Background: Hospital-acquired infections (HAI) contribute to the emotional stress and functional disorders of the patient and in some cases, can lead to a state of disability that reduces quality of life. Often, HAI are one of the factors that lead to death. The purpose of this study was to analyze the cases of HAI identified in public hospitals at the county level, through case report sheets, as they are reported according to the Romanian legislation. Methods: We performed a cross sectional study design based on the case law of the data reported to the Mures Public Health Directorate, by all the public hospitals belonging to this county. We tracked hospital-acquired infections reported for 2017-2018, respectively, a number of 1024 cases, which implies a prevalence rate of 0.44%, 1024/228,782 cases discharged from these hospitals during the studied period. Results: The most frequent HAIs were reported by the intensive care units (48.4%), the most common infections being the following: bronchopneumonia (25.3%), enterocolitis with Clostridioides difficile (23.3%), sepsis, surgical wound infections and urinary tract infections. At the basis of HAI were 22 pathogens, but the five most common germs were Clostridioides difficile, Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. Bronchopneumonia have been most frequently reported in intensive care units, the most common being identified the Acinetobacter baumannii agent. Sepsis and central catheter infections also appeared predominantly in intensive care units, more often with Klebsiella pneumoniae. The enterocolitis with Clostridioides difficile, were the apanage of the medical sections. Infections with Staphylococcus aureus have been identified predominantly in the surgical sections at the level of the surgical wounds. Urinary infections had a similar distribution in the intensive care units, the medical and surgical sections, with Klebsiella pneumoniae being the most commonly incriminated agent. Conclusions: We showed a clear correspondence between the medical units and the type of HAI: what recommends the rapid, vigilant and oriented application of the prevention and control strategies of the HAI. Author Contributions: Data curation, S.V., S.A. and I.M.; Funding acquisition, B.G. and A.R.; Investigation, S.V., Réka Toth and I.M.; Methodology, S.V. and S.A.; Resources, R.T., B.G., A.R. and I.M.; Supervision, S.V., S.A. and I.M.; Visualization, R.T. and B.G.; Writing-original draft, S.V. and A.R.; Writing-review and editing, S.A. and B.G. All authors have read and agreed to the published version of the manuscript. Funding: This research received no external funding. Conflicts of Interest:The authors declare no conflict of interest.

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Urinary tract infections due to the presence of a urinary catheter represent a real problem for patients who have to carry such an invasive device for a long time.Our aim was to identify the susceptibility of extended spectrum beta lactamases (ESBL) versus non-ESBL bacteria to antibiotics in urinary tract infections in patients who are chronic carriers of urinary catheters.The retrospective study included a period of 5 years, a total of 405 patients who are chronic carriers of urinary catheters, admitted to rehabilitation and palliative care units.Escherichia coli (E coli) was isolated in 41.2% of patients, Klebsiella pneumoniae (K pneumoniae) in 24.7%, and Proteus mirabilis (P mirabilis) in 15.3%. E coli microbial resistance rates ranged from a minimum of 7.5% (nitrofurantoin) to a maximum of 77.1% (ampicillin). In the case of K pneumoniae, microbial resistance ranged from 34.2% (netilmicin) to 73.2% (ceftriaxone). Resistance rates of P mirabilis ranged from 11.1% (cefepim) to 89.5% (ampicillin). Positivity of ESBL bacteria was identified in 47.4% of patients. Resistance rates of ESBL-positive E coli ranged from 50.0% (ceftriaxone) to 88.1% (cefepime), and ESBL-negative E coli rates ranged from 3.4% (cefepime) to 64.4% (amikacin). Resistance rates of ESBL-positive K pneumoniae ranged between 39.1% (netilmicin) and 85.1% (ceftriaxone), and ESBL-negative K pneumoniae between 7.1% (cefepime) and 53.3% (amikacin). In cases of ESBL-positive P mirabilis, rates ranged from 13.3% (cefepime) to 90.3% (ceftriaxone), whereas in cases of ESBL-negative P mirabilis, rates ranged between 8.3% (cefepime) and 80.0% (trimetroprim).Bacteriuria and asymptomatic catheter infection in chronic carriers is an important public health concern due to the frequent presence of multidrug-resistant bacteria. Our study highlights the need to develop control programs of catheter infections to minimize the risk of infections associated with these medical devices, and also the need for treatment of the infection rather than catheter colonization or contamination.

Introduction: Hepcidin is a regulatory protein in iron metabolism; we do not know the role in chronic kidney disease anemia. Methods: 22 patients with CKD anemia and 15 patients with CKD without anemia were investigated. CKD anemia-inclusion criteria: over 18 years, hemoglobin ≤12 g/dl for women and ≤13 g/dl for men, no treatment for anemia 6 months before enrollment, glomerular filtration rate (eGFR) <60 ml/min/1.73m² and stable creatinine three months before enrollment. Exclusion criteria: infection, bleeding, malignancy, systemic or liver disease, immunosuppression, renal replacement therapy. CKD without anemia-inclusion criteria: over 18 years, no anemia or treatment for anemia, CKD with stable creatinine values three months before enrollment. Exclusion criteria: medical conditions known to have a role in the development of polycythemia. Hepcidin-25 and ferritin were measured by ELISA method. Erythropoietin (EPO), tumor necrosis factor (TNF)-α, interleukin (IL)-6 were evaluated using chemiluminescent enzyme immunometric assays. Unpaired T test, Pearson correlation and multiple regression were used for statistical analysis. Results: Hemoglobin values were significantly lower in anemia group. There were no differences in terms of eGFR, age, body mass index, serum hepcidin, erythropoietin, fibrinogen, IL-6, and TNF-α between CKD patients with and without anemia. Serum hepcidin correlated positively with ferritin (r=0.45 p<0.05), TNF-α (r=0.54, p<0.05) and negatively with erythropoietin (r=-0.51, p<0.05). Multiple linear regression analysis demonstrated that TNF-α is an independent predictor of serum hepcidin in our patients (p=0.003, R=0.71). Conclusion: We found no differences in serum hepcidin, erythropoietin and inflammatory markers in non-dialysis CKD patients with and without anemia.

Introduction:Gallbladder hydrops is an increase in the volume of the gallbladder without any inflammatory sign, bacterial infection or the presence of any abnormalities of the biliary ducts or of the gallbladder. Case presentation: A 52-year-old man presented at the Department of Internal Medicine complaining of moderate intensity pain in the right upper quadrant, low fever, fatigue, general weakness, symptoms stemming from an excessive intake of food (a meal abundant in animal proteins, fats, and alcohol) which appeared following a 6-week period of food restriction. On examination, the patient presented a globular abdomen, sensitive to deep palpation in the right upper quadrant, the liver and spleen being impalpable. Blood tests performed on admission showed liver-specific pathological changes. Abdominal ultrasound revealed hepatomegaly with homogeneous echostructure, slightly increased echogenicity with rear attenuation, with no focal images, intrahepatic biliary duct dilatation, or dilated suprahepatic veins. The gallbladder looked dropsical, with slender walls, with images of hyperechoic infundibular calculi with a posterior shadow cone, the largest having 14 mm. The portal vein and bile duct were normal in appearance. Conclusions: Gallbladder hydrops is a disorder commonly seen in children. Its occurrence in adults is uncommon, moreover since it occurs simultaneously with an episode of acute toxic hepatitis. Surgery for this patient was possible only after normalization of liver function tests, on admission there being no subjective complaints of marked intensity that required immediate surgery.