Colonization, Infection and Risk Factors for Death in an Infectious Disease ICU in Romania

Knowing the bacterial strains in the intensive care unit (ICU) is important for reducing the rate of bacterial transmission and the risk of healthcare-associated infections (HAIs), allowing for targeted interventions to reduce the risk of death by HAIs. We performed a retrospective case-control study in a single center that included 320 bacteriologically screened patients from the ICU of the Infectious Diseases Hospital in Constanta between September 2017 and March 2020. Sixty-five secondary bacterial infections were identified as the cause of hospital admission and 60 bacterial colonizations. There were 20 cases and 300 controls for the mortality rate and risk factors for death. Multivariate analysis identified that hospitalization of patients for HIV infection (OR 11.82, 95% CI: 1.69-83.62, P ≤0.05) and Clostridioides difficile infection (OR 7.38, 95% CI: 1.39 -39.22, P ≤ 0.05) were independent risk factors associated with death. We observed that the number of colonizations or secondary infections in the ICU was similar, and the mortality rate in the ICU was influenced by HIV infection or Clostridioides difficile infection

Forty-eight-week efficacy and safety and early CNS tolerability of doravirine (MK-1439), a novel NNRTI, with TDF/FTC in ART-naive HIV-positive patients

INTRODUCTION: Doravirine (DOR) is an investigational NNRTI (aka MK-1439) that retains activity against common NNRTI-resistant mutants. We have previously reported the Part 1 results from a two-part, randomized, double-blind, Phase IIb study in ART-naïve HIV-1-positive patients (1). At doses of 25, 50, 100 and 200 mg qd, DOR plus open-label tenofovir/emtricitabine (TDF/FTC) demonstrated potent antiretroviral activity comparable to EFV 600 mg qhs plus TDF/FTC and was generally well tolerated at week 24. DOR 100 mg was selected for use in patients continuing in Part 1 and those newly enrolled in Part 2. METHODS: Patients receiving DOR 25, 50 or 200 mg in Part 1 were switched to 100 mg after dose selection. In Part 2, 132 additional patients were randomized 1:1 to DOR 100 mg qd or EFV 600 mg qhs (each with TDF/FTC). We present week 48 efficacy and safety results for all patients in Part 1, and early (week 8) CNS tolerability only for patients randomized to DOR 100 mg or to EFV in Parts 1 and 2 combined. The primary safety endpoint is the % of patients with pre-specified CNS events (all causality) by week 8 for DOR 100 mg qd vs EFV (Parts 1 + 2 combined). RESULTS: Part 1 week 48 efficacy and safety results are shown below. CONCLUSIONS: In ART-naïve, HIV-1-positive patients also receiving TDF/FTC, DOR 100 mg qd demonstrated potent antiretroviral activity and immunological effect at week 48 and was generally safe and well tolerated. Patients who received DOR 100 mg qd had significantly fewer treatment-emergent CNS AEs by week 8 than those who received EFV

Long-term effects of evolocumab in participants with HIV and dyslipidemia: results from the open-label extension period

Objectives: People with HIV (PWH) are at an increased risk of atherosclerotic cardiovascular disease. Suboptimal responses to statin therapy in PWH may result from antiretroviral therapies (ARTs). This open-label extension study aimed to evaluate the long-term safety and efficacy of evolocumab up to 52\u200aweeks in PWH. Design: This final analysis of a multinational, placebo-controlled, double-blind, randomized phase 3 trial evaluated the effect of monthly subcutaneous evolocumab 420\u200amg on low-density lipoprotein cholesterol (LDL-C) during the open-label period (OLP) following 24\u200aweeks of double-blind period in PWH with hypercholesterolemia/mixed dyslipidemia. All participants enrolled had elevated LDL-C or nonhigh-density lipoprotein cholesterol (non-HDL-C) and were on stable maximally tolerated statin and stable ART. Methods: Efficacy was assessed by percentage change from baseline in LDL-C, triglycerides, and atherogenic lipoproteins. Treatment-emergent adverse events (TEAEs) were examined. Results: Of the 467 participants randomized in the double-blind period, 451 (96.6%) received at least one dose of evolocumab during the OLP (mean age of 56.4\u200ayears, 82.5% male, mean duration with HIV of 17.4\u200ayears). By the end of the 52-week OLP, the overall mean (SD) percentage change in LDL-C from baseline was -57.8% (22.8%). Evolocumab also reduced triglycerides, atherogenic lipid parameters (non-HDL-C, apolipoprotein B, total cholesterol, very-low-density lipoprotein cholesterol, and lipoprotein[a]), and increased HDL-C. TEAEs were similar between placebo and evolocumab during the OLP. Conclusion: Long-term administration of evolocumab lowered LDL-C and non-HDL-C, allowing more PWH to achieve recommended lipid goals with no serious adverse events. Trail registration: NCT02833844. Video abstract: http://links.lww.com/QAD/C441

ASSOCIATED DISEASES IN ROTAVIRUS GASTROENTERITIS IN CHILDREN HOSPITALIZED IN CLINICAL INFECTIOUS DISEASES HOSPITAL OF CONSTANTA

Our study included 505 children hospitalized in the Clinical Hospital of Infectious Diseases Constanta in 2011-2012 with gastroenteritis with rotavirus. We analyzed the medical records of the patients and extracted demographic data, temperature, and frequency of vomiting and diarrheic stools. We divided the group of cases into 4 groups associated with: respiratory disease (RD) – 160 cases, digestive disease (DD) – 52 cases, eruptive disease (ED) – 11 cases, and a group without other associated diseases (simple) – 282 cases. We found significant differences between the four groups regarding the number of stools, the number of vomiting per day, the mean value of maximum temperature, the mean value of hospitalization

Toxic Megacolon – A Three Case Presentation

Introduction: Toxic megacolon is a life-threatening disease and is one of the most serious complications of Clostridium difficile infection (CDI), usually needing prompt surgical intervention. Early diagnosis and adequate medical treatment are mandatory

ACQUIRED DRUG RESISTANCE TO NRTI CLASS IN TREATMENT-EXPERIENCED HIV INFECTED PATIENTS FROM THE CONSTANTA COUNTY: THERAPEUTIC IMPLICATIONS

Objective. To determine the prevalence of acquired drug resistance (ADR) and of resistance patterns in treatment-experienced HIV infected patients from Constanta in order to establish the best therapeutic options in NRTI class. Material and methods. A retrospective study which included 144 treatment-experienced HIV patients with confirmed viral failure. The strains isolated from these patients were analysed in the Molecular Genetic Laboratory of „Matei Bals“ National Institute of Infectious Diseases, Bucharest and the resulting sequences were saved in FASTA format. The HIV-1 subtyping was based on „REGA HIV01&2 Automated subtyping tool version 2.0“ algorithm. „Stanford HIVdb Program version 8.4“ was used in order to determine the therapeutic options. For statistical calculations, the R-Project software was used. Graphic representations were performed using GNUPLOT program. Results. The prevalence of the acquired drug resistance was 92.36%. The most frequent mutation occurred at the level of the codon 184. The TAM-2 path was more frequently selected compared to TAM-1. Association between TAM1 and TAM 2 were also found, mutation K65R being rarely met. Conclusions. The prevalence of the acquired drug resistance in our study was high, The most valuable therapeutic option in the INRT class remains tenofovir, due to the mutational profile, which was selected on account of the extensive use of thymidine analogues

Analysis of the Arbovirosis Potential Occurrence in Dobrogea, Romania

Climate change creates new challenges for preventing and protecting human health against different diseases that could appear and propagate. The Aedes albopictus mosquito species is an important vector for different diseases like dengue fever or zika. Although this species is not “indigenous” in Europe, its presence is noticed in many countries on the continent. The Ae. albopictus establishment is conditioned by the species’ characteristics and environmental factors. To assess the possible spread of Ae. albopictus in the Dobrogea region (situated in the Southeast of Romania), we conducted the following analysis: (1) Investigation of the current distribution and climatic factors favoring Ae. albopictus’ establishment in Europe; (2) Analysis of climate dynamics in Dobrogea in terms of the parameters identified at stage (1); (3) Testing the hypothesis that the climate from Dobrogea favors Ae. albopictus’ establishment in the region; (4) Building a Geographic Information System (GIS)-based model of the potential geographic distribution of Ae. albopictus in Dobrogea. Results show that the climate of Dobrogea favors the apparition of the investigated species and its proliferation

Analysis of the Arbovirosis Potential Occurrence in Dobrogea, Romania

Climate change creates new challenges for preventing and protecting human health against different diseases that could appear and propagate. The Aedes albopictus mosquito species is an important vector for different diseases like dengue fever or zika. Although this species is not “indigenous” in Europe, its presence is noticed in many countries on the continent. The Ae. albopictus establishment is conditioned by the species’ characteristics and environmental factors. To assess the possible spread of Ae. albopictus in the Dobrogea region (situated in the Southeast of Romania), we conducted the following analysis: (1) Investigation of the current distribution and climatic factors favoring Ae. albopictus’ establishment in Europe; (2) Analysis of climate dynamics in Dobrogea in terms of the parameters identified at stage (1); (3) Testing the hypothesis that the climate from Dobrogea favors Ae. albopictus’ establishment in the region; (4) Building a Geographic Information System (GIS)-based model of the potential geographic distribution of Ae. albopictus in Dobrogea. Results show that the climate of Dobrogea favors the apparition of the investigated species and its proliferation

UPDATES ON THE PATHOGENESIS, EPIDEMIOLOGY AND DIAGNOSIS OF CLOSTRIDIUM DIFFICILE INFECTION

The infection with Clostridium difficile (CDI) is a cause of acute gastroenteritis (AGE), which is likely to severely develop into pseudomembranouse colitis (PMC), ileus and toxic megacolon. At the begining, CDI was considered a nosocomial infection, later proven to be communitary-acquired infections. The susceptibility for CDI is related to the alteration in intestinal microbiota after antibiotics or immunosuppressant treatments, postoperative disruption of mucosal barriers, trauma, tumour proliferation, ischemia or necrosis, as well as in other conditions caused by aging, alcoholism, diabetes, neoplasias, immunosuppression, angiopathies. Concern regarding the outbreak of new CDI-epidemics is still high, due to genetic and bacterial variability and spores resistance in outer environment. The diagnosis of CDI is a continuous challenge for clinicians, based on the correlation between clinical, epidemiological data and complex laboratory investigations

Porcelain Aorta in a Young Person Living with HIV Who Presented with Angina

People living with human immunodeficiency virus have an increased cardiovascular risk due to higher prevalence of traditional risk factors, such as smoking, dyslipidemia, hypertension, diabetes, or obesity, and particular risk factors, such as inflammation, endothelial dysfunction, and antiretroviral therapy. Thus, people living with human immunodeficiency virus can develop accelerated atherosclerosis. The incidence of coronary artery disease in these patients may be twice as high compared with that of HIV-negative individuals with similar characteristics. “Porcelain aorta” is a term used to describe extensive circumferential calcification of the thoracic aorta. The pathophysiology of porcelain aorta is not fully understood. We present a case of a young man who was a smoker and living with HIV since childhood, without other traditional cardiovascular risk factors, who presented to the emergency room with a positive stress test for myocardial ischemia. Transthoracic echocardiography revealed normal regional and global myocardial wall motion, ascending aorta ectasia, and moderate aortic regurgitation. Coronary angiography showed a critical calcified proximal left anterior descending artery stenosis and an important calcification of the thoracic aorta. Therefore, the most important challenge was the management of coronary syndrome in a young person living with HIV, with associated porcelain aorta and aortic regurgitation