Molecular characterisation of methicillin-susceptible and methicillin-resistant Staphylococcus aureus in inpatients and outpatients in Bosnia and Herzegovina.

The aim of this study was to investigate the genetic background of methicillin-susceptible (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) obtained from clinical specimens of inpatients and outpatients. Methicillin resistance was confirmed by the presence of the mecA gene by PCR. The genetic characterisation was performed using spa typing and the algorithm based upon repeat pattern (BURP). Staphylococcus aureus was isolated from 68 and 79 inpatient and outpatient samples, 31 (46 %) and 14 (18 %) of which were MRSA, respectively. Among 37 inpatients and 65 outpatients with MSSA, 22 and 38 spa types were clustered into seven and eight spa-CCs, respectively. The main MSSA spa-CC of inpatients and outpatients was spa-CC015 (multilocus sequence typing (MLST) CC45). Most MRSA were associated with spa-CC355/595 (MLST CC152). MRSA-related background was found in 32 % of inpatients and 43 % of outpatients with MSSA, suggesting that MRSA did not arise from predominant MSSA clones.

Role of poultry meat in sporadic Campylobacter infections in Bosnia and Herzegovina: laboratory-based study.

AIM: To investigate genetic diversity and specificity of Campylobacter jejuni and Campylobacter coli strains isolated from humans, retail poultry meat, and live farm chickens in Zenica-Doboj Canton, Bosnia and Herzegovina, and identify the role of poultry meat in sporadic Campylobacter infections. METHODS: We determined the type of Campylobacter species using standard microbiological methods and multiplex polymerase chain reaction (PCR), and performed pulsed field gel-electrophoresis (PFGE) and restriction fragment length polymorphism (RFLP) typing of the flaA gene to investigate genetic diversity among the isolates. RESULTS: We isolated C jejuni and C coli from 75 (5.2%) of 1453 samples of consecutive outpatients with sporadic diarrhea; from 51 (34.7%) of 147 samples of poultry meat; and from 15 out of 23 farm chicken samples. The proportion of C coli found among human (30.1%), poultry meat (56.9%), and farm chicken isolates (53.3%), was greater than the proportion of C jejuni. Fourteen and 24 PFGE genotypes were identified among 20 C coli and 37 C jejuni isolates, respectively. Identical PFGE genotypes were found in two cases of human and poultry meat isolates and two cases of poultry meat and farm chicken isolates. CONCLUSION: Only a minority of human Campylobacter isolates shared identical PFGE type with poultry meat isolates. Although poultry is the source of a certain number of human infections, there may be other more important sources. Further research is required to identify the environmental reservoir of Campylobacter spp responsible for causing human disease and the reason for the high prevalence of C coli human infections in this region.

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.

Antibiotic resistance of coliform bacteria from community-acquired urinary tract infections in the Zenica-Doboj Canton, Bosnia and Herzegovina.

AIM: To collect routine susceptibility data for coliform organisms isolated from patients with community-acquired urinary tract infections (CAUTIs) in Zenica-Doboj Canton during 2004, with a view to guiding empiric therapy. METHODS: Consecutive urine samples were analyzed by standard procedures. Antimicrobial susceptibility testing to fifteen antimicrobials was performed by disc-diffusion method according to causative agents (E. coli/non E. coli), age (0-6, 7-14, 15-19, 20-64, > or = 65) and gender of patients. RESULTS: E. coli and other coliforms (non-E. coli) were isolated from 2473 (11%) out of 22,451 urine samples submitted, 1,618 (65.4%) and 856 (34.6%), respectively. Inclusion of non-E. coli significantly increased overall resistance rates in all tested antibiotics except for ampicillin and trimethoprim/sulfamethoxazole, and it was significantly higher in males than in females in all analysed subsets (p < 0.05). Specific age resistance rates to nitrofurantoin was in the range of 15-63% and 2-12% in males and females, respectively. Resistance rates to ciprofloxacin in the two oldest age groups were 51% and 57% in males, and 11% i 17% in females. CONCLUSIONS: Because of significant proportion of non-E. coli isolates, CAUTIs represent important problem in this region. Due to high ampicillin and trimethoprim/sulfamethoxazole resistance rates for all analysed subsets these drugs should be left for empiric therapy, and it is highly recommended to perform urinalysis in all patients. Ciprofloxacin and nitrofurantoin should also be considered as the first-line therapy in women above 20 years of age and in children, respectively. Continuous surveillance of antibiotic resistance of CAUTIs as well as introduction of drug prescribing control is important.

Antibiotic resistance of coliform organisms from community-acquired urinary tract infections in Zenica-Doboj Canton, Bosnia and Herzegovina.

OBJECTIVES: To collect routine susceptibility data for coliforms isolated from patients with community-acquired urinary tract infections (UTIs) in Zenica-Doboj Canton, Bosnia and Herzegovina and to relate them to bacterial identification and patient demographics with a view to guiding empirical therapy. METHODS: During 1998-2001, 54 638 consecutive urine samples were analysed by standard procedures. Antimicrobial susceptibility testing for 15 antimicrobials was performed by the disc diffusion method. RESULTS: A total of 10 765 Escherichia coli and other coliforms were isolated, of which 5043 (46.8%) were duplicates. Resistance rates were significantly higher in duplicate isolates for almost all antibiotics tested (P<0.05), except for ampicillin, cefazolin, aztreonam and co-trimoxazole. Inclusion of coliforms other than E. coli (25.8%) significantly increased resistance rates for all tested antibiotics (P<0.001) except imipenem. Overall coliform resistance rates were significantly higher in males than in females (P<0.001). CONCLUSIONS: Due to high ampicillin and trimethoprim/sulfamethoxazole resistance rates for all subsets analysed it is highly recommended to perform urinalysis and antibiotic susceptibility testing in all patients, except in the age group 0-6 years of male patients and in the age group 20-64 years of female patients, in which empirical therapy with these antibiotics can be applied. Nitrofurantoin should also be considered as the first-line therapy, especially in children. It is important for physicians to know susceptibility data for UTIs in order to optimize the use of empirical therapy.