Introduction Information on healthcare-associated C.difficile infection (HA-CDI) in COVID-19 patients is limited. We aimed to assess the characteristics of HA-CDI acquired during and before the COVID-19 pandemic. Methods We conducted a retrospective study in a tertiary care hospital, in which since March 2020 exclusively COVID-19 patients are hospitalized. We compared HA-CDI adult patients hospitalized in March 2020-February 2021 with those hospitalized during the same period in 2017-2018. Results We found 51 cases during 2020-2021 (COVID-19 group), incidence 5.6/1000 adult discharge and 99 cases during 2017-2018 (pre-COVID-19 group), incidence 6.1/1000 adult discharge (p=0.6). The patients in COVID-19 group compared to pre-COVID-19 group were older (median age 66 vs 62 years), with similar rate of comorbidities, but with higher rate of cardiovascular diseases (62.7% vs 42.4%) and less immunosuppression (21.6% vs 55.6%), they had a higher proton pump inhibitors use (94.1% vs 32.3%), and a longer hospitalization (median 19 vs 14 days). Eighty-five (85.9%) patients in pre-COVID-19 group versus 44 (86.3%) patients in COVID-19 group received antimicrobial treatment – mainly cephalosporins (34,1%), quinolones (22,3%) and glycopeptides (21,1%) in pre-COVID-19 group and mainly cephalosporins and macrolides (63,6% each) in COVID-19 group. We found four HA-CDI-related deaths in pre-COVID-19 group and none in the COVID-19 group. Conclusions The HA-CDI incidence in COVID-19 group did not change versus the same period of time during 2017-2018. The antibiotic use was the most important factor associated with HA-CDI. We identified a high use of broad-spectrum antibiotics despite the lack of empirical antimicrobial recommendations in COVID-19. What is important: Information on healthcare-acquired C.difficile in COVID-19 patients is limited, but not only C.difficile infection remains a worrying issue, but is also an emerging topic. We found that antibiotic use seems to be the most important factor associated with CDI and our data emphasize the need for rational use of antibiotics and for ongoing attention regarding CDI in COVID-19 patients.

Adding tigecycline to CDI standard therapy did not increase the clinical cure nor reduce the rate of CDI recurrences.

Objective:The aim of our study was to retrospectively validate a previously described rapid clinical score (RCS) in distinguishing tuberculous meningitis (TBM) from viral meningitis (VM) in people who are at increased risk of tuberculosis, as well as from cryptococcal meningitis (CM) in HIV-infected patients.Methods:We performed a retrospective study of patients admitted with a diagnosis of aseptic meningitis between January 2012 and December 2015, to a referral hospital for infectious diseases. The variables included in RCS were duration of symptoms before admission, neurological stage, cerebrospinal fluid (CSF) to blood glucose ratio, and CSF protein. We included in this retrospective study 31 patients with definite or probable TBM including 14 HIV-infected patients, 62 HIV-noninfected patients with VM, and 18 HIV-infected patients with CM.Results:The sensitivity of RCS to distinguish TBM from VM was 96.7%, with a specificity of 81.1% and the area under the receiver operating characteristic (ROC) curve was 0.949 (0.90–0.99). When all four criteria from the RCS were present, the specificity increased at 100%. In HIV-infected patients, the sensitivity and specificity of RCS in differentiating TBM from CM were 86.6% and 27.7%, respectively, and the area under the ROC curve was 0.669 (0.48–0.85).Conclusion:This easy-to-use RCS was found to be helpful in differentiating TBM from VM, with a better sensitivity than molecular amplification techniques and a relatively good specificity. However, the RCS was not useful to differentiate between TBM and CM in HIV-infected patients.

IntroductionLate presentation is associated with increased healthcare costs, rates of HIV transmission and poor outcome. In Romania, in 2012, one third of individuals with new HIV diagnosis were late presenters (LP).ObjectiveThe aim of the study was to evaluate the epidemiological and clinical characteristics associated with late presentation.MethodsWe retrospectively studied patients over 18 years old, notified in our institution between January 2012 and December 2013, including 499 out of 727 newly diagnosed patients in Bucharest. LP were defined as patients presenting with CD4 T-cell count below 350 cells/mm3 or with an AIDS defining event. Patients with advanced HIV disease (AHD) were defined as persons with a CD4 T-cell count below 200 cells/mm3. Differences between groups were analyzed using the Mann-Whitney U test for continuous variables and the chi-square test for dichotomous variables. Multivariable analysis was performed using binary logistic regression.ResultsOut of 499 patients included, 362 (72%) were male. The median age was 30 (IQR 26–36). A total of 302 (61%) were LP and 184 (37%) were patients with AHD. A total of 170 (34%) were asymptomatic and 114 (23%) presented with an AIDS-defining event. The median CD4 count was 293 cells/mm3 (IQR 125–471) and the median HIV viral load was 100,191 copies/mL (IQR 34,560–272,936). Characteristics of LP compared with non-LP are shown in Table 1. Stage C disease has been shown by multivariable analysis to be associated with LP (p<0.001, OR=11.56, 95% CI 4.94–27.03).ConclusionsMore than half of newly HIV diagnosed patients in Bucharest were LP. The proportion of LP was highest among heterosexually acquired cases. Although most our patients were young, late presentation was associated with age over 35 years. The lower proportion of LP among IVDU compared with those heterosexually infected could be explained by a higher proportion of HIV screening tests among IVDU.

The number of serological assays for SARS-CoV-2 has skyrocketed in the past year. Concerns have been raised regarding their performance characteristics, depending on the disease severity and the time of the analysis post-symptom onset (PSO). Thus, independent validations using an unbiased sample selection are required for meaningful serology data interpretation. We aimed to assess the clinical performance of six commercially available assays, the seroconversion, and the dynamics of the humoral response to SARS-CoV-2 infection. The study included 528 serum samples from 156 patients with follow-up visits up to six months PSO and 161 serum samples from healthy people. The IgG/total antibodies positive percentage increased and remained above 95% after six months when chemiluminescent immunoassay (CLIA) IgG antiS1/S2 and electro-chemiluminescent assay (ECLIA) total antiNP were used. At early time points PSO, chemiluminescent microparticle immunoassay (CMIA) IgM antiS achieved the best sensitivity. IgM and IgG appear simultaneously in most circumstances, and when performed in parallel the sensitivity increases. The severe and the moderate clinical forms were significantly associated with higher seropositivity percentage and antibody levels. High specificity was found in all evaluated assays, but the sensitivity was variable depending on the time PSO, severity of disease, detection method and targeted antigen.

Table of contentsA1 The outcome of patients with recurrent versus non-recurrent pneumococcal meningitis in a tertiary health-care hospital in BucharestCristian-Mihail Niculae, Eliza Manea, Raluca Jipa, Simona Merisor, Ruxandra Moroti, Serban Benea, Adriana HristeaA2 Influence of bacteriophages on sessile Gram-positive and Gram-negative bacteriaAlina 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-CercelA3 The utility of inflammatory biomarkers in the prognostic evaluation of septic patients – past, present and futureAlina Orfanu, Cristina Popescu, Anca Leuștean, Remulus Catană, Anca Negru, Alexandra Badea, Radu Orfanu, Cătălin Tilișcan, Victoria Aramă, Ştefan Sorin AramăA4 Etiologic and clinical features of bacterial meningitis in infantsConstanța-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 LuminosA5 The diagnostic and prognostic role of neutrophil to lymphocyte count ratio in sepsisAlina Orfanu, Victoria Aramă, Ştefan Sorin Aramă, Anca Leuştean, Remulus Catană, Anca Negru, Gabriel Adrian Popescu, Cristina PopescuA6 Whooping cough in a HIV positive patientRamona Georgiana Stanculete, Ana Vaduva Enoiu, Adelina Raluca Marinescu, Voichita LazureanuA7 Cronobacter sakazakii sepsis in varicella patientAdelina-Raluca Marinescu, Alexandru Crișan, Voichița Lăzureanu, Virgil Musta, Narcisa Nicolescu, Ruxandra LazaA8 Anaerobes an underdiagnosed cause of prosthesis joint infectionAnca-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 TălăpanA9 Streptococcus pneumoniae meningitis presenting with normal CSF – case presentationRamona Ștefania Popescu, Luminița Bradu, Dragoș Florea, Adrian Streinu-CercelA10 Extrapulmonary manifestations of infection with Mycoplasma pneumoniae – study on 24 casesDaniela Anicuta Leca, Elena Bunea, Andra Teodor, Egidia MiftodeA11 The molecular diagnosis of severe bacterial sepsis in pediatric populationMădălina Merișescu, Gheorghiță Jugulete, Adrian Streinu-Cercel, Dragoș Florea, Monica LuminosA12 Acute Staphylococcus aureus endocarditis with multiple septic complications in a patient with diabetes mellitus – case presentationRamona Ștefania Popescu, Anamaria Dobrotă, Adina Ilie, Liliana Lucia PreoțescuA13 Is Streptococcus suis meningitis an under-diagnosed zoonosis?Adriana Hristea, Raluca Jipa, Nicoleta Irimescu, Irina Panait, Eliza Manea, Simona Merisor, Cristian Niculae, Daniela TălăpanA14 Klebsiella pneumoniae isolated from blood. Antimicrobial resistance – past and presentLiana Cătălina Gavriliu, Otilia Elisabeta Benea, Șerban Benea, Alexandru Rafila, Olga Dorobăț, Mona PopoiuA15 Antibiotics resistance in Staphylococcus a...

IntroductionAfter the 2008 introduction of new psychoactive substances (NPS) in Romania, the number of newly diagnosed HIV infections showed significant increase among injecting drug users (IDUs). Our objective was to analyze the differences between co-infections related to the HIV infection, based on the way of transmission (IDUs versus sexually infected).Materials and MethodsA retrospective transversal study was carried out, analyzing 245 adult HIV-positive patients, diagnosed between January 2013 and December 2013 in our hospital. We collected socio-demographic, epidemiological and laboratory data at the diagnosis and analyzed them using SPSS version 20.ResultsMost patients (71%, 174/245) were men and the median age was 32 years (IQR: 26–38). 91 patients (37%) were former/active IDUs (most of them injecting both opioids and NPS), while 154 patients (63%) were sexually infected, with 84% being heterosexuals and 16% men having sex with men (MSM). The median CD4 count, at the moment of diagnosis, was 294 cells/mm3 (IQR: 119–483).Other co-infections at diagnosis were toxoplasmosis (four patients), cryptococcosis (two patients) and cytomegalovirus reactivations (three patients) without significant association between the two groups.ConclusionHeterosexual transmission was the most common way of HIV transmission in 2013 in contrast with EU/CEE, where MSM accounted for the majority of cases of HIV epidemics in 2012 [1]. Sexually transmitted HIV infection was associated with late presentation, stage C and syphilis. We noted a high percentage of IDU transmission, which was associated with stage A and hepatitis C infection.

No abstract