Epidemiology of Campylobacter jejuni and Campylobacter coli Infections in the Zenica – Doboj Canton, Bosnia and Herzegovina – A Laboratory Based Surveillance in the 1999–2001 Period

Previous studies in the Zenica – Doboj Canton, Bosnia and Herzegovina, indicated some different epidemiological features of Campylobacter infections and high degree of antimicrobial resistance. Therefore, it was important to investigate epidemiology of Campylobacter jejuni and Campylobacter coli infections by demographic features and antimicrobial resistance in the 1999–2001 period. A total number of 40 (75.5%) C. jejuni and 13 (24.5%) C. coli non-repeated clinical isolates were analyzed. More than half of isolates, 30 (56.6%) were from urban dwellers. Campylobacter isolates mainly obtained from children under 6 years of age, 42 (79.2%), resulting in far off highest incidence rate of 41.4/100,000/year in this age group. There was noted high degree of resistance to ciprofloxacin in children less than 6 years of age (14.3%), and extremely high overall erythromycin-resistance rate (30%). Campylobacteriosis in this region is a public health concern not in the term of the number reported cases, but of distinctive epidemiologic features

Methicillin-resistant S. aureus (MRSA), extended-spectrum (ESBL)- and plasmid-mediated AmpC ß-lactamase -producing Gram-negative bacteria associated with skin and soft tissue infections in hospital and community settings

AIM To investigate the characteristics of meticillin-resistant S. aureus (MRSA), extended-spectrum (ESBL), and plasmid-mediated AmpC beta-lactamase producing Gram-negative bacteria causing skin and soft tissue infections (SSTIs) in hospital and outpatient settings of Zenica-Doboj Canton, Bosnia and Herzegovina. ----- METHODS Antibiotic susceptibility was determined by disc-diffusion and broth microdillution methods according to CLSI guidelines. MecA gene was detected by PCR, and genetic characterization of MRSA was performed using spa-typing and the algorithm based upon repeat patterns (BURP). Double-disk-synergy test was used to screen for ESBLs. PCR was used to detect blaESBL alleles. Genetic relatedness of the strains was tested by PFGE. ----- RESULTS Seventeen in-patients with MRSA, 13 with ESBL-producing Gram-negative bacteria and three patients co-infected with both, were detected. Five MRSA and 16 ESBL-producing Gram-negative bacteria were found in outpatient samples. Klebsiella spp. was isolated in 11 in- and seven outpatients. MLST CC152 was the most prevalent MRSA. Seven (38.9%) Klebsiella spp. yielded amplicons with primers specific for SHV, TEM-1 and CTX-M group 1 β-lactamases. Eight K. pneumonia (44.4%) and 16 (64%) MRSA (including the in- and outpatient) strains were clonally related. ----- CONCLUSION The presence of MRSA and ESBL-producing organisms causing SSTIs in the community poses a substantial concern, due to the high morbidity and mortality associated with possible consequent hospital infections

Effect of inoculum size of Enterobacteriaceae producing SHV and CTX-M extended-spectrum ß-lactamases on the susceptibility to ß-lactam combinations with inhibitors and carbapenems

Aim Many extended-spectrum β-lactamases (ESBL) producingisolates of E. coli and K. pneumoniae are susceptible in vitro toamoxycillin-clavulanate (AMC), ceftazidime-clavulanate (CAZ/cl), and piperacillin-tazobactam (TZP), but MICs increase substantiallywhen higher inoculum is applied. The aim of this studywas to determine the effect of inoculum size on the susceptibilityof E. coli and K. pneumoniae isolates with well characterized ESBLs,to amoxycillin (AMX), AMC - amoxycilin + clavulanate,ceftazidime (CAZ), CAZ/cl - ceftazidime + clavulanate, piperacillin(PIP), TZP - tazobactam + piperacilin, imipenem (IMI) andmeropenem (MEM).Methods Minimum inhibitory concentrations (MIC) were determinedby broth microdilution method using inocula that differed100 fold in density.Results Inoculum effect for CAZ/cl was detected in 52% of SHV-2producing K. pneumoniae strains followed by AMC (43%) andTZP (38%). SHV-5 producing K. pneumoniae strains showed themost pronounced inoculum effect with CAZ/cl and AMC and tolesser extent with TZP. Inoculum effect was observed for AMC,CAZ/cl and TZP in 71% of SHV-12 producers. E. coli producingSHV-5 β-lactamase showed the most pronounced inoculumeffect with AMC, followed by CAZ/cl and TZP. Strains producingCTX-M β-lactamases had a marked inoculum effect with CAZ/cl,AMC and TZP. Carbapenems did not show inoculum effect withany type of ESBLs.Conclusion According to the results of this study, carbapenemsremain the antibiotics of choice for the treatment of infectionscaused by ESBL-producing Enterobacteriaceae

Characterization of the extended-spectrum β-lactamases and determination of the virulence factors of uropathogenic Escherichia coli strains isolated from children

BACKGROUND AND AIM: The aim of the study was to characterize ESBL-producing uropathogenic Escherichia coli (UPEC) strains isolated in children. That included the investigation of virulence factors and the analysis of the types of β-lactamases at the molecular genetic level. ----- MATERIAL AND METHODS: During the 2-year study period, 77 ESBL-producing E. coli strains were recovered from urine samples of febrile children with significant bacteriuria hospitalized at one Croatian hospital. Susceptibility of isolates to bactericidal serum activity was tested by Shiller and Hatch method, while adhesin expression was determined by agglutination methods. Characterization of ESBLs was performed by PCR with specific primers for ESBLs and by sequencing of bla (ESBL) genes. Genotyping of the E. coli isolates was performed by pulsed-field gel electrophoresis (PFGE). ----- RESULTS: Twenty-seven (35.1 %) and 50 (64.9 %) ESBL-producing UPEC strains were isolated in neonates and infants, respectively. Of 70 strains investigated for the presence of virulence factors, adhesins were detected in 48.6 % strains (8.6 % in the neonate and 40 % in the infants group) giving a statistically significant difference in adhesin expression between the two groups (p < 0.01). Hemolysin was produced by 84.3 %, whereas 70 % of strains were serum-resistant. The bla (TEM) gene was detected in 22 (28 %) and bla (SHV) gene in 57 strains (74 %), whereas bla (CTX-M) gene was detected in only two isolates (2.5%). In ten isolates, bla (TEM) and bla (SHV) were simultaneously detected. Sequencing of bla (SHV) genes revealed that SHV-5 β-lactamase was by far the most prevalent and was found in 51 strains (66 %). The strains were clonally related as demonstrated by PFGE and assigned into ten clusters. ----- CONCLUSIONS: Infection control measures should be employed and the consumption of expanded-spectrum cephalosporins in the hospital should be restricted