Dijagnostika infekcija mokraćnog sustava u Zavodu za javno zdravstvo Grada Zagreba (The Diagnosis of Urinary Tract Infection at Zagreb Institute of Public Health)

Infekcije mokraćnog sustava (IMS) jedne su od najčešćih bakterijskih infekcija. Osobito su im sklone žene. Procjenjuje se da gotovo 50% žena ima iskustvo barem jedne takve simptomatske infekcije tijekom života. U starijoj životnoj dobi pad seksualne aktivnosti u žena i porast opstruktivnih smetnji zbog hipertrofije prostate u muškaraca gotovo izjednačuje incidenciju IMS u muškaraca i žena.[1,2] Duža primjena antimikrobnih lijekova u liječenju IMS u muškaraca razlogom je češće rezistencije sojeva  Escherichia coli. U starijoj dobnoj skupini (≥ 65 god.) posebno je izražena rezistencija sojeva  E. coli  na fluorokinolone, s većom zastupnjenošću  rezistencije na norfloksacin u muškaraca (23,75%) nego u žena (13,81%). [3]U Odsjeku za infekcije mokraćno-spolnog sustava tijekom 2005. godine obrađeno je 30480 uzoraka mokraće izvanbolničkih pacijenata s područja grada Zagreba i Zagrebačke županije, od čega 7347 (24,10%) uzoraka mokraće muškaraca i 23133 (75,90%) uzoraka mokraće žena. Obrada uzoraka vršena je prema algoritmu za obradu i analizu uzoraka mokraće Hrvatskog društva za medicinsku mikrobiologiju i parazitologiju.[4,5

Emergence of Uropathogenic Extended-Spectrum b Lactamases-Producing Escherichia coli Strains in the Community

The aim of this study was to determine the virulence characteristics and resistance pattern of the extended-spectrum b lactamases (ESBLs)-producing Escherichia coli strains isolated from urine of outpatients in the Zagreb region during a five-month period, and to compare them with the non ESBLs-producing E. coli strains isolated in the same period. Out of 2,451 E. coli strains isolated from urine of nonhospitalized patients with significant bacteriuria, a total of 39 ESBLsproducing strains (1.59%) were detected by a double-disk diffusion technique and by the broth-dilution minimal inhibitory concentration reduction method. The 45 non ESBLs-producing strains were randomly chosen, and phenotype of the two groups of strains was characterized and compared. Serogroup O4, hemolysin production, expression of P- and type 1 fimbriae as well as resistance to gentamicin and amikacin were significantly more prevalent characteristics among the ESBLs-producing strains than among non ESBLs-producing strains (p<0.01), while higher prevalence of trimethoprim- sulfamethoxazole resistance among ESBLs-producing strains was not statistically significant (p>0.05). Chromosomal DNA analysis by pulsed-field gel electrophoresis exhibited a great genomic similarity among ESBLs-producing strains and revealed that those highly virulent and resistant E. coli strains isolated from urine of outpatients in the Zagreb region had a clonal propagation

Genital human papillomavirus infection in women from the Zagreb region

Human papillomavirus (HPV) infection is the most common sexually transmitted infection, especially among young, sexually active individuals. As persistent infection with oncogenic types may lead to cervical cancer, HPV testing is a useful tool to screen for women at risk for subsequent development of cervical cancer. The aim of the study was to determine the prevalence of high-risk HPV (hrHPV) infection in different age groups of cytologically selected women from the Zagreb region, and to evaluate the frequency and results of repeat hrHPV testing. During a one-year study period (November 2005 to November 2006), a total of 3,440 cervical samples from women attending gynecological services of public and private health care systems were received. They were tested for 13 hrHPV genotypes by the polymerase chain reaction based AMPLICOR HPV test (Roche Molecular Systems). The overall prevalence of hrHPV was 34.6%. Most samples were obtained from women aged 21-30 years (44.2%), followed by the 31-40 (27.6%), 41-50 (15.7%), 51-60 (5.3%) and 261 (2.4%) age groups. Out of 3,227 cervical samples obtained from women of known age, 4.9% were obtained from the group of girls younger than 21, in which the highest prevalence of hrHPV (49.4%) was found. A similar prevalence was observed in women aged 21-30 (45.1%). The prevalence gradually decreased with age. During the study period, repeat hrHPV testing was performed in samples from 66 women at different intervals. Out of 28 women that were hrHPV negative on initial testing, only five women turned positive on repeat testing. Out of 38 women that were positive on initial testing, in one-third hrHPV could not be detected on repeat testing. As expected, hrHPV infection was highly prevalent in female adolescents and young women. Further investigation on repeat hrHPV testing is needed to assess virus clearance and rate of newly acquired infection

Emergence of uropathogenic extended-spectrum beta lactamases-producing Escherichia coli strains in the community

The aim of this study was to determine the virulence characteristics and resistance pattern of the extended-spectrum/lactamases (ESBLs)-producing Escherichia coli strains isolated from urine of outpatients in the Zagreb region during a five-month period, and to compare them with the non ESBLs-producing E. coli strains isolated in the same period. Out of 2451 E. coli strains isolated from urine of nonhospitalized patients with significant bacteriuria, a total of 39 ESBLs-producing strains (1.59%) were detected by a double-disk diffusion technique and by the broth-dilution minimal inhibitory concentration reduction method. The 45 non ESBLs-producing strains were randomly chosen, and phenotype of the two groups of strains was characterized and compared. Serogroup O4, hemolysin production, expression of P- and type 1 fimbriae as well as resistance to gentamicin and amikacin were significantly more prevalent characteristics among the ESBLs-producing strains than among non ESBLs-producing strains (p 0.05). Chromosomal DNA analysis by pulsed-field gel electrophoresis exhibited a great genomic similarity among ESBLs-producing strains and revealed that those highly virulent and resistant E. coli strains isolated from urine of outpatients in the Zagreb region had a clonal propagation

Frequency of Haemophilus spp. in urinary and and genital tract samples

Aim To determine the prevalence and antibiotic susceptibility of Haemophilus influenzae and H. parainfluenzae isolated from the urinary and genital tracts. Methods Identification of strains bacteria Haemophilus spp. was carried out by using API NH identifi-cation system, and antibiotic susceptibility was performed by Kirby-Bauer disk diffusion method. Results A total number of 50 (0,03%) H. influenzae and 14 (0,01%) H. parainfluenzae (out of 180, 415 samples) were isolated from genitourinary tract. From urine samples of the girls under 15 years of age these bacteria were isolated in 13 (0,88%) and two (0,13%) cases, respectively, and only in one case(0,11%) of the UTI in boys (H. influenzae). In persons of fertile age, it was only H. influenzae bacteria that was found in urine samples of the five women (0,04%) and in three men (0,22%). As a cause of vulvovaginitis, H. influenzae was isolated in four (5,63%), and H. parainfluenzae in two (2,82%) girls. In persons of fertile age, H. influenzae was isolated from 10 (0,49%) smears of the cervix, and in nine (1,74%) male samples. H. parainfluenzae was isolated from seven (1,36%) male samples. (p<0.01). Susceptibility testing of H. influenzae and H. parainfluenzae revealed that both pathogens were signifi- cantly resistant to cotrimoxasol only (26.0% and 42.9%, respectively). Conclusion In the etiology of genitourinary infections of girls during childhood, genital infections of women in fertile age (especially in pregnant women), and men with cases of epididimytis and/or orchitis,it is important to think about this rare and demanding bacteria in terms of cultivation

Resistance of uropathogenic strains of Escherichia coli in pregnant women and other women in generative ages in comparison with antibiotics consumption in Zagreb

Aim To compare resistance of uropathogenic strains of Escherichia coli (UPEC) to antibiotics in women in generative ages and pregnant women during two year period (2004 and 2008) in Zagreb, andcomparison of resistance and the consumption of antibiotics. Methods The standard disk-diffusion method was used for sensitivity testing to 16 different antibiotics.Data on antibiotic utilization were used to calculate the number of defined daily doses (DDD) and DDD per 1000 inhabitants using Anatomical-Therapeutic-Chemical/DDD methodology.Data on antibiotic consumption during pregnancy were collected using a questionnaire filled in by 893 women after delivery.Results During 2004 resistance of UPEC to antimicrobial drugs was not different in pregnant and in non-pregnant women, with the exception of amoxicillin and nitrofurantoin, with statistically higher resistance in pregnant women (p <0.01). Four years later the statistically higher resistance to norfloxacin was observed in non-pregnant women (p <0.01). Comparing the resistance in 2004 and 2008, in the both groups of women a statistically significant decrease of resistance to cefalexin and nitrofurantoin was detected (p <0.01). Outpatient utilization of antimicrobial drugs in Zagreb increased significantly, from 32 to 39 DDD/1000 inhabitants per day. The most used antibiotic was co-amoxiclav, and its utilization increased from 9.6 to 12.2 DDD/1000/day. Amoxicillin and co-amoxiclav were used during pregnancy by 9.6% interviewed women. Conclusion The observed significant decrease of resistance to cefalexin makes that antibiotic the drug of choice for treatment of urinary tract infections in women in generative ages, and together with coamoxiclavcan be administered in pregnancy. Constant monitoring of urinary tract pathogens resistance to antimicrobial agents ensures the effectiveness of empirical therapy, whose versatile use is limited due the potentially harmful effects of antimicrobial drugs on fetus

Characteristics of uropathogens in outpatient catheter-associated urinary tract infections

During the two years period the prevalence of uropathogens responsible for catheter-associated urinary tract infection (CAUTI) in outpatients was investigated including their differences in antimicrobial susceptibility according to the age and gender. Indwelling urinary catheter(IUC)constitutes 0.3% of all processed urine samples.Significant bacteriuria was found in 92.5% of IUC,and polimicrobial ethiology in 63.2%. The most CAUTI (79.3%) was found in elderly male patients (>65 years). The most frequently isolateduropathogens were Esherichia coli and other Enterobacteriaceae, Pseudomonas aeruginosa, and enterococci. The very high resistance of all Enterobacteriaceae to beta-lactams, fluoroquinolones, and co trimoxazole was observed with significantly much higher fluoroquinolone (p<0.01) and co-trimoxazole (p<0.05) resistance in elderly male patients as compared with younger ones

Characterization of ESBL-producing Escherichia coli and Klebsiella pneumoniae strains isolated from urine of nonhospitalized patients in the Zagreb region

Aim To determine the prevalence of ESBL-producing Escherichia coli and Klebsiella pneumoniae strains isolated from urine of nonhospitalized patients during a three-year period, to determine their antibiotic susceptibility, investigate the transfer of ESBL genes with cotransfer of resistance and to characterize isolated beta-lactamases. Methods Antimicrobial susceptibility was determined by disk diffusion and broth microdilution methods. The double-disk test was used for ESBL detection. Transfer of resistance was performed by broth mating method and characterization of isolated beta-lactamases by polymerase chain reaction. Results The prevalence of ESBL-producing E. coli was 1.5% and of K. pneumoniae 4.1% with its different distribution according to patients`age and gender. ESBL-producing K. pneumoniae showed high resistance rates to aminoglycosides, cotrimoxazole, nitrofurantoin and quinolones while ESBL-producing E. coli isolates, with exception of high aminoglycoside resistance, showed low resistance rates to other antibiotics. Successful conjugation of ESBL genes was obtained with 25% E. coli and 76.2% K. pneumoniae strains. Comparing to E. coli, K. pneumoniae strains showed higher rates of aminoglycosideand cotrimoxazole resistance cotransfer. Beta-lactamases of investigated strains belonged to TEM, SHV and CTX-M families.Conclusion The existence of multiple-resistant ESBL-producing E. coli and K. pneumoniae strains was confirmed in observed outpatient population. ESBL-producing K. pneumoniae isolates, in contrast toESBL-producing E. coli, showed higher resistance rates to non-beta-lactam antibiotics, probably caused by cotransfer of resistance genes located on the same plasmid as ESBL genes. It is important to monitor the prevalence of such strains and their possible spreading in the outpatient population of the Zagreb regio