ANTIBIOTIC RESISTANCE SPECTRUM OF NON FERMENTING GRAM NEGATIVE BACILLI ISOLATED IN THE ORTHOPEDIC TRAUMATOLOGY CLINIC OF "SF. SPIRIDON" CLINICAL EMERGENCY HOSPITAL IASI.

AIM: The retro-prospective analysis of antibiotic sensitivity of non-fermenting gram negative bacilli strains circulating in the Orthopedics-Traumatology Clinic from "Sf. Spiridon" Emergency Clinical Hospital in view of determining the trend of the resistance phenomenon and indicating the most useful treatment for the infections caused by these strains. MATERIAL AND METHODS: The retrospective component was conducted from 01.01.2003 to 31.12.2012, and the result of the diffusimetric antibiograms was taken from the hospital's informatics system; the prospective component of the study involved the collection of pathological products from the patients admitted during January-December 2013, who showed clinical suspicion of infection, in compliance with the general collection norms for the products destined for the bacteriological exam. RESULTS: From the total 167 strains of Pseudomonas aeruginosa isolated and identified from the patients, 48 (28.74%) were sensitive to at least one antibiotic from each tested class, 29 (17.39%) were resistant to a single antibiotic and the rest of 90 (53.89%) showed multiple resistance. We noticed a statistically significant difference between the number of strains sensitive to at least one antibiotic from each tested class and those with multiple resistance (p < 0.05). For the strains of Acinetobacter baumanii combined resistance was identified for 121 (87.04%), out of which 55 (39.56%) were resistant to two classes of antibiotics and the other (47.48%) to all three classes. The most frequently met was the association of resistance to quinolones and aminoglycosides, namely for a number of 49 strains (35.25%); only 3.59% of them were simultaneously sensitive to the three classes of antibiotics. CONCLUSION: The already high percentages and the rising trends of antibiotic resistance of non-fermenting gram-negative bacteria described in this study confirm the continuous decrease of the efficiency of antimicrobial agents and underline the necessity of a global strategy which aims at all health sectors regarding the rational use of antibiotics, on the one hand, and the continuation of studies concerning the surveillance of the antimicrobial resistance phenomenon, on the other hand.

Analysis of antibiotic resistance pattern of S. aureus strains isolated from the Orthopedics-Traumatology Section of "Sf. Spiridon" Clinical Emergency Hospital, Iasi.

AIM: The retrospective analysis of antibiotic sensibility of S. aureus strains isolated from infected patients from the Orthopedics-Traumatology Clinic of "Sf. Spiridon" Clinical Emergency Hospital, Iasi during January 2003-December 2013, in view of determining the evolution trend of the resistance phenomenon and of pinpointing the most useful treatment for these strains. MATERIAL AND METHOD: The antibiotic sensitivity test was carried out using two methods: diffusimetric-Kirby-Bauer and the MIC determination by E-test (for the strains isolated in 2013); the interpretation of the sensitivity was made in a standardized manner, in compliance with the CLSI (Clinical and Laboratory Standards Institute) standard for antibiotics testing in force. RESULTS: The sensitivity testing for beta-lactams proved that during the 11 years of the study, the average value of the frequency of resistant strains was of 41.59% +/- 8.68. The highest frequency of MRSA (Methicillin Restant S. aureus) strains was noticed in 2012 (58.6%), followed by 2004 (50.7%). Even if in 2013 it dropped to 38.9%, the trend calculated for 2003-2013 is slightly rising (y = 0.0073x + 0.372). Out of the total of 495 S. aureus strains that were isolated, 164 (33.13%) were completely sensitive to the tested antibiotics and 26 (5.25%) were resistant only to beta-lactams. The other MRSA strains associated multiple resistance and MIC for vancomycin varied between 0.5-2 mg/ml. Two strains whose MIC was of 0.5 mg/ml were sensitive to most classes of tested antibiotics, including beta-lactams, except for macrolides (erythromycin), and the strain whose MIC was of 2 mg/ml, was resistant to all classes of tested antibiotics, except for glycopeptides and oxazolidiones. The other tested strains had a MIC for vancomycin equal to 1 mg/ml. CONCLUSIONS: Due to the fact that there are infections with SAMR strains in a rather worrying percentage (53.9%) that are resistant to the other classes of antibiotics, the only therapeutic solution being the vancomycin treatment, its use should be limited solely to those cases when it is really necessary. Fortunately, no vancomycin resistant MRSA strains have been identified in our country, but this phenomenon should be kept under close surveillance.

Retrospective study on the etiological spectrum and antibiotic resistance in infections associated with osteosynthesis materials.

AIM: To determine the prevalence of infections according to their etiologic spectrum and antibiotic sensitivity in patients with or without implants and endoprostheses. MATERIAL AND METHODS: This retrospective study was conducted based on a customized study protocol on 773 cases admitted to the Clinic of Orthopedics - Traumatology of the Iasi "Sf. Spiridon" Emergency Hospital in the interval January 1, 2003 - December 31, 2011 for postoperative infectious complication. RESULTS: S. aureus was more frequently found in the patients without implant (58.2%) and in those with subcutaneous implant (45.5%); the lowest frequency was noticed in the patients with endoprosthesis (27.1%), the frequency distributions showing marked statistically significant differences (p = 0.001). P. aeruginosa was more frequently detected in the patient group with endoprosthesis (30.2%), while in the other groups it was found in approximately 7% (p = 0.001). The presence of Acinetobacter spp. was significantly higher in patients with deep implant (12.9%), with the lowest frequency noticed in the patients without implant (4.5%) (p = 0.029). Of the total isolated and identified types, 59.6% were non-multidrug-resistant (non-MDR), the remaining 40.4% being MDR types. CONCLUSIONS: S. aureus was the most frequent etiological agent in patients with or without cutaneous implant (45.5 and 58.2%, respectively), and P. aeruginosa (30.2%) in the endoprosthesized patients. Implementation of a preoperative screening protocol for the identification of healthy S. aureus carriers (Methicillin-sensitive S. aureus - MSSA/Methicillin-resistant S. aureus - MRSA) and subsequent decolonization would be an efficient way of reducing the incidence of infections caused by this bacterium.

[Relevance of L-type calcium channels for the non-genomic effects of estradiol and aldosterone upon contractile activity in isolated arteries]. / Relevanta canalelor de calciu de tip L pentru efectele non-genomice ale estradiolului si aldosteronului asupra activitatii contractile în artere izolate.

UNLABELLED: Non-genomic vascular effects of steroids are incompletely understood, despite progress made regarding some aspects, such as the mechanism of endothelium-dependent relaxation by estrogens. AIM: To investigate the involvement of certain mechanisms in the rapid, non-genomic effects of estradiol (EST) and aldosterone (ALD) on endothelium-dependent and -independent vasomotor responses. MATERIAL AND METHODS: Isometric myography of rings from aorta, mesenteric arch, and first order mesenteric branches isolated from male Wistar rats was used. RESULTS: We found that L-type calcium channels (Cav1.2) are important for endothelium-independent relaxation induced by EST, while ALD reduces the involvement of Cav1.2 in phenylephrine-induced contraction and potentates both NO- and EDHF-mediated endothelium-dependent relaxation. To further examine the relevance of Cav1.2 for the vascular effects of EST and ALD, we were using rings with and without functional endothelium, precontracted by direct activation of Cav1.2 (Bay K 8644), high extracellular K+, phenylephrine, and under complete Cav1.2 block (nifedipine). Data suggest that EST, which directly inhibits Cav1.2 in transfected HEK cells, uses mainly this path to induce endothelium-independent relaxation, and that ALD may induce a rightward shift in the voltage-dependence of Cav1.2.

The importance of EDHF in endothelium-dependent relaxation increases distally in mesenteric arteries depending upon the contracting agent.

AIM: The importance of endothelium-derived hyperpolarizing factor (EDHF) in endothelium-dependent relaxation (EDR) is influenced by multiple factors, including vascular territory and caliber, pre-existing tone and its determining factors. METHOD: Using isometric myography we noticed that in rat mesenteric resistance arteries (RMA2; 2nd order branches) EDHF-mediated relaxation is increased when precontraction is induced by prostaglandin F2 (PGF) compared to phenylephrine (PHE) and we investigated the participation of certain K channels. Here we extend the study on more proximal vascular fragments; from mesenteric arcade and from 1st order branches. RESULTS: The EDHF component of EDR is stronger distally only when precontraction is induced by PHE. Moreover, morphometric analysis shows a strong inverse correlation between the magnitude of EDHF response and arterial caliber. CONCLUSIONS: Other authors have shown that EDHF increases in relative importance distally, but we show that this change in EDR profile depends upon the contracting agent used, with implications regarding the physiological relevance of accumulated data refering to EDHF and nitric oxide as mediators of EDR in resistance arteries.