Editorial

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Malaria – Diagnostic Methods

Malarija je još uvijek najznačajnija parazitarna infekcija na svijetu, značajan uzrok pobola i smrtnosti u endemskim zemljama te predstavlja velik rizik za putnike u te krajeve. Ključan dio u globalnoj borbi protiv malarije je mogućnost brze i točne detekcije uzročnika. Tehnološki napredak otvara nove dijagnostičke mogućnosti no, najstarija metoda, konvencionalna mikroskopska dijagnostika malarije i dalje predstavlja zlatni standard. Cilj ovog teksta je pregledati dio relevantne literature o dijagnostičkim metodama za malariju koje se najčešće upotrebljavaju u kliničkoj praksi u endemskim i neendemskim zemljama: mikroskopskoj dijagnostici, brzim antigenskim testovima (BAT), molekularnim metodama i serologiji. Također, iznosimo podatke o nekim od novijih napredaka u dijagnozi malarije.Malaria remains the most important and impactful parasitic infection in the world, causing significant morbidity and mortality in endemic countries, and posing a great health risk for travellers to those areas. A major component in the global fight against malaria is the ability to detect it both quickly and accurately. Technological advancements continually provide us with new diagnostic methods, but the oldest method, conventional microscopic diagnosis of malaria, is still considered to be the gold standard. Here, we review some of the relevant literature on diagnostic methods for malaria most commonly applied in the clinical setting, both in endemic and non-endemic areas: microscopic diagnosis, rapid antigen tests (RDTs), molecular methods and serology. We also inform on some of the more recent advancements in the diagnosis of malaria

Microbiological diagnostics of invasive meningococcal disease in Croatia – are standard methods optimal methods even today

Potvrda dijagnoze invazivne meningokokne bolesti (IMB) često je onemogućena zbog rane primjene antibotika. Nekultivacijske molekularne metode postaju zato novi "zlatni standard" u mikrobiološkoj dijagnostici IMB u razvijenim zemljama i preporučeno pomagalo u ostalim zemljama. Uvođenje molekularnih testova 2005. godine u rutinsku dijagnostku IMB u Klinici za infektivne bolesti "Dr. Fran Mihaljević" značajno su ubrzali i unaprijedili postavljanje etiološke dijagnoze. U razdoblju od siječnja 2005. do travnja 2013 godine više od 50% slučajeva IMB potvrđeno je samo real time PCR testom. Pojava invazivnih penicilin-rezistentnih izolata N. meningitidis nameće potrebu praćenja gena penA, odgovornog za rezistenciju na penicilin. Dobra osjetljivost izolata na ciprofloksacin, rifampicin i ceftriakson omogućava nam primjenu ovih antibiotika u profilaksi prema sadašnjim preporukama struke. Serotipizacija i serosubtipizacija nisu više preporučene rutinske metode u karakterizaciji izolata meningokoka. Cjepiva protiv meningokoka grupe B pripremljena od proteina vanjske membrane (OMV cjepiva) mogla su biti primijenjena uspješno uglavnom samo u nacionalnim okvirima. Međutim s razvojem reverzne vakcinologije i pojavom multikomponentnih MenB cjepiva (fHBP, NHBA, NadA, OMP Novi Zeland – P1.7-2,4) postaje značajno genotipizirati lokalne izolate i pratiti obuhvat zaštićenosti populacije ponuđenim novim cjepivima u nacionalnim okvirima. To će zasigurno biti dio našeg budućeg rada samostalno i/ili u suradnji s europskim referentnim centrima za meningokoke i Europskim centrom za prevenciju i kontrolu bolesti (ECDC).Culture-confirmed diagnosis of invasive meningococcal disease (IMD) is often hindered by early antibiotic treatment. Nonculture molecular standardized methods are now essential tools and almost "new gold standard" in microbiological diagnostics of IMD in developed world and recommended tool in other parts of the world. The introduction of the real time PCR in routine diagnostics of IMD at the University Hospital for Infectious Diseases (UHID) in 2005 significantly improved etiological diagnosis of disease. More than 50% of IMD cases of hospitalized patients in UHID from January 2005 to April 2013 were confirmed only by real time PCR. The emergence of penicillin resistant N. meningitidis invasive isolates leads us to the introduction of the detection of penA gene responsible for penicillin resistance. Nevertheless, IMD prophylaxis in Croatia may continue to be based on the current recommendations of epidemiological service due to proved susceptibility to all antibiotics commonly used for this purpose, rifampicin, ciprofloxacin and ceftriaxone. Serotyping and serosubtyping are not any more recommended in routine characterization of meningococcal isolates. OMV vaccines against N. meningitidis serogroup B, prepared from outer membrane proteins, have not proved to be successful supranational. However, after the development of reverse vaccinology and multicomponent MenB (fHBP, NHBA, NadA, OMP New Zealand – P1.7-2,4) vaccine genotyping was placed as an important tool for following up characteristics of invasive meningococcal isolates as well as following up of vaccine coverage with the available new and future MenB vaccines or perhaps broad range vaccines. This will undoubtedly be a part of our future work on the national level and/or in cooperation with other European national reference centres and the European Centre for Disease Prevention and Control (ECDC)

Profile of invasive group A and group B Streptococcal infections in patients hospitalised at the University Hospital for Infectious Diseases „Dr. Fran Mihaljević” during the period from 2011 to 2018

Cilj: Beta hemolitički streptokoki (BHS) su rjeđe uzročnici invazivne bolesti (IB). Očekivano je BHS grupe B češći izolat kod bolesnika s IB. Međutim, u rutinskom radu u posljednje je vrijeme uočeno sve više izolata BHS grupe A iz krvi. Stoga je cilj bio analizirati pojavnost i učestalost IB uzrokovane BHS grupe A i B kod bolesnika liječenih u Klinici za infektivne bolesti (KIB) u dužem periodu. Metode: Podatci o bolesnicima i BHS za razdoblje 2011.- 2018. godine prikupljeni su iz elektronske baze podataka Centralnog dijagnostičkog laboratorija KIB te je učinjena podatkovna analiza. Rezultati: Tijekom razdoblja od 2011. do 2018. god. iz primarno sterilnih uzoraka identificirano je 151 BHS A i B. Većina izolata bila je iz krvi – 96,7%. Podjednako je bilo izolata BHS A i BHS B. Najviše izolata zabilježeno je 2012. i 2017. godine. BHS A izolata bilo je najviše u 2012. godini, 54% više od BHS B, a u 2016.g. 50 % više od broja BHS B izolata. U skupini djece koja je činila 19,9% bolesnika, najčešći je izolat bio BHS A. Odrasli su činili 80,1% bolesnika. Većina oboljelih bili su stariji od 65 godina. Na odjelima za intenzivno liječenje hospitalizirano je 12 djece i 18 odraslih. Zaključak: Invazivne infekcije BHS A i B utječu na najranjivije dobne skupine, djecu i starije. U našoj studiji oboljeli su najčešće bili bolesnici stariji od 65 godina. BHS-A bio je češće uzrok IB u dječjoj skupini. Zbog karakteristika BHS-A bilo bi dobro imati mogućnost upotpuniti dijagnostiku karakterizacijom BHS-A izolata osobito u nadzoru promjena u virulenciji. To bi također bio doprinos u praćenju i evidenciji potencijalnih epidemija.Aim: Beta-haemolytic streptococci (BHS) rarely cause invasive disease (ID). Usually the most common cause of ID is group B BHS (BHS-B). However, in our recent routine work higher number of group A BHS (BHS-A) isolates from blood was noted. The aim of this study was to report trends and findings by group BHS-A and BHS-B causing laboratory confirmed disease from 2011 to 2018 at the University Hospital for Infectious Diseases „Dr. Fran Mihaljević”. Methods: Data on patients from the electronic database of microbiological laboratory at UHID for the period 2011-2018 was collected and analysed. Results: During the period 2011-2018, 151 BHS A and B were identified from normally sterile body sites. Most isolates were from blood cultures (96.7%). BHS-A and BHS-B were isolated almost equally. The highest number of isolates was recorded in 2012 and 2017. The number of BHS A isolates peaked in 2012, 54% more than BHS-B, and 50% more in 2016. Children presented 19.9% of patients, and were mostly isolated with BHS-A. 80.1% patients were adults. Adults predominated in the age group >65 years. 12 children and 18 adults were hospitalised in intensive care unit. Conclusion: Invasive group A and group B streptococcal infections predominantly affect most vulnerable age groups, children and elderly. In this study invasive BHS disease is most common among adults above 65 years of age. BHS-A was most common cause of invasive disease among paediatric patients as well as in the age group above 65 years. Typing and characterization of BHS-A isolates due to its characteristics should be foreseen as important diagnostic tool, especially to monitor changes in virulence and to prevent potential outbreaks

Epidemiological and clinical characteristics of patients with invasive meningococcal disease hospitalized at the University Hospital for Infectious Diseases "Dr. Fran Mihaljevic", Zagreb

Restrospektivno su analizirane epidemiološke i kliničke značajke invazivne meningokokne bolesti (IMB) kod 108 hospitaliziranih bolesnika, u petogodišnjem razdoblju, od 2003. – 2007. godine, što je prosječno iznosilo 22 bolesnika godišnje. IMB je najčešća kod dojenčadi i male djece, te u djece školske dobi. Sveukupno 73% bolesnika bila su djeca u dobi do 15 godina, prosječne starosti 2,8 godina, a 27% su bili stariji bolesnici. Ukupna smrtnost među našim bolesnicima bila je 4,6% (3,7% među djecom do 15 godina, a u starijih bolesnika 6,8%). Bolest se klinički prezentirala kao meningitis kod 14 (13%), sepsa kod 28 (26%) ili sepsa s meningitisom kod 66 (61%) bolesnika. Etiološka dijagnoza bila je potvrđena kod svih bolesnika dokazom uzročnika iz primarno sterilnih materijala (krv i/ili cerebrospinalni likvor). Kultivacijom je uzročnik dokazan u 32%, a molekularnim metodama (PCR) u 74% bolesnika. Prevladavala je N. meningitidis serogrupe B (83%), zatim serogrupe C (12%) te serogrupa W 135 (1,8%), dok je kod 2,7% dokazan negrupabilan soj. Svi hospitalizirani bolesnici bili su sporadični slučajevi, nije zabilježena niti jedna epidemija. U razdoblju od 2003. do 2007. godine kod naših je bolesnika dokazano 7 izolata N. meningitidis smanjene osjetljivosti na penicilin. U svim se slučajevima radilo o izolatima serogrupe B. Uz već postojeća cjepiva protiv meningokoka (A, C, Y, W135), u tijeku su opsežna istraživanja u razvoju i primjeni djelotvornog cjepiva protiv N. meningitidis serogrupe B, koje će, nadamo se, doprinijeti smanjenju incidencije ove teške i potencijalno smrtonosne bolesti.We retrospectively analyzed epidemiological and clinical characteristics of invasive meningococcal disease (IMD) in 108 hospitalized patients in the period of five years, from 2003 to 2007. On average, 22 patients with meningococcal disease were treated per year. IMD was the commonest in infants and small children, and in school age children. Altogether 73 % of all patients were children up to 15 years of age (mean age 2,8 years) while the remaining 27% were older patients. The total mortality rate among our patients was 4,6% (3,7% among children up to 15 years of age, and 6,8% in older patients). The disease clinically presented as meningitis in 14 (13%), as sepsis in 28 (26%) or sepsis with meningitis in 66 (61%) patients. Etiological diagnosis from primarily negative samples (blood and/or cerebrospinal fluid) proved positive in all patients. N.meningitidis was confirmed by cultivation in 32%, and by PCR method in 74% of cases. In etiologically confirmed cases, the most common serogroup of N.meningitidis was serogroup B (83%), followed by serogroup C (12%) and serogroup W135 (1,8%), while in 2,7% of patients a non-groupable strain was isolated. All patients were sporadic cases. In the period from 2003 to 2007, N.meningitidis with reduced susceptibility to penicillin was detected in 7 isolates, all of them belonging to serogroup B. Along with currently available vaccine against meningococcus (A, C, Y, W 135), continuous efforts are undertaken worldwide to develop an efficient vaccine against N. meningitidis serogroup B, that would, we hope, contribute in reducing the incidence of this severe and potentially fatal disease

Microbiological diagnostics of invasive meningococcal disease in Croatia – are standard methods optimal methods even today

Potvrda dijagnoze invazivne meningokokne bolesti (IMB) često je onemogućena zbog rane primjene antibotika. Nekultivacijske molekularne metode postaju zato novi "zlatni standard" u mikrobiološkoj dijagnostici IMB u razvijenim zemljama i preporučeno pomagalo u ostalim zemljama. Uvođenje molekularnih testova 2005. godine u rutinsku dijagnostku IMB u Klinici za infektivne bolesti "Dr. Fran Mihaljević" značajno su ubrzali i unaprijedili postavljanje etiološke dijagnoze. U razdoblju od siječnja 2005. do travnja 2013 godine više od 50% slučajeva IMB potvrđeno je samo real time PCR testom. Pojava invazivnih penicilin-rezistentnih izolata N. meningitidis nameće potrebu praćenja gena penA, odgovornog za rezistenciju na penicilin. Dobra osjetljivost izolata na ciprofloksacin, rifampicin i ceftriakson omogućava nam primjenu ovih antibiotika u profilaksi prema sadašnjim preporukama struke. Serotipizacija i serosubtipizacija nisu više preporučene rutinske metode u karakterizaciji izolata meningokoka. Cjepiva protiv meningokoka grupe B pripremljena od proteina vanjske membrane (OMV cjepiva) mogla su biti primijenjena uspješno uglavnom samo u nacionalnim okvirima. Međutim s razvojem reverzne vakcinologije i pojavom multikomponentnih MenB cjepiva (fHBP, NHBA, NadA, OMP Novi Zeland – P1.7-2,4) postaje značajno genotipizirati lokalne izolate i pratiti obuhvat zaštićenosti populacije ponuđenim novim cjepivima u nacionalnim okvirima. To će zasigurno biti dio našeg budućeg rada samostalno i/ili u suradnji s europskim referentnim centrima za meningokoke i Europskim centrom za prevenciju i kontrolu bolesti (ECDC).Culture-confirmed diagnosis of invasive meningococcal disease (IMD) is often hindered by early antibiotic treatment. Nonculture molecular standardized methods are now essential tools and almost "new gold standard" in microbiological diagnostics of IMD in developed world and recommended tool in other parts of the world. The introduction of the real time PCR in routine diagnostics of IMD at the University Hospital for Infectious Diseases (UHID) in 2005 significantly improved etiological diagnosis of disease. More than 50% of IMD cases of hospitalized patients in UHID from January 2005 to April 2013 were confirmed only by real time PCR. The emergence of penicillin resistant N. meningitidis invasive isolates leads us to the introduction of the detection of penA gene responsible for penicillin resistance. Nevertheless, IMD prophylaxis in Croatia may continue to be based on the current recommendations of epidemiological service due to proved susceptibility to all antibiotics commonly used for this purpose, rifampicin, ciprofloxacin and ceftriaxone. Serotyping and serosubtyping are not any more recommended in routine characterization of meningococcal isolates. OMV vaccines against N. meningitidis serogroup B, prepared from outer membrane proteins, have not proved to be successful supranational. However, after the development of reverse vaccinology and multicomponent MenB (fHBP, NHBA, NadA, OMP New Zealand – P1.7-2,4) vaccine genotyping was placed as an important tool for following up characteristics of invasive meningococcal isolates as well as following up of vaccine coverage with the available new and future MenB vaccines or perhaps broad range vaccines. This will undoubtedly be a part of our future work on the national level and/or in cooperation with other European national reference centres and the European Centre for Disease Prevention and Control (ECDC)

The most common causes of bacterial meningitis in patients treated at the University Hospital for Infectious Diseases "Dr. Fran Mihaljević" in the period from 2011 until 2013

Iako se pojedini uzročnici povezuju s karakterističnim kliničkim slikama ili epidemiološkim podacima, etiologija bakterijskog meningitisa temelji se na mikrobiološkoj dijagnostici. Cilj rada je bio prikazati učestalost uzročnika bakterijskog meningitisa u bolesnika liječenih u Klinici za infektivne bolesti u razdoblju od 2011. do 2013. godine. U promatranom razdoblju kultivacijom i/ili molekularnom dijagnostikom dokazan je bakterijski uzročnik u 212 slučajeva bakterijskog meningitisa. Bilo je 108 (50,94%) izvanbolničkih i 104 (49,06%) bolničkih uzročnika. Najčešći izvanbolnički uzročnici su bili Streptococcus pneumoniae 19,81% (42/212 izolata), Neisseria meningitidis 15,57% (33/212) i Listeria monocytogenes 7,55% (16/212), a u neonatalnoj dobi Streptococcus agalactiae (3/6). Od bolničkih uzročnika najčešće je izoliran koagulaza negativan stafilokok 16,98% (36/212), zatim Staphylococcus aureus 8,49% (18/212), Pseudomonas aeruginosa 6,13% (13/212), Acinetobacter baumannii 5,19% (11/212) i Klebsiella pneumoniae 3,3% (7/212). Rezistencija na antibiotike je očekivano veća u bolničkih izolata.Although some pathogens are related to specific clinical presentations or epidemiological data, the etiology of bacterial meningitis is based on diagnostic microbiology. The main purpose of this paper was to present the frequency of pathogens isolated from patients hospitalized at the University Hospital for Infectious Diseases "Dr. Fran Mihaljević" in the period from 2011 until 2013. In this period, a total of 212 cases of bacterial meningitis were diagnosed by cultivation and/or by molecular method. There were 108 (50,94 %) community-acquired and 104 (49,06%) nosocomial pathogens isolated. The most common community-acquired pathogens were Streptococcus pneumoniae 18,83% (42/212 isolates), Neisseria meningitidis 14,79% (33/212) and Listeria monocytogenes 7,17% (16/212) and in the neonatal age Streptococcus agalactiae (3/6). Coagulase-negative staphylococci (CoNS) were the most common nosocomial isolates 16,98% (36/212), followed by Staphylococcus aureus 8,49% (18/212), Pseudomonas aeruginosa 6,13% (13/212), Acinetobacter baumannii 5,19% (11/212) and Klebsiella pneumoniae 3,3% (7/212). As expected, higher rates of resistance were recorded in nosocomial pathogens

Identification of microorganisms on mobile phones of intensive care unit health care workers and medical students in the tertiary hospital

Aim To identify and investigate a difference between microorganisms present on intensive care unit (ICU) health care workers’ (HCW, doctors, nurses or medical technicians) and medical students’ mobile phones as well as to investigate a difference between the frequency and the way of cleaning mobile phones. Methods Fifty swabs were collected from HCWs who work in the ICU (University Hospital Centre Osijek) and 60 swabs from medical students (School of Medicine, University of Osijek). Microorganisms were identified according to standard microbiological methods and biochemical tests to the genus/species level. Results Out of 110 processed mobile phones, mobile phones microorganisms were not detected on 25 (22.7%), 15 (25%) students’ and 10 (20%) HCW’s mobile phones. No statistically significant difference was found between the number of isolated bacteria between the HCW’ and students’ mobile phones (p>0.05). Statistically significant difference was found between both HCW and students and frequency of cleaning their mobile phones (p<0.001). A significant difference was also obtained with the way of cleaning mobile phones between HCWs and students (p <0.001). Conclusion The most common isolated microorganisms in both groups were coagulase-negative staphylococci (CoNS) and Staphylococcus aureus. Most HCWs cleaned their mobile phones at least once a week, 35 (52.0%), and most medical students several times per year, 20 (33.3%). HCW clean their mobile phones with alcohol disinfectant in 26 (40.0%) and medical students with dry cloth in 20 (33.3%) cases

Post-exposure prophylaxis of meningococcal disease

Invazivna meningokokna bolest (IMB) javlja se najčešće sporadično, ali iznenada i s visokim letalitetom. Uzročnik se prenosi kapljičnim putem iz nazofarinksa asimptomatskog kliconoše ili oboljele osobe, češće tijekom zimskih mjeseci. U Hrvatskoj, kao i u drugim dijelovima Europe, IMB najčešće uzrokuje Neisseria meningitidis serološke grupe B. Prosječna incidencija IMB u Hrvatskoj u proteklih petnaestak godina iznosi 1,07 na 100 000 stanovnika, dok u Brodsko-posavskoj županiji iznosi 0,78 na 100 000 stanovnika. Oboljeli se obavezno liječe u bolnici, a pravovremeno započeto antimikrobno liječenje povećava vjerojatnost povoljnog ishoda bolesti. Zbog visoke stope smrtnosti IMB, javnozdravstvene aktivnosti usmjerene su na otkrivanje bliskih kontakata u kojih se mora provesti pravodobna i učinkovita kemoprofilaksa. U ovom radu prikazujemo slučaj šestogodišnje djevojčice oboljele od IMB i protuepidemijske mjere provedene u cilju sprječavanja sekundarnih slučajeva.Invasive meningococcal disease (IMD) occurs most often sporadically, but suddenly and with high mortality rates. The pathogen is transmitted by droplets from the nasopharynx of asymptomatic carrier or patient, commonly during the cold season. Serogroup B meningococcus dominates in Croatia as elsewhere in Europe. The average incidence over the past fifteen years has been 1,07 per 100 000 population in Croatia while in the Brod – Posavina County the average incidence has been 0,78 per 100 000 population. Patients with IMD should be hospitalized and treated immediately with antibiotics to improve patient outcome. Due to the high mortality rates of meningococcal disease, public health activities are focused on providing timely and effective chemoprophylaxis to close contacts. We describe a six-year-old girl with IMD and post-exposure prophylaxis activities in order to prevent secondary cases

Multiresistant isolates from sterile material of patients treated in the Pediatrics and Surgery Departments of the University Hospital Osijek in the period 2008–2012

Ovim istraživanjem ispitana je učestalost pojavnosti rezistentnih Gram pozitivnih i Gram negativnih bakterija izoliranih iz primarno sterilnih kliničkih uzoraka bolesnika liječenih na odjelima s različitom bolesničkom populacijom, u Klinici za pedijatriju i Klinici za kirurgiju KBC-a Osijek u razdoblju od 2008. godine do 2012. godine. U promatranom razdoblju u Klinici za pedijatriju i Klinici za kirurgiju KBC-a Osijek rezistentne bakterije izolirane su iz 62 klinička uzorka. U Klinici za pedijatriju bilo je 32 izolata (51,61%) rezistentnih bakterija, a u Klinici za kirurgiju 30 izolata. Najviše je bilo izolata Klebsiella pneumoniae ESBL 41,93% (26/62 izolata), zatim Pseudomonas aeruginosa 27,41% izolata (17/62), meticilin rezistentni Staphylococcus aureus – MRSA 20,96% izolata (13/62) i Acinetobacter baumannii 9,67% izolata (6/62). U Klinici za pedijatriju zabilježena je veća učestalost Gram negativnih rezistentnih izolata za razliku od Klinike za kirurgiju gdje je najčešće izoliran MRSA (12/30). Najčešće izolirana rezistentna bakterija u Klinici za pedijatriju bila je K. pneumoniae ESBL 71,87% (23/32), a zabilježen je samo jedan izolat MRSA. A. baumannii izoliran je samo iz kliničkih uzoraka bolesnika liječenih u Klinici za kirurgiju, a i P. aeruginosa je bio nešto češće izoliran na kirurškim odjelima nego u Klinici za pedijatriju (10 odnosno 7 izolata). Utvrdili smo da je u razdoblju od 2008. do 2012. godine došlo do pada pojavnosti multirezistentnih izolata u Klinici za pedijatriju i Klinici za kirurgiju KBC Osijek i da je najviše rezistentnih izolata zabilježeno u prve dvije godine promatranog razdoblja. Iako izolati P. aeruginosa nisu bili rezistentni na cefalosporine 3. i 4. generacije, zabrinjava visok postotak rezistencije izolata na karbapeneme (58,81% na imipenem i 35,29% na meropenem).The study analyzed the incidence of resistant Gram-positive and Gram-negative bacteria isolated from sterile clinical specimens of patients treated at wards with different hospital population, the Department of Pediatrics and Department of Surgery of the University Hospital Osijek in the period from 2008 to 2012. During the study period resistant bacteria were isolated from 62 clinical samples collected from Pediatrics and Surgery Departments of the University Hospital Osijek. There were 32 isolates (51.61%) of resistant bacteria collected in the Pediatrics Department, and a total of 30 isolates in the Surgery Department. The majority of isolates were isolates of Klebsiella pneumoniae ESBL 41.93% (26/62), followed by Pseudomonas aeruginosa 27.41% (17 / 62), Staphylococcus aureus – MRSA 20.96% (13/62) and Acinetobacter baumannii 9.67% (6/62). Asignificantly higher incidence of Gram-negative resistant isolates was recorded in the Pediatrics Department as opposed to Surgery Department where the most frequent isolate was MRSA (12/30). The most commonly isolated resistant bacteria in the Pediatrics Department were K. pneumoniae ESBL 71.87% (23/32), and only one isolate of MRSA was recorded. A. baumannii was isolated only from clinical specimens of patients treated in the Surgery Department, and P. aeruginosa was also more frequently isolated in the Surgery Department than Pediatrics Department (10 and 7 isolates, respectively). Our study established that in the period from 2008 to 2012 there was a decline in the incidence of multiresistant isolates in the Pediatrics and Surgery Departments of the University Hospital Osijek and that the largest number of resistant isolates was recorded in the first two years of the study period. Although P. aeruginosa isolates were not resistant to the 3rd and 4th generation of cephalosporins, special attention should be given to a high percentage of carbapenem resistance (58.81% to imipenem and 35.29% to meropenem)