BackgroundAwareness about antibiotic resistance depends on the attitudes and information about antibiotic resistance of both patients and physicians. Persons who practice self-medication are at high risk of also self-medicating with antibiotics. The purpose of the present study was to evaluate the awareness about antibiotic resistance by investigating the practice in a group of self-medication users in a sample of adults in Romania and the variables associated with such practice.Material and MethodsA cross-sectional self-filled questionnaire based study was conducted from December 2016 through January 2017 amongst 218 self-medication users (SMUG). The attitudes, the level of knowledge, the perceptions, about antibiotic use (ABU) and about antibiotic resistance (ABR) were compared to a reference group represented by medical residents group in their specialty training (MRG) considered to have a higher level of knowledge and awareness about ABU and ABR.ResultsThe response rate was 87.2% in the SMUG group and 100% in the MRG group. The SMUG group reported self-medication practices for antibiotics with a high frequency at any time in life (72%), but with a very low frequency from the month previous to the date of the study (12%), comparative with the MRG group (75% and 7%, respectively). The multivariate logistic regression analysis showed that self-medication with antibiotics at any time in life in the SMUG group could be predicted by the answers to two questions regarding the practices and knowledge about ABU (Q13 and Q20). On the other hand, in the MRG group, a question about ABR perception (Q23), could be predictor for self-medication with antibiotics. Self-medication with antibiotics in the month previous to the date of the study in the SMUG group could be predicted with three questions: one about ABU practice (Q14), one about ABR perception (Q26) and one referring to ABR knowledge (Q28). On the other hand, in the MRG group, a question about ABR knowledge (Q32) could be predictor for self-medication with antibiotics. The reduced awareness about ABR in the SMUG group, is revealed by the reduced number of subjects (38%), who did not know that missing an antibiotic dose during a medical treatment contributes to ABR, comparative with the MRG group (84%). Indirectly, low ABR awareness in the SMUG group is revealed by the confusion about the appropriate use of antibiotics in bacterial or viral infections (that antibiotics are not used against viruses).ConclusionsThe findings from our study on the awareness about antibiotic resistance in the SMUG group might help the policy makers and regulatory authorities to develop educational programs directed to change the perceptions and attitudes about the appropriate use of antibiotics in order to diminish self-medication practices with antibiotics.

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A 59 year-old male patient diagnosed with cecal cancer, surgically treated -right hemicolectomy with ileotransverse anastomosis suddenly presented in the 5th postoperative day fever, hypotension, abdominal pain, and vomiting faeces. The intraoperatory diagnosis was postoperative peritonitis due to anastomotic leak; exploratory laparotomy, segmental colectomy, transverse ileostomy, lavage and drainage were performed. Before surgical reintervention, blood cultures were performed and empirical antiinfective therapy was started using ertapenem, vancomycin and fluconazole. A postoperative ICU admission was decided due to septic shock and MODS: acute respiratory failure, acute cardio-circulatory failure, coagulopathy and metabolic acidosis, which required complex treatment: ventilatory support, haemodynamic optimization, antibiotics, analgesia, deep venous thromboembolism prophylaxis, nutrition. In the 3 rd day after reintervention, microbiological examination of the intraoperatory collected peritoneal fluid identified a triple germ association: Escherichia coli, Enterococcus faecalis and Proteus mirabilis, which were sensitive to the chosen antibiotics; the blood cultures were sterile. After 3 days of severe evolution, the multiple organ dysfunction gradually improved and the patient was discharged from ICU 10 days later.

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Pyoderma gangrenosum (PG) is a rare neutrophilic inflammatory disease, characterized by necrotizing and painful ulcers of unknown cause, that it is often misinterpreted. PG is usually idiopathic and includes dysregulation of the autoimmune system and frequently has an association with other systemic diseases (inflammatory bowel disease, rheumatological, hematological disease or malignancy). The most common localization is on the lower legs, mainly in the pretibial area. We describe a case of Pyoderma gangrenosum in a 43 year-old female patient with erythemato-edematous big plaque, covered with sphacelous, yellow-green pus, localized on the left inguinal area and pubic area, which is a rare localization of this disease.