Antimicrobial resistance. An observational retrospective study from a single center in South-East Romania
Keywords:
Antimicrobial resistance, Multidrog-resistant organisms, Antimicrobial stewardship, ResistanceAbstract
Antimicrobial resistance (AMR) represents a major global health concern, contributing to prolonged hospitalizations, treatment failures, and increased mortality. The objective of this study was to analyze antimicrobial resistance patterns among clinical isolates in the Microbiology Laboratory of the Emergency Clinical Hospital “Sfantul Andrei,” Constanta, Romania.
This observational, retrospective study was conducted between April 15 and September 30, 2025. A total of 11179 clinical samples were analyzed, including 4771 urine cultures and 6408 other clinical samples (blood cultures, exudates, and bacterial cultures). Antimicrobial resistance testing was performed using both disk diffusion assays and the VITEK automated system, following CLSI and INSP guidelines. Data was anonymized and recorded in a Microsoft Excel database for statistical evaluation.
Among urine cultures, multidrug-resistant organisms (MDROs) were identified in 2.24% of samples and extensively drug-resistant organisms (XDROs) in 0.90%. The most prevalent resistances included glycopeptide-resistant isolates (1.32%), vancomycin-resistant Enterococcus (1.19%), and extended-spectrum β-lactamase (ESBL) production (1.04%). Among other clinical samples, notable resistance patterns included β-lactam resistance (3.97%), cefoxitin screen resistance (4.38%), and penicillin-binding protein modifications (2.09%).
Overall, MDR prevalence exceeded XDR, suggesting a moderate level of resistance within the hospital setting. The study revealed a generally low prevalence of high-level antimicrobial resistance, though β-lactam and cefoxitin screen resistances were relatively elevated, suggesting the possible presence of MRSA and antibiotic misuse. Continuous surveillance and strict infection control measures are essential to prevent the spread of resistant strains. These findings provide a foundation for strengthening local AMR monitoring systems and guiding antimicrobial stewardship programs within the hospital.
Downloads
References
1. Alali WQ, AlFouzan W, Dhar R. Prevalence of antimicrobial resistance in Gram-negative clinical isolates from a major secondary hospital in Kuwait: a retrospective descriptive study. Germs. 2021 Dec;11(4):498–511.
2. Karruli A, Massa A, Bertolino L, Andini R, Sansone P, Dongiovanni S, et al. Clinical Characteristics and Outcome of MDR/XDR Bacterial Infections in a Neuromuscular Semi-Intensive/Sub-Intensive Care Unit. Antibiot Basel Switz. 2022 Oct 13;11(10):1411.
3. Mousavi SM, Babakhani S, Moradi L, Karami S, Shahbandeh M, Mirshekar M, et al. Bacteriophage as a Novel Therapeutic Weapon for Killing Colistin-Resistant Multi-Drug-Resistant and Extensively Drug-Resistant Gram-Negative Bacteria. Curr Microbiol. 2021 Dec;78(12):4023–36.
4. Karaiskos I, Giamarellou H. Carbapenem-Sparing Strategies for ESBL Producers: When and How. Antibiot Basel Switz. 2020 Feb 5;9(2):61.
5. MacDougall C, Johnstone J, Prematunge C, Adomako K, Nadolny E, Truong E, et al. Economic evaluation of vancomycin-resistant enterococci (VRE) control practices: a systematic review. J Hosp Infect. 2020 May;105(1):53–63.
6. Paritala ST, Gandhi G, Agrawal K, Sengupta P, Sharma N. Glycopeptides: Insights Towards Resistance, Clinical Pharmacokinetics and Pharmacodynamics. Indian J Microbiol. 2025 Mar;65(1):32–50.
7. Bozdogan B, Appelbaum PC. Oxazolidinones: activity, mode of action, and mechanism of resistance. Int J Antimicrob Agents. 2004 Feb;23(2):113–9.
8. Denizon M, Hong E, Terrade A, Taha MK, Deghmane AE. A Hunt for the Resistance of Haemophilus influnezae to β-Lactams. Antibiot-Basel. 2024 Aug;13(8):761.
9. Sparo M, Delpech G, Garcia Allende N. Impact on Public Health of the Spread of High-Level Resistance to Gentamicin and Vancomycin in Enterococci. Front Microbiol. 2018 Dec 18;9:3073.
10. Bradford PA. Extended-spectrum β-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev. 2001 Oct;14(4):933–51, table of contents.
11. Saenhom N, Kansan R, Chopjitt P, Boueroy P, Hatrongjit R, Kerdsin A. Evaluation of in-house cefoxitin screening broth to determine methicillin-resistant staphylococci. Heliyon. 2022 Feb;8(2):e08950.
12. Rastmanesh S, Zeinaly I, Alivirdiloo V, Mobed A, Darvishi M. Biosensing for rapid detection of MDR, XDR and PDR bacteria. Clin Chim Acta. 2025 Feb 1;567:120121.
13. Morrison L, Zembower TR. Antimicrobial Resistance. Gastrointest Endosc Clin N Am. 2020 Oct;30(4):619–35.
14. Christaki E, Marcou M, Tofarides A. Antimicrobial Resistance in Bacteria: Mechanisms, Evolution, and Persistence. J Mol Evol. 2020 Jan;88(1):26–40.
15. Brinkac L, Voorhies A, Gomez A, Nelson KE. The Threat of Antimicrobial Resistance on the Human Microbiome. Microb Ecol. 2017 Nov;74(4):1001–8.
Downloads
Published
Data Availability Statement
The data supporting the findings of this study are available from the corresponding author upon reasonable request. The data are not publicly available due to institutional and ethical restrictions.
Issue
Section
License
Copyright (c) 2026 Christopher Dennis Mihai, Lavinia Daba, Sevigean Ali, Andreea Badea, Olimpia Lepadatu, Ramona Stoicescu, Adina Honcea, Mihaela Botnarciuc
This work is licensed under a Creative Commons Attribution 4.0 International License.
