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Microorganisms
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Infectious Disease Surveillance in Romania
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Infectious Disease Surveillance in Romania

A special issue of Microorganisms (ISSN 2076-2607). This special issue belongs to the section "Public Health Microbiology".

Deadline for manuscript submissions: 15 July 2025 | Viewed by 2975

Special Issue Editor

Dr. Daniela Piţigoi

E-Mail Website
Guest Editor
1. Department of Epidemiology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
2. National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania
Interests: vaccine preventable diseases; surveillance; vaccination; infection control; influenza; West Nile

Special Issue Information

Dear Colleagues,

Communicable diseases continue to pose a challenge to public health systems, both globally and in Romania. Diseases can spread rapidly from one country to another, with new pathogens being identified frequently. Antibiotic resistance, a lack of information, misinformation, vaccine hesitancy, migration, economic and social crises are the risk factors associated with outbreaks, so it is necessary to implement robust, functional surveillance systems that provide timely information regarding the monitoring of communicable disease trends; this is in order to identify risk factors and areas for intervention. Epidemiological surveillance systems must be capable of collecting and analyzing data, disseminating information to public health authorities and regularly assessing the effectiveness of the disseminated data.

This Special Issue aims to present recent findings related to the surveillance and control of  communicable diseases in Romania. We welcome both original research and review articles whose scope includes, but is not limited to, the following topics:

  • The surveillance, epidemiology, clinical and microbial features of communicable diseases in Romania;
  • The surveillance of vaccine-preventable diseases and vaccinations in special population groups;
  • The molecular epidemiology of specific infections;
  • Challenges and advances in the surveillance and control of outbreaks, and in alert management;
  • The surveillance of influenza, COVID-19 and severe acute respiratory infections;
  • The surveillance of healthcare-associated infections, antimicrobial resistance and antibiotic consumption;
  • The technologies and tools used for the surveillance and control of communicable diseases, including vaccination monitoring;

We look forward to receiving your contributions.

Dr. Daniela Piţigoi
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Microorganisms is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • surveillance
  • vaccine preventable diseases
  • antimicrobial resistance
  • health care associated infection
  • influenza
  • COVID-19
  • Romania

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Published Papers (4 papers)

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Research

30 pages, 1272 KiB  
Article
Microbiological Profiles, Antibiotic Susceptibility Patterns and the Role of Multidrug-Resistant Organisms in Patients Diagnosed with Periprosthetic Joint Infection over 8 Years: Results from a Single-Center Observational Cohort Study from Romania
by Serban Dragosloveanu, Rares-Mircea Birlutiu, Bogdan Neamtu and Victoria Birlutiu
Microorganisms 2025, 13(5), 1168; https://doi.org/10.3390/microorganisms13051168 - 21 May 2025
Abstract
This study examines temporal patterns in pathogens isolated from prosthetic joint infection (PJI) cases and antimicrobial resistance patterns at a Romanian orthopedic center. We have conducted a retrospective cohort study that included 674 patients undergoing hip or knee replacement revision surgery between January [...] Read more.
This study examines temporal patterns in pathogens isolated from prosthetic joint infection (PJI) cases and antimicrobial resistance patterns at a Romanian orthopedic center. We have conducted a retrospective cohort study that included 674 patients undergoing hip or knee replacement revision surgery between January 2016 and December 2023. From these, 102 confirmed PJI cases requiring surgical intervention were selected for analysis. We isolated 27 microorganisms from acute PJI cultures and 82 from chronic PJIs. Staphylococcus epidermidis (33 cases, 30.3%; 95% CI 22.0–40.3) was the predominant pathogen, with coagulase-negative Staphylococci (22 cases, 20.18%; 95% CI 0.9–41.3) and Enterobacteriaceae (13 cases, 11.9%; 95% CI 6.4–18.3) also prevalent. Methicillin resistance was identified in 43.6% of coagulase-negative staphylococci and 45.5% of Staphylococcus aureus isolates. All Gram-positive isolates remained susceptible to vancomycin, linezolid, and tigecycline. Among Gram-negative bacilli, Klebsiella oxytoca and Proteus mirabilis showed resistance to third-generation cephalosporins, with phenotypic profiles suggestive of extended-spectrum β-lactamase (ESBL) production. All Escherichia coli, Enterobacter spp., and Citrobacter freundii strains were fully susceptible to tested agents, while Pseudomonas aeruginosa exhibited reduced susceptibility to ciprofloxacin, aztreonam, and imipenem. Among the isolated strains, 47 were multidrug-resistant (MDR), with Staphylococcus aureus accounting for the highest MDR count, including methicillin resistance. The distribution of microorganism types and MDR strains remained consistent throughout the study period, with no significant association between infection type and MDR strain presence or between infection site and microorganism presence except for a strong association between MDR strains and the type of microorganism (p < 0.05). The microbial profile and resistance patterns in PJIs have remained stable over eight years. Our observations do not suggest that MDR PJIs are more commonly acute cases, contrary to what has been highlighted in previous reports. The ongoing prevalence of MDR strains underscores the importance of targeted antimicrobial treatments based on local susceptibility profiles. Full article
(This article belongs to the Special Issue Infectious Disease Surveillance in Romania)
16 pages, 602 KiB  
Article
Comorbidities and Severe COVID-19 Outcomes: A Retrospective Analysis of Hospitalized Patients in Three Counties in Romania
by Réka Bodea, Toader Septimiu Voidăzan, Lorand Iozsef Ferencz and Zoltán Ábrám
Microorganisms 2025, 13(4), 787; https://doi.org/10.3390/microorganisms13040787 - 29 Mar 2025
Viewed by 417
Abstract
The COVID-19 pandemic represents a major global health crisis, with clinical manifestations ranging from asymptomatic infection to fatal outcomes. While all individuals are susceptible, specific populations, particularly those with pre-existing medical conditions, face a heightened risk of severe disease. This study aimed to [...] Read more.
The COVID-19 pandemic represents a major global health crisis, with clinical manifestations ranging from asymptomatic infection to fatal outcomes. While all individuals are susceptible, specific populations, particularly those with pre-existing medical conditions, face a heightened risk of severe disease. This study aimed to assess the prevalence of severe COVID-19 among hospitalized patients with comorbidities in the Central Region of Romania, and to analyze the association between these conditions and mortality. We conducted a retrospective cohort study using data from the Corona Forms platform (2020–2022), encompassing hospitalized cases across three Romanian counties. A total of 1458 patients with confirmed SARS-CoV-2 infection and documented comorbidities were included. Demographic characteristics, comorbid conditions, and hospitalization outcomes were analyzed. The overall mortality rate among comorbid patients was 89.3%. Renal, neurologic, hepatic disease, cardiovascular conditions, obesity, type 2 diabetes mellitus, and cerebrovascular accidents are significant risk factors for death outcomes in the SARS-CoV-2-infected study population. The strength of their association varies, with odds ratios ranging from 25.32 to 1. The findings underscore the critical impact of comorbidities on COVID-19 severity and mortality among the Central Romanian population, emphasizing the necessity of targeted clinical interventions and public health strategies to protect high-risk populations. Full article
(This article belongs to the Special Issue Infectious Disease Surveillance in Romania)
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18 pages, 1819 KiB  
Article
Bacterial Diversity in Pet Rabbits: Implications for Public Health, Zoonotic Risks, and Antimicrobial Resistance
by Smaranda Crăciun, Cristiana Ştefania Novac, Nicodim Iosif Fiţ, Cosmina Maria Bouari, Lucia Victoria Bel and George Cosmin Nadăş
Microorganisms 2025, 13(3), 653; https://doi.org/10.3390/microorganisms13030653 - 13 Mar 2025
Viewed by 817
Abstract
This study examined epidemiological aspects of rabbit pathologies, identified bacterial strains, and assessed their antimicrobial resistance, emphasizing rabbits as potential reservoirs for zoonotic multidrug resistant (MDR) bacteria and the need for continuous monitoring and antimicrobial stewardship. Samples from rabbits were cultivated and then [...] Read more.
This study examined epidemiological aspects of rabbit pathologies, identified bacterial strains, and assessed their antimicrobial resistance, emphasizing rabbits as potential reservoirs for zoonotic multidrug resistant (MDR) bacteria and the need for continuous monitoring and antimicrobial stewardship. Samples from rabbits were cultivated and then identified using Vitek® 2 and MALDI-TOF. Antimicrobial susceptibility was assessed by disk diffusion testing. This study analyzed 170 individuals with various pathologies, with males (58.24%) outnumbering females (41.76%). Dental abscesses (35.29%) and respiratory infections (28.24%) were most common. Antibiotic exposure was noted in 47.06% of cases, primarily involving trimethoprim (35.56%). Of the total samples, 91.18% tested positive, revealing 200 isolates from 23 bacterial genera, with Staphylococcus spp. (31%) and Escherichia coli (12%) being most frequently identified as well as species with zoonotic potential, such as Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae, Proteus mirabilis, and Enterococcus faecium. Antimicrobial susceptibility testing showed high efficacy for florfenicol (75%), ciprofloxacin (74.12%), and amikacin (68.65%), while significant resistance was found for kanamycin, neomycin, and trimethoprim. Nearly 49% of strains were MDR, with Gram-positive cocci, Enterobacteriaceae, and non-Enterobacteriaceae showing varying resistance, across 18 MDR genera. In conclusion, pet rabbits are potential reservoirs of zoonotic and MDR bacterial species, posing a risk for their owners. Full article
(This article belongs to the Special Issue Infectious Disease Surveillance in Romania)
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20 pages, 1231 KiB  
Article
Cryptococcus neoformans: Brain Preference, Gender Bias, and Interactions with Mycobacterium tuberculosis and Toxoplasma gondii in HIV-Positive Patients
by Ruxandra Moroti, Adriana Hristea, Georgiana Neagu, Irina Penescu, Dragos Florea, Catalin Tiliscan and Serban Nicolae Benea
Microorganisms 2025, 13(3), 481; https://doi.org/10.3390/microorganisms13030481 - 21 Feb 2025
Viewed by 904
Abstract
Cryptococcus neoformans, a high-priority pathogen (WHO, 2022) and ubiquitous fungus, is responsible for hundreds of thousands of meningoencephalitis cases annually, with a high fatality rate. Its distribution is uneven: it primarily affects immunocompromised individuals (especially HIV-positive patients). Our study aims to explore [...] Read more.
Cryptococcus neoformans, a high-priority pathogen (WHO, 2022) and ubiquitous fungus, is responsible for hundreds of thousands of meningoencephalitis cases annually, with a high fatality rate. Its distribution is uneven: it primarily affects immunocompromised individuals (especially HIV-positive patients). Our study aims to explore the Cryptococcus’ brain tropism in immunosuppressed patients, its gender preference and the possible interactions with other opportunistic neurotropic microorganisms, such as Mycobacterium tuberculosis (MTB) and the brain microbiota, with a particular focus on Toxoplasma gondii (T. gondii). Methods: We conducted a retrospective descriptive analysis of all cases diagnosed with central nervous system cryptococcosis (Crypto-CNS) in HIV-positive patients admitted over 10 years (2010–2019) in a tertiary Romanian hospital. We examined their demographic, clinical, immunobiological, and imaging data, as well as their medical history, comorbidities, and coinfections. Results: Forty-two cases were admitted, with a male predominance (3.6:1) and a mean age of 33.3 years; 24% were diagnosed concomitantly with HIV infection and Crypto-CNS. All patients were severely immunosuppressed, with CD4 counts <200 cells/mm3 (median = 20.5 [1–163], mean = 31.6). Recent/concomitant tuberculosis was found in 10 (27.7%). T. gondii-seropositive patients developed Crypto-CNS at a lower immunological state than seronegative ones (27.1 CD4 cells/mm3 vs. 46.7 cells/mm3, means). Of 25 cases with available brain imagery, 28% had high intracranial pressure. Twelve patients (28.5%) died during the hospitalization within 26.3 days (mean, SD = 21.4); 1-year mortality increased to 50%. In-hospital mortality was associated with lower CD4 counts, increased intracranial pressure, and T. gondii-seropositivity. Conclusions: Crypto-CNS in HIV-positive patients mainly affects men and may be promoted by concomitant or recent tuberculosis. T. gondii may confer some protection even at low immune levels but increases mortality when immunity is critically low. Full article
(This article belongs to the Special Issue Infectious Disease Surveillance in Romania)
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