Camburu, Alina Cozma, Manuela Podani, Roxana Dumitriu, Liana Gavriliu, Șerban Benea, Elisabeta Benea

A59 Epidemiological aspects of HIV infection in Oltenia region

Andreea Cristina Stoian, Florentina Dumitrescu, Augustin Cupșa, Lucian Giubelan, Irina Niculescu, Loredana Ionescu, Livia Dragonu

A60 HIV risk behaviors and prevalence among patients in methadone maintenance therapy (MMT) from Arena center, Bucharest

Adrian Octavian Abagiu, Loredana Nicoleta Stoica, Catrinel Blaga, Archontis Koulosousas, Roxana Ștefănescu, Alice Atomoaie, Florentina Paraschiv, Florin Matache Duna

A61 Therapeutic options in a case of severe psoriasis associated with both HIV infection and hepatitis C virus previously treated with fumaric acid esters

Rodica Olteanu, Roxana Ion, Alexandra Zota, Isra Ennour Jaballah, Lara Mahfoud, Georgeta Preda, Magda Constantin

A62 Prevalence of autoantibodies against gangliosides in asymptomatic HIV-infected patients

Ilinca Nicolae, Corina Daniela Ene, Mădălina Irina Mitran, Vasile Benea, Mircea Tampa, Simona Roxana Georgescu

A63 Subclinical inflammation in HIV-infected patients undergoing antiretroviral therapy – a cross sectional study

Iulia Cristina Bodoșca, Cristina Murariu, Cătălin Tilișcan, Victoria Aramă, Cristina Popescu, Daniela Munteanu, Mihaela Rădulescu, Violeta Molagic, Raluca Năstase, Alina Orfanu, Anca Leuștean, Remulus Catană, Anca Negru, Adrian Streinu-Cercel, Sorin Aramă

A64 Severe Guillain-Barré syndrome occurring after chickenpox with favorable evolution

Iuliana CAramăngiu, Ovidiu Rosca, Monica Cialma, Radu Opreanu, Laurențiu Vochita, Iosif Marincu

A65 Echovirus 30 infection with pulmonary and cardiac complications – case report

Vlad Murărescu, Marilena Palaghiță, Alina Cristina Neguț, Cornel Camburu, Adrian Streinu-Cercel

A66 Herpetic encephalitis with favorable evolution in an adult immunocompetent patient

Irina Duşan, Patricia Poptelecan, Bogdan Trincă, Sorina Mitrescu, Livius Tirnea, Iosif Marincu

A67 Clinical-evolutional aspects in present-day measles

Narcisa Nicolescu, Alexandru Crișan, Voichița Lăzureanu, Ruxandra Laza, Virgil Musta, Adelina-Raluca Marinescu, Andreea Bîrlad

A68 Pneumococcal superinfection in children with influenza

Victor Daniel Miron, Anca Cristina Drăgănescu, Constanța-Angelica Vișan, Anuța Bilașco, Daniela Pițigoi, Oana Săndulescu, Monica Luminița Luminos

A69 Varicella complicated with transverse myelitis - case presentation

Monica Luminos, Endis Osman, Magdalena Vasile, Anca Cristina Drăgănescu, Constanța-Angelica Vișan, Anuța Bilașco, Camelia Kouris, Sabina Șchiopu, Mădălina Merișescu

A70 Clinical forms of enterovirus infections during the summer season of 2016

Monica Luminos, Anca Cristina Drăgănescu, Constanța-Angelica Vișan, Anuța Bilașco, Camelia Kouris, Endis Osman, Sabina Vintilă, Magda Vasile, Mădălina Merișescu

A71 Face off – HIV and lymphoma – case series presentation

Liana Cătălina Gavriliu, Otilia Elisabeta Benea, Alina Angelescu, Ramona Zamfir, Daniela Camburu, Georgeta Ducu, Alina Cozma, Roxana Dumitriu, Manuela Podani, Șerban Benea, Mihaela Ionică

A72 Coxsackie infection complicated by pancytopenia – pediatric case report

Gheorghiță Jugulete, Adina Stăncescu, Cristina Elena Popescu, Luminița Marin, Diana Zaharia, Cristina Dumitrescu, Lucia Tudor, Sabina Vintilă

A73 Viral respiratory infections in children in the season 2015–2016

Constanța-Angelica Vișan, Anca Cristina Drăgănescu, Anuța Bilașco, Magda Vasile, Mădălina Merișescu, Camelia Kouris, Cristina Negulescu, Endis Osman, Diana-Maria Slavu, Sabina Vintilă, Daniela Pițigoi, Monica Luminos

A75 The severity of A H1N1 Influenza infection in the 2015–2016 season

Cleo Roșculeț, Catrinel Olimpia Ciuca, Dalila Toma, Cătălin Apostolescu, Andrei Rogoz, Andrei Stangaciu, Viorica Mitescu, Doina Iovănescu, Cornel Camburu, Bogdana Manu

A76 Acute respiratory distress syndrome in a child with measles

Ana Vaduva-Enoiu, Ramona Georgiana Stanculete, Adelina Raluca Marinescu, Voichita Elena Lazureanu

A77 Management challenges of right-sided infectious endocarditis in an HIV positive patient – case presentation

Elena-Violeta Niță, Sînziana Dumitru, Daniela-Ioana Munteanu, Anca Ruxandra Negru, Remulus Catană, Ioan Diaconu, Bogdana Manu, Ligia Ionescu, Liliana Ion, Cătălin Tilișcan, Victoria Aramă

A78 Bacterial infection in critical patients with severe A H1N1 influenza virus infection (epidemiology, development, therapeutic decisions)

Doina Viorica Iovănescu, Cleo Nicoleta Roșculeț, Andrei Rogoz, Cătălin Apostolescu, Viorica Mitescu, Tudor Vladoiu, Dalila Toma, Catrinel Ciuca

A79 Epidemiological aspects of severe acute respiratory infection cases (SARI) in the season 2015–2016, in the Clinical Hospital of Infectious Diseases – Constanța, Romania

Iulia Gabriela Șerban, Marioara Neacșu

A80Overexpression of IL-6 trans signaling pathway in viral infections

Simona Roxana Georgescu, Vasile Benea, Corina Daniela Ene, Mircea Tampa, Cristina Iulia Mitran, Ilinca Nicolae

A81 Acute viral hepatitis B with persistent HBsAg – description and evolution

George Ciprian Pribac, Mirandolina Prisca, Fulvia Ursoiu, Carmen Neamtu, Bogdan Totolici, Coralia Cotoraci, Aurel Ardelean

A82 Prevalence of cervical pathogens in a population of pregnant female patients monitored in a tertiary care hospital in Bucharest, Romania

Simona Elena Albu, Mara Carsote, Beatrice Miclăuș, Diana Mihai, Oana Săndulescu, Cristina Vasiliu

A83 Prevalence of group B Streptococcus during pregnancy in a cohort of patients monitored in a tertiary care hospital in Bucharest, Romania

Cristina Vasiliu, Mara Carsote, Corina Gorgoi, Beatrice Miclăuș, Diana Mihai, Oana Săndulescu, Simona Elena Albu

A84 Infectious hematoma in the gastrocnemius muscle – case presentation

Amelia Blescun, Gelu Breaza

A85 Reflections towards the underexplored HTLV Romanian viral circulation - adult T‐cell leukemia/lymphomas, a case series

Sabina Vintila, Felicia Mihai, Meilin Omer, Cornel Dragan, Daniela Pitigoi

A86 A febrile confusion syndrome with acute onset – case presentation

Mirela Ciucu, Marius-Dan Ionescu, Cristina Roskanovic, Valentina Barbu, Iulian Diaconescu, Florentina Dumitrescu, Irina Niculescu

A87 Retrobulbar optic neuritis in a HIV-positive patient - case report

Mihaela Ionică, Ramona-Alexandra Zamfir, Alina Cozma, Otilia Elisabeta Benea

A88 A rare presentation of Q fever – case presentation

Alexandra-Sînziana Dumitru, Daniela-Ioana Munteanu, Violeta Niță, Cristina Popescu, Iulia Bodosca, Angelica Tenita, Viorica Ispas, Victoria Aramă

A89 Tinea incognita – case presentation

Vasile Benea, Simona Roxana Georgescu, Mircea Tampa, Diana Oana Leahu, Cristina Maria Safta, Mihaela Anca Benea

A90 Incidence and risk factors associated with TORCH infections during pregnancy

Oana Săndulescu, Octavian Munteanu, Roxana Bohâlțea, Livia Trașcă, Monica Cîrstoiu

A91 Acute respiratory failure in critical patients with sepsis

Doina Viorica Iovănescu, Cleo Nicoleta Roșculeț, Andrei Rogoz, Cătălin Gabriel Apostolescu, Viorica Daniela Mitescu, Tudor Gheorghe Vladoiu, Dalila Toma, Catrinel Ciuca

A92 Cochleo-vestibular deficit secondary to Granulicatella elegans meningitis

Mădălina Georgescu

A93 Influenza 2015/2016 – clinical, epidemiological and virological characteristics of cases admitted in three infectious diseases hospitals

Daniela Pițigoi, Alina Elena Ivanciuc, Mihaela Lazar, Teodora Ionescu, Carmen Maria Cherciu, Cristina Țecu, Maria Elena Mihai, Maria Nițescu, Rodica Bacruban, Delia Azamfire, Aura Dumitrescu, Elena Ianosik, Daniela Leca, Elena Duca, Andra Teodor, Codrina Bejan, Emanoil Ceaușu, Simin-Aysel Florescu, Corneliu Popescu, Grațiela Târdei, Codrina Juganariu, Emilia Lupulescu

A94 Severe complications of varicella requiring hospitalization in previously healthy children in Brașov county

Ligia Rodina, Maria Elena Cocuz

A95 Clinical forms of Clostridium difficile colitis in children

Gheorghiță Jugulete, Adina Stăncescu, Cristina Elena Popescu, Luminița Marin, Diana Zaharia, Cristina Dumitrescu, Endis Osman

A96 Community-acquired pneumonia – demographic, clinical and etiological aspects

Irina Niculescu, Augustin Cupșa, Iulian Diaconescu, Florentina Dumitrescu, Livia Dragonu, Andreea Stoian, Lucian Giubelan, Cristina Roskanovic

A97 Acute myocarditis in an adult patient with chickenpox - Case report

Ramona-Alexandra Zamfir, Mihaela Ionica, Otilia-Elisabeta Benea

A98 Caustic oropharyngeal wound with acute group F streptococcal superinfection mimicking diphtheria – case report and differential diagnosis

Maria-Cristina Sîrbu, AnaMaria Dobrotă, Alina Cristina Neguț, Roxana Duda, Rodica Bacruban, Daniela Pițigoi, Cristiana Cerasella Dragomirescu, Daniela Tălăpan, Olga Dorobăț, Adrian Streinu-Cercel, Anca Streinu-Cercel

A99 Clostridium difficile infection in HIV-positive patients admitted in the National Institute for Infectious Diseases “Prof. Dr. Matei Balș” in 2015

Mihaela Ionica, Ramona-Alexandra Zamfir, Alina Cozma, Otilia Elisabeta Benea

A100 Title: Epidemiology of Candida oral infections (stomatitis) in Romania

Sergiu Fendrihan, Ecaterina Scortan, Mircea Ioan Popa

A101 Anthrax case series in south-eastern Romania

Corneliu P Popescu, Șerban N Benea, Andra E Petcu, Adriana Hristea, Adrian Abagiu, Iuliana A Podea, Raluca E Jipa, Georgeta Ducu, Raluca M Hrișcă, Dragoș Florea, Manuela Nica, Eliza Manea, Simona Merișor, Cristian M Nicolae, Simin A Florescu, Irina M Dumitru, Emanoil Ceaușu, Sorin Rugină, Ruxandra V Moroti

A102 Knowledge, risk perception and attitudes of healthcare workers at the National Institute for Infectious Diseases “Prof. Dr. Matei Balș” regarding Ebola

Daniela Pițigoi, Teodora Ionescu, Oana Săndulescu, Maria Nițescu, Bogdan Nițescu, Iulia Monica Mustaţă, Sorina Claudia Boldeanu, Florentina Furtunescu, Adrian Streinu-Cercel

A103 A case of abdominopelvic actinomycosis with successful short-term antibiotic treatment

Diana Gabriela Iacob, Simona Alexandra Iacob, Mihaela Gheorghe

A104 A case of pneumonia caused by Raoultella planticola

Iulian Diaconescu, Irina Niculescu, Floretina Dumitrescu, Lucian Giubelan

A105 Vitamin D deficiency and sepsis in childhood

Adriana Slavcovici, Raluca Tripon, Roxana Iubu, Cristian Marcu, Mihaela Sabou, Monica Muntean

A106 The clinical and epidemiological aspects and prophylaxis of Lyme disease among patients who presented with tick bites to the Clinical Infectious Disease Hospital “Toma Ciorbă”

Ion Chiriac, Tiberiu Holban, Liviu Tazlavanu

A107 Drug-resistant tuberculosis in HIV infected patients

Raluca Jipa, Eliza Manea, Roxana Cernat, Kezdi Iringo, Andrei Vâță, Manuela Arbune, Teodora Moisil, Adriana Hristea

A108 Kidney injury molecule-1 and urinary tract infections

Corina-Daniela Ene, Ilinca Nicolae, Roxana Simona Georgescu

A109 The impact of microbiological agents on serum gangliosides in patients with benign prostate hyperplasia

Corina-Daniela Ene, Cosmin-Victor Ene, Roxana Simona Georgescu, Marilena Ciortea , Lucreția Dulgheru, Ilinca Nicolae

A110 Toxocariasis - the experience of the Iași Infectious Diseases Hospital between 2013–2015

Mihaela Cătălina Luca, Ioana-Alina Harja-Alexa, Roxana Nemescu, Mădălina Popazu, Andrei Ștefan Luca

A111 Species of anaerobic Gram-positive cocci involved in odontogenic abscesses

Gabriela Bancescu, Bogdan Dabu, Adrian Bancescu

A112 Clostridium difficile infection recurrences

Eliza Manea, Raluca Jipa, Adriana Hristea

A113 Differential diagnosis of staphylococcal and tuberculous osteodiscitis – case report

Adina Elena Ilie, Săftica-Mariana Pohrib, Alina Cristina Neguț, Maria-Sabina Tache, Maria Magdalena Moțoi, Oana Săndulescu, Ion Aurel Iliescu, Adrian Streinu-Cercel

A114 Severe clinical forms of respiratory syncytial virus infections

Cristina Tecu, Maria-Elena Mihai, Mihaela Lazăr, Carmen Cherciu, Alina Ivanciuc, Daniela Pițigoi, Emilia Lupulescu

A115 Acinetobacter baumannii postoperative sepsis associated with Clostridium difficile enterocolitis in an immune suppressed elderly patient

Mirela Paliu, Manuela Curescu, Bianca Cerbu, Iosif Marincu

A116 Risk factors and their impact on psychopathology and quality of life among people living with HIV/AIDS in Romania

Fulvia Ursoiu, Mirandolina Prișcă, George Ciprian Pribac

A117 Antivirals susceptibility of influenza viruses circulating in Romania

Maria Elena Mihai, Carmen Maria Cherciu, Alina Elena Ivanciuc, Cristina Tecu, Emilia Lupulescu

A118 Retrospective study of hospitalized cases of sepsis at the Hospital Clinic of Infectious Diseases “Toma Ciorbă”

Irina Bunescu, Tiberiu Holban, Ana Pasnin, Stela Semeniuc, Raisa Popovici, Galina Chiriacov

Keywords

  • Respiratory Syncytial Virus
  • Progressive Multifocal Leukoencephalopathy
  • Clostridium Difficile Infection
  • Cerebral Spinal Fluid
  • Fecal Microbiota Transplantation

Pathogenesis of bacterial infections

A1 The outcome of patients with recurrent versus non-recurrent pneumococcal meningitis in a tertiary health-care hospital in Bucharest

Cristian-Mihail Niculae1, Eliza Manea1, Raluca Jipa1,2, Simona Merisor1, Ruxandra Moroti1,2, Serban Benea1,2, Adriana Hristea1,2

1National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Correspondence: Cristian-Mihail Niculae (niculae_cristian87@yahoo.com)

Background

Pneumococcal meningitis (PM) is a life-threatening disease. Recurrent PM is relatively rare and associated with predisposing conditions. This study analyzed the outcome of patients with recurrent versus non-recurrent PM.

Methods

We conducted a retrospective study, analyzing the records of all the patients hospitalized between 2005 and 2015 for PM in our institution. We included patients with the diagnostic of PM based on appearance on Gram stain, a positive latex agglutination reaction of cerebral spinal fluid (CSF) samples and/or a positive culture for Streptococcus pneumoniae (CSF culture or blood culture and concomitant meningitis). We defined “recurrent meningitis” as at least two episodes of meningitis, separated by a period of at least 4 weeks.

Results

We identified a total of 194 PM episodes in 182 patients. Thirty eight (20 %) patients were diagnosed with recurrent meningitis, and they had 93 prior episodes recorded. The majority of patients with recurrent meningitis experienced two meningitis episodes, but we found 3 patients with 7, 11 and 40 recurrent episodes. Nineteen (50 %) patients in recurrent meningitis group and 90 (58 %) in non-recurrent group were men. Median age of patients with recurrent versus non-recurrent meningitis was 29 versus 57 years (p < 0.001). Nine (24 %) patients with recurrent meningitis versus 64 (41 %) patients with non-recurrent meningitis had an underlying immunosuppressive condition (p = 0.02, OR:0.41, 95 % CI:0.18–0.92). The immunosuppression was: diabetes mellitus in 32 (44 %), alcoholism in 19 (26 %), end-stage liver disease in 7 (9.5 %) and malignancy, malnutrition, pregnancy, splenectomy and immunosuppressive therapy in 15 (20.5 %). We found dissemination of infection from a contiguous site in 74 (38 %) cases, bone defects and/or CSF leakage in 36 (18.5 %) cases and hematogenous spread in 14 (7.2 %) cases. A cranial bone discontinuity and/or CSF leakage were identified in recurrent versus non-recurrent meningitis in 21 (55 %) versus 15 (10 %) episodes (p < 0.001, OR:14.41, 95 % CI:6.21–33.4). Hematogenous spread was observed only in the non-recurrent meningitis group. In recurrent versus non-recurrent meningitis, impaired consciousness on admission was noted in 15 (40 %) versus 64 (41 %). We noted one death (2.6 %) among patients with recurrent PM group vs 42 (27 %) in the non-recurrent group (p<0.001, OR:0.07, 95 % CI:0.01–0.5). Death was associated with non-recurrent meningitis (p < 0.001), contiguous spread (p = 0.014), immunodepression (p = 0.01) and impaired consciousness (p = 0.005).

Conclusions

Patients with recurrent meningitis were younger, with less immunosuppression conditions and had a better survival versus those with non-recurrent meningitis. Mortality of PM was associated with immunosuppression and impaired consciousness, but the small number of deaths in the recurrent group did not allow us to analyses the differences between the two groups.

A2 Influence of bacteriophages on sessile Gram-positive and Gram-negative bacteria

Alina Cristina Neguț1,2, Oana Săndulescu1,2, Anca Streinu-Cercel1,2, Dana Mărculescu1, Magdalena Lorena Andrei1, Veronica Ilie1, Marcela Popa3, Coralia Bleotu5, Carmen Chifiriuc3,4, Mircea Ioan Popa2, Adrian Streinu-Cercel1,2

1National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 3Research Institute of the University of Bucharest, Bucharest, Romania; 4Microbiology Department, Faculty of Biology, University of Bucharest, Bucharest, Romania; 5Ștefan S. Nicolau Institute of Virology, Romanian Academy, Bucharest, Romania
Correspondence: Alina Cristina Neguț (negoitza_alina@yahoo.com)

Background

Bacteriophages are hypothesized to contribute to biofilm eradication through multiple actions, such as: 1) amplification in host cells; 2) production of depolymerizing enzymes that degrade the matrix of extracellular polymeric substances; 3) induction of depolymerizing enzymes in host cells; 4) infection of persistent bacterial cells and lysis upon reactivation [1].

Methods

We have performed an in vitro experiment in the National Institute for Infectious Diseases „Prof. Dr. Matei Balș”, assessing the influence on biofilm formation and biofilm eradication of commercially-available bacteriophage cocktails Intesti and Pyo (Eliava BioPreparations, Tbilisi, Georgia) in different binary dilutions (1/2 through 1/64) as presented in Neguț et al., GERMS 2014. We have used two bacterial models: Gram-positive model (117 strains of Staphylococcus spp.) and Gram-negative model (44 strains of Pseudomonas aeruginosa) [2].

Results

Intesti and Pyo bacteriophages inhibited biofilm formation of both Gram-positive (p = 0.004, p = 0.001) and Gram-negative (p = 0.001, p = 0.001) models for all the dilutions used, respectively. The median optical density (OD) of staphylococcal culture decreased with 8.114 % (−9.386 %, 16.533 %) for the dilution 1/64 of Intesti, and 8.108 % (0.684 %, 20.143 %) for Pyo, respectively. The median OD decreased with 29.191 % (4.607 %, 48.448 %) for the dilution 1/2 of Intesti, and 35.555 % (6.122 %, 47.852 %) for Pyo, respectively. For the Gram-negative model, the OD decreased with 20.554 % (6.542 %, 44.814 %) for 1/64 Intesti and with 15.817 % (2.711 %, 38.082 %) for 1/64 Pyo dilution. The OD decreased with 40.806 % (10.582 %, 64.275 %) for 1/2 Intesti and 35.101 % (5.445 %, 48.742 %) for 1/2 Pyo dilution, respectively. The decrease in biofilm density as measured by the rate of change (ROC) was higher for the Gram-negative model compared with the Gram-positive model, but statistical significance was ascertained only for Intesti (p < 0.001, Z = −3.712 at 1/64 dilution, and borderline significance at 1/2 dilution: p = 0.050, Z = −1.959). Eradication of preformed biofilm was achieved in both models through the addition of phages: Intesti and Pyo for Staphylococcus spp. (p < 0.001, p = 0.009) and Intesti for Pseudomonas aeruginosa (p = 0.011).

Conclusions

By extrapolating our findings we hypothesize that phages may eventually represent an option for primary prophylaxis through coating of orthopedic prostheses and for secondary prophylaxis, by preventing osteomyelitis relapses through biofilm reduction when administered via local instillations.

References

1. Harper D, Parracho H, Walker J, et al. Bacteriophages and biofilms. Antibiotics. 2014;3:270–284

2. Neguț AC, Săndulescu O, Streinu-Cercel A, et al. Bacteriophage-driven inhibition of biofilm in Pseudomonas aeruginosa. Paper presented at ASM Microbe 2016, Boston, USA,

Acknowledgement

Carol Davila University of Medicine and Pharmacy, Young Researchers Grant 28341/2013; PhD thesis of ACN.

A3 The utility of inflammatory biomarkers in the prognostic evaluation of septic patients – past, present and future

Alina Orfanu1,2, Cristina Popescu1,2, Anca Leuștean1, Remulus Catană1,2, Anca Negru1,2, Alexandra Badea1, Radu Orfanu3, Cătălin Tilișcan1,2, Victoria Aramă1,2, Ştefan Sorin Aramă2

1National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 3“Foisor” Clinical Hospital of Orthopedics and Traumatology, Bucharest, Romania
Correspondence: Alina Orfanu (alina.lobodan@yahoo.com)

Background

Sepsis is a severe, life-threatening syndrome with high incidence and mortality rate, which needs a rapid diagnosis and severity evaluation in order to avoid fatal complications. If the diagnosis has preset criteria (SOFA score more than 2), the prognosis remains an important problem in septic patients management. Over the years, several markers of inflammation were evaluated such as fibrinogen, C reactive protein or procalcitonin (PCT). Objectives: to appreciate the efficacy of neutrophil/lymphocyte ratio (NLR), mean platelet volume (MPV), red cell distribution width (RDW) and PCT in sepsis prognosis and to correlate their values with the severity and with the estimated mortality rate.

Methods

Prospective study realized in the Matei Balș Institute between October 2015 – July 2016, including 55 patients diagnosed with sepsis. There were evaluated: number of SIRS criteria, primary sites of infection, incriminated germs, organ failures, septic metastases and there were calculated two scores of severity - APACHE (Acute Physiology and Chronic Health Evaluation), APS (Admission Point Score) and the estimated mortality rate. The statistical analysis was realized using SPSS.

Results

The study included 55 patients with a mean age of 57.9 years old and a sex ratio M:F = 1:1.75. The primary septic focus was found in 92.7 % of cases: respiratory (43.1 %), digestive (31.4 %), urinary (21.6 %), others (3.9 %). The most frequent isolated germs were E. coli (46.7 %), Streptococcus pneumoniae (20 %), Clostridium difficile (13.3 %), others including Klebsiella, Legionella, Neisseria meningitidis (20 %). 3.6 % of patients had septic metastases (cerebral or cutaneous) and 67.3 % presented at least one organ failure: hematological (57.3 %), renal (21.8 %), respiratory (5.5 %). The mean value of initial NLR was 17.7 and it was statistically significant correlated with the number of organ failures, with APACHE (p = 0.01) and APS (p = 0.01) scores and with the mortality rate (p = 0.01). This last correlation was stronger than the one between PCT with the mortality. VPM (mean value of 8.1 fl) and RDW (14.5) did not correlate with the two scores. PCT with a median of 14.58 ng/mL was correlated with APACHE (p = 0.02), APS (p = 0.05) and mortality rate (p = 0.05).

Conclusions

Septic patients’ outcome can be easily appreciated using NLR, which proved an important prognostic role in sepsis through the statistically correlations with the severity scores and the estimated mortality rate. PCT also remains a good test to appreciate the severity. Although some studies showed the importance of VPM and RDW in sepsis, these markers weren’t associated with the prognosis.

A4 Etiologic and clinical features of bacterial meningitis in infants

Constanța-Angelica Vișan1,2, Anca-Cristina Drăgănescu1, Anuța Bilașco1, Camelia Kouris1, Mădălina Merișescu1, Magdalena Vasile1, Diana-Maria Slavu1, Sabina Vintilă1, Endis Osman1, Alina Oprea1, Sabina Sandu1, Monica Luminos1,2

1National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Correspondence: Constanța-Angelica Vișan (angelica.visan@yahoo.com)

Background

Neonatal bacterial meningitis is a rare disease, but characterized by particularly high severity. Group B Streptococcus is the leading cause of neonatal meningitis and is responsible for infections followed by serious neurological sequelae. Although Neisseria meningitidis is not a common causative agent of meningitis in this age group, in our clinic cases we diagnosed a few cases in newborns and infants up to 3 months. Objectives: Study of bacterial meningitis diagnosed in newborns and infants up to 3 months. Setting peculiarities determined by the etiologic agent and the age of the children on the evolution and development of sequelae.

Methods

Retrospective study of cases of bacterial meningitis in children aged 0–3 months, admitted to our clinic between 2014 and 2016.

Results

In the time period studied in our clinic 6 cases of bacterial meningitis were diagnosed in infants younger than 3 months: 2 cases of neonatal meningitis produced by group B Streptococcus developed serious neurological sequelae (encephalomalacia, cortical atrophy, ventriculomegaly). Neisseria meningitidis was isolated from 2 newborns and 2 infants aged two months and caused purulent meningitis that evolved favorably, without sequelae.

Conclusions

Group B Streptococcus is a major cause of neonatal sepsis and bacterial meningitis respectively and is responsible for particularly severe neurological sequelae. That's why additional measures are required for surveillance of pregnant women, for early detection and intra-partum prophylactic treatment to reduce morbidity newborn by this infection. Neisseria meningitidis, although not considered a common etiologic agent of meningitis in infants, was responsible for four of the cases detected. This demonstrates the presence of N. meningitidis in the population and the effects of exposing children to highly pathogenic agents in the first days of life. Although cases treated in our clinic have evolved favorably, their presence is an alarm signal for epidemiological measures and an argument for completing the diagnostic guidelines of bacterial meningitis in infants.

A5 The diagnostic and prognostic role of neutrophil to lymphocyte count ratio in sepsis

Alina Orfanu1,2, Victoria Aramă1,2, Ştefan Sorin Aramă2, Anca Leuştean1, Remulus Catană1,2, Anca Negru1,2, Gabriel Adrian Popescu1,2, Cristina Popescu1,2

1National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Correspondence: Alina Orfanu (alina.lobodan@yahoo.com)

Background

The rapid diagnosis in sepsis, especially in cases without the evidence of a septic focus, represents an important challenge in clinical practice. The neutrophil/lymphocyte count ratio (NLCR) is an easily measurable parameter which can have a role in diagnosis of sepsis and also in assessing the severity of septic patients. NLCR was evaluated especially in patients with severe sepsis admitted in ICU and the data about its importance in so called community acquired sepsis are lacunar. Objective: To analyze the diagnostic and prognostic value of NLCR in patients with community acquired sepsis.

Methods

We performed a prospective single center study that included consecutive cases of sepsis admitted in Matei Balș Institute. For each patient we determined NLCR at admission. Two groups of patients were created: group 1 with NLCR < 10 and group 2 with NLCR > 10. Clinical and biological parameters and also the severity calculated with APACHE IV and APS scores were comparatively analyzed between the two groups.

Results

Fifty-five consecutive patients with sepsis were analyzed, with mean age of 57.92 years old and sex ratio F:M = 1.75:1. Group 1 included 21 patients with NLRC <10 (38.18 %) and group 2–34 patients with NLRC >10 (61.82 %). The comparative analysis between the two groups showed: more patients with 3 or 4 criteria for systemic inflammatory response syndrome (SIRS) in the second group (55.88 % vs. 42.85 %), more patients with identified etiology in the second group (32.32 % vs. 14.28 %) but without statistical significance (p = 0.2543), more patients with at least one organ dysfunction (76.47 % vs. 52.38 %, p = 0.032) and with procalcitonin at baseline > 2 ng/mL (medium PCT in the first group = 2.88 ng/mL vs. medium PCT in the second group = 16.88 ng/mL) in the second group. The correlations of initial value of NLRC with the severity scores (APACHE IV and APS) and with the estimated mortality rate were statistically significant (p = 0.01). The last correlation was stronger than the one between procalcitonin and the mortality rate (p = 0.05).

Conclusions

NLRC more than 10 was associated with severity expressed through the number of SIRS criteria and the presence of organ dysfunction at baseline. The value of NLRC was correlated with severity appreciated with APACHE IV and APS scores and with the estimated rate of mortality. NLRC is an easy to obtain biomarker which can be very helpful in order to assess the severity of sepsis.

A6 Whooping cough in a HIV positive patient

Ramona Georgiana Stanculete1, Ana Vaduva Enoiu1, Adelina Raluca Marinescu1, Voichita Lazureanu2

1Dr. Victor Babeş Clinical Hospital of Infectious Diseases and Pneumology, Timişoara, Romania; 2Dr. Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
Correspondence: Ramona Georgiana Stanculete (ramona.stanculete@gmail.com)

Background

Whooping cough is a highly contagious acute infectious disease caused by bacilli of the genus Bordetella pertussis, parapertussis and extremely rare in humans B. bronchiseptica with paroxysmal cough and variable impaired general condition, hematological changes and high risk of complications.

Case report

We present a 28 years patient diagnosed with HIV stage C3 in 1996, for which antiretroviral treatment (Abacavir + Lamivudine, Darunavir, Ritonavir scheme initiated in 2009). The patient came in the Clinic Infectious Diseases because of fever, cough initially dry, thereafter productive in bouts fallowed by episodes of faintness, sweating, exertional dyspnea, weight loss (~15 kg in the last 3 weeks). At the moment of hospitalization, the patient shows influenced general condition orthopnea , oxygen saturation 92 % without O2 mask, discreet congestive pharynx, tongue with chalky deposits, right basal crepitation rales, tachycardia HR = 125 b/min, liver with lower edge at 2 cm under the right costal margin, without meningeal irritation signs. Biological leukocytosis with lymphocytosis, inflammatory syndrome, lymphocyte CD4 = 243 cells/L, viremia = 5087 copies/mL. The chest-ray revealed interstitial drawing that looks like frosted glass designed predominantly perihilar right, dilated bronchi, alveolointerstitial type opacities suprahilar and infrahilar right side. We suspected pneumocystosis pulmonary tuberculosis (which was denied) and whooping cough, Bordetella pertussis IgM which was positive. We initiated treatment with oxygen on mask, rebalancing electrolyte solutions antibiotics, antifungical and expectorant, with a slowly favorable evolution.

Conclusions

The disease is very contagious and was considered a childhood infection but now it has been identified also in adults.

Consent

Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

A7 Cronobacter sakazakii sepsis in varicella patient

Adelina-Raluca Marinescu, Alexandru Crișan, Voichița Lăzureanu, Virgil Musta, Narcisa Nicolescu, Ruxandra Laza

Dr. Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
Correspondence: Adelina-Raluca Marinescu (marinescu_adelina24@yahoo.com)

Background

Primo-infection with varicella zoster virus causes varicella, one of the most frequent pathologies in the first stage of childhood and not only. The complications of this disease may vary from pyogenic infections to pneumonia and neurological (cerebellar) lesions.

Case report

We present the clinical case of a 8-months old male baby with no significant pathological antecedents, admitted into the clinic of the “Victor Babeș” Timișoara Hospital of Infectious Diseases between 29.05-08.06.2016 with the diagnosis of varicella and Cronobacter sakazakii sepsis. The present disease started 5 days prior to admission into our clinic with polymorphous eruption in crust stage. Afterwards fever is associated (T = 39 °C). We mention the fact that all along the disease the baby was following ibuprofen treatment. Due to the fact that the baby’s condition remains strongly influenced, the non-steroidal anti-inflammatory treatment is associated with cefuroxime and acyclovir. In the 6th day of disease the tumefaction of the right inferior limb is associated. At admission, the baby had strongly influenced condition, tumefaction of the inferior right limb, was dyspneic, sleepy with polymorphous eruption in crust stage, therefore the baby is admitted directly into the Intensive Care Unit. Hemoculture was positive for Cronobacter sakazakii. Thrombocytes = 55.000/μL, VSH = 45 mm/h, CRP = 272.79 mg/dL, serum urea = 43.8 mg/dL, creatinine = 0.33 mg/dL. Evolution was favorable with symptomatology remission under established treatment.

Conclusions

Within the last years in medical practice other complications of extreme gravity of varicella emerged: cellulitis, compartment syndrome, sepsis of various etiologies (Streptococcus, Staphylococcus, Gram negative germs, etc.) Performant modern apparel certainly contributes to establishing the bacteriologic diagnosis and implicitly the antibiogram which led to an optimal therapeutical behavior. From experience, we consider that the varicella zoster virus is more virulent, being able to cause severe forms or complication in certain patients categories.

Consent

Written informed consent was obtained from the parents for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

A8 Anaerobes an underdiagnosed cause of prosthesis joint infection

Anca-Ruxandra Negru1,2, Daniela-Ioana Munteanu1, Raluca Mihăilescu1, Remulus Catană1,2, Olga Dorobăț1, Alexandru Rafila1,2, Emilia Căpraru1, Marius Niculescu3, Rodica Marinescu2,3, Olivera Lupescu2,4, Vlad Predescu2,5, Adrian Streinu-Cercel1,2, Victoria Aramă1,2, Daniela Tălăpan1,2

1National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 3Clinical Hospital Colentina, Bucharest, Romania; 4Floreasca Emergency Hospital, Bucharest, Romania; 5“St. Pantelimon” Emergency Clinical Hospital, Bucharest, Romania
Correspondence: Daniela-Ioana Munteanu (danielaioana.mn@gmail.com)

Background

Anaerobic bacteria are not a common cause of prosthesis joint infection (PJI) but their implication may be greater than expected because of many false negative results due to the difficulties in isolating and identifying this type of bacteria. Sonication is a very important tool for the microbiological diagnosis giving the clinician a higher chance to find the microorganism involved in PJI. The aim of this study was to evaluate the prevalence of anaerobic bacteria in PJI and the main epidemiological characteristics of infections produced by anaerobes.

Methods

We performed a prospective 4-year study conducted in National Institute for Infectious Diseases Prof. Dr. Matei Balș, Bucharest between 2012 and 2016, in which we included all orthopedic sonicated implants sent from the regional centers. The implants were sonicated at 40 kHz on BactoSonic® ultrasonic bath (Bandelin, Germany) and the sonication fluid was cultured on both aerobe and anaerobe media. The period of incubation was 7 days for aerobe culture and 14 days for anaerobe cultures, respectively. Vitek®2 Compact automated system (Healthcare, BioMérieux, USA) was used for bacteria identification and antibiotic susceptibility. The interpretation of the results was made according to the latest EUCAST breakpoints.

Results

Among 94 sonicated orthopedic implants we isolated 5 anaerobic bacteria (5.3 % prevalence). Propionibacterium acnes was isolated in 3 cases, on one clavicle plate and on one hip and one shoulder replacement. Parvimonas micra and Finegoldia magna were the other two anaerobes isolated from a hip and knee prosthesis. Patients from whom anaerobe bacteria were isolated were 3 males and 2 females with a median age of 48 years (45; 67). All the anaerobic infections were monobacterial. The median time between surgery and the onset of the symptoms was 12 months (5;30). All the isolated strains were sensitive to all the antibiotics tested except for metronidazole to which Propionibacterium acnes is resistant.

Conclusions

In our study the prevalence of anaerobic PJI was 5.3 %, a prevalence similar to the one cited in the literature but this prevalence may be higher. Anaerobic bacteria are slow growing organisms and they require special conditions to grow, thus the number of false negative results can be significant.

A9 Streptococcus pneumoniae meningitis presenting with normal CSF – case presentation

Ramona Ștefania Popescu1,2, Luminița Bradu2, Dragoș Florea1,2, Adrian Streinu-Cercel1,2

1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 2National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania
Correspondence: Ramona Ștefania Popescu (ramona.stefania.popescu@gmail.com)

Background

Streptococcus pneumoniae, along with Neisseria meningitidis, represent two of the most frequent causes of bacterial meningitis in adolescents and young adults. Delayed diagnosis or inadequate treatment of this condition may result in serious complications such as brain damage, hearing loss or even death.

Case report

We present the case of a 37 year old female, without any known medical condition, under no current medication, who was admitted in our clinic for fever, chills, fronto-occipital headache, nausea, vomiting, photophobia, symptoms which had been present for the last 36 hours with progressive enhancement. Upon physical examination she was febrile (38.3 °C), sweating, no pulmonary crackles or cardiac murmurs, her blood pressure was 100/60 mmHg and pulse rate was 74 bpm, without hepatosplenomegaly, oriented to time and place but with signs of meningeal irritation (Kernig's sign, Brudzinski's sign, and nuchal rigidity). Laboratory tests revealed leukocytosis with neutrophilia, biological inflammatory syndrome, electrolyte imbalance, positive procalcitonin, negative HIV, HTLV serology, negative markers of viral hepatitis B or C, normal urinalysis, negative hemocultures, and sinus X-ray showed bilateral maxillary sinusitis. Lumbar puncture at the moment showed no cerebrospinal fluid (CSF) modification: normal pressure, clear appearance, negative Pandy’s reaction, 1 cell/μL, protein – 31 mg/dL, glucose – 57 mg/dL, chloride – 700 mg/dL, negative CSF cultures. PCR using mass spectrometry (PLEX – ID) performed from CSF identified Streptococcus pneumoniae. Cranial magnetic resonance imaging (MRI) with contrast showed minimal meningeal enhancement, with no other modifications. Given all this data (clinical appearance and identification of Streptococcus pneumoniae in CSF using PLEX-ID), we considered the case as bacterial meningitis at an early stage, with normal CSF. She received treatment with meropenem 2 g q8h, vancomycin 1 g q12h and dexamethasone for 14 days with very good clinical response. The lumbar puncture repeated after 10 days showed no change from the previous examination. The patient fully recovered with no sequelae.

Conclusions

Bacterial meningitis exhibiting apparently normal CSF parameters, even if uncommon, is a very well-recognized phenomenon. A lumbar puncture which shows no abnormalities in CSF cannot exclude bacterial meningitis in the early stage of the disease. Empiric antibiotic should be used when the diagnosis of bacterial meningitis is strongly suspected even in the cases with normal CSF results. PCR technique represents a great tool in establishing the causative pathogen of meningitis, making possible the diagnosis of this condition even in the early stages when no changes in the CSF are noticeable.

Consent

Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

A10 Extrapulmonary manifestations of infection with Mycoplasma pneumoniae – study on 24 cases

Daniela Anicuta Leca, Elena Bunea, Andra Teodor, Egidia Miftode

“Gr.T.Popa” University of Medicine and Pharmacy, Iași, Romania
Correspondence: Daniela Anicuta Leca (lecadaniela@ymail.com)

Background

Important etiologic agent of atypical pneumonia, Mycoplasma pneumoniae can cause frequent extrapulmonary manifestations (MEP – neurological, cardiac, skin, joints, gastrointestinal), which sometimes evolve isolated, thus making diagnosis and proper treatment difficult.

Methods

The study was retrospective and included 24 diagnosed cases of infection with Mycoplasma pneumoniae, hospitalized in the Department of Clinical Infectious Diseases, University of Medicine and Pharmacy “Gr.T.Popa” Iaşi, in the period 2013–2016.

Results

The annual evolution of morbidity revealed a relatively constant number of cases in the period 2013–2015, with a significant increase in cases in 2016 (45.83 %). The study included 14 children and 10 adults, sex ratio (F/M) 1.18 and a predominant urban origin of cases (15 urban/9 rural). Of the 24 patients, 21 showed signs of single respiratory manifestations (25 %) or in combination with skin manifestations (20.83 %), joints (12.5 %), liver (12.5 %) or neurological manifestations (45.83 %). Respiratory impairment was more common in adults (p = 0.007) and neurological impairment in children (p = 0.008) and in women (p = 0.05), with no difference by gender or age, referred to other extra pulmonary manifestations. MEP patients were admitted to hospital early (8 days versus 16 days). The average duration between the occurrence of respiratory and extrapulmonary events was a day for the joint, 4.6 days for neurological, 7 days for liver manifestations and 12.5 days for skin manifestations. MEP appearance was not favored by the patient’s immune suppressed status (p = 0.807), previously administered antibiotic therapy before hospitalization (p = 0.632). Those with only pulmonary manifestations frequently received macrolides prior to hospitalization (p = 0.011) with no difference between the 2 groups with the administration of beta-lactams (p = 0.102). Leukocytosis was detected in a high proportion of those with MEP (p = 0.05), and we identified no statistically significant difference between the two groups in terms of the values of other inflammation tests, of liver cytolysis tests, pulmonary radiographic changes (p = 0.795) or the frequency of complications (p = 0.345). The average length of hospitalization was higher in patients with MEP (10.83 days versus nine days those without MEP).

Conclusions

Mycoplasma pneumoniae should be considered in all cases with fever and respiratory symptoms evolving unfavorably treated with betalactamine and associates MEP.

A11 The molecular diagnosis of severe bacterial sepsis in pediatric population

Mădălina Merișescu1,2, Gheorghiță Jugulete1,2, Adrian Streinu-Cercel1,2, Dragoș Florea1,2, Monica Luminos1,2

1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 2National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania
Correspondence: Mădălina Merișescu (madalinamerisescu@gmail.com)

Background

In children, bacterial sepsis is a not a very common condition but it is often accompanied by severe complications that can leave sequelae. Sometimes it can be life-threatening and requires a complex and quickly set treatment. Sepsis is more common in immunosuppressed patients.

Methods

We conducted a 5 years study from Jan 2011 to Dec 2015 on 2851 children admitted in our pediatric intensive care unit of the National Institute for Infectious Diseases for severe forms of SIRS and bacterial sepsis. Some of them were immunosuppressed. We watched the correlation of data obtained by hemocultures, CSF cultures versus PCR and the clinical evolution of the patients.

Results

In the 60 months of study, 265 children met the clinical and biological criteria for severe bacterial sepsis; 68 % of the patients came from other hospitals, reason for which we consider that the etiology is most likely nosocomial pathogens. Sex distribution was approximately equal. Considering age distribution, children in the group 3–5 years of age prevailed; 49 of them were immunosuppressed; 10 patients had acquired immunosuppression, 20 congenital and 19 mixed. We obtained 163 hemoculture positive results (61 %) and 112 obtained by molecular methods. The data were correlated with conventional methods of diagnosis.

Conclusions

Bacterial sepsis in children is a serious condition resulting in 24 deaths (14 %) in our study. It requires quick etiologic diagnosis and establishment of appropriate emergency treatment. PCR is an effective and rapid diagnosis method, identifying the causal agent in 42 % of cases.

A12 Acute Staphylococcus aureus endocarditis with multiple septic complications in a patient with diabetes mellitus – case presentation

Ramona Ștefania Popescu1,2, Anamaria Dobrotă2, Adina Ilie2, Liliana Lucia Preoțescu1,2

1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 2National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania
Correspondence: Anamaria Dobrotă (dobrota_anamaria@yahoo.co.uk)

Background

Staphylococcus aureus is a common colonizing and infecting agent in humans [1], with increased mortality in case of bacteremia.

Case report

A 60 year old man with a history of diabetes and hypertension was referred to our clinic with the suspicion of infective encephalitis. The onset of symptoms was 10 days prior to presentation with high fever, malaise, lower limb muscular weakness which progressed to paresthesia, rigidity and intense headache with bradypsychia and bradylalia. The patient denied using any recreational drugs, recent head trauma or any other open skin lesions. At admission he was febrile, bedridden, with generalized muscular atrophy, Janeway lesions, petechiae, 5th right toe necrosis, left endophthalmitis, holosystolic murmur in the apex with radiation to the axilla, hepatomegaly, with no signs of meningeal irritation. The lab reports showed leukocytosis with neutrophilia, anemia, thrombocytopenia, acute inflammatory syndrome, positive procalcitonin, hyperglycemia with high glycated hemoglobin level, hyponatremia, hypokalemia, hypoalbuminemia. Transthoracic echocardiography showed mobile mitral valve vegetation on the anterior leaflet, 10 mm in diameter, with normal ejection fraction. Two sets of blood cultures grew methicillin-susceptible Staphylococcus aureus (MSSA). Chest X-ray showed peripheral, bilateral, lower lobe infiltrative densities. Head magnetic resonance imaging (MRI) showed suggestive images for small abscesses in the supratentorial region. Given this data, the diagnosis of infective endocarditis with multiple septic emboli (pulmonary, ocular, cerebral) was established. Antibiotic therapy with linezolid and rifampin was initiated, due to a very good multiple organ penetration. As musculoskeletal secondary determination (septic arthritis, thigh abscess) and linezolid hematological side effects (anemia) occurred, we switched therapy to oxacillin, amikacin and levofloxacin. The patient had a good clinical response, with a total course of antibiotic therapy of 6 weeks. He was referred to a cardiovascular surgeon for further monitoring.

Conclusions

Patients suffering from uncontrolled diabetes have a higher risk of infections with endogenous microbes, with more severe outcomes. In our case, even if the MSSA strain isolated in hemocultures didn’t represent a therapeutic challenge in terms of antibiotics options, it did develop into a severe and life threatening illness. This strain of MSSA possibly used all its energy in the synthesis of multiple virulence genes (adhesion, penetration, invasion) which determined numerous extra-cardiac complications of endocarditis.

References

1. Sulla F, Bussius DT, Acquesta F, et al. Vancomycin minimum inhibitory concentrations and lethality in Staphylococcus aureus bacteremia. Germs. 2015;5:39–43.

Consent

Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

A13 Is Streptococcus suis meningitis an under-diagnosed zoonosis?

Adriana Hristea1,2, Raluca Jipa1,2, Nicoleta Irimescu1, Irina Panait1, Eliza Manea1, Simona Merisor1, Cristian Niculae1, Daniela Tălăpan1,2

1National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Correspondence: Adriana Hristea (adriana_hristea@yahoo.com)

Background

Streptococcus suis is a commensal pathogen of swine, a neglected pathogen that can be transmitted to humans by close contact with sick or carrier pigs. Meningitis and sepsis are the most frequent clinical manifestations in humans. A recently published systematic review identified 24 studies including 913 patients with meningitis due to Streptococcus suis [1]. Most cases have been reported in Asia. Objective: to draw attention to a potential under-diagnosed cause of meningitis and sepsis in our country.

Methods

We performed a retrospective analysis of patients diagnosed with Streptococcus suis infection between January 2005-December 2015 in one tertiary care hospital in Bucharest, Romania. We also reviewed the Steptococcus pneumoniae meningitis, according to the microbiological method confirming the etiology.

Results

We identified five patients hospitalized for Streptococcus suis infection – four patients had meningitis and one patient had endocarditis. Two patients reported contact with pork meat.

In patients with meningitis the median age was 43 years (IQR 40–45), with a male: female ratio of 3:1. Three patients presented with altered level of consciousness and two with severe hearing impairment. Cerebral spinal fluid (CSF) examination showed changes characteristic for bacterial meningitis. Latex agglutination test for Streptococcus pneumoniae was positive in two patients, nonetheless, Streptococcus suis was isolated in CSF in all patients. They were all treated with a third generation cephalosporin for 14 days and all of them improved. Two patients developed sequelae, consisting in permanent sensorineural deafness and ataxia.

In the studied period we identified a total of 194 cases of pneumococcal meningitis, in which the diagnosis was based on appearance on Gram stain and/or positive latex agglutination reaction of CSF samples in 82 (42 %) and positive culture in 112 (58 %) patients.

The patient with endocarditis was a 40 year old male, who was admitted for fever and malaise. Echocardiography showed aortic valve endocarditis. The patient underwent treatment with a beta-lactam/beta-lactamase inhibitor and an aminoglycoside for 4 weeks, and after valve replacement with a glycopeptide for 4 weeks.

Conclusions

Streptococcus suis could be miss-identified as other species of streptococci, thus in the settings that lack resources to routinely speciate α-hemolytic streptococci and where (undercooked) pork is a basic diet, underdiagnosis of Streptococcus suis infection is likely. Hearing loss, although is not a complication related to Streptococcus suis meningitis, is frequently reported.

References

1. van Samkar A, Brouwer MC, Schultsz C, van der Ende A, van de Beek D. Streptococcus suis meningitis: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2015;9:e0004191.

Antimicrobial resistance

A14 Klebsiella pneumoniae isolated from blood. Antimicrobial resistance – past and present

Liana Cătălina Gavriliu1,2, Otilia Elisabeta Benea1,2, Șerban Benea1,2, Alexandru Rafila1,2, Olga Dorobăț1,2, Mona Popoiu2

1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 2National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania
Correspondence: Liana Cătălina Gavriliu (lianagavriliu@yahoo.com)

Background

Romania reports an increasing number of resistant Klebsiella pneumoniae (KP) strains isolated from invasive infections every year. The most recent report of the European Antimicrobial Resistance Surveillance Network (EARS-Net) has placed us among the first countries regarding KP resistance to fluoroquinolones, third generation cephalosporins, aminoglycosides, carbapenems, and multidrug resistance. We analyzed the antimicrobial resistance of bloodstream KP isolates in 2010 and 2015 in the National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania.

Methods

The antimicrobial susceptibility tests of KP strains isolated from blood between January 1st 2010 - December 31st 2010 and between January 1st 2015 - December 31st 2015 were analyzed. We compared the resistance trend between these two periods. Statistical analysis was performed using Fisher exact test. p < 0.05 was considered significant.

Results

We identified 18 strains of KP in 2010: 46.15 % resistant to aminopenicillin-betalactamase inhibitors association, 37.7 % resistant to piperacillin-tazobactam, 38.46 % resistant to third generation cephalosporins, 47.07 % resistant to fluoroquinolones, 41.17 % resistant to aminoglycosides. We didn’t find any strains resistant to carbapenems. 38.88 % of the strains had combined resistance to fluoroquinolones, third generation cephalosporins and aminoglycosides and 22.22 % were extended-spectrum betalactamases (ESBL) producing strains. In 2015, 37 strains of KP were isolated. The resistance rates to aminopenicillin-betalactamase inhibitors association, piperacillin-tazobactam, third generation cephalosporins, fluoroquinolones, aminoglycosides were 36.11 %, 24.32 %, 29.72 %, 27.02 % and 21.62 %, respectively. One strain was resistant to carbapenems. 21.62 % of the strains had combined resistance and 29.73 % were ESBL. The overall resistance to aminopenicillin-betalactamase inhibitors association, piperacillin-tazobactam, third generation cephalosporins, fluoroquinolones, gentamycin, amikacin, trimethoprim-sulfamethoxazole and the combined resistance decreased statistically non-significant. The same thing was noticed for the increasing rate of ESBL producing strains.

Conclusions

The percentage of KP strains isolated from blood increased between 2010 and 2015. We didn’t find statistically significant changes of the resistance rates of KP to all the classes of tested antimicrobials. The presence of carbapenem resistance among the isolates from 2015 could be a major problem for the public health and hospital-acquired infections control. Our data regarding the proportion of resistant bloodstream KP strains are different from those reported by EARS-Net. We found lower and decreasing resistance rates to fluoroquinolones, aminoglycosides, third generation cephalosporins, carbapenems and combined resistance. Still, with Romania occupying one of the first places in Europe regarding KP isolated from invasive infections resistance to antibiotics, further monitoring is mandatory and efforts should be made in order to control this problem.

A15 Antibiotics resistance in Staphylococcus aureus isolated from blood cultures

Livia Dragonu1,2, Augustin Cupşa1,2, Iulian Diaconescu1,2, Irina Niculescu1,2, Lucian Giubelan1,2, Florentina Dumitrescu1,2, Andreea Cristina Stoian1, Camelia Guţă2, Simona Puiu2

1University of Medicine and Pharmacy Craiova, Craiova, Romania; 2“Victor Babeș” Clinical Hospital of Infectious Diseases and Pneumology, Craiova, Romania
Correspondence: Livia Dragonu (livia_dragonu@yahoo.com)

Background

Staphylococcus aureus has a high incidence in human infectious pathology, registering severe infections caused by antibiotic-resistant strains. In Romania, methicillin-resistant S. aureus (MRSA) accounts to up to 53.8 % of S. aureus strains isolated from blood cultures (EARS-Net report 2012). In many European countries, the percentage of MRSA invasive infections caused by S. aureus decreased below 25 % through the implementation of programs designed to limit bacterial resistance. Objectives: to determine the antibiotics resistance of S. aureus strains isolated from blood cultures.

Methods

We performed a retrospective study (01.01.2011 - 06.01.2016) analyzing blood cultures results collected from patients hospitalised in the Infections Disease and Pneumology Clinics of “Victor Babeş” Hospital from Craiova. The antibiotics resistance of 180 S. aureus strains isolated from blood cultures was analyzed based on the results of disc diffusion sensitivity testing. The methicillin-resistant strains presented an inhibition zone around the disk of cefoxitin (30 mcg) under 22 mm. The results’ evaluation was carried out by comparing percentage differences and by performing the Chi2 test.

Results

During the study period, 1806 blood cultures were performed, and only 233 (12.9 %) were positive. Blood cultures were positive for S. aureus in 77 % of cases, Klebsiella pneumoniae in 8.1 % of cases and Escherichia coli in 4.5 % of cases. Distribution by age of blood culture positive for S. aureus were: under 1 year old - 14.8 % of cases, 1–16 years old - 17.3 % and over 16 years old - 67.8 %. The blood cultures MRSA percentage was 45.5 % (82 out of 180 tested strains) with a peak in 2013 (28 strains) compared to 2015 (8 strains). The antibiotics resistance in S. aureus isolated strains was: to penicillin 83.9 %, to oxacillin 45.5 %, to clarithromycin 45.4 %, to amoxicillin/clavulanic acid 31.6 %, to trimethoprim/sulfamethoxazole 30.8 %, to ceftriaxone 24.5 %, to meropenem 19.3 %, to levofloxacin 18 %, to gentamicin 17.7 %, to chloramphenicol 11.9 %, to clindamycin 10.4 %, to vancomycin 7.78 %, to linezolid 4.9 %. The MRSA percentage was higher in infants (53.3 %) compared to adults (44.8 %), without statistically significant difference.

Conclusions

S. aureus was the most common etiologic agent isolated in blood cultures, with a high prevalence of methicillin-resistant strains (45.5 %). From the tested antibiotics, the lowest resistance was observed at linezolid and vancomycin. Clindamycin, aminoglycosides and fluoroquinolones were active against strains of MRSA without antibiotics multiresistance.

A16 Predominance of CTX-M enzymes in extended-spectrum β-lactamase-producing Enterobacteriaceae in two hospitals of Quebec City

Bunescu Irina1, Marilyse Vallée2, Ann Huletsky2, Dominique K. Boudreau2, Ève Bérubé2, Richard Giroux2, Jean Longtin3, Yves Longtin4, Michel G. Bergeron2

1Department of Infectious Diseases and Medical Parasitology, Medical and Pharmaceutical University Nicolae Testemițanu, Chișinău, Republic of Moldova; 2Research Center of Infectious Diseases of Laval University Québec, Québec, Canada; 3Hospital Center of Laval University, Québec, Canada; 4Cardiology and Pulmonology University Institute of Québec, Québec, Canada
Correspondence: Bunescu Irina (bunescu.irina@yahoo.com)

Background

β-lactamases production remains the most important mechanism of β-lactam resistance. The most prevalent extended-spectrum β-lactamases (ESBL) in hospital and community settings that preferentially hydrolyze cefotaxime, belong to plasmid-mediated ESBL, is CTX-M. Our objective was to study bacterial resistance to improve the diagnosis and treatment of infections with these pathogens.

Methods

Fifty-nine strains (isolated from urine and several from blood) were collected between June 23rd and September 23rd 2011 from two hospitals of Quebec City in Canada. Strains were sent to the Research Center of Infectious Diseases of Laval University in Quebec City. Identification and antibiotic resistance were determined using the Vitek® 2 System (bioMérieux). ESBL production was tested according to CLSI recommendations. Crude DNA extracts were prepared from each strain by a rapid DNA extraction method. DNA was used for PCR amplification using different primers specific to bla TEM, bla SHV, and bla CTX-M genes. All amplicons produced were sequenced, to identify the genes of resistance.

Results

From 59 strains tested, 32 (54.2 %) were ESBL+, and 28 (45.8 %) were ESBL-. Escherichia coli was the most prevalent species with a percentage of 88.1 % of the strains tested. The 32 ESBL producing-strains were positive for at least one of the resistance genes tested. The predominant resistance gene was bla CTX-M either alone or in combination with the bla TEM gene, all present in E. coli. Sequence analysis of the 28 bla CTX-M genes found revealed that 18 strains were members of CTX-M group 1, and 10 were members of CTX-M group 9. Two different resistance genes were identified in 15 strains: bla CTX-M + bla TEM (13) and bla SHV + bla TEM (2). However, sequence data revealed that all bla TEM genes identified in both ESBL+ and ESBL strains did not encode ESBL. This suggests that the resistance phenotype in ESBL-producing strains with two resistance genes should be conferred by bla CTX-M or bla SHV genes. Another resistance gene, not tested in this study, is most likely responsible for the ESBL resistance phenotype in the strain containing only the bla TEM-non-ESBL gene.

Conclusions

This study showed that bla CTX-M are the most prevalent resistance genes in ESBL-producing Enterobacteriaceae in Quebec City and are part of groups 1 and 9. This is consistent with global data showing the predominance of the CTX-M ESBL worldwide and with recent epidemiological data, in other regions in Canada, showing that CTX-M-15 as well as CTX-M-14 and CTX-M-9, being respectively part of groups 1 and 9, are most commonly found.

A17 Postoperative meningoencephalitis with Acinetobacter baumannii XDR – a therapeutic challenge - Case report

Cleo Nicoleta Roșculeț, Dalila-Ana Toma, Catrinel Ciuca, Daniela Tălăpan, Cătălin Apostolescu, Andrei Rogoz, Andrei Stangaciu, Viorica Mitescu, Tudor Vladoiu, Doina Iovănescu

National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania
Correspondence: Cleo Nicoleta Roșculeț (cleo_n_rosculet@yahoo.com)

Background

Acinetobacter baumannii is an aerobic Gram negative bacterium which, depending on the profile of resistance (MDR- multidrug resistance, XDR- extensive drug resistance, PDR- pandrug resistance), may be exceptionally the source of severe infection, more or less therapeutically controllable.

Case report

We have chosen to bring forward the peculiar case of a 62 year old man, who was transferred to our department for agitation, confusion (GCS = 7–8) and fever occurring 12 days in the postoperatory period (left otomastoidectomy) under the suspicion of bacterial meningoencephalitis. The patient’s medical records emphasize a history of chronic suppurative otomastoiditis surgically treated twenty years before. From that moment forward, the patient presented numerous relapses (left ear pain, purulent otorrhea) accompanied by neurological involvement (left facial nerve peripheral palsy), for which local treatment and outpatient antibiotic therapy were conducted. Two years before admission, a tympanic-mastoid cavity with purulent discharge was clinically perceived. MRI confirmed the presence of an abscess in the left petrous part of the temporal bone. Successive evaluations were conducted through multidisciplinary approach, but the surgical intervention was delayed. On the current admission, blood and multiple samples were taken and a lumbar puncture was performed. The CSF aspect was highly suggestive of bacterial meningoencephalitis. The patient was immediately started on broad-spectrum antibiotics aimed at covering highly resistant bacteria. CSF cultures came back positive for Acinetobacter baumannii XDR (colistin sensitivity present). Following complex therapy, the clinical and biological profile improved. The neurological status became stable (GCS = 12–13), thus permitting surgical reintervention.

Conclusions

All minimal ear infectious involvement must be promptly addressed in order to prevent local complications that may lead to destructive irreversible lesions. Once these lesions appear, a multidisciplinary approach becomes compulsory and high financial and human costs are implied.

Consent

Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

A18 Septic arthritis with Burkholderia cepacia

Michaela Oana, Simona Costin

“Dr. Constantin Papilian” Military and Emergency Hospital, Cluj-Napoca, Romania
Correspondence: Michaela Oana (sincostin@yahoo.com)

Case report

We present the case of a 39 years urban female, which shortly after an arthroscopic procedure develops fever, chill, partial functional impotence, local swelling. In joint puncture we isolated Burkholderia cepacia, susceptible only to meropenem, minocycline and trimethoprim. After 2 weeks of meropenem and 4 weeks of minocycline the evolution was favorable, but soon subfebrility, swelling, pain and functional impotence reappeared. After 8 months Burkholderia cepacia (with similar susceptibility) is isolated again. She took meropenem (6 g/day) in combination with doxycycline 14 days, followed by meropenem and trimethoprim. The intra-articular devices were removed. The patient became afebrile, local evolution was favorable and the culture negative in day 18. On day 21 she develops agranulocytosis and we discontinued trimethoprim, decreased the dose of meropenem and supplemented with granulocyte growth factor. Then the evolution was favorable: local, hematological and bacteriological. We continued the therapy another 5 weeks with meropenem and up to 6 weeks with minocycline.

Consent

Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

A19 A novel approach for managing hard-to-treat infections

Alina Cristina Neguț1,2, Oana Săndulescu1,2, Anca Streinu-Cercel1,2, Maria Magdalena Moțoi1, Mircea Ioan Popa2, Adrian Streinu-Cercel1,2

1National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Correspondence: Alina Cristina Neguț (negoitza_alina@yahoo.com)

Background

The emergence and spread of antibiotic resistance has become a worldwide top priority health problem. Besides genetic resistance, bacteria have developed a multitude of mechanisms leading to tolerance to antimicrobials. It is estimated by the Centers for Disease Control and Prevention that in the USA 23,000 people die every year due to infections with multidrug resistant bacteria.

Methods

We have performed a pilot experimental study in the National Institute for Infectious Diseases „Prof. Dr. Matei Balș”, treating six patients with combined therapy: antibiotics and bacteriophages. The study received Ethics Committee approvals: Matei Balș c/5101/02.10.2014 and Carol Davila 47/26.01.2015. The pathogenic agents were evaluated for phage susceptibility to commercial Georgian phage cocktails, namely Pyo and Intesti (Eliava BioPreparations, Tbilisi, Georgia). We included in the study patients failing antibiotic therapy, with hard-to-treat infections due to antibiotic resistant bacteria, biofilm formation or hard to sterilize infection sites. Phages were administered orally or/and topically.

Results

This pilot study included the following types of infections: recurrent endocarditis with Staphylococcus aureus, chronic osteomyelitis with S. aureus and P. aeruginosa, periprosthetic dorsolumbar soft-tissue infection with S. aureus, chronic cutaneous infection with S. simulans, E. coli and P. aeruginosa, axillary hidradenitis with Proteus mirabilis and S. epidermidis and chronic osteomyelitis with S. aureus. For all six cases the combined therapy proved to be safe, with no adverse reactions and no adverse changes in laboratory parameters. A total of 5 patients had negative cultures during therapy, but 7 days after the end of therapy the cultures became positive again for 3 of the cases. For one patient (recurrent endocarditis with S. aureus) we concluded that the timespan between relapses was longer after receiving the combined therapy compared with antimicrobial treatment alone. In one case (periprosthetic dorsolumbar soft-tissue infection with S. aureus) we achieved sustained bacteriological response, although the patient was considered hard-to-treat due to a history of multiple drug allergy syndrome, presence of multiple foreign bodies (metallic rods and screws), with biofilm formation and a history of unsuccessful long term antibiotic therapy.

Conclusions

To our knowledge, this is the first experimental trial conducted in Romania with combined therapy antibiotics and bacteriophages since 1975, which proved the safety of bacteriophages in clinical settings. We consider this study the cornerstone for future research regarding in vivo phage therapy in Romania.

Acknowledgement

Carol Davila University of Medicine and Pharmacy, Young Researchers Grant 28341/2013; PhD thesis of ACN.

A20 Nineteen months surveillance for multidrug resistant organisms (MDRO) by detecting asymptomatic colonization

Daniela Tălăpan1,2, Olga Mihaela Dorobăț1, Mona Popoiu1, Alexandru Mihai1, Doina Iovănescu1, Cleo Roşculeț1, Cătălin Apostolescu1,2, Gabriel-Adrian Popescu1,2, Adrian Abagiu1, Ruxandra Moroti-Constantinescu1,2, Adriana Hristea1,2, Victoria Aramă1,2, Otilia Benea1,2, Mădălina Simoiu1, Rodica Bacruban1, Adrian Streinu-Cercel1,2, Alexandru Rafila1,2

1National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Correspondence: Daniela Tălăpan (dtalapan@gmail.com)

Background

Healthcare-associated infections (HAI) surveillance programs may focus, amongst others, on specific microorganisms like multidrug resistant organisms (MDROs). Methicillin-resistant Staphylococcus aureus (MRSA) and other MDROs of public health concern may pose problems in acute and non-acute healthcare settings, so detecting and monitoring these is important in hospital-based prevention, surveillance and control efforts. The program of HAI surveillance and control in the National Institute for Infectious Diseases “Prof. Dr. Matei Balș” includes actively screening for MDROs of all patients admitted in the ICU and regardless of the ward, for those transferred from other healthcare settings into our hospital.

Methods

The study was conducted between January 1st 2015 – July 31st 2016 by collecting swabs from criteria based selected patients: pharyngeal (908), nasal (880) and rectal (823). A total of 2,611 swabs were processed in 19 months’ interval. The targeted microorganisms were MRSA, vancomycin resistant enterococci (VRE) and other multidrug resistant Gram-negative bacteria. Swabs were inoculated on appropriate chromogenic culture media from Oxoid, UK (Brilliance MRSA agar, Brilliance VRE agar, Brilliance ESBL agar) and were interpreted at 24–48 hours of incubation at 37 °C, aerobic atmosphere. All microorganisms were identified and tested for susceptibility to antimicrobials by MicroScan Walk Away 96 Plus (Siemens, USA). EUCAST guidelines were used for interpretation. The KPC, MBL and OXA-48 Confirm kits (Rosco Diagnostica, Denmark) were used to determine the carbapenemase-producing strains.

Results

MRSA was detected in 4.84 % of the pharyngeal and 5.79 % of the nasal swabs. The positive rectal swabs, counted one per patient, were 28.06 % (231/823). A percentage of 68.83 % of rectal swabs were positive for one microorganism, 25.97 % positive for 2 microorganisms and 5.20 % for 3 microorganisms. The total number of microorganisms isolated from rectal swabs was 315 (Escherichia coli 32.69 %, VRE 26.34 %, Klebsiella pneumoniae 23.17 %, Pseudomonas aeruginosa 5.39 %, Acinetobacter baumannii 4.12 % and other MDROs less than 3 % each). VRE carriage varied between 21.89 % in 2015 and 30.13 % in 2016. The proportion of Klebsiella pneumoniae carbapenemase-producer strains has increased from 5/38 (13.1 %) in all year 2015 to 10/35 (28.5 %) in first 7 months of 2016. Only one other microorganism (Enterobacter cloacae) was carbapenemase producer.

Conclusions

MRSA colonization varied between 4.84 % (pharyngeal) and 5.79 % (nasal). VRE carriage increased with 10 % in 2016 and carbapenemase-producing Klebsiella pneumoniae doubled in the first 7 months of 2016, compared with 2015.

Acknowledgement

We are thankful to Emilia Căpraru and Mariana Răduț for their important help in isolation of bacterial strains included in the study.

A21 Antimicrobial resistance of Gram-positive cocci isolated from clinical specimens in the National Institute of Infectious Diseases “Prof Dr. Matei Balș” between 2009–2015

Olga Mihaela Dorobăț1, Daniela Tălăpan1,2, Alexandru Mihai1, Ioana Bădicuț1,2, Mona Popoiu1, Alina Borcan1,2, Alexandru Rafila1,2

1National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Correspondence: Olga Mihaela Dorobăț (olgadorobat@yahoo.com)

Background

Bacterial infections remain one of the important causes of disease worldwide and the options for treating are limited due to the emergence of antimicrobial resistance (AMR). The aim of this study is to evaluate the AMR of Gram-positive cocci isolated in National Institute of Infectious Diseases “Prof. Dr. Matei Balș” between 2009–2015.

Methods

A total of 7808 non-duplicated strains: 2067 Staphylococcus aureus, 651 coagulase-negative staphylococci, 292 Streptococcus pneumoniae, 922 Enterococcus faecalis, 251 Enterococcus faecium and 3621 Streptococcus pyogenes were tested for their antimicrobial resistance. Susceptibility tests were performed in automated systems Vitek 2C (BioMerieux) and MicroScan Walkaway (Siemens), and also with Sensititre (Thermo Scientific) MIC plates and Etest (BioMerieux); for Streptococcus pneumoniae disk diffusion method was used. Results were interpreted using CLSI and EUCAST criteria.

Results

Staphylococcus aureus resistance to oxacillin varied from 34.4 % in 2009 to 55.7 % in 2011 and has decreased to 44.8 % in 2015. Erythromycin and clindamycin resistant strains of Staphylococcus aureus have increased between 2009–2014 from 45.2 % to 58.1 %, and from 13.8 % to 58.3 %, respectively. Staphylococcus aureus strains resistant to quinolones have varied annually to ciprofloxacin (13.4–21.9 %) and moxifloxacin (8.4–16.8 %) without a clear increasing or decreasing tendency. Trimethoprim-sulfamethoxazole resistance has remained at low levels (0.5–1.5 %) and no strains have been resistant to linezolid and vancomycin. The incidence of resistance was higher for coagulase-negative staphylococci, most isolated from blood, 60.5–81.7 % for oxacillin, 21.2–42.1 % for trimethoprim-sulfamethoxazole. The incidence of penicillin-resistant Streptococcus pneumoniae strains isolated from invasive infections decreased from 37.5 % in 2010 to 12.0 % in 2015. Enterococcus faecium was more resistant compared with Enterococcus faecalis to all tested antimicrobials, for gentamicin with 45.7–75.5 % compared with 38.7–61.5 % and for ciprofloxacin 35.7–64.5 % compared to 85.7–100 %. The first vancomycin-resistant Enterococcus faecium strains were isolated in 2012 with an incidence of 4.3 % which reached 35.0 % in 2014. Only two Enterococcus faecalis vancomycin-resistant strain were isolated, one in 2013 and one in 2014. Streptococcus pyogenes resistance to erythromycin increased significantly over time from 7.6 % in 2010 to 16.9 % in 2015.

Conclusions

Oxacillin resistance incidence in Staphylococcus aureus has registered a slight decrease, since 2011, from 55.7 % to 44.8 % in 2015. Coagulase-negative staphylococci are significantly more resistant than Staphylococcus aureus. In 2012 the firsts strains of Enterococcus faecium resistant to vancomycin were isolated and in 2014 their proportion reached 35.0 %. Continuous monitoring of antimicrobial resistance is highly needed, in particular to guide an efficient empirical therapy.

A22 The high percentage of carbapenem-resistant Gram-negative bacilli in Romania: an analysis and some proposals

Gabriel Adrian Popescu1,2 (gabrielp9@yahoo.com)

1National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

Background

Carbapenems are probably the most important last-line antibiotics for treatment of infections involving multidrug-resistant gram-negative bacteria. In the last years, the emergence of carbapenem-resistance of Gram-negative bacilli is considered one of the worldwide most important challenges of public health.

Methods

The analysis is based on antimicrobial resistance data collected by NIPH for 2012–2015 and national antibiotics sales for 2011–2015, provided by IMSHealth Romania. The European level data were obtained from EARS Net and ESAC Net newest reports.

Results

The percentage of carbapenem-resistance in Escherichia coli was low in the past four years, 0 (2012) - 2.1 % (2015) in the past four years, but several resistant isolates represent an alert for the risk of community acquired infections due to XDR strains. For other Gram-negative bacteria the carbapenem-resistance is already high or rapidly emerging: Klebsiella pneumoniae, from 15 % (2012) to 35.1 % (2015), third highest resistance level in EARS Net; Pseudomonas aeruginosa 60 % (2012) - 66.4 % (2015), first resistance percentage in EARS Net and Acinetobacter baumannii 81.5 % (2012) to 82.1 % (2015) fourth resistance level in EARS Net; similar high percentages were obtained when the results only from Infectious Diseases Hospitals were analyzed. The risk factors for carbapenem-resistance are carbapenem usage and carbapenem-resistant bacteria transmission. The carbapenems usage in Romania increased with 113 % after 2013 (R2 = 0.746) and germ transmission is probably at a high level in our hospitals, as several very recent examples had proven.

Conclusions

The high percentage of carbapenem-resistance in Romania is related to misuse of carbapenems (generated by some pseudo-science myths) and to germ transmission in Romanian hospitals. Both problems need to be addressed and Infectious Diseases specialists could play a pivotal role in the control of this public health severe emergency

Acknowledgement

The author acknowledges support received from National Institute for Public Health and IMSHealth Romania for data collection.

A23 Etiological, clinical and therapeutic considerations on 78 cases of healthcare associated meningitis or ventriculitis admitted in the “Sf. Parascheva” infectious diseases clinical hospital, Iași, from 2011 to 2015

Mihnea Hurmuzache1,2, Georgiana Enache1, Alexandra Ciocan1, Mircea Bararu3, Madalina Popazu1

1Infectious Diseases Hospital “Sf Parascheva”, Iași, Romania; 2“Gr.T.Popa” University of Medicine and Pharmacy, Iași, Romania; 3“N. Oblu” Clinical Hospital of Neurosurgery, Iaşi, Romania
Correspondence: Mihnea Hurmuzache (mihnea_hurmuzache@yahoo.com)

Background

Healthcare-associated meningitis or ventriculitis is a serious and life-threatening complication of invasive neurosurgical procedures or penetrating head trauma.

Methods

The current study reviewed 78 cases of health care-associated meningitis or ventriculitis which were treated in “Sf Parascheva” Infectious Diseases Hospital Iași from January 2011 to December 2015.

Results

The reviewed cases involved 78 adult patients. The age of the patients was between 18 and 89, with a higher frequency in the age group 60–80. Healthcare-associated bacterial meningitis may occur after neurosurgical procedures, head trauma, placement of internal or external ventricular catheters, ENT and maxillofacial surgery. From 78 cases, in 42 there was a positive cerebrospinal fluid culture. The most frequent agents are Gram negative bacilli (Pseudomonas spp, Acinetobacter spp, Escherichia coli and Klebsiella pneumoniae) and Gram positive cocci (Staphylococcus aureus – with a particular focus on MRSA, coagulase-negative Staphylococcus and Streptococcus pneumoniae). At the admission in the clinic the signs and symptoms were: fever, headache, changes in mental status (Glasgow Coma scale 3–12), nausea/vomiting, focal neurologic deficit, neck stiffness, seizures and photophobia. The diagnostic evaluation involved neuroimaging investigation (CT/MRI) and cerebrospinal fluid analysis. Empiric antimicrobial therapy should be directed towards the likely infecting pathogen. The complications involved were brain abscess, ventriculitis, cranial nerve damage, deafness and blindness. The outcome was negative in 38 % of cases and positive in 62 % (with disability in 30 patients and without disability in 32 patients).

Conclusions

Healthcare-associated meningitis or ventriculitis remains challenging in terms of diagnosis, treatment and prevention.

A24 Nosocomial infection dynamics in an Intensive Care Department – an overview (epidemiological and clinical monitoring, advanced therapeutic intervention)

Doina Viorica Iovănescu1, Cleo Nicoleta Roșculeț1, Andrei Rogoz1, Cătălin Gabriel Apostolescu1,2, Viorica Mitescu1 , Tudor Vladoiu1, Dalila Toma1, Catrinel Ciuca1

1National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Correspondence: Doina Viorica Iovănescu (liviuiovanescu@yahoo.com)

Background

In a medical world in which infections are caused by bacteria with increased virulence, nosocomial infection is a serious threat for all medical departments. Epidemiological data must be thoroughly collected and interpreted in the setting of clinical facts, thus guiding the complex process of therapeutic intervention.

Methods

We analyzed the clinical data obtained in our ICU department over a period of 6 months in 2016 and outlined the main patterns involved in the occurrence and evolution of nosocomial infections. The main sources of nosocomial infections were venous and arterial catheters responsible for bloodstream infections (4 cases), orotracheal intubation (5 cases) causing severe ventilator-associated pneumonia and bladder catheterization responsible for most cases of urinary tract infections (4 cases). Every nosocomial infection’s ethology was analyzed and correlated to its clinical impact. Suggestive signs developed when peripheral catheters were implanted and fever was the first sign of catheter-associated bloodstream infection. The purulent aspect of pulmonary secretions in intubated patients was the first omen of VAP. The turbid aspect of urine indicated a potentially hospital-acquired infection in patients with bladder catheterization.

Results

In our Institute – specialized in diagnosis and treatment of infectious diseases – nosocomial infections in different stages of evolution are part of our current pathology. Based on this argument, in our ICU from January to July 2016, there were 13 cases considered “imported” nosocomial infections – failure of previous treatments – and 1 case was declared “novel” nosocomial infection – ventilator associated pneumonia (VAP) with A. baumannii in an immunocompromised patient with end stage AIDS/HIV infection. Unfortunately, his evolution was continually unfavorable with subsequent death.

Ten patients with “imported” nosocomial infections had favorable evolutions, and were discharged in good conditions. The 2 others died as a result of VAP with MRSA and VAP with P. aeruginosa respectively.

Conclusions

Most of the patients admitted to our clinic over a period of 6 months were infected with multi-resistant bacteria at the time of admission thus emphasizing the spread of germs with high antibiotic resistance in the community and the necessity of a thorough bacteriological survey at the time of inter-hospital transfer. Nosocomial infections remain a constant threat whose dynamics must be closely monitored in the future.

Viral hepatitis - epidemiology, treatment and monitoring

A25 Safety and efficacy of interferon free treatment in patients with HCV chronic hepatitis- experience of a single Internal Medicine center

Laura Iliescu, Georgiana Minzala, Letitia Toma, Mihaela Baciu, Alina Tanase, Carmen Orban

Fundeni Clinical Institute, Bucharest, Romania
Correspondence: Laura Iliescu (laura_ate@yahoo.com)

Background

The use of directly acting antiviral agents in chronic HCV hepatitis has proved to be efficient and safe in clinical trials.

Methods

Transaminases, bilirubin, blood cell count at initiation, 2, 4, 8, 12 weeks of treatment were evaluated in 124 patients with HCV associated cirrhosis, undergoing treatment with dasabuvir (Exviera™), ombitasvir, paritaprevir, ritonavir (Viekirax™) and ribavirin. HVC-RNA was determined at initiation and at end of therapy (EOT).

Results

We included 124 patients of which 56 were males. The mean age was 51.7 ± 23.4 years. Two patients with liver transplant and a patient with HCV genotype 1a received 24 weeks of treatment. Two patients did not receive ribavirin: one with minor thalassemia, one with polyarthritis. We included 2 patients with diabetic nephropathy with end stage renal disease (ESRD), one undergoing hemodialysis. 58 patients have reached the end of treatment (one patient with liver transplant); 57 of them had undetectable viremia; one had viremia <15 IU/mL. 15 patients have been evaluated at 12 weeks after EOT; they all had undetectable viremia at EOT, and had sustained virologic response. Ribavirin was discontinued in 7 patients - 2 due to severe cutaneous reactions - erythroderma. Both patients with ESRD discontinued ribavirin after week 2 due to severe anemia. One patient with systemic lupus stopped ribavirin at week 2 due to hypotension. A patient with thalassemia presented duodenal hematoma with pancreatic reaction in the first week, with improvement under medical therapy and discontinuation of ribavirin, with undetectable viremia at EOT. Ribavirin doses were decreased at week 4 in a patient with variceal bleeding, and stopped at week 8 due to severe anemia. These patients also had virologic response at EOT. Another patient presented with hepatocellular carcinoma in week 2; he underwent transarterial chemoembolization in week 8, with decompensation by ascites, ultimately with good evolution, undetectable viremia at EOT and complete response of the nodule. The mean initial levels of transaminases were double the normal values; they decreased dramatically after the first two weeks of treatment and low levels were maintained throughout therapy. The mean initial bilirubin level was normal, with values increasing during the first month: 1.4 mg/dL at week 2 and 2.84 mg/dL at week 4. Afterwards there was a small constant decrease and normalization after EOT.

Conclusions

Therapy with Exviera™/Viekirax™/ribavirin is well tolerated, safe and efficient in patients with chronic HCV hepatitis and cirrhosis. Ribavirin dose reductions should not be a milestone in therapy.

A26 Viusid in treatment of chronic viral hepatitis B and C

Victor Pantea1, Gheorghe Placinta1, Valentin Cebotarescu1, Lilia Cojuhari1, Paulina Jimbei2

1Faculty of Medicine, Nicolae Testemițanu State Medical and Pharmacy University, Chișinău, Republic of Moldova; 2Toma Ciorbă Clinical Hospital for Infectious Diseases, Chișinău, Republic of Moldova
Correspondence: Victor Pantea (victor.pantea@usmf.md)

Background

At the Clinical Hospital for Infectious Diseases, a study has been performed to evaluate antiviral and hepatoprotective effects of the medicinal product Viusid in treatment of viral hepatitis B and C.

Methods

The study involved 20 patients with chronic viral hepatitis: B - 10 patients (Group I), and C – 10 patients (Group II), among them in Group I – 7 men and 3 women, and in Group II – 4 and 6, respectively. The patient examination included physical exam, biochemistry tests (ALT, AST, GGT), complete blood count, molecular biology assays (HBV DNA and HCV RNA quantification by PCR). Viusid was prescribed as follows: 1 sachet 3 times daily (every 8 hours) for 3 months. The patient physical examinations were performed monthly, and the laboratory tests – at the beginning and at the end of treatment.

Results

Clinical manifestations were scanty in both groups: right hypochondriac pain in 44.4 % of cases in Group I, and 36.4 % – in Group II, weakness or fatigue – 22.2 % in Group I, 9.1 % – in Group II. At the end of treatment no clinical manifestations were present. Complete blood count, leukocyte count remained in the normal range with nonsignificant evolution. Lymphocyte count trended to increase within the normal range. Platelet count did not change significantly. Biochemistry tests: positive evolution of both total and direct bilirubin levels with their normalization in both groups was observed. ALT, AST and GGT were increased in all patients of both groups. In Group II, the average values of these parameters tended to reduce. In patients of Group I, the reduction was more significant than in those of Group II. Molecular biology assays. The HCV RNA level decreased from 442,843,736 IU/mL to 288,801,564 IU/mL, but did not become negative. The HBV DNA level reduced on average by 50 % (at the beginning of treatment – 4,729,167 IU/mL, and 1,833,933 IU/mL – at the end of treatment), and in 4 patients HBV DNA was not detected.

Conclusions

The treatment of both patient groups with Viusid showed that the clinical and biochemical improvement that was more apparent in Group I, which indicates the protective effect of the medicinal product Viusid; the reduction of HBV DNA level by 50 % and HCV RNA level by 40 %, denotes an antiviral effect of the drug.

A27 The management of hyperbilirubinemia in HCV cirrhotic patients who underwent therapy with direct acting antivirals

Cristina Popescu1,2, Anca Leuștean1, Cristina Dragomirescu1, Alina Orfanu1,2, Cristina Murariu1, Laurențiu Stratan1, Alexandra Badea1, Cătălin Tilișcan1,2, Daniela Munteanu1,2, Raluca Năstase1, Violeta Molagic1,2, Mihaela Rădulescu1,2, Remulus Catană1,2, Victoria Aramă1,2

1National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Correspondence: Cristina Popescu (crispopescu3@yahoo.com)

Background

The FDA warned that the direct acting antiviral (DAA) can cause severe liver injury in patients with advanced liver disease. However, liver decompensation was not reported in patients with HCV Child-Pugh A cirrhosis. In July 2016 a case of HCV Child-Pugh A patient treated with ombitasvir-paritaprevir/ritionavir-dasabuvir (OPrD) with severe liver decompensation was reported. The jaundice during OPrD therapy was reported especially in HIV-HCV co-infected patients. A guideline regarding the management of these patients has not been published yet. Objective: to analyze the predictive factors for hyperbilirubinemia during DAA therapy for HCV Child-Pugh A cirrhosis and also to establish the management of these patients.

Methods

This is a prospective study of patients with HCV genotype 1 Child-Pugh A cirrhosis, treated with OPrD-ribavirin regimen, in the Third Department of Matei Balș Institute. We analyzed the patients who developed hyperbilirubinemia during antiviral therapy in order to identify the risk factors for this side effect. The management of these patients was also analyzed. The statistical analysis was made with open-epi 3.0 program.

Results

Eighty-seven patients with HCV compensated cirrhosis are treated in our department with OPrD-ribavirin regimen. Three patients discontinued the antiviral therapy, two of them because of liver decompensation. After one month of therapy, 20 patients had total bilirubin more than 2 mg/dL and 7 of them had total bilirubin more than 4 mg/dL (the maxim value was 21 mg/dL). In the same time, these patients developed anemia and 16 of them permanently discontinued ribavirin. Five patients had high value of bilirubin (more than 10 mg/dL): one patient with predominance of unconjugated bilirubin and severe anemia (with hemolytic mechanism with recovery after ribavirin discontinuation and 2 patients with liver decompensation (with discontinuation of DAA regimen). Three of these patients did not develop liver decompensation and a slow recovery after discontinuation of ribavirin was observed. The risk factors for hyperbilirubinemia were analyzed and two of them were highly correlated with this side effect: Child-Pugh score at baseline 6 (RR 8 (4.48; 14.28) with p < 0.0000001) and baseline level of platelet count less than 100000/cmm (RR 5.36 (1.973; 14.56) with p < 0.0001).

Conclusions

Hyperbilirubinemia in patients with compensated cirrhosis treated with OPrD-ribavirin regimen represents a severe side effect. Ribavirin must be discontinued in this situation and sometimes all DAA regimen has to be withdrawn. The most important risk factors for this side effect are: Child-Pugh score at baseline 6 and platelet count at baseline below 100000/cmm.

A28 The efficacy of ombitasvir-paritaprevir/ritonavir, dasabuvir and ribavirin in patients with genotype 1 HCV compensated cirrhosis

Cristina Popescu1,2, Laurențiu Stratan1, Remulus Catană1,2, Anca Leuștean1, Cristina Dragomirescu1, Alexandra Badea1, Cristina Murariu1, Raluca Năstase1, Violeta Molagic1, Daniela Munteanu1,2, Cătălin Tilișcan1,2, Mihaela Rădulescu1,2, Alina Orfanu1,2, Ioan Diaconu1,2, Anca Negru1,2, Iulia Bodosca1, Violeta Niță1, Victoria Aramă1,2

1National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Correspondence: Cristina Popescu (crispopescu3@yahoo.com)

Background

The Romanian National Health System has approved the use of direct acting antivirals (DAA) for treatment of HCV compensated cirrhosis. The approved regimen contains a protease inhibitor, paritaprevir (boosted with ritonavir), a NS5A inhibitor - ombitasvir and a non-nucleoside NS5A inhibitor – dasabuvir (OPrD), recommended for 12 weeks in genotype 1b and for 24 weeks in genotype 1a. This DAA regimen is associated with ribavirin. Objective: to evaluate the real life data regarding the efficacy of this regimen in genotype 1 HCV infected patients with compensated cirrhosis.

Methods

We performed a prospective analysis of all patients with HCV compensated cirrhosis treated in Third Department of Matei Balș Institute since November 2015 until July 2016. We included all patients who underwent at least four weeks of antiviral therapy. We analyzed the evolution of clinical and biological parameters and also the trend of HCV viral load.

Results

Until now 88 of our patients received approval for OPrD therapy, 87 for compensated cirrhosis and one with F3 fibrosis and severe depression. A patient experienced liver decompensation during the third month of therapy, when cholangiocarcinoma was diagnosed, and died 2 weeks later. Our patients are in different stages of therapy: 37 patients at the end of follow-up (EF) – 42.52 %, 30 patients at the end of therapy (EOT) – 34.48 %, 5 patients during the third month of therapy – 5.74 %, 10 patients during the second month of therapy – 11.49 % and 5 patients during the first month. From the 27 patients whose viral load has been analysed after 4 weeks of therapy, 24 registered undetectability (88.88 %) and 2 patients had a viral load under the low limit of quantification. 66 patients finished the therapy and all had undetectable viral load. 38 patients finished the 12 weeks monitoring period and all of them registered sustained virologic response. Two patients prematurely discontinued antiviral therapy due to liver decompensation and cardiac disorders. From 53 patients with abnormal ALT at baseline, 32 (60.37 %) had normal ALT after 2 weeks of therapy and 50 (94.33 %) patients had normal ALT after 4 weeks of therapy.

Conclusions

The OPrD–Riba regimen was highly efficient in difficult to treat patients with compensated cirrhosis. All the patients that have completed the therapy achieved undetectable viral load and furthermore, in the case of those who completed the 12 weeks period of follow-up, SVR 12 was achieved.

A29 The efficacy of direct acting antivirals regimen without ribavirin in HCV genotype 1b infected patients with compensated cirrhosis

Anca Leuștean1, Victoria Aramă1,2, Alina Orfanu1,2, Remulus Catană1,2, Laurențiu Stratan1, Cristina Dragomirescu1, Cristina Murariu1, Alexandra Badea1, Cătălin Tilișcan1,2, Daniela Munteanu1,2, Violeta Molagic1,2, Raluca Năstase1, Mihaela Rădulescu1,2, Cristina Popescu1,2

1National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Correspondence: Anca Leuștean (anca_Leustean@yahoo.com)

Background

The regimen approved for the therapy of HCV Child Pugh A cirrhosis, contained at the beginning different combinations of direct acting antivirals and ribavirin. Some recent studies have shown that the association of ribavirin did not increase the efficacy of the regimen. Recently, in some countries the local protocols for therapy of HCV compensated cirrhosis recommend only DAA without ribavirin. Most of the available data about the importance of ribavirin in the therapy of patients with compensated cirrhosis came for clinical studies and data from real life will be very useful. Objective: to analyze the efficacy of ombitasvir-paritaprevir/ritonavir –dasabuvir (OPrD) without ribavirin in patients with HCV Child Pugh A cirrhosis.

Methods

This is a prospective analysis of the OPrD regimen efficacy without ribavirin in patients with compensated HCV cirrhosis, monitored in Third Department of Matei Balș Institute.

Results

Between November 2015 and July 2016, 87 patients received approval for OPrD and ribavirin therapy for HCV compensated cirrhosis, 86 for genotype 1b and one patient with genotype 1 with undetermined subtype. Some of our patients had contraindications for ribavirin usage (chronic anemia – 2 patients) and we also have patients with prematurely discontinuation of ribavirin. 85 patients started ribavirin, but after one month of antiviral therapy, the ribavirin was discontinued for 16 patients (18.82 %) and for 23 (27.05 %) patients the dose was reduced. The most important reason for ribavirin discontinuation and dose reduction was severe anemia but we also have patients with moderate or mild anemia but with severe jaundice (7 patients with total bilirubin more than 4 mg/dL – among them, 5 patients had bilirubin more than 10 mg/dL). After two more months of therapy, other 7 patients discontinued ribavirin. Out of 81 patients who received at least 2 months of therapy, 23 patients discontinued ribavirin (28.39 %) and for 20 patients the ribavirin dose was reduced (24.69 %). Only 38 patients received full dosage of ribavirin for at least two months. Despite the ribavirin dose reduction or discontinuation all the patients who completed 12 weeks of therapy achieved undetectable viral load and all patients who completed the follow-up period achieved sustained virologic response.

Conclusions

The efficacy of OPrD regimen in patients with HCV compensated cirrhosis is similar with or without ribavirin. Because sometimes the ribavirin side effects can conduct to a prematurely discontinuation of all antiviral regimen, we thought that in difficult to treat patients, the regimen without ribavirin could be a better option.

A30 Liver decompensation during ombitasvir-paritaprevir/ritonavir-dasabuvir and ribavirin regimen in HCV infected patients with Child-Pugh A cirrhosis

Cristina Popescu1,2, Cristina Dragomirescu1, Anca Leuștean1, Cristina Murariu1, Laurențiu Stratan1, Alexandra Badea1, Remulus Catană1,2, Alina Orfanu1,2, Raluca Mihaela Năstase1, Violeta Molagic1,2, Daniela Munteanu1,2, Cătălin Tilișcan1,2, Victoria Aramă1,2

1National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Correspondence: Cristina Dragomirescu (dragomirescu.cristina@yahoo.com)

Background

Patients with HCV cirrhosis need urgent antiviral therapy. However, the patients with liver cirrhosis represent difficult to treat cases and appropriate monitoring is necessary. The most important data regarding the safety of ombitasvir-paritaprevir/ritonavir-dasabuvir (OPrD) and ribavirin regimen in HCV cirrhotic patients came from Turquoise II clinical trial, real life data being lacunar. According to Romanian guideline and also with summary of product characteristics, this regimen is recommended only in Child A cirrhosis. Objective: To analyze the risk of liver decompensation during OPrD-ribavirin regimen in HCV Child-Pugh A cirrhotic patients.

Methods

We performed a prospective study of HCV Child A cirrhotic patients monitoring in Third Department of Matei Balș Institute who developed liver decompensation during OPrD therapy. We correlated the liver decompensation with some clinical and biological characteristics at baseline.

Results

Eighty seven Child A cirrhotic patients were treated in our Department: 70 patients had 5 points at Child score (80.45 %) and 17 patients 6 points (19.55 %). Five patients (5.74 %) developed liver decompensation during antiviral therapy. Two patients permanently discontinued antiviral therapy: one after 23 days of therapy − because after the discontinuation of ribavirin and supportive therapy the outcome wasn’t good and the second one was diagnosed with cholangiocarcinoma after 9 weeks of therapy. Two patients with liver decompensation had a good outcome after cessation of ribavirin and supportive therapy. They had completed the therapy with OPrD and achieved SVR12. One patient is still in hospital under strict monitoring; ribavirin was stopped but OPrD regimen was not yet discontinued. The mean age was 63 year-old, 3 male and 2 female, 3 naive patients and 2 previously treated with null response. All the patients had Child score 6. All the patients had at baseline: abnormal INR (but less than 1.7 – the limit accepted by Child Pugh score), platelet count under 100000/cmm, mild increase of total bilirubin (between 2 and 3 mg/dL for 4 patients and below 2 mg/dL for one patient) and albumin below 3.5 g/dL in one patient. Four patients had esophageal varices at baseline and all patients had an increased spleen diameter.

Conclusions

Liver decompensation in patients with Child Pugh score A during OPrD-ribavirin regimen has a low rate of probability, but this situation is possible. The diagnosis of compensated cirrhosis probably has to take into account more clinical and biological parameters, not only the ones used by Child Pugh score.

A31. The safety of direct acting antivirals in HCV compensated cirrhotic patients - an interim analysis

Victoria Aramă1,2, Remulus Catană1,2, Cristina Dragomirescu2, Cristina Murariu2, Anca Leuștean2, Laurențiu Stratan2, Alexandra Badea2, Alina Orfanu1,2, Anca Negru1,2, Raluca Năstase2, Violeta Molagic2, Daniela Munteanu1,2, Cătălin Tilișcan1,2, Mihaela Rădulescu1,2, Ioan Diaconu2, Violeta Niță2, Iulia Bodoșca2, Cristina Popescu1,2

1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 2National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania
Correspondence: Remulus Catană (catana.remulus@yahoo.com)

Background

The regimen containing NS5A inhibitor - ombitasvir, protease inhibitor paritaprevir boosted with ritonavir and non-nucleoside inhibitor dasabuvir (OPrD) associated with ribavirin was approved in Romania from November 2015 for genotype 1 HCV infected patients with compensated cirrhosis. The safety data regarding this therapeutic regimen came from clinical studies where many patients with severe comorbidities were excluded. The data coming from real-life are more relevant in this context. Objective: the aim of our study is to analyze and to report the side effects that occurred during and after OPrD-riba regimen and also the management of these side effects.

Methods

We performed a prospective study using the database of cirrhotic patients treated with OPrD-riba regimen in Third Department of Matei Balș Institute. All the adverse events that occurred in these patients were introduced into a database and we established the correlation between the regimen and each side effect, the grade of each side effect and also its management.

Results

A total of 87 patients were followed, with a median age of 63 years (IQR 54–70 years) and 47 % males. 36 patients (41.4 %) reported at least one clinical adverse event. The most common were fatigue (26.4 %), pruritus (13.8 %), dizziness (8 %), sleeping disorders (6.9 %), nausea and/or vomiting (6.9 %), muscle and/or bone pain (4.6 %), headache (3.4 %), diarrhoea (3.4 %) and skin rash (2.3 %). The main laboratory abnormalities were anemia (44.8 %) and hyperbilirubinemia (23 %). After the first month of treatment, 20 patients (23 %) developed mild anemia (hemoglobin level 11–12 g/dL) and 19 (21.8 %) developed moderate anemia (hemoglobin level < 11 g/dL). A total bilirubin level > 2 mg/dL after one month of therapy was observed in 20 patients (23 %) and for 16 (18.4 %) of them ribavirin was discontinued. Three patients discontinued treatment, two of them because of liver decompensation.

Conclusions

The most important side effect was anemia which was correlated with ribavirin use and for some cases ribavirin discontinuation was necessary. Jaundice was another side effect more difficult to control. Complete therapy discontinuations due to adverse events were infrequent.

A32 The access of patients with HCV compensated cirrhosis to the National Program of therapy with direct acting antivirals

Cristina Popescu1,2, Alexandra Badea1, Anca Leuștean1, Alina Orfanu1,2, Anca Negru1,2, Laurențiu Stratan1, Cristina Dragomirescu1, Remulus Catană1,2, Cristina Murariu1, Violeta Molagic1,2, Raluca Năstase1, Cătălin Tilișcan1,2, Daniela Munteanu1,2, Mihaela Rădulescu1,2, Ioan Diaconu1,2, Violeta Niță1, Iulia Bodoșca1, Victoria Aramă1,2

1National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Correspondence: Alexandra Badea (alexandrambadea@yahoo.com)

Background

The Romanian patients known with genotype 1 HCV compensated cirrhosis have access to direct acting antivirals (DAA) therapy since November 2015 for free, through a National Program financed by Romanian Health Insurance. The eligibility criteria for DAA regimen were: genotype 1 of HCV, detectable viral load, cirrhosis diagnosed by FibroMax (BioPredictive France) if fibrotest is more than 0.75 and compensated cirrhosis according to Child Pugh score (Child Pugh score A – 5 and 6 points). Objectives: to analyze all the causes that led to the failure of access to DAA regimen via Romanian National Program.

Methods

We performed a prospective study in which we enrolled all the patients known with compensated cirrhosis who received vouchers for access to the therapy (FibroMax, viral load and HCV genotyping test). The current status of each patient was analyzed.

Results

120 patients were included in the DAA therapy program in Third Department of Matei Balș Institute. Among them: 88 (78.33 %) received the approval, 17 patients are awaiting the approval (14.16 %), 3 patients were ineligible despite F4 fibrosis due to the diagnosis of hepatocellular carcinoma and 12 (10 %) had fibrosis less than F4 and were ineligible according to the local guideline. From our patients only 92 (76.66 %) had F4 fibrosis according to the FibroMax. In 4 cases the previous fibrosis investigated by FibroMax or Fibroscan was F3 and the patients had severe comorbidities. Despite these data, the evaluation of FibroMax during the National Program showed F2 fibrosis and were ineligible for DAA therapy. In one case, the result of FibroMax was F2 but the patient had significant clinical signs of cirrhosis and the therapy was approved. For twenty-two patients the FibroMax showed F3 fibrosis (19.16 %). However, they were known with compensated cirrhosis previously diagnosed by: FibroMax, Fibroscan, liver biopsy or by clinical findings like esophageal varices. Among them, 15 patients were considered eligible for therapy (65.21 %): 11 patients have already received the approval (78.57 %) and 4 patients are awaiting the commission’s decision. Eight patients without clinical signs of cirrhosis were declared ineligible (34.78 %), despite the previous evaluation of fibrosis by non-invasive methods.

Conclusions

The fibrosis cannot be always correctly determined by FibroMax; it is important to use other alternative test for an accurate diagnosis of cirrhosis. Moreover, even the tests manufacturer from BioPredictive recommends that a fibrotest score with a value more than 0.60 can be interpreted as severe fibrosis and must be treated urgently.

A33 Severe reactivation of chronic hepatitis B after discontinuation of nucleos(t)ide analogues – a case series

Cristina Popescu1,2, Alina Orfanu1,2, Anca Leuștean1, Alexandra Badea1, Laurențiu Stratan1, Remulus Catană1,2, Cătălin Tilișcan1,2, Victoria Aramă1,2

1National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania; 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Correspondence: Alina Orfanu (alina.lobodan@yahoo.com)

Background

Nucleos(t)ide analogues (NAs) realize a proper suppression of viral replication in chronic hepatitis B (HBV), but a negligible immune control, so a lifelong therapy is necessary. The highest risk after therapy discontinuation, even in patients who achieved undetectable viral load (VL), is the viral reactivation. Reactivation flares appear in 10 % of cases after therapy cessation and are associated with jaundice, hepatocytolysis and high VL. Some cases can develop fulminant hepatitis with high mortality rate.

Methods

We present a series of 3 cases of viral reactivation following discontinuation of Entecavir (ETV), administered for chronic HBV.

Results

In 2015–2016, three patients known with chronic HBV were admitted in our department for jaundice and ALT increase. The first case is a young woman, pregnant in 24 weeks, under ETV for 4 years, with negative HBeAg and undetectable VL, who decided to stop therapy when she discovered the pregnancy. Six months later she was admitted in our clinic for important hepatocytolysis. The biological exams revealed: ALT > 20 x upper limit of normal (ULN), positive HBeAg, HBV VL of 9 log IU/mL, normal prothrombin concentration and mild hyperbilirubinemia. The patient received off label lamivudine with slow decrease of ALT and VL of 2 log IU/mL at delivery. ETV therapy was reintroduced after d