title: ETIOLOGY AND RESISTANCE PROFILE OF ISOLATED STRAINS FROM SEVERE SYSTEMIC INFECTIONS IN PATIENTS WITH IMMUNODEPRESSION--EXPERIENCE OF THE IASI INFECTIOUS DISEASES HOSPITAL 2011-2014.
abstract: Microbial resistance is an increasingly serious threat to global public health and it is linked to patient's age, immune status, and also antibiotic overuse or misuse and repeated hospitalizations. The high incidence of infections caused by multidrug-resistant bacteria requires rethinking the first-line therapeutic schemes.
  
  
  OBJECTIVE
  Retrospective study of the etiologic and antibiotic resistance profile of the bacterial strains isolated from immunocompromised hosts diagnosed with severe systemic infections, aimed at gaining a better understanding of the potential infectious sources and optimizing the antibiotic therapy.
  
  
  METHODS
  178 cases of severe sepsis associated with immunosuppression (caused by diabetes, malignancies, liver cirrhosis, chronic alcohol abuse, kidney failure) were admitted to the "St. Parascheva" Infectious Diseases Hospital Iaşi in the interval January 2011- December 2014.
  
  
  RESULTS
  The mean age of the study patients was 61 years, most patients being female (53%) and living in urban areas (51%). The causal agents were: Escherichia coli (20.2%), Klebsiella pneumoniae (16.8%), Pseudomonas aeruginosa (14.6%), Methicillin-Sensitive Staphylococcus aureus (MSSA) (11.2%), Enterococcus spp. (10.1%), Methicillin-Resistant Staphylococcus aureus (MRSA) (8.9%), Proteus spp.(5%), Acinetobacter baumanii (5%), Streptococcus pyogenes (1.6%), Staphylococcus epidermidis (1.1%) and Citrobacter (0.5%). As to the resistance profile the following were found: 100% susceptibility of MRSA and Enterococcus species to vancomycin, as well as for the Enterococcus species; 27% of E. coli strains were resistant to beta-lactams and 20% of Klebsiella pneumoniae to carbapenems. Antibiotic therapy associated two or three drugs with an immediate result and a favorable outcome in 84.2% of the cases.
  
  
  CONCLUSIONS
  The etiological agents implicated in the occurrence of severe sepsis in patients with acquired immunosuppression were Gram-positive bacteria (GPB) as well as Gram-negative bacteria (GNB) with moderate resistance to usual antibiotics. The infections caused by GNB were predominant in immunocompromised patients, but also in those with associated urinary and respiratory tract infections and chronic indwelling urinary catheters. In our severe sepsis patients Gram positive bacteria caused mainly skin and joint infections.
authors.forename: Claudia-Elena
authors.initials: CE
authors.lastname: Pleşca
authors.forename: Mihaela Cătălina
authors.initials: MC
authors.lastname: Luca
authors.forename: A St
authors.initials: AS
authors.lastname: Luca
authors.forename: Simona
authors.initials: S
authors.lastname: Constantinescu
authors.forename: Luminiţa Smaranda
authors.initials: LS
authors.lastname: Iancu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D001419:Bacteria / Q000187:drug effects*; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D004352:Drug Resistance, Microbial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects; D006094:Gram-Positive Bacteria / Q000187:drug effects; D055819:Hospitals, Isolation; D006785:Hospitals, University; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012383:Romania / Q000453:epidemiology; D012424:Rural Population / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents