Evolution of Antimicrobial Resistance in Klebsiella pneumoniae over 3 Years (2019-2021) in a Tertiary Hospital in Bucharest, Romania.

BACKGROUND: The antimicrobial resistance (AMR) of Klebsiella pneumoniae recorded a steep upward trend over the last two decades, among which carbapenem-resistant Klebsiella pneumoniae (CRKP) is one of the most concerning strains considering the development and spread of AMR. The aim of this study was to analyze the evolution of AMR for Klebsiella pneumoniae and to describe the risk factors of AMR for Klebsiella pneumoniae, including the COVID-19 pandemic. METHODS: We conducted a retrospective study on Klebsiella pneumoniae non-duplicative isolates collected from patients admitted to a tertiary hospital in Bucharest, Romania, from January 2019 to December 2021. We evaluated AMR changes by comparing resistance between 2019 and the mean of 2020-2021. RESULTS: The rates of AMR increased for third-generation cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and colistin and decreased for trimethoprim/sulfamethoxazole (TMP/SMX), 45.7% in 2019 vs. 28.3% in 2021. A longer length of hospital stay (ꭓ2 = 49.68, p < 0.01); recent antibiotic consumption, RR = 1.38, 95% CI [1.21, 1.57]; and recent contact with hospital settings, RR = 1.54, 95% CI [1.32, 1.8] were risk factors for multidrug-resistant (MDR) Klebsiella pneumoniae. CONCLUSIONS: The AMR of Klebsiella pneumoniae increased during 2020-2021 for most of the potential active antibiotics; only TMP/SMX resistance decreased, and it may represent a treatment option for CRKP or MDR Klebsiella pneumoniae infections. Decreasing the excessive use of antibiotics and the implementation of prevention and control measures in healthcare settings are mandatory for avoiding further increases in the AMR rate of Klebsiella pneumoniae.

Cell and tissue engineering and clinical applications: an overview.

Most human tissues do not regenerate spontaneously; this is why cell therapies and tissue engineering are promising alternatives. The principle is simple: cells are collected in a patient and introduced in the damaged tissue or in a tridimentional porous support and harvested in a bioreactor in which the physico-chemical and mechanical parameters are controlled. Once the tissues (or the cells) are mature they may be implanted. In parallel, the development of biotherapies with stem cells is a field of research in turmoil given the hopes for clinical applications that it brings up. Embryonic stem cells are potentially more interesting since they are totipotent, but they can only be obtained at the very early stages of the embryo. The potential of adult stem cells is limited but isolating them induces no ethical problem and it has been known for more than 40 years that bone marrow does possess the regenerating functions of blood cells. Finally, the properties of foetal stem cells (blood cells from the umbilical cord) are forerunners of the haematopoietic system but the ability of these cells to participate to the formation of other tissues is more problematic. Another field for therapeutic research is that of dendritic cells, antigen presenting cells. Their efficiency in cell therapy relies on the initiation of specific immune responses. They represent a promising tool in the development of a protective immune response against antigens which the host is usually unable to generate an efficient response (melanomas, breast against cancer, prostate cancer, ..). Finally, gene therapy, has been nourishing high hopes but few clinical applications can be envisaged in the short term, although potential applications are multiple (haemophilia, myopathies, ..). A large number of clinical areas stand as candidates for clinical applications: leukaemia and cancers, cardiac insufficiency and vascular diseases, cartilage and bone repair, ligaments and tendons, liver diseases, ophthalmology, diabetes, neurological diseases (Parkinson, Huntington disease, ..), .. Various aspects of this new regenerative therapeutic medicine are developed in this work.

[Influence of protocol on the quality of blood pressure self-monitoring]. / Influence du protocole sur la qualité de l'automesure tensionnelle.

OBJECTIVES: To determine the minimum number of self-measurements of blood pressure to provide the maximum quality and reliability during home-blood pressure monitoring. METHODS: We studied 38 hypertensive subjects in which we compared self-reported with electronically stored home BP (OMRON HEM 720 CIC). Subjects were asked to measure BP in the sitting position, three times consecutively in the morning and three times in the evening during 7 consecutive days. BP values over the 7 days were averaged and the differences with BP recorded over the first day (6 values per day), the first 2 days, the first 3 days, the first 4 days, the first 5 days and the first 6 days were calculated. Confidence interval were calculated. RESULTS: We observed that 47% of patients completed the entire protocol (42 measurements over 7 days), but 89% completed 4 days with 6 measurements. Erroneous reporting was evident in 10% of patients. In patients which performed 100% of the 42 planned values, confidence interval for the mean value was < 4 mmHg for SBP and < 3 mmHg for DBP when the patient completed a 4 days protocol with a minimum of 4 measurements per day. CONCLUSIONS: These results indicate that determining average home blood pressure over 4 consecutive days with 2 measurements twice daily, is the minimum protocol that provides a reliable estimate of home blood pressure with a good quality of patient reporting.

Development of non-live vectors and procedures (liposomes, pseudo-viral particles, toxin, beads, adjuvantsellipsis) as tools for cancer vaccines.

Recombinant virus encoding tumor antigens are the most used vectors in human clinical trials of cancer vaccines because of their ability to target exogenous antigen in the endogenous MHC class I pathway and to elicit CTL. However, their use requires different constraining procedures to avoid their spreading. The immunosuppression of cancer patients may also increase their intrinsic toxicity. Therefore, the development of non-live vectors may avoid these drawbacks. Different groups now clearly demonstrated that particulate antigens when they are phagocytosed could be targeted in the MHC class I pathway. They also induce CTL in mice which when immunized with these particulate antigens were protected against a challenge with tumors expressing this antigen. Other strategies using toxins or antigens fused or incorporated into various oil or lipid based chemical adjuvants have also succeeded in the induction of CTL response and in some cases have been shown to be efficient as cancer vaccine.