{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:49:34Z","timestamp":1792799374668,"version":"4.5.0"},"reference-count":33,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T00:00:00Z","timestamp":1742947200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Competitiveness Operational Programme grant of the Romanian Ministry of European Funds","award":["P_37_745, MySmis 103454"],"award-info":[{"award-number":["P_37_745, MySmis 103454"]}]},{"name":"Competitiveness Operational Programme grant of the Romanian Ministry of European Funds","award":["#833247"],"award-info":[{"award-number":["#833247"]}]},{"name":"ERC Advanced Grant","award":["P_37_745, MySmis 103454"],"award-info":[{"award-number":["P_37_745, MySmis 103454"]}]},{"name":"ERC Advanced Grant","award":["#833247"],"award-info":[{"award-number":["#833247"]}]},{"name":"a Spinoza Grant from the Netherlands Organization of Scientific Research","award":["P_37_745, MySmis 103454"],"award-info":[{"award-number":["P_37_745, MySmis 103454"]}]},{"name":"a Spinoza Grant from the Netherlands Organization of Scientific Research","award":["#833247"],"award-info":[{"award-number":["#833247"]}]},{"name":"the University of Medicine and Pharmacy of Craiova, Romania","award":["P_37_745, MySmis 103454"],"award-info":[{"award-number":["P_37_745, MySmis 103454"]}]},{"name":"the University of Medicine and Pharmacy of Craiova, Romania","award":["#833247"],"award-info":[{"award-number":["#833247"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Sepsis is one of the major causes of death in modern society. This study is part of the FUSE (Functional Genomics in Severe Sepsis) project under the Human Functional Genomics Romania initiative. Our aim was to assess the epidemiology of sepsis in a tertiary academic hospital in southwestern Romania. Materials and methods: The study enrolled 184 patients with severe infections between May 2017 and November 2019, following the Sepsis-2 guidelines (SIRS criteria). Results: The present cohort of community-acquired severe infections shows respiratory and urinary tract as main sites of severe infection. The demographic and clinical characteristics of this Romanian study group are in line with those of other severe infection European cohorts. However, the predominance of confirmed Clostridium difficile cases represents a strong deviation, raising significant concerns for the communities to which the patients belong. Conclusions: Sepsis, with its complex pathophysiology and clinical presentation, remains one of the most daunting global health issues. In our cohort, the high number of Clostridium difficile cases prompts high vigilance and immediate intervention.<\/jats:p>","DOI":"10.3390\/medicina61040596","type":"journal-article","created":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T10:47:40Z","timestamp":1743072460000},"page":"596","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["An Epidemiological Survey of Sepsis in a Tertiary Academic Hospital from Southwestern Romania"],"prefix":"10.3390","volume":"61","author":[{"given":"Andra","family":"Grigorescu","sequence":"first","affiliation":[{"name":"Human Genomics Laboratory, Functional Genomics Group, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florentina","family":"Dumitrescu","sequence":"additional","affiliation":[{"name":"Infectious Disease Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Hospital for Infectious Diseases and Pneumology \u201cVictor Babe\u015f\u201d Craiova, 200515 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Dorobantu","sequence":"additional","affiliation":[{"name":"Human Genomics Laboratory, Functional Genomics Group, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Regional Centre of Medical Genetics Dolj, County Clinical Emergency Hospital Craiova, 200642 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adina","family":"Dragos","sequence":"additional","affiliation":[{"name":"Human Genomics Laboratory, Functional Genomics Group, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrei","family":"Pirvu","sequence":"additional","affiliation":[{"name":"Human Genomics Laboratory, Functional Genomics Group, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Regional Centre of Medical Genetics Dolj, County Clinical Emergency Hospital Craiova, 200642 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela","family":"Roskanovic","sequence":"additional","affiliation":[{"name":"Infectious Disease Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Hospital for Infectious Diseases and Pneumology \u201cVictor Babe\u015f\u201d Craiova, 200515 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"on behalf of the FUSE study","family":"on behalf of the FUSE study","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana","family":"Streata","sequence":"additional","affiliation":[{"name":"Human Genomics Laboratory, Functional Genomics Group, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Regional Centre of Medical Genetics Dolj, County Clinical Emergency Hospital Craiova, 200642 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai","family":"Ioana","sequence":"additional","affiliation":[{"name":"Human Genomics Laboratory, Functional Genomics Group, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Regional Centre of Medical Genetics Dolj, County Clinical Emergency Hospital Craiova, 200642 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai G.","family":"Netea","sequence":"additional","affiliation":[{"name":"Human Genomics Laboratory, Functional Genomics Group, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands"},{"name":"Department of Immunology and Metabolism, Life & Medical Sciences Institute, University of Bonn, 531143 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2073-8865","authenticated-orcid":false,"given":"Anca-Lelia","family":"Riza","sequence":"additional","affiliation":[{"name":"Human Genomics Laboratory, Functional Genomics Group, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands"},{"name":"Regional Centre of Medical Genetics Dolj, County Clinical Emergency Hospital Craiova, 200642 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1097\/01.CCM.0000050454.01978.3B","article-title":"2001 SCCM\/ESICM\/ACCP\/ATS\/SIS International Sepsis Definitions Conference","volume":"31","author":"Levy","year":"2003","journal-title":"Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, Regional, and National Sepsis Incidence and Mortality, 1990\u20132017: Analysis for the Global Burden of Disease Study","volume":"395","author":"Rudd","year":"2020","journal-title":"Lancet"},{"key":"ref_4","unstructured":"(2024, June 14). Vital Signs: Making Health Care Safer|VitalSigns|CDC, Available online: https:\/\/archive.cdc.gov\/www_cdc_gov\/vitalsigns\/sepsis\/infographic.html."},{"key":"ref_5","unstructured":"(2024, June 14). CDC HAI Prevention, Control and Outbreak Response for Public Health and Healthcare, Available online: https:\/\/www.cdc.gov\/healthcare-associated-infections\/php\/toolkit\/index.html."},{"key":"ref_6","unstructured":"(2024, June 14). Healthcare-Associated Infections. Available online: https:\/\/www.ecdc.europa.eu\/en\/healthcare-associated-infections."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e886","DOI":"10.1016\/S2468-2667(22)00250-X","article-title":"Estimating Antimicrobial Resistance Burden in Europe\u2014What Are the next Steps?","volume":"7","author":"Harbarth","year":"2022","journal-title":"Lancet Public Health"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Waterlow, N.R., Cooper, B.S., Robotham, J.V., and Knight, G.M. (2024). Antimicrobial Resistance Prevalence in Bloodstream Infection in 29 European Countries by Age and Sex: An Observational Study. PLoS Med., 21.","DOI":"10.1371\/journal.pmed.1004301"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Emons, M., Blanquart, F., and Lehtinen, S. (2023). Temporal Trends in Antibiotic Resistance in Europe, 1998\u20132019. medRxiv.","DOI":"10.1101\/2023.09.27.23296241"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Li, Y., Wang, Y., Guo, J., Li, H., Yang, H., and Zhang, D. (2022). Comparison of Patients with Community-Acquired and Hospital-Acquired Sepsis or Septic Shock: A Systematic Review and Meta-Analysis. Res. Sq.","DOI":"10.21203\/rs.3.rs-2318958\/v1"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Szab\u00f3, S., Feier, B., Capatina, D., Tertis, M., Cristea, C., and Popa, A. (2022). An Overview of Healthcare Associated Infections and Their Detection Methods Caused by Pathogen Bacteria in Romania and Europe. J. Clin. Med., 11.","DOI":"10.3390\/jcm11113204"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"190","DOI":"10.37358\/MP.17.1.4814","article-title":"Early Stratification of Sepsis Using Presepsine in Emergency Department (North-East of Romania Experience)","volume":"54","author":"Cretu","year":"2017","journal-title":"Mat. Plast."},{"key":"ref_13","first-page":"e65213","article-title":"D-Dimer as a Useful Biomarker in Early Diagnosis of Neonatal Sepsis: A Single-Center Study from Romania","volume":"16","author":"Lungu","year":"2024","journal-title":"Cureus"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Voidazan, S., Albu, S., Toth, R., Grigorescu, B., Rachita, A., and Moldovan, I. (2020). Healthcare Associated Infections\u2014A New Pathology in Medical Practice?. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17030760"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Giubelan, L.-I., Neac\u0219u, A.I., Rotaru-Zavaleanu, A.D., and Osiac, E. (2024). Antimicrobial Resistance in Sepsis Cases Due to Escherichia Coli and Klebsiella Pneumoniae: Pre-Pandemic Insights from a Single Center in Southwestern Romania. Healthcare, 12.","DOI":"10.3390\/healthcare12171713"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Scheer, C.S., Giamarellos-Bourboulis, E.J., Ferrer, R., Idelevich, E.A., Annane, D., Artigas, A., Aslan, A.T., Bottari, G., Bouma, H.R., and Cerny, V. (2025). Status of Sepsis Care in European Hospitals: Results from an International Cross-Sectional Survey. Am. J. Respir. Crit. Care Med.","DOI":"10.1164\/rccm.202406-1167OC"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3947","DOI":"10.1038\/s41467-024-48296-z","article-title":"Assessment of Three Antibiotic Combination Regimens against Gram-Negative Bacteria Causing Neonatal Sepsis in Low-and Middle-Income Countries","volume":"15","author":"Vilken","year":"2024","journal-title":"Nat. Commun."},{"key":"ref_18","first-page":"404","article-title":"Sepsis Syndrome in Croatian Intensive Care Units: Piloting a National Comparative Clinical Database","volume":"47","author":"Gornik","year":"2006","journal-title":"Croat. Med. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1007\/s10096-024-04809-8","article-title":"A Decade of Neonatal Sepsis in Stockholm, Sweden: Gram-Positive Pathogens Were Four Times as Common as Gram-Negatives","volume":"43","author":"Oldendorff","year":"2024","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_20","first-page":"332","article-title":"Pathogenesis of Sepsis","volume":"1","author":"Anggraini","year":"2022","journal-title":"Sci. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1080\/1120009X.2018.1516272","article-title":"Distribution of Main Gram-Positive Pathogens Causing Bloodstream Infections in United States and European Hospitals during the SENTRY Antimicrobial Surveillance Program (2010\u20132016): Concomitant Analysis of Oritavancin in Vitro Activity","volume":"30","author":"Mendes","year":"2018","journal-title":"J. Chemother."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1080\/19490976.2017.1323616","article-title":"Collateral Damage during Antibiotic Treatment of C. Difficile Infection in the Aged Host: Insights into Why Recurrent Dis-ease Happens","volume":"8","author":"Shin","year":"2017","journal-title":"Gut Microbes"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Cersosimo, L.M., Graham, M., Monestier, A., Pavao, A., Worley, J.N., Peltier, J., Dupuy, B., and Bry, L. (2023). Central in Vivo Mechanisms by Which C. difficile\u2019s Proline Reductase Drives Efficient Metabolism, Growth, and Toxin Production. bioRxiv.","DOI":"10.1101\/2023.05.19.541423"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"16020","DOI":"10.1038\/nrdp.2016.20","article-title":"Clostridium Difficile Infection","volume":"2","author":"Smits","year":"2016","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"s17","DOI":"10.1017\/ash.2022.86","article-title":"Impact of Exposure to Potentially Contaminated Hospital Beds on Risk of Hospital-Onset C. Difficile Infection","volume":"2","author":"Witt","year":"2022","journal-title":"Antimicrob. Steward. Healthc. Epidemiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S45","DOI":"10.7326\/M18-3444","article-title":"A Tiered Approach for Preventing Clostridioides Difficile Infection","volume":"171","author":"Rohde","year":"2019","journal-title":"Ann. Intern. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1136\/bmjqs-2019-009953","article-title":"Preventing Clostridioides Difficile Infection in Hospitals: What Is the Endgame?","volume":"29","author":"Hota","year":"2020","journal-title":"BMJ Qual. Saf."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1503\/cmaj.111449","article-title":"Is Clostridium Difficile Infection Still a Problem for Hospitals?","volume":"184","author":"Enoch","year":"2012","journal-title":"Cmaj"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"V\u00e1zquez-Mart\u00ednez, E.R., Garc\u00eda-G\u00f3mez, E., Camacho-Arroyo, I., and Gonz\u00e1lez-Pedrajo, B. (2018). Sexual Dimorphism in Bacterial Infections. Biol. Sex. Differ., 9.","DOI":"10.1186\/s13293-018-0187-5"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Gay, L., Melenotte, C., Lakbar, I., Mezouar, S., Devaux, C., Raoult, D., Bendiane, M.-K., Leone, M., and M\u00e8ge, J.-L. (2021). Sexual Dimorphism and Gender in Infectious Diseases. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.698121"},{"key":"ref_31","unstructured":"World Health Organization (2022). Antimicrobial Resistance Surveillance in Europe 2022\u20132020 Data, WHO."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1186\/s13613-021-00942-1","article-title":"Characteristics of Sepsis-2 Septic Shock Patients Failing to Satisfy the Sepsis-3 Septic Shock Definition: An Analysis of Real-Time Collected Data","volume":"11","author":"Vermassen","year":"2021","journal-title":"Ann. Intensive Care"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1080\/23744235.2017.1383630","article-title":"The Influence of a Change in Septic Shock Definitions on Intensive Care Epidemiology and Outcome: Comparison of Sepsis-2 and Sepsis-3 Definitions","volume":"50","author":"Driessen","year":"2018","journal-title":"Infect. Dis."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/4\/596\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:00:23Z","timestamp":1760029223000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/4\/596"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,26]]},"references-count":33,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["medicina61040596"],"URL":"https:\/\/doi.org\/10.3390\/medicina61040596","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,26]]}}}