Vaccines are fundamental instruments upon which all modern medicine is hinged. This has recently come into the light because of the COVID-19 pandemic caused by SARS-CoV-2. We aimed to assess the knowledge and attitudes of the public regarding vaccination. To this end, a questionnaire, which was disseminated to the general population between 2017 and 2019, was used. We evaluated the responses from 1647 individuals (61% female, with a median age of 37 years, mostly from urban settings). Most respondents (85%) had children and were in favor of vaccination. Our study underlines the role that family physicians have in the education and information of citizens. A small, but considerable, number of respondents (108, 7.84% of those with children) had not vaccinated their children according to the national vaccination scheme. Deterrents were considered to be lack of information and fear of side effects. However, 167 of our respondents (12.12% out of 1377 respondents with children) said that their child experienced adverse events—most of which were mild local reactions. Alternatives to vaccination were proposed by some. In this study, we highlight the attitudes of respondents and multiple gaps in general knowledge, both of which may need to be addressed, especially in light of the current pandemic situation and past failed campaigns.

The rCIM is a rapid (less than 3 h), cheap and accurate test for the detection of CPEs, which can be implemented in low-resource settings, making it a useful tool for microbiology laboratories.

Background Romania is one of the European countries reporting very high antimicrobial resistance (AMR) rates and consumption of antimicrobials. We aimed to characterize the AMR profiles and clonality of 304 multi-drug resistant (MDR) Acinetobacter baumannii (Ab) and Pseudomonas aeruginosa (Pa) strains isolated during two consecutive years (2018 and 2019) from hospital settings, hospital collecting sewage tanks and the receiving wastewater treatment plants (WWTPs) located in the main geographical regions of Romania. Methods The strains were isolated on chromogenic media and identified by MALDI-TOF-MS. Antibiotic susceptibility testing and confirmation of ESBL- and CP- producing phenotypes and genotypes were performed. The genetic characterization also included horizontal gene transfer experiments, whole-genome sequencing (WGS), assembling, annotation and characterization. Results Both clinical and aquatic isolates exhibited high MDR rates, especially the Ab strains isolated from nosocomial infections and hospital effluents. The phenotypic resistance profiles and MDR rates have largely varied by sampling point and geographic location. The highest MDR rates in the aquatic isolates were recorded in Galați WWTP, followed by Bucharest. The Ab strains harbored mostly blaOXA-23, blaOXA-24, blaSHV, blaTEM and blaGES, while Pa strains blaIMP, blaVIM, blaNDM, blaVEB, blaGES and blaTEM, with high variations depending on the geographical zone and the sampling point. The WGS analysis revealed the presence of antibiotic resistance genes (ARGs) to other antibiotic classes, such as aminoglycosides, tetracyclines, sulphonamides, fosfomycin, phenicols, trimethoprim-sulfamethoxazole as well as class 1 integrons. The molecular analyses highlighted: (i) The presence of epidemic clones such as ST2 for Ab and ST233 and ST357 for Pa; (ii) The relatedness between clinical and hospital wastewater strains and (iii) The possible dissemination of clinical Ab belonging to ST2 (also proved in the conjugation assays for blaOXA-23 or blaOXA-72 genes), ST79 and ST492 and of Pa strains belonging to ST357, ST640 and ST621 in the wastewaters. Conclusion Our study reveals the presence of CP-producing Ab and Pa in all sampling points and the clonal dissemination of clinical Ab ST2 strains in the wastewaters. The prevalent clones were correlated with the presence of class 1 integrons, suggesting that these isolates could be a significant reservoir of ARGs, being able to persist in the environment.

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We have read the article published by Mitteregger et al. [...]

Background: Romania is one of the European countries reporting very high antimicrobial resistance (AMR) rates and consumption of antimicrobials. We aimed to characterize the AMR profiles and clonality of 304 multi-drug resistant (MDR), carbapenemase (CP) and extended spectrum beta-lactamase (ESBL) producing Acinetobacter baumannii (Ab) and Pseudomonas aeruginosa (Pa) strains isolated during two consecutive years (2018 and 2019) from hospital settings, hospital collecting sewage tanks and the receiving wastewater treatment plants (WWTPs) located in the main geographical regions of Romania. Methods: The strains were isolated on chromogenic media and identified by MALDI-TOF-MS. Antibiotic susceptibility testing and confirmation of ESBL- and CP- producing phenotype were performed. The genetic analyses consisted of PCR for ESBL and CP genes, horizontal gene transfer experiments, whole-genome sequencing (WGS), assembling, annotation and characterization. Results: Both clinical and aquatic isolates exhibited high MDR rates, especially the Ab strains isolated from nosocomial infections and hospital effluents. The phenotypic resistance profiles and MDR rates have largely varied by sampling point and by geographic location. The highest MDR rates in aquatic isolates were recorded in Galați WWTP followed by Bucharest. The Ab strains harbored mostly blaOXA-23, blaOXA-24, blaSHV, blaTEM and blaGES, while Pa strains blaIMP, blaVIM, blaNDM, blaVEB, blaGES and blaTEM, with high variations depending on the geographical zone and the sampling point. The WGS analysis revealed the presence of antibiotic resistance genes (ARGs) to other antibiotic classes, such as aminoglycosides, tetracyclines, sulphonamides, fosfomycin, phenicols, trimethoprim-sulfamethoxazole as well as class 1 integrons. The molecular Ab and Pa analyses highlighted: i) the presence of epidemic clones such as ST2 for Ab and ST233 and ST357 for Pa; ii) the relatedness between clinical and hospital wastewater strains and iii) the possible dissemination of clinical Ab strains belonging to ST2 (also proved in the conjugation assays to transfer blaOXA-23 or blaOXA-72 genes), ST79 and ST492 and of clinical Pa strains belonging to ST357, ST640 and ST621 in the wastewaters. Conclusion: The prevalent clones were strongly associated with the presence of class 1 integrons, suggesting that those isolates could be a significant reservoir of ARGs and are able to persist into the environment.

Antibiotic resistance is a global, far-reaching phenomenon. Natural resistance to antibiotics, expressed or inducible, is common in Enterobacterales and can occur through the production of different enzymes such as penicillinases, ESBLs or cephalosporinases. In association with other resistance mechanisms, strains that lead to untreatable infections can emerge. Improper infection control measures are responsible for the selection and spread of these strains. The dissemination of acquired Extended-Spectrum Beta-Lactamases (ESBLs) across the globe is well known, a wide spectrum of enzymes being responsible for their different hydrolytic activity. Another important set of enzymes, the cephalosporinases (with the chromosomal cephalosporinase AmpC as the most important), are also concerning as their hyper-expression can alter wide spectrum beta-lactams, like carbapenems. These mechanisms can be readily observed through phenotypic tests, like antibiotic interactions on the disk diffusion antibiogram, or derepression / inhibition of enzymes using key antibiotics. Keywords: ESBL, cephalosporinase, AmpC, carbapenemase, cloxacillin, oxacillin, antibiotic resistance, antibiogram, Enterobacterales