Surgical site infections (SSIs) determine an increase in hospitalization time and antibiotic therapy costs. The aim of this study was to identify the germs involved in SSIs in patients from the Clinical Emergency County Hospital of Craiova (SCJUC) and to assess their resistance to antimicrobials, with comparisons between surgical wards and the intensive care unit (ICU). The biological samples were subjected to classical bacteriological diagnostics. Antibiotic resistance was tested by disc diffusion. We used hierarchical clustering as a method to group the isolates based upon the antibiotic resistance profile. The most prevalent bacterial species isolated were Staphylococcus aureus (S. aureus; 50.72%), followed by Escherichia coli (E. coli; 17.22%) and Pseudomonas aeruginosa; 10.05%). In addition, at lower percentages, we isolated glucose-non-fermenting, Gram-negative bacteria and other Enterobacteriaceae. The antibiotic resistance varied greatly between species; the most resistant were the non-fermenting Gram-negative rods. E. coli exhibited lower resistance to third generation cephalosporins, quinolones and carbapenems. By contrast, Klebsiella was resistant to many cephalosporins and penicillins, and to a certain extent to carbapenems due to carbapenemase production. The non-fermenting bacteria were highly resistant to antibiotics, but were generally sensitive to colistin. S. aureus was resistant to ceftriaxone (100%), penicillin (91.36%), amoxicillin/clavulanate (87.50%), amikacin (80.00%) and was sensitive to levofloxacin, doxycycline, gentamycin, tigecycline and teicoplanin. The Enterobacteriaceae resistance was only slightly higher in the ICU, particularly to carbapenems (imipenem, 31.20% in the ICU vs. 14.30% in the surgical wards; risk ratio = 2.182). As regards Staphylococcus species, but for non-fermenting bacteria, even if the median was almost the same, the antibiotic resistance index values were confined to the upper limit in the ICU. The data gathered from this study may help infection control teams to establish effective guidelines for antibiotic therapies in various surgical procedures, in order to minimize the risk of developing SSIs by the efficient application of the anti-infection armamentarium.

High resolution ultrasonography has already become an important tool in the diagnosis and management of inflammatory arthritis of the hand and wrist, but lately it has been proven to be the method of choice in the evaluation of traumatic lesions of tendons, annular pulleys, nerves, and ligaments and at the same time in detecting foreign bodies. The objective of this paper is to review and describe the current knowledge on these US findings and to highlight the ultrasonography role in the evaluation of non-inflammatory conditions of the hand and wrist.

Rheumatoid arthritis (RA) is the most widespread inflammatory rheumatic disease with about 10% of all rheumatic diseases and a global prevalence of about 1%. Through its features - joint proliferation, articular panic, articular cartilage degradation and bone erosion � RA has a destructive and disabling character and a major socio-economic impact. Osteoporosis is a bone system disease characterized by loss of bone mass and alteration of bone architecture, with consequences on bone fragility correlated with an increased fracture risk. With a major socio-economic impact, the World Health Organization (WHO) has declared osteoporosis as a public health problem, third on cardiovascular and oncological.

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Aim: To evaluate the clinical non-inferiority of a 3-day protocol of systemic antibiotics adjunctive to subgingival instrumentation (SI) compared with a 7-day-protocol in patients with Stage III/IV Grade C periodontitis.Materials and Methods: Fifty systemically healthy patients (32.7 ± 4.3 years) with aggressive periodontitis (AgP; Stage III/IV Grade C periodontitis) were treated by SI and adjunctive amoxicillin and metronidazole and were randomly assigned to Group A: (n = 25) 500 mg antibiotics (AB) 3 times a day for 3 days, followed by placebo 3 times a day for 4 days, or Group B: (n = 25) 500 mg AB 3 times a day for 7 days.Clinical, microbial, and immunological parameters were assessed at baseline, 3 months, and 6 months, and patient-related outcomes were assessed after 2 weeks. The primary outcome variable was the number of residual sites with pocket depth (PD) ≥6 mm at 6 months.Results: For the primary outcome variable (the number of residual sites with PD ≥6 mm at 6 months), the null hypothesis was rejected and non-inferiority of the 3-day AB protocol compared with the 7-day AB protocol was demonstrated (the upper limits of the 95% confidence interval for intention to treat analysis: [À2.572; 1.050] and per protocol analysis: [À2.523; 1.318] were lower than the assumed margin of Δ = 3.1). Comparable clinical improvements were obtained for all parameters with both antibiotic protocols (p > .05). All investigated periodontopathogens and pro-inflammatory host-derived markers were statistically significantly reduced without differences between the treatments (p > .05).Conclusions: These findings indicate that in patients with AgP (Stage III/IV Grade C periodontitis), a 3-day systemic administration of amoxicillin and metronidazole Jaccard/EFP research prize competition winner.

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

BackgroundThe most common complications of surgical wounds are abscesses and necrosis.PurposeTo establish the aetiology of surgical wound infections in post-surgery patients from the hospital and to assess the resistance of the germs isolated to antimicrobials. Variations in antibiotic resistance profile in relation to the type of suppuration and surgical wards were compared in order to establish the most effective therapeutic protocols.Material and methodsFrom 165 hospitalised and ambulatory patients we collected: pus from abscesses/phlegmons, ear, nose and throat suppurations, discharge from superficial and deep surgical wounds. We performed classical bacteriological diagnosis and Kirby Bauer testing.ResultsStaphylococcus aureus was isolated in 41.15% of cases, coagulase-negative staphylococci in 4.31% and in the remainder Gram-negative bacilli: Klebsiella spp. (13.88%), Escherichia coli (13.40%), Pseudomonas (8.13%), Proteus (6.22%), non-fermentative Gram-negative bacilli (4.78%), Enterobacter (1.91%) and Citrobacter (0.48%).Staphylococcus aureus was resistant to ceftriaxone (100%), penicillin (91.36%), amoxicillin (83.33%), amikacin (80.00%) and ampicillin (67.92%). E. coli strains were resistant to chloramphenicol (100.00%), amoxicillin clavulanate (87.50%) and ampicillin (64.50%). Klebsiella was resistant to ampicillin (100%), amoxicillin clavulanate (87.50%) and amikacin (50.00%). Pseudomonas was found to be highly resistant to cefpirome (87.50%), meropenem (66.67%) and tigecycline (66.67%).36.84% of all strains were resistant to more than five antibiotics. The average resistance index of strains isolated from the superficial suppurations was higher than those isolated from the deep suppurations (Student’s t = −3.025, p = 0.0014). The resistance index also indicated that the strains isolated from hospitalised patients were more resistant than those from ambulatory patients (Student’s t = −3.4237, p = 0.0008).ConclusionThis study shows the prevalence of multidrug resistant strains in our hospital and their involvement in surgical wound infections. Continuous microbiological surveillance of germs isolated from surgical suppurations and their resistance to antimicrobials is essential for defining antibacterial policies on surgical wards.References and/or AcknowledgementsNo conflict of interest.

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