Antimicrobial Resistance in Romania: Updates on Gram-Negative ESCAPE Pathogens in the Clinical, Veterinary, and Aquatic Sectors

Abstract

Multidrug-resistant Gram-negative bacteria such as Acinetobacter baumannii, Pseudomonas aeruginosa, and members of the Enterobacterales order are a challenging multi-sectorial and global threat, being listed by the WHO in the priority list of pathogens requiring the urgent discovery and development of therapeutic strategies. We present here an overview of the antibiotic resistance profiles and epidemiology of Gram-negative pathogens listed in the ESCAPE group circulating in Romania. The review starts with a discussion of the mechanisms and clinical significance of Gram-negative bacteria, the most frequent genetic determinants of resistance, and then summarizes and discusses the epidemiological studies reported for A. baumannii, P. aeruginosa, and Enterobacterales-resistant strains circulating in Romania, both in hospital and veterinary settings and mirrored in the aquatic environment. The Romanian landscape of Gram-negative pathogens included in the ESCAPE list reveals that all significant, clinically relevant, globally spread antibiotic resistance genes and carrying platforms are well established in different geographical areas of Romania and have already been disseminated beyond clinical settings.

COVID-19 Pandemic Modulates the Environmental Contamination Level with Enteric Bacteria from WWTPs

“…This phenomenon also led to the excretion and dissemination of bacteria from secondary infections in the wastewater and then in the receiving aquatic environments. [24]. In the same time, Amin and co. [25] showed that microbiological analysis on Covid and non-Covid hospitals from Bangladesh indicated 97% from wastewater samples positive for E. coli were positive for Sars-CoV-2 too.…”

“…This could be explained by the fact that Timisoara was the SARS-CoV-2 entrance gate in Romania and therefore the Covid-19 incidence was higher than central and eastern side of Romania as well as the medical treatment was implemented earlier which could induce an early acquired resistance of fecal bacteria to pharmaceutical compounds. Some studies showed that Gram-negative bacteria antibiotic resistance, especially faecal such as E. coli, increased during the COVID-19 progression compared to Gram-positive bacteria [24].…”

COVID-19 Pandemic Modulates the Environmental Contamination Level with Enteric Bacteria from WWTPs

“…A clinical research study from Romania demonstrated that both the number of hospitalized patients and the number of bacterial isolates was lower before the emergence and installation of the COVID-19 pandemic. This phenomenon also led to the excretion and dissemination of bacteria from secondary infections to wastewater and then to the receiving aquatic environments [24]. At the same time, Amin and Co. [25] showed that a microbiological analysis on COVID-19 and non-COVID-19 hospitals from Bangladesh indicated that 97% of the wastewater samples positive for E. coli were positive for SARS-CoV-2 too.…”

“…Some studies showed that Gram-negative bacterial antibiotic resistance, especially fecal bacteria such as E. coli, increased during the COVID-19 progression compared with Gram-positive bacteria [24].…”