ABSTRACT
BACKGROUND: Carbapenem-resistant Klebsiella pneumoniae (Cr-Kpn) is becoming a growing public health problem through the failure of adequate treatment. This study's objectives are to describe the sources of Cr-Kpn in our hospital over 22 months, associating factors with the outcome of Cr-Kpn-positive patients, especially those with NDM+OXA-48-like (New Delhi Metallo-ß-Lactamase and oxacillinase-48), and the effectiveness of the treatments used. METHODS: A retrospective observational cohort study including all hospitalized patients with Cr-Kpn isolates. We reported data as percentages and identified independent predictors for mortality over hospital time through multivariate analysis. RESULTS: The main type of carbapenemases identified were NDM+OXA-48-like (49.4%). The statistical analysis identified that diabetes and co-infections with the Gram-negative, non-urinary sites of infection were factors of unfavorable evolution. The Cox regression model identified factors associated with a poor outcome: ICU admission (HR of 2.38), previous medical wards transition (HR of 4.69), and carbapenemase type NDM (HR of 5.98). We did not find the superiority of an antibiotic regimen, especially in the case of NDM+OXA-48-like. CONCLUSIONS: The increase in the incidence of Cr-Kpn infections, especially with NDM+OXA-48-like pathogens, requires a paradigm shift in both the treatment of infected patients and the control of the spread of these pathogens, which calls for a change in public health policy regarding the use of antibiotics and the pursuit of a One Health approach.
ABSTRACT
AIM: To asses the frequency of smoking habits among the school staff from Iasi. METHODS: An anonymous questionnaire with 21 items was administrated to 675 subjects (165 were male and 510 were female) who had performed periodic chest X-ray control during September 2001. The mean age of the group was 42.5 years. RESULTS: 41.8% of the men never smoked, 17.5% were ex-smokers and 40.6% regular smokers. The same rate in women as follow: 68.8%, 6.6%, 24.5%. The age for beginning smoking in women (18-20 years) was significantly higher than that in men (14-15 years). The highest prevalence of tobacco smoke was found among auxiliary personnel men (47.5%) and teachers women (28.2%) and the lowest among kinder garden teachers men and women (18.2% and 21.3%). Despite of the fact the majority of smokers had knowledge about smoking relationship with chronic bronchitis (85.4%-85.1% men and 85.6% women), lung cancer (87%-89.2% male and 85.6% female) and cardiovascular diseases (84.3%-88.1% men and 82.4% women), 55.2% of all smokers (53.7% male, 56% female) had never tried to quit smoking. CONCLUSIONS: It is obvious that the rules on smoking restriction in Romania schools are needed.
