Usporedba zastupljenosti spolno prenosivih patogena u uzorcima prvog mlaza urina muškaraca zagrebačke regije

Cilj istraživanja bila je detekcija spolno prenosivih patogena u sedimentu prvoga mlaza urina uzetog umjesto obriska uretre u 290 muškaraca. Uzorci su obojani i kultivirani, te upotrijebljeni u multiplex testu lančane reakcije polimerazom koja detektira šest spolno prenosivih patogena simultano (Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum i Trichomonas vaginalis). Uretritis je utvrđen u svega 32/290 (11%) bolesnika detekcijom signifikantnog broja polimorfonuklearnih leukocita u uzorcima, a etiološka dijagnoza postavljena je u njih 27 od 32. Najčešći uzročnik uretritisa bila je C. trachomatis (65,6%), a potom N. gonorrhoeae i U. urealyticum (9,3%). Koinfekcija je utvrđena u 5 od 32 bolesnika s uretritisom. U bolesnika s negonokoknim uretritisom, dominantni uzročnik bila je C. trachomatis, dok je M. genitalium utvrđena s nižom učestalošću od očekivane. Mikrobiološka analiza je najčešće tražena zbog probira ili kontrole (109/37,6%), te u bolesnika s kroničnim prostatitisom (38/13,1%). Spolno prenosivi patogeni detektirani su značajno češće u bolesnika s uretritisom, nego u bolesnika iz ostalih dijagnostičkih skupina (p 0,05). Daljnje istraživanje i analiza više uzoraka prikupljenih od bolesnika s uretritisom neophodni su da bi se utvrdila uloga M. genitalium u negonokoknom uretritisu

Diffusion of OXA-48 carbapenemase among urinary isolates of Klebsiella pneumoniae in non-hospitalized elderly patients

Background: Recently, a dramatic increase of Klebsiella pneumoniae positive for OXA-48 β-lactamases was observed first in the hospital setting and later in the long-term care facilities (LTCFs) and community in the Zagreb County, particularly, in urinary isolates. The aim of the study was to analyse the epidemiology and the mechanisms of antibiotic resistance of OXA-48 carbapenemase producing K. pneumoniae strains isolated from urine of non-hospitalized elderly patients. ------ Results: The isolates were classified into two groups: one originated from the LTCFs and the other from the community. Extended-spectrum β-lactamases (ESBLs) were detected by double disk-synergy (DDST) and combined disk tests in 55% of the isolates (51/92). The ESBL-positive isolates exhibited resistance to expanded-spectrum cephalosporins (ESC) and in majority of cases to gentamicin. LTCFs isolates showed a significantly lower rate of additional ESBLs and consequential resistance to ESC and a lower gentamicin resistance rate compared to the community isolates, similarly to hospital isolates in Zagreb, pointing out to the possible transmission from hospitals.ESBL production was associated with group 1 of CTX-M or SHV-12 β-lactamases. Ertapenem resistance was transferable from only 12 isolates. blaOXA-48 genes were carried by IncL plasmid in 42 isolates. In addition IncFII and IncFIB were identified in 18 and 2 isolates, respectively. Two new sequence types were reported: ST4870 and ST4781. ----- Conclusions: This study showed eruptive and extensive diffusion of OXA-48 carbapenemase to LTCFs and community population in Zagreb County, particularly affecting patients with UTIs and urinary catheters. On the basis of susceptibility testing, β-lactamase production, conjugation experiments, MLST and plasmid characterization it can be concluded that there was horizontal gene transfer between unrelated isolates, responsible for epidemic spread of OXA-48 carbapenemase in the LTCFs and the community The rapid spread of OXA-48 producing K. pneumoniae points out to the shortcomings in the infection control measures

Activity of fosfomycin against nosocomial multiresistant bacterial pathogens from Croatia: a multicentric study

Aim To determine in vitro susceptibility of multiresistant bacterial isolates to fosfomycin. Methods In this prospective in vitro study (local non-random sample, level of evidence 3), 288 consecutively collected multiresistant bacterial isolates from seven medical centers in Croatia were tested from February 2014 until October 2016 for susceptibility to fosfomycin and other antibiotics according to Clinical and Laboratory Standards Institute methodology. Susceptibility to fosfomycin was determined by agar dilution method, while disc diffusion was performed for in vitro testing of other antibiotics. Polymerase chain reaction and sequencing were performed for the majority of extended spectrum beta-lactamase (ESBL)- producing Klebsiella pneumoniae (K. pneumoniae) and carbapenem-resistant isolates. Results The majority of 288 multiresistant bacterial isolates (82.6%) were susceptible to fosfomycin. The 236 multiresistant Gram- negative isolates showed excellent susceptibility to fosfomycin. Susceptibility rates were as follows: Escherichia coli ESBL 97%, K. pneumoniae ESBL 80%, Enterobacter species 85.7%, Citrobacter freundii 100%, Proteus mirabilis 93%, and Pseudomonas aeruginosa 60%. Of the 52 multiresistant Gram- positive isolates, methicillin-resistant Staphylococcus aureus showed excellent susceptibility to fosfomycin (94.4%) and vancomycin-resistant enterococcus showed low susceptibility to fosfomycin (31%). Polymerase chain reaction analysis of 36/50 ESBL-producing K. pneumoniae isolates showed that majority of isolates had CTX-M-15 beta lactamase (27/36) preceded by ISEcp insertion sequence. All carbapenem-resistant Enterobacter and Citrobacter isolates had bla(VIM-1) metallo- beta-lactamase gene. Conclusion With the best in vitro activity among the tested antibiotics, fosfomycin could be an effective treatment option for infections caused by multiresistant Gram-negative and Gram-positive bacterial strains in the hospital settin