{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T19:32:34Z","timestamp":1791401554004,"version":"4.3.3"},"reference-count":34,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T00:00:00Z","timestamp":1771113600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: Healthcare-associated infections (HAIs) remain a major source of morbidity, mortality, and healthcare burden, and were profoundly affected by the COVID-19 pandemic through changes in case mix, care organization, and antimicrobial use. This study aimed to compare the epidemiology, etiology, ward distribution, risk factors, and outcomes of HAIs during the pandemic and post-pandemic periods in southeastern Romania, with particular emphasis on Clostridioides difficile infection (CDI), multidrug-resistant (MDR) pathogens, and in-hospital mortality. Methods: This retrospective observational study included 3929 patients with confirmed HAIs reported by 10 hospitals in one Romanian county between March 2020 and December 2024, divided into a pandemic period (March 2020\u2013March 2022) and a post-pandemic period (April 2022\u2013December 2024). Sociodemographic, clinical, ward-related, therapeutic, and microbiological variables, together with discharge status and cause of death, were analyzed using Fisher\u2019s exact test, Z-tests with Bonferroni correction, the Mann\u2013Whitney U test, and multivariable models, applying national and ECDC-aligned surveillance definitions for HAIs. Results: Patients were predominantly older adults (median age 67 years), with a slight male and urban predominance. Hospital stays were longer during the pandemic. Immunosuppression, previous surgery, antisecretory therapy, and chemotherapy were more frequent post-pandemic. HAIs were mainly reported from medical wards, with a relative shift towards intensive care units during the pandemic; pediatric wards carried a smaller burden. CDI was the leading HAI (about half of all cases) with higher post-pandemic prevalence, whereas SARS-CoV-2 infections predominated in medical and surgical wards; Acinetobacter baumannii and Klebsiella pneumoniae clustered in intensive care units during the pandemic, and were more often associated with mortality. Overall, 59.7% of patients improved and 17.5% died, with higher mortality during the pandemic, while post-pandemic deaths were more frequently unrelated to HAIs. Conclusions: This study demonstrates a substantial and ongoing burden of healthcare-associated infections in southeastern Romania, with elderly patients with prolonged hospital stays and complex medical conditions being most affected and experiencing considerable mortality, particularly in medical and intensive care units. After the pandemic, Clostridioides difficile infections became more prevalent in the context of repeated antibiotic use and immunosuppression. Mortality among patients with HAIs was higher during the pandemic, whereas in the post-pandemic period deaths were more often unrelated to HAIs, underscoring the need to strengthen antimicrobial stewardship programs and infection prevention strategies.<\/jats:p>","DOI":"10.3390\/antibiotics15020214","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T11:11:28Z","timestamp":1771240288000},"page":"214","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Etiologic Patterns and Evolution of Healthcare-Associated Infections in the Pandemic and Post-Pandemic Periods: A County-Level Multicenter Study from Southeastern Romania"],"prefix":"10.3390","volume":"15","author":[{"given":"Corina","family":"Voinea","sequence":"first","affiliation":[{"name":"Doctoral School of Medicine, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus\u2014Corp B, 900470 Constanta, Romania"},{"name":"Public Health Directorate Constanta, 1 Lacramioraei Alley, 900643 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2386-543X","authenticated-orcid":false,"given":"Elena","family":"Mocanu","sequence":"additional","affiliation":[{"name":"Department of Public Health and Management, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus\u2014Corp B, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6591-0038","authenticated-orcid":false,"given":"Elena","family":"Dantes","sequence":"additional","affiliation":[{"name":"Doctoral School of Medicine, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus\u2014Corp B, 900470 Constanta, Romania"},{"name":"Department of Pneumology, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus\u2014Corp B, 900470 Constanta, Romania"},{"name":"Clinical Hospital of Pneumopthisiology Constanta, 40 Santinelei Street, 900002 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanda","family":"Jurja","sequence":"additional","affiliation":[{"name":"Doctoral School of Medicine, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus\u2014Corp B, 900470 Constanta, Romania"},{"name":"Department of Ophthalmology, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus\u2014Corp B, 900470 Constanta, Romania"},{"name":"County Clinical Emergency Hospital \u201cSt. Apostle Andrew\u201d Constan\u021ba, 145 Tomis Boulevard, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6476-453X","authenticated-orcid":false,"given":"Ana-Maria","family":"Neculai","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus\u2014Corp B, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurora","family":"Craciun","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus\u2014Corp B, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5969-6688","authenticated-orcid":false,"given":"Lucian","family":"Serbanescu","sequence":"additional","affiliation":[{"name":"County Clinical Emergency Hospital \u201cSt. Apostle Andrew\u201d Constan\u021ba, 145 Tomis Boulevard, 900591 Constanta, Romania"},{"name":"Department of Obstetrics\u2014Gynecology, Faculty of Medicine, Ovidius University of Constanta, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7474-2395","authenticated-orcid":false,"given":"Ana-Maria","family":"Dascalu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 020021 Bucharest, Romania"},{"name":"Emergency University Hospital Bucharest, Splaiul Independen\u021bei nr. 169, Sector 5, 050098 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela Cezarina","family":"Mehedinti","sequence":"additional","affiliation":[{"name":"Department of Functional and Morphological Science, Faculty of Medicine and Pharmacy, Dunarea de Jos University, 800010 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorin","family":"Rugina","sequence":"additional","affiliation":[{"name":"Doctoral School of Medicine, Faculty of Medicine, Ovidius University of Constanta, 1 University Alley, Campus\u2014Corp B, 900470 Constanta, Romania"},{"name":"Romanian Academy of Medical Sciences, 1 I.C. Br\u0103tianu Boulevard, Sector 3, 030171 Bucharest, Romania"},{"name":"Academy of Romanian Scientists, Ilfov Street, No. 3, Sector 3, 050044 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Abubakar, U., Awaisu, A., Khan, A.H., and Alam, K. (2023). Impact of COVID-19 pandemic on healthcare-associated infections: A systematic review and meta-analysis. Antibiotics, 12.","DOI":"10.3390\/antibiotics12111600"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Dobrovi\u0107, K., \u0160krobo, T., Selec, K., Jeli\u0107, M., \u010civljak, R., Per\u0161ec, J., Sakan, S., Bu\u0161i\u0107, N., Mihel\u010di\u0107, A., and Hleb, S. (2023). Healthcare-associated bloodstream infections due to multidrug-resistant Acinetobacter baumannii in a COVID-19 intensive care unit: A single-center retrospective study. 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