romana english

Original papers

Cornelia Tudose, Dragos Bumbacea, Miron Bogdan on behalf of BACTRO group
Antibiotic resistance of S. pneumoniae and H. influnenzae strains isolated from patients with community acquired respiratory tract infections. BACTRO multicenter, multidisciplinary study


Community respiratory tract infections are common in clinical practice. Antimicrobial treatment should be promptly administered and guided by a probabilistic approach according to the clinical presentation and local patterns of bacterial resistance. Bacterial resistance is widespread, with large geographical variations related to behaviors in antibiotics prescription. S. pneumoniae and H. influenzae are the most frequent pathogens responsible for respiratory tract infections etiology. Methods. We assessed the antibiotics susceptibility of S. pneumoniae and H. influenzae strains isolated from patients with community respiratory tract infections, prospectively enrolled over a period of 3 consecutive years, by determining the MIC. Analysis was performed using both cutoffs provided by European Committee on Antimicrobial Susceptibility testing (EUCAST) and CLSI. Consequently we evaluated the influence of different factors associated with the development of bacterial resistance. Results. We analyzed 293 S. pneumoniae strains and 265 H. influenzae strains isolated during 1999-2001, mainly from sputum (68.3% and 74.9% respectively of total isolates) . We observed a high proportion of S. pneumoniae resistant to penicillin (6.1% resistant and 48.5% with intermediate susceptibility) and to erythromycin (39% resistant strains). H. influenzae strains were resistant to amoxicillin in 26% of cases and the presence of betalactamase was certified in 13% of tested isolates; 18.3% of H. influenzae strains were resistant to amoxicillin through specific mechanisms other than by producing betalactamase. Other antibiotic resistances were assessed. Conclusions. In Romania clinician must consider the high prevalence of antibiotic resistance, particulary of S. pneumoniae to macrolides and beta-lactams (thus requiring the use of high doses of betalactams) and the high proportion of beta-lactamase producing H. influenzae.

Keywords: respiratory infections, antibiotic resistance

Changes in spirometry over time in uraemic patients receiving longterm hemodialysis therapy


Complications of respiratory system in patients suffering from chronic renal failure who are treated with regular haemodialysis are well known. However, the influence of the duration of haemodialysis on pulmonary function is less understood. The aim of this study was to determine spirometry changes in patients on chronic haemodialysis over a five-year period. We tested 21 patients, out of which 11 female and 10 male, mean age of 50 (±11) years. The mean duration of haemodialysis was 52.2 (±44.7) months at the time of the inclusion. We performed spirometry testings in all patients, one hour before start and one hour after completion of haemodialysis. All parameters of spirometry recorded one hour after completion of haemodialysis (FVC, FEV1, FEF75, 50, 25, % of predicted), improved significantly (p<0,01). After five years, only FVC demonstrated significant decline and none of the recorded spirometry parameters improved significantly one hour post haemodyalisys compared to pre-haemodialysis period. Analysis of post-dialysis parameters of spirometry at the study onset and following five years of hemodialysis showed that all parameters, except FEF50 (p>0,05), significantly deteriorated (p<0,01).

Patients who are on long term haemodialysis show a significant decline in FVC following five years of treatment. Although the spirometry changes in observed population treated with chronic haemodialysis have reversible character during the first years of renal replacement therapy, five years after these changes become irreversible.

Key words: spirometry, uremia.

Radiation induced lung injuries secondary to radiotherapy for breast cancer

Claudia Lucia Toma1,2, Tudor Ciprut2, Svetlana Bugarin2, Dorina Rosca2, Miron Alexandru Bogdan1,2
Radiation induced lung injuries secondary to radiotherapy for breast cancer


Modern radiotherapy decreased the number and severity of the effects of irradiation on the lung. Yet, the increased cancer incidence makes the related radiation injuries to remain actual, radiotherapy being frequently used in cancer treatment. Aim of the study consists in analysis of the radiological pattern of radiation induced lung disease due to radiotherapy for breast cancer. Material and method. Sixty-eight female patients were evaluated for clinical and radiological suspicion of radiation pneumonitis after radiotherapy for breast cancer between 2001 and 2009 in „Marius Nasta" Institute of Pneumoftiziology, Bucharest. The following procedures were performed: medical history, physical examination, chest radiography and CT-scan (in a subgroup of 27 patients). Radiotherapy toxicity was evaluated based on the RTOG/EORTC (Radiation Therapy Oncology Group/European Organization for the Research and Treatment of Cancer) classification and radiological lesions based on Arriagada classification. Results. Fifty patients (73.5%) were symptomatic (fever, dry couth, dyspnea, chest pain, fatigability), the other 18 were asymptomatic. Symptoms were mild to moderate corresponding to grade 1 (27 patients, 39.7%) or grade 2 (23 patients, 33.8%) according to RTOG/EORTC scale. All patients had radiological lesions: 25 patients (36.7%) had grade 2 lesions (linear opacities), 25 patients (36.7%) had grade 3 lesions (patchy opacities) and 18 patients (26.5%) had grade 4 lesions (dense opacities), according to Arriagada classification. Symptoms were more frequent in patients with extensive lesions on chest radiography. CT-scan, performed in 27 patients, showed more accurate images. Conclusions. Chest radiography remains the simplest method in screening for radiation pneumonitis and monitoring its outcome. Adverse effects secondary to radiotherapy are usually mild and self-limited, and the most difficult task remains the differential diagnosis with infections and cancer relapse.

Keywords: radiation pneumonitis, breast cancer, radiation therapy, pulmonary radiation toxicity